Why so many anesthesiology residency vacancies?

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radsisrad

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Apparently, there are lots of anesthesiology vacancies even at top-notch places. Is the flight from anesthesiology that severe?
 
radsisrad said:
Apparently, there are lots of anesthesiology vacancies even at top-notch places. Is the flight from anesthesiology that severe?
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What is the definition of top-notch? $? reputation? location? life style?
 
Or it could just be the age distribution in action - lots of people hitting retirement age.
 
It’s no secret that private practice money is better and with increasing loan burden/cost of living/etc some people won’t even look to a private practice job. I assume when you say “top notch” you’re referring to big name academic practices in “desirable” cities. Well some of these cities are also some of the most expensive so with loans, families, mortgages that academic check starts to not be able to cut it.

On the other hand, if you’re single or have family money, and don’t mind renting a 250-300k is always better than that resident salary.

Private practice vs academics also gravitates to two distinct personality types with probably some degree of gray area in between. Not everyone is cut out for academics and vice versa.
 
radsisrad said:
Apparently, there are lots of anesthesiology vacancies even at top-notch places. Is the flight from anesthesiology that severe?
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True “top” institutions pay abysmally low, even compared to a bad AMC deal. Often it is (sort of) less work, but many academic ivory towers just struggle to recruit - it’s like you are paying them to put the name on your CV. Also, there are some well-known places where it’s exceedingly hard to get promoted and thus a solid pay raise.
 
A lot of academic places are also expanding aggressively and with the non-compete issues may require hiring staff from outside.
 
radsisrad said:
Apparently, my OP wasn't clear. I'm talking about residency spots.

Examples include BID, Brigham, and MGH... and that's just in Boston.
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Are you talking about the 2018 match? There were only 9 unfilled positions and a 97% fill rate. I don’t think there’s much of a flight from anesthesiology
 
Twiggidy said:
Are you talking about the 2018 match? There were only 9 unfilled positions and a 97% fill rate. I don’t think there’s much of a flight from anesthesiology
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30-something R spots on ERAS now, from what I understand. I was curious whether med students these days are shying away from anesthesiology due to CRNA and/or reimbursement concerns.
 
radsisrad said:
30-something R spots on ERAS now, from what I understand. I was curious whether med students these days are shying away from anesthesiology due to CRNA and/or reimbursement concerns.
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Hey, taking a look at your posts I think you’re an M3? There isn’t a flight from Anesthesiology. An increased number of R spots is likely easily explained by a program wanting additional “cheap labor” compared to hiring more CRNA’s. From what I remember the northeast programs you mentioned rely more on residents than CRNAs for staffing their ORs.

Additionally, re: CRNAs and declining reimbursement, do an SDN search for anesthesia + CRNA and only posts 2005. You’ll see the exact same conversations people were having back in 2002 and every year since then til today. It’s been 16 years. There’s still great jobs out there. People always want something to be worried about.
 
radsisrad said:
30-something R spots on ERAS now, from what I understand. I was curious whether med students these days are shying away from anesthesiology due to CRNA and/or reimbursement concerns.
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Exactly the post above....

Despite what is said on this forum, anesthesiology is still one of the more sought after fields if you want flexibility and good pay. You just may have to deal with some BS, but every field has varying levels of BS.
 
Of the 4 spots not filled in CA 3 were at a super random (likely new) program and 1 at USC which tends to hold a spot open for transfers IN to the program
 
radsisrad said:
30-something R spots on ERAS now, from what I understand. I was curious whether med students these days are shying away from anesthesiology due to CRNA and/or reimbursement concerns.
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Wrong. We’ve seen an upward trajectory of competitiveness for categorical anesthesia spots at mid-to-upper tier programs the last 5 years. Can’t speak for newer, community-based programs.
 
Twiggidy said:
It’s no secret that private practice money is better and with increasing loan burden/cost of living/etc some people won’t even look to a private practice job. I assume when you say “top notch” you’re referring to big name academic practices in “desirable” cities. Well some of these cities are also some of the most expensive so with loans, families, mortgages that academic check starts to not be able to cut it.

On the other hand, if you’re single or have family money, and don’t mind renting a 250-300k is always better than that resident salary.
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Don’t mind renting!!? Only on SDN can someone making 300k not afford a home...
 
dannyboy1 said:
Don’t mind renting!!? Only on SDN can someone making 300k not afford a home...
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Yea it's a good chunk of us too. NYC programs graduates couple hundred grads a year.. Many are in significant debt with no savings and most end up staying in the area for whatever reasons. We are competing against lawyers, wall streets, coders, who has been making 6 figures since their early 20s. With a 1 bedroom costing close to 1M in many areas in NYC, it will take a WHILE before being able to afford it. A 300k income will only give you a take home of like 170k or so
 
If you are dead set on living in a place like the Bay Area or Manhattan do yourself a favor and practice in a high income group (bfe or otherwise) for 5 years before making that jump. Live like a resident, pay off debt and save, save, save and then and only then consider a $1,000,000 1000 sft home.

my 2 cents.
 
In other words... be financially responsible and first get out of your financial whole and don’t make a deeper one immediately after residency.
 
sevoflurane said:
If you are dead set on living in a place like the Bay Area or Manhattan do yourself a favor and practice in a high income group (bfe or otherwise) for 5 years before making that jump. Live like a resident, pay off debt and save, save, save and then and only then consider a $1,000,000 1000 sft home.

my 2 cents.
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5 years is too long when half your life is almost over after finishing residency.

And also where do you even find these jobs? My friend in other fields like medicine/neurology tells me they get email recruiters of jobs for 750k working in BFE. I haven't received any email of jobs like that. Even the ones in awful locations, the emails are offering 400 or so. At that tax bracket it better be SIGNIFICANTLY higher to justify going to BFE

In NYC it's not hard at all to find a job making 300+. 400k+ will long hours w good amount of call though
 
anbuitachi said:
5 years is too long when half your life is almost over after finishing residency.

And also where do you even find these jobs? My friend in other fields like medicine/neurology tells me they get email recruiters of jobs for 750k working in BFE. I haven't received any email of jobs like that. Even the ones in awful locations, the emails are offering 400 or so. At that tax bracket it better be SIGNIFICANTLY higher to justify going to BFE

In NYC it's not hard at all to find a job making 300+. 400k+ will long hours w good amount of call though
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I had a couple of 700k+ years in BFE.
But do as you like. I like to give perspective from my own personal road. I can tell you that after doing BFE for almost 7 years, I have set myself up to retire super early and live in my dream location.

Nothing is free. You need to make sacrifices one way or the other.
 
sevoflurane said:
I had a couple of 700k+ years in BFE.
But do as you like. I like to give perspective from my own personal road. I can tell you that after doing BFE for almost 7 years, I have set myself up to retire super early and live in my dream location.

Nothing is free. You need to make sacrifices one way or the other.
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How were you able to locate those jobs? I'm not seeing any ads for 700+ jobs in BFE or even close to it
 
anbuitachi said:
How were you able to locate those jobs? I'm not seeing any ads for 700+ jobs in BFE or even close to it
Click to expand...

You need to invest time into it. It’s not going to land in your lap. Understanding certain markets (and needs), willingness to work hard and a touch of luck. Start early.
 
sevoflurane said:
If you are dead set on living in a place like the Bay Area or Manhattan do yourself a favor and practice in a high income group (bfe or otherwise) for 5 years before making that jump. Live like a resident, pay off debt and save, save, save and then and only then consider a $1,000,000 1000 sft home.

my 2 cents.
Click to expand...

100% correct. People should really do soul searching as a new grad before practicing in areas like this
 
anbuitachi said:
How were you able to locate those jobs? I'm not seeing any ads for 700+ jobs in BFE or even close to it
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I find it a little comical that you think these jobs are gonna be advertised. How many times do we have to say that the good gigs are never advertised. You gotta do some leg work. Talk to people, go to meetings, make some calls. Reach out to alumni and friends of alumni, etc.
 
SaltyDog said:
I find it a little comical that you think these jobs are gonna be advertised. How many times do we have to say that the good gigs are never advertised. You gotta do some leg work. Talk to people, go to meetings, make some calls. Reach out to alumni and friends of alumni, etc.
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Uh he was talking about BFE jobs. I thought the reason these jobs pay so high is because they need to to attract applicants. If people all over are applying why are they paying 750k. you'd think one would be more open about advertising.
 
anbuitachi said:
Uh he was talking about BFE jobs. I thought the reason these jobs pay so high is because they need to to attract applicants. If people all over are applying why are they paying 750k. you'd think one would be more open about advertising.
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Because many of the “good” gigs in BFE with high salaries will just “get by” until the right person comes along. It’s not that bad that they need to be on Gaswork or use recruiters to get a flood of subpar applicants. It’s takes the right person many times to fit in to these practices.
 
anbuitachi said:
Uh he was talking about BFE jobs. I thought the reason these jobs pay so high is because they need to to attract applicants. If people all over are applying why are they paying 750k. you'd think one would be more open about advertising.
Click to expand...

What @Twiggidy said.
 
SaltyDog said:
Was that the result of a large subsidy, or did you somehow have an amazing payer mix in BFE??
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Both, but mainly subsidy and strong contract negotiations with insurance companies.

Negotiated with the hospital that all Medicare to be paid at $50 a unit (hospital made up the difference so our lowest collection was $50/unit).

Cardiac made $1000 per day + $1500 per heart case. So if you did 2 hearts by 3 then you’re walking home with 4K @ 3pm.

Not a bad gig, but there were only 4 of us doing hearts which meant a lot of call.

It was a good gig, but I was also very ready for it to end so I could move on and start my “real life”.

Definatly was a sacrifice for the future.
Life is real good now.
 
I also should note that I came in as one of the new partners of a newly forming group. So timing and a little luck played into the equation. No buy in or anything of that nature. I felt like I understood that particular market as I personally sat down with the CEO of the hospital to run through everything. I knew what I was getting into,
 
dannyboy1 said:
Don’t mind renting!!? Only on SDN can someone making 300k not afford a home...
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I'm assuming you don't live anywhere near NYC, or you don't have kids, or both. 300k, after taxes, is a joke in this area. Add student loans in and you're toast.
 
facted said:
I'm assuming you don't live anywhere near NYC, or you don't have kids, or both. 300k, after taxes, is a joke in this area. Add student loans in and you're toast.
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That said, there are millions of people who happily live there on much less. You just can’t expect to have a typical doctor lifestyle.
 
nimbus said:
That said, there are millions of people who happily live there on much less. You just can’t expect to have a typical doctor lifestyle.
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Absolutely. But the vast majority of them don't own a home, they rent. Median home price in Manhattan is over 700k, and that's before we even consider parts of town, school zoning, etc
 
I don’t know anything about California, but you can be within an hour drive (and commuter rail proximity) of big east coast cities, including NYC, and find nice housing in good towns for 500k-ish. Will it be a McMansion? Nope. But who wants that? If you spend a million in those areas then you can have a couple acres or possibly be on or near water. If you are dead set on living in Manhattan then you are going to pay for it, though...plus you’ll have city taxes on top of NY state taxes. If you can’t live comfortably in NYC metro on a doctor salary then you need to re-examine both your priorities and lifestyle.
 
GravelRider said:
I don’t know anything about California, but you can be within an hour drive (and commuter rail proximity) of big east coast cities, including NYC, and find nice housing in good towns for 500k-ish.
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I don't know how human beings can tolerate hourlong commutes to work. Each way.

But here's to hoping they don't come to their senses and move out to the sticks where I want to be. 🙂
 
dannyboy1 said:
Don’t mind renting!!? Only on SDN can someone making 300k not afford a home...
Click to expand...

Visited a good friend about 5 years out of training now doing pain in Manhattan. Making 400K per him. Invited me to see his “fancy” new place. He lived there with his wife and 2 kids. It was a glorified shoebox at 800sqft paying 6500 a month. His apartment was the same size and quality as the apartments I used to rent during my residency. Depressing.
 
pgg said:
I don't know how human beings can tolerate hourlong commutes to work. Each way.

But here's to hoping they don't come to their senses and move out to the sticks where I want to be. 🙂
Click to expand...

I do 30 mins and it's driving me insane. A train is much more tolerable but even that gets old when there are delays.
 
GravelRider said:
I don’t know anything about California, but you can be within an hour drive (and commuter rail proximity) of big east coast cities, including NYC, and find nice housing in good towns for 500k-ish. Will it be a McMansion? Nope. But who wants that? If you spend a million in those areas then you can have a couple acres or possibly be on or near water. If you are dead set on living in Manhattan then you are going to pay for it, though...plus you’ll have city taxes on top of NY state taxes. If you can’t live comfortably in NYC metro on a doctor salary then you need to re-examine both your priorities and lifestyle.
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I live in NYC suburbs, and a mediocre house is not going for 500k. I paid over a million for 2500 sq ft, and that's VERY average in my town, .25 acre, nowhere near the water. I'm on a commuter line and about 30-40 train from NYC but things aren't much better even further north. There are definitely cheaper towns, but schools are not good and you'll be paying for private school most likely.

Things are DEFINITELY not better in LI or in NNJ.

Do you live in this area? Are you from this area? Please let me know where you can easily find a 500k house here in a good school district.
 
chocomorsel said:
So... you are telling us that you are making $115K? Really?
Click to expand...

What I'm saying is that 300k where I live will barely get you into a 1 bedroom condo. There will be a physician shortage in my area unless:

A) salaries increase
B) a change in call systems, and that's for all specialties
C) or the housing market tanks

Edit: And the point of posting the article is to show how ridiculous it has become to buy in "desired" areas the even someone making over 100k will struggle to buy a home. That's just capitalism though...
 
Last edited:
Twiggidy said:
What I'm saying is that 300k where I live will barely get you into a 1 bedroom condo. There will be a physician shortage in my area unless:

A) salaries increase
B) a change in call systems, and that's for all specialties
C) or the housing market tanks

Edit: And the point of posting the article is to show how ridiculous it has become to buy in "desired" areas the even someone making over 100k will struggle to buy a home. That's just capitalism though...
Click to expand...

Agree. In many big cities 100k is the new 40k and 300k is the new 100k. People need to keep that in mind. It’s not 30 years ago.
 
pgg said:
I don't know how human beings can tolerate hourlong commutes to work. Each way.

But here's to hoping they don't come to their senses and move out to the sticks where I want to be. 🙂
Click to expand...

Oh I’m certainly not suggesting an hour long commute to work. Plus the jobs there are terrible, so certainly not worth it. Though, there are people who commute to NYC from as far away as PA with a two hour each way commute. I’m suggesting expand the live/work radius to an hour and visit the city during time off.

facted said:
I live in NYC suburbs, and a mediocre house is not going for 500k. I paid over a million for 2500 sq ft, and that's VERY average in my town, .25 acre, nowhere near the water. I'm on a commuter line and about 30-40 train from NYC but things aren't much better even further north. There are definitely cheaper towns, but schools are not good and you'll be paying for private school most likely.

Things are DEFINITELY not better in LI or in NNJ.

Do you live in this area? Are you from this area? Please let me know where you can easily find a 500k house here in a good school district.
Click to expand...

Depends how close your suburbs are. I’m saying expand the radius to an hour and things become much more affordable. The school district thing is realtor speak to drive up housing prices, in my opinion. NY, CT, and MA all have good public school systems in place from a state level. The differences between districts where middle class or upper middle class families live is negligible...again, in my opinion.

If you expand that radius to 2 hours then things get wildly cheap (as far as the northeast is concerned).
 
GravelRider said:
If you expand that radius to 2 hours then things get wildly cheap (as far as the northeast is concerned).
Click to expand...

This is true, and for the most part holds up in California as well, but for me, if I'm 2hr away from SF, LA, or SD, I just cant see myself making trips there to visit. The plus side of the northeast as you mentioned is the better infrastructure system (trains) that California lacks.
 
GravelRider said:
Oh I’m certainly not suggesting an hour long commute to work. Plus the jobs there are terrible, so certainly not worth it. Though, there are people who commute to NYC from as far away as PA with a two hour each way commute. I’m suggesting expand the live/work radius to an hour and visit the city during time off.



Depends how close your suburbs are. I’m saying expand the radius to an hour and things become much more affordable. The school district thing is realtor speak to drive up housing prices, in my opinion. NY, CT, and MA all have good public school systems in place from a state level. The differences between districts where middle class or upper middle class families live is negligible...again, in my opinion.

If you expand that radius to 2 hours then things get wildly cheap (as far as the northeast is concerned).
Click to expand...
Do you have any conception of commuting times in the NY area? I live 20 miles N of NYC in one of the closest towns to NYC in Westchester. Driving time into NYC would be north of an hour, easily, during rush hour. Wife's commute via train from station to Grand Central is about 30 minutes, but that doesn't include commuting time on either end of that. Her total commute time is 1:15.

And like I said, any real estate near me is astronomicaly expensive. There are no 500k houses near me.

And the school district thing is no joke, here. Are schools here better on average than other states? If course. Does that mean the public schools in every town are great? Far from it.
 
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