Anesthesia Field

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HueySmith

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I've been reading around this forum and reddit, and noticed that CRNA is a huge deal in the field of Anesthesia.

Would you still recommend future medical students like me to pursue the field (given that I've done rotations and that I like the field) despite the fact that CRNA will compete with me for jobs?

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I've been reading around this forum and reddit, and noticed that CRNA is a huge deal in the field of Anesthesia.

Would you still recommend future medical students like me to pursue the field (given that I've done rotations and that I like the field) despite the fact that CRNA will compete with me for jobs?

Would recommend a search. This is a very popular topic and a thread about this pops up every couple weeks. Most of us have answered it many many times already so its tiring to keep repeating.

Basically do it if you really love the field and can't imagine doing something else. It's not a lifestyle specialty and pay is going down and will keep going down. You also wont have much respect. Some of my patients dont know we are doctors. They think we walk in, give them meds, they sleep, and we walk out and come back at the end and wake them up. If you are OK with that, then do it.
 
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Is pay really going down? Not according to the statistics I've seen for this year...

But let's say it is. What if you do a fellowship after the residency? Wouldn't that put me and other people interested in anesthesia in a safe spot?
 
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Is pay really going down? Not according to the statistics I've seen for this year...

But let's say it is. What if you do a fellowship after the residency? Wouldn't that put me and other people interested in anesthesia in a safe spot?
Theoretically...I would say yes, but if would follow that if you did a fellowship in a particular field, you should enjoy that work as well since you will be advertising that you are willing to do that work. Otherwise, you just wasted a year on a fellowship. But then again, I'm just an intern, so take what I say with several grains of salt.
 
Is pay really going down? Not according to the statistics I've seen for this year...
Here is what Richard Novak at Stanford predicts:
  1. Lower income (as adjusted for inflation). There will be multiple causes for this: a) An aging population, with the significantly lower pay for attending to Medicare patients, b) Obamacare and other governmental payment cuts, c) Bundled insurance payments to hospitals, requiring anesthesiologists to negotiate for every nickel of that payment due to them, and d) Corporate anesthesia (see #9 below).
To be fair, I've read similar things about pay going down in other fields, not just anesthesia.
 
Theoretically...I would say yes, but if would follow that if you did a fellowship in a particular field, you should enjoy that work as well since you will be advertising that you are willing to do that work. Otherwise, you just wasted a year on a fellowship. But then again, I'm just an intern, so take what I say with several grains of salt.
I'm still in med school in Sweden but I thought everybody did a fellowship after residency to ensure a good job market.

As a FMG anesthesia looks like a good field and my hopes have always been doing a residency within that followed by a fellowship and then settle down somewhere good. lol.
 
I'm still in med school in Sweden but I thought everybody did a fellowship after residency to ensure a good job market.

As a FMG anesthesia looks like a good field and my hopes have always been doing a residency within that followed by a fellowship and then settle down somewhere good. lol.
I love Sweden. Why not stay there? I hear the anesthesiologists do well in Sweden?
 
Here is what Richard Novak at Stanford predicts:
  1. Lower income (as adjusted for inflation). There will be multiple causes for this: a) An aging population, with the significantly lower pay for attending to Medicare patients, b) Obamacare and other governmental payment cuts, c) Bundled insurance payments to hospitals, requiring anesthesiologists to negotiate for every nickel of that payment due to them, and d) Corporate anesthesia (see #9 below).
To be fair, I've read similar things about pay going down in other fields, not just anesthesia.
But can't that be said to any field today? Why do people hack more on anesthesia?
Edit: u just added that didn't u lol
 
I love Sweden. Why not stay there? I hear the anesthesiologists do well in Sweden?
Nah, the grass is not greener over here let's get that right :D Besides, there is more to this world than just Sweden.

It's very, very common to read threads about how anesthesiologists are having it rough, job market dying and salaries going down due to nurses and whathaveyou. But how come I rarely see the counter to that problem by doing a fellowship? Is doing a fellowship impossible or what's the deal? Isn't that the perfect way to escape all potential predicted problems for this field?
 
But can't that be said to any field today? Why do people hack more on anesthesia?
Edit: u just added that didn't u lol

  1. Large national corporations will continue buying up private anesthesia practices, perhaps eliminating the current model in which groups cover one hospital or one city alone. In the last three months, Sheridan, the physician services division of AmSurg, Corp has purchased the 60-physician, 140-anesthetist Northside Anesthesiology Consultants in Atlanta, and the 240-physician Valley Anesthesiologists & Pain Consultants in Phoenix. In these purchases, senior board members and partners receive seven-digit checks to sell their practice, then all physicians in the practice’s future labor for a discounted wage, perhaps as low as 50% of the prior income. If this trend becomes widespread, this subset of the anesthesia workforce will become low paid practitioners, while the purchasing corporations will make significant profits for their stockholders.

wow that hurts
 
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It's very, very common to read threads about how anesthesiologists are having it rough, job market dying and salaries going down due to nurses and whathaveyou. But how come I rarely see the counter to that problem by doing a fellowship? Is doing a fellowship impossible or what's the deal? Isn't that the perfect way to escape all potential predicted problems for this field?
Lots of people here have talked about whether or not to do a fellowship. As well as which fellowships to do or not do. The topic has definitely come up multiple times on this forum, from what I've seen.
 
  1. Large national corporations will continue buying up private anesthesia practices, perhaps eliminating the current model in which groups cover one hospital or one city alone. In the last three months, Sheridan, the physician services division of AmSurg, Corp has purchased the 60-physician, 140-anesthetist Northside Anesthesiology Consultants in Atlanta, and the 240-physician Valley Anesthesiologists & Pain Consultants in Phoenix. In these purchases, senior board members and partners receive seven-digit checks to sell their practice, then all physicians in the practice’s future labor for a discounted wage, perhaps as low as 50% of the prior income. If this trend becomes widespread, this subset of the anesthesia workforce will become low paid practitioners, while the purchasing corporations will make significant profits for their stockholders.
wow that hurts
I'm pretty sure there's something similar to that for other fields.

Then again, I will not be matching until 2023 as earliest. I don't know how the market will look by then. Right now I'm just trying to get some notion of what I think I would get the most out of. The latter is important because I'll begin researching after the summer, and doing research within desired specialty is always appreciated, no?

Anesthesia with fellowship just seemed like the best combination for a FMG looking for decent pay and work hours.
 
But can't that be said to any field today? Why do people hack more on anesthesia?
Edit: u just added that didn't u lol

Hospitals have the power. Main issue is control over patient and admissions, fields like gas and rads cannot control this and therefore have limited bargaining power (rads at least currently do not have competition from mid-levels. Tele-rads and AI are the main threats though boots on the ground are needed for light IR, biopsies, breast, drains etc)...if can control where your patients go then you have some clout
 
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I'm pretty sure there's something similar to that for other fields.

Then again, I will not be matching until 2023 as earliest. I don't know how the market will look by then. Right now I'm just trying to get some notion of what I think I would get the most out of. The latter is important because I'll begin researching after the summer, and doing research within desired specialty is always appreciated, no?

Anesthesia with fellowship just seemed like the best combination for a FMG looking for decent pay and work hours.

Well its different for FMG. Most FMG i know have no loans, vs 200k debt with 6% interest for American grads. FMG are also mostly limited to only a few less competitive fields, like IM, anesthesia, FM, peds, neuro, etc. Out of these, anesthesia is very different from the rest, and if you have no loans, and young, 4 years of residency is not bad, plus you make income during residency. Even a 200k post residency is not bad for FMG, since med school in other countries may be significantly easier to get into than the US, and significantly cheaper, and possibly even less rigorous for some countries. Any medical field is a good deal for FMG.
 
Well its different for FMG. Most FMG i know have no loans, vs 200k debt with 6% interest for American grads. FMG are also mostly limited to only a few less competitive fields, like IM, anesthesia, FM, peds, neuro, etc. Out of these, anesthesia is very different from the rest, and if you have no loans, and young, 4 years of residency is not bad, plus you make income during residency. Even a 200k post residency is not bad for FMG, since med school in other countries may be significantly easier to get into than the US, and significantly cheaper, and possibly even less rigorous for some countries. Any medical field is a good deal for FMG.
Maybe that's true for FMGs from nations with poor standards for medical education etc, but from what I understand Swedish med schools are very difficult to get into, rigorous, have high standards, and so on. For example, the Karolinska Institute is arguably as good as the majority of US med schools. Lund and Uppsala are really good too.
 
Nah, the grass is not greener over here let's get that right :D Besides, there is more to this world than just Sweden.
Honest question...What's not greener in Sweden?

Medicine in the USA has:
- hostile medical student loans and interest rate
- hostile MOC
- hostile accreditation bullies
- hostile administration with meaningless alphabet degrees/certifications/doctorates
- hostile patients with internet google search medical expertise
- hostile malpractice climate
- hostile insurance
- hostile AMCs
- hostile priviate practice sellouts to said hostile AMCs
- hostile government that wants to cut your pay
- hostile social media campaign against all doctors for being rich, greedy, stupid

I guess coming here for residency isn't too bad without any student loan debt. But it's not like during residency or as an attending you go to work on a yellow brick road smelling the roses and feeding hummingbirds out of your hand.
 
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To all the snobs: FMGs may have an easier way of getting into medical school and may have attended weaker medical schools than US grads, but it's much tougher for them to get into an American residency program. For a program to bother dealing with visa issues, cultural issues, healthcare system knowledge issues, unreliable recommendations etc., that FMG had better be worth it. Meaning that the average FMG needs to be much better than the average American grad for the same position, and that tends not to change a lot even as an attending (if the person is an immigrant). There is a reason almost 50% of this country voted with Trump, and it wasn't love of foreigners.
 
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I've been reading around this forum and reddit, and noticed that CRNA is a huge deal in the field of Anesthesia.

Would you still recommend future medical students like me to pursue the field (given that I've done rotations and that I like the field) despite the fact that CRNA will compete with me for jobs?
Obviously not. This forum is choke-full of threads about similar questions. Just search.
 
To all the snobs: FMGs may have an easier way of getting into medical school and may have attended weaker medical schools than US grads, but it's much tougher for them to get into an American residency program. For a program to bother dealing with visa issues, cultural issues, healthcare system knowledge issues, unreliable recommendations etc., that FMG had better be worth it. Meaning that the average FMG needs to be much better than the average American grad for the same position, and that tends not to change a lot even as an attending (if the person is an immigrant). There is a reason almost 50% of this country voted with Trump, and it wasn't love of foreigners.

That is true but i have seen programs who just dont fill but need bodies, and i figure they pretty much take anyone (could be wrong, maybe they got really high scores), but they sure were awful in the hospital
 
That is true but i have seen programs who just dont fill but need bodies, and i figure they pretty much take anyone (could be wrong, maybe they got really high scores), but they sure were awful in the hospital
If you take a top-level FMG (or USMG) and put him in a bad program, you will probably get a bad anesthesiologist. If you take even an average grad and put him in a great program, you will get a pretty good attending. The quality of the program is a much better predictor than the quality of the person, although discrimination can decrease the quality of teaching. Anesthesiology is not something one can learn just by reading Miller at home.

So I am not at all surprised by your personal experience.
 
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I've been reading around this forum and reddit, and noticed that CRNA is a huge deal in the field of Anesthesia.

Would you still recommend future medical students like me to pursue the field (given that I've done rotations and that I like the field) despite the fact that CRNA will compete with me for jobs?


The underlying business of anesthesia remains solid. What we get paid for the services we perform has not increased with the rate of inflation but has increased over the years. Things that have changed over the years have a lot more to do with our responsibilities as anesthesiologist, changing surgical landscape to more minimalist approaches, out of OR coverage expansion, group consolidation and management company acquisitions etc. I would recommend the field of anesthesiology if it fits what you are looking for regarding the practice of medicine. Many great opportunities. CRNAs don't worry me much.
 
The underlying business of anesthesia remains solid. What we get paid for the services we perform has not increased with the rate of inflation but has increased over the years. Things that have changed over the years have a lot more to do with our responsibilities as anesthesiologist, changing surgical landscape to more minimalist approaches, out of OR coverage expansion, group consolidation and management company acquisitions etc. I would recommend the field of anesthesiology if it fits what you are looking for regarding the practice of medicine. Many great opportunities. CRNAs don't worry me much.
Thank you, that's the kind of reply I was looking for.

AND if CRNAs become a problem, a fellowship after anesthesia residency would be the best counter to that. Problem solved.

Honest question...What's not greener in Sweden?

Medicine in the USA has:
- hostile medical student loans and interest rate
- hostile MOC
- hostile accreditation bullies
- hostile administration with meaningless alphabet degrees/certifications/doctorates
- hostile patients with internet google search medical expertise
- hostile malpractice climate
- hostile insurance
- hostile AMCs
- hostile priviate practice sellouts to said hostile AMCs
- hostile government that wants to cut your pay
- hostile social media campaign against all doctors for being rich, greedy, stupid

I guess coming here for residency isn't too bad without any student loan debt. But it's not like during residency or as an attending you go to work on a yellow brick road smelling the roses and feeding hummingbirds out of your hand.

Everything has its ups and downs. I weighed those and drew the conclusion that I'm better off in the US.

Btw, what's that last thing supposed to mean? We Swedes are known for working hard ^^
 
Thank you, that's the kind of reply I was looking for.

AND if CRNAs become a problem, a fellowship after anesthesia residency would be the best counter to that. Problem solved.

Not exactly problem solved. By doing a fellowship, you lost 250k in salary in that 1 year that you couldve made if you werne't forced to go to fellowship. And I see fellowship as a temporary solution. It wont be long before CRNAs have their own 'fellowships' and before you know it doctors will be forced to do 2, then 3 , then all the fellowships to get a job.


Just that the grass isn't always greener on the other side.

THe grass is only greener on the other side if you are in US.
 
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  1. Large national corporations will continue buying up private anesthesia practices, perhaps eliminating the current model in which groups cover one hospital or one city alone. In the last three months, Sheridan, the physician services division of AmSurg, Corp has purchased the 60-physician, 140-anesthetist Northside Anesthesiology Consultants in Atlanta, and the 240-physician Valley Anesthesiologists & Pain Consultants in Phoenix. In these purchases, senior board members and partners receive seven-digit checks to sell their practice, then all physicians in the practice’s future labor for a discounted wage, perhaps as low as 50% of the prior income. If this trend becomes widespread, this subset of the anesthesia workforce will become low paid practitioners, while the purchasing corporations will make significant profits for their stockholders.
wow that hurts
If anesthesiologists would stop working for AMCs, that kind of exploitation wouldn't happen. Unfortunately, bills have to be paid, so many take the short term paycheck at the cost of the future of their profession.
 
Not exactly problem solved. By doing a fellowship, you lost 250k in salary in that 1 year that you couldve made if you werne't forced to go to fellowship. And I see fellowship as a temporary solution. It wont be long before CRNAs have their own 'fellowships' and before you know it doctors will be forced to do 2, then 3 , then all the fellowships to get a job.




THe grass is only greener on the other side if you are in US.
Really funny that no matter where you live, the grass will always be greener on that other side.
Not exactly problem solved. By doing a fellowship, you lost 250k in salary in that 1 year that you couldve made if you werne't forced to go to fellowship. And I see fellowship as a temporary solution. It wont be long before CRNAs have their own 'fellowships' and before you know it doctors will be forced to do 2, then 3 , then all the fellowships to get a job.




THe grass is only greener on the other side if you are in US.

But if nurses can do fellowships - wouldn't that be a major threat for all specialties? Soon we have nurses that can do surgical fellowships allowing them to perform a little bit of surgery --> nurses will sometimes be considered over actual surgeons --> even surgeons now have to do fellowships.
 
Really funny that no matter where you live, the grass will always be greener on that other side.


But if nurses can do fellowships - wouldn't that be a major threat for all specialties? Soon we have nurses that can do surgical fellowships allowing them to perform a little bit of surgery --> nurses will sometimes be considered over actual surgeons --> even surgeons now have to do fellowships.

No. its all turf protection and lobbying and the amount of risk nurses are willing to take. medical fields are easier to take over cause you can learn a lot from reading. even doctors often go to update.com and treat based on their protocol/recommendations. nurses can do the same if they know where to look. for surgery, you can't do that. you have to train under a surgeon and build muscle memory and experience. its also different that nurses were doing 'anesthesia' before anesthesiologists came along and the field turned into a physician field. anesthesia is all related. surgery can be very different. thats why there are specialties you go into directly instead of doing gen surg and then doing a fellowship. knowing how to do a appendectomy doesn't mean you will know how to do a FESS, or a ORIF. but a general anesthesiologist can still do many OB cases, peds, regional, thoracic, etc. so it's much easier to train CRNAs cause they can all be trained the same way, and it is much easier for them to take over because they have the #s.
 
No. its all turf protection and lobbying and the amount of risk nurses are willing to take. medical fields are easier to take over cause you can learn a lot from reading. even doctors often go to update.com and treat based on their protocol/recommendations. nurses can do the same if they know where to look. for surgery, you can't do that. you have to train under a surgeon and build muscle memory and experience. its also different that nurses were doing 'anesthesia' before anesthesiologists came along and the field turned into a physician field. anesthesia is all related. surgery can be very different. thats why there are specialties you go into directly instead of doing gen surg and then doing a fellowship. knowing how to do a appendectomy doesn't mean you will know how to do a FESS, or a ORIF. but a general anesthesiologist can still do many OB cases, peds, regional, thoracic, etc. so it's much easier to train CRNAs cause they can all be trained the same way, and it is much easier for them to take over because they have the #s.

Ok, well, I'm not here to argue for anesthesia as I have no idea how it is in the states. You know a thousand times better than what I do. I'm just a guy from Sweden hoping for a residency within a good field (good can indicate many things but in my case it's decent work hours, pay and interesting). Anesthesia just seemed the perfect specialty for me to go but obviously, looking at it closer you see the threats this field is facing. "No problem", I thought as doing a fellowship would put me in a safe spot but apparently even that is facing issues.

So at this point I have no idea what to say or do (still trying to determine which research groups to contact as I need to begin researching within desired field).

Edit: I'm graduating 2022 so earliest match day for me would be 2023. I don't know how much can change in 4-5 years. Just a parenthesis.
 
Ok, well, I'm not here to argue for anesthesia as I have no idea how it is in the states. You know a thousand times better than what I do. I'm just a guy from Sweden hoping for a residency within a good field (good can indicate many things but in my case it's decent work hours, pay and interesting). Anesthesia just seemed the perfect specialty for me to go but obviously, looking at it closer you see the threats this field is facing. "No problem", I thought as doing a fellowship would put me in a safe spot but apparently even that is facing issues.

So at this point I have no idea what to say or do (still trying to determine which research groups to contact as I need to begin researching within desired field).

Edit: I'm graduating 2022 so earliest match day for me would be 2023. I don't know how much can change in 4-5 years. Just a parenthesis.

According to average work hours on Association of American Medical Colleges, anesthesiologists work an average of 61 hours/week, which is one of the highest. Definitely interesting field, but expect to work hard, with dropping pay in anesthesiology.
 
According to average work hours on Association of American Medical Colleges, anesthesiologists work an average of 61 hours/week, which is one of the highest. Definitely interesting field, but expect to work hard, with dropping pay in anesthesiology.
It is one of the highest, but the pay is one of the best /h.

At this point I'm more leaning towards IM + cardiology and stop there (i.e, no subspecialty).

So how are general cardiologists having it? Any cardiological nurses that will take over the jobs any time soon? ^^
 
It is one of the highest, but the pay is one of the best /h.

At this point I'm more leaning towards IM + cardiology and stop there (i.e, no subspecialty).

So how are general cardiologists having it? Any cardiological nurses that will take over the jobs any time soon? ^^
Cardiology is a subspecialty of IM.
 
a good field (good can indicate many things but in my case it's decent work hours, pay and interesting)
30 years ago you can have all 3.
10 years ago you can pick 2.
Today as a new grad you can pick 1 if you're lucky. "Interesting" is free so that's most likely the only one you get.

Or at least that's the impression this board leaves.
 
30 years ago you can have all 3.
10 years ago you can pick 2.
Today as a new grad you can pick 1 if you're lucky.

Or at least that's the impression this board leaves.
lol, that's what it has come down to, huh?

Sometimes (always) I wish I was one of those Youtubers making 200 000+$/month by sitting on my butt and make videos. But oh well, life was never fair.
 
True, but they're all considered fellowships, right ;)?

Lets hope the future is bright for general cardiologists...
Actually, no, IM isn't a fellowship, but cardiology is a fellowship. There are "super" fellowships as well (e.g., interventional cardiology).

At least judging by the cardiology forum, things don't sound great for general cardiology, mainly because they apparently increased fellowship spots by a large number and so are graduating a lot more cardiologists. However, again judging by the cardiology forum, if you're happy living in a good mid-sized city and not places like NYC, Boston, Chicago, Southern California, then you can still find a decent job. Cardiologists work hard though, which probably doesn't fit with your "decent work hours" requirement.
 
Actually, no, IM isn't a fellowship, but cardiology is a fellowship. There are "super" fellowships as well (e.g., interventional cardiology).

At least judging by the cardiology forum, things don't sound great for general cardiology, mainly because they apparently increased fellowship spots by a large number and so are graduating a lot more cardiologists. However, again judging by the cardiology forum, if you're happy living in a good mid-sized city and not places like NYC, Boston, Chicago, Southern California, then you can still find a decent job. Cardiologists work hard though, which probably doesn't fit with your "decent work hours" requirement.
I checked the work hours for swedish cardiologists... :(

Well... I don't know what to say once again. Is there no specialty at all that is interesting, has decent pay and work hours? Derm ofc, but then again - I'm an IMG.

Edit: Is it harder to land a fellowship within gastro than getting into ophthalmology or EM?
 
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I checked the work hours for swedish cardiologists... :(

Well... I don't know what to say once again. Is there no specialty at all that is interesting, has decent pay and work hours? Derm ofc, but then again - I'm an IMG.
That depends on what you find interesting (personal choice), what you consider decent pay (>$300k per year?), and what you consider good work hours (40 hours per week, regular M-F, no nights, no weekends, minimal call, call always from home?).
 
Interested:
- Opthalmology
- Gastroenterology
- Maybe EM

And yes, >$300k/year with 45-55 hours/week

How does it look for IMGs for those specialties?
 
Interested:
- Opthalmology
- Gastroenterology
- Maybe EM

And yes, >$300k/year with 45-55 hours/week

How does it look for IMGs for those specialties?
Unless you're already an ophthalmologist (attending) in Sweden , ophtho is most likely out for you. Too competitive for IMGs. See the NRMP data.

For GI, you'd have to go through IM. GI is the most competitive fellowship for IM. So at a minimum you'd have to (1) get into a solid IM program (which is tough as an IMG), (2) have a lot of relevant research for GI, and (3) the IM residency and GI fellowship programs would have to be willing to sponsor you for a visa. According to NRMP (2017), US grads had an 84.6% match rate into GI (319/377 US grads matched), while the total matched was 66.4% (493/742) which includes US grads so presumably the match rate is a lot lower than 66.4% for IMGs. So it's potentially possible for you, but very difficult.

EM is difficult too. According to NRMP (2017), 78.2% of EM positions were filled by US grads. A lot of the rest are by US-IMGs who don't need a visa. But like GI it's potentially possible for you, just very difficult. You definitely need to do a couple of rotations in the US at some point and get good SLOEs because SLOEs matter a lot in EM. By the way, you can work 40-50 hours in EM, but it's not easy work (e.g., mutlitasking, pace can be intense)! And a majority of your career will be nights, weekends, and holidays. So it's limited hours, but certainly not regular hours.
 
Unless you're already an ophthalmologist (attending) in Sweden , ophtho is most likely out for you. Too competitive for IMGs. See the NRMP data.

For GI, you'd have to go through IM. GI is the most competitive fellowship for IM. So at a minimum you'd have to (1) get into a solid IM program (which is tough as an IMG), (2) have a lot of relevant research for GI, and (3) the IM residency and GI fellowship programs would have to be willing to sponsor you for a visa. According to NRMP (2017), US grads had an 84.6% match rate into GI (319/377 US grads matched), while the total matched was 66.4% (493/742) which includes US grads so presumably the match rate is a lot lower than 66.4% for IMGs. So it's potentially possible for you, but very difficult.

EM is difficult too. According to NRMP (2017), 78.2% of EM positions were filled by US grads. A lot of the rest are by US-IMGs who don't need a visa. But like GI it's potentially possible for you, just very difficult. You definitely need to do a couple of rotations in the US at some point and get good SLOEs because SLOEs matter a lot in EM. By the way, you can work 40-50 hours in EM, but it's not easy work (e.g., mutlitasking, pace can be intense)! And a majority of your career will be nights, weekends, and holidays. So it's limited hours, but certainly not regular hours.

Judging by that, it seems that EM is the way to go actually. I don't mind irregular hours at all! Seems like this specialty is getting more and more competive as years go...

What are "SLOEs"? Are those letters of recommendation?

During the final semester in Karolinska we can choose to do 3 month rotations (partner universities) in either:
University of Minnesota, Minneapolis
University of Iowa
UCLA School of Medicine
Northwestern University Feinberg School of Medicine
Baylor College of Medicine, Houston
Albert Einstein College of Medicine

Whn you say good "SLOEs", do you mean getting these - what I'm assuming are letters of recommendation - from top schools? Are those above any decent? If no, I can always contact other schools when I'm a final year student and hope for the best
 
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Judging by that, it seems that EM is the way to go actually. I don't mind irregular hours at all! Seems like this specialty is getting more and more competive as years go...

What are "SLOEs"? Are those letters of recommendation?

During the final semester in Karolinska we can choose to do 3 month rotations (partner universities) in either:
University of Minnesota, Minneapolis
University of Iowa
UCLA School of Medicine
Northwestern University Feinberg School of Medicine
Baylor College of Medicine, Houston
Albert Einstein College of Medicine

Whn you say good "SLOEs", do you mean getting these - what I'm assuming are letters of recommendation - from top schools? Are those above any decent? If no, I can always contact other schools when I'm a final year student and hope for the best
SLOE = Standardized Letter of Evaluation. See here. Basically everyone needs at least one SLOE to even apply to EM. You can get SLOEs from anywhere really, not necessarily the "top" schools. In fact, in EM, the best programs aren't necessarily the big brand name programs (like in other specialties), but often county hospitals, inner city hospitals, and so on have really good EM programs too. All those places you listed are decent places to get an SLOE though. Oddly enough, I actually have been to most of those places you list, visiting friends and family.
 
SLOE = Standardized Letter of Evaluation. See here. Basically everyone needs at least one SLOE to even apply to EM. You can get SLOEs from anywhere really, not necessarily the "top" schools. In fact, in EM, the best programs aren't necessarily the big brand name programs (like in other specialties), but often county hospitals, inner city hospitals, and so on have really good EM programs too. All those places you listed are decent places to get an SLOE though. Oddly enough, I actually have been to most of those places you list, visiting friends and family.
I see, but what about normal letters of recommendation? Do you also need those, or are those completely replaced by SLOE:s? If not, maybe I can get both a letter of recommendation and SLOE from the same place I rotate in...
 
It is one of the highest, but the pay is one of the best /h.

At this point I'm more leaning towards IM + cardiology and stop there (i.e, no subspecialty).

So how are general cardiologists having it? Any cardiological nurses that will take over the jobs any time soon? ^^

I think youve been reading too much forbes. The pay is not one of the best /h at all.
 
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If anesthesiologists would stop working for AMCs, that kind of exploitation wouldn't happen. Unfortunately, bills have to be paid, so many take the short term paycheck at the cost of the future of their profession.
It's also a matter of markets. In some markets, more than 50% of the jobs are AMCs, and the rest PP groups with AMC mentality. So what should one do?
 
Judging by that, it seems that EM is the way to go actually. I don't mind irregular hours at all! Seems like this specialty is getting more and more competive as years go...
The main difference between EM and anesthesiology is the way EM is seen by the ubiquitous bean counters: as a profit center, because it refers patients to the hospital. Anesthesiology is just a cost center. That's a huge difference, and that's why hospitals are willing to pay almost double for an EM doc (on an hourly basis).
 
The main difference between EM and anesthesiology is the way EM is seen by the ubiquitous bean counters: as a profit center, because it refers patients to the hospital. Anesthesiology is just a cost center. That's a huge difference, and that's why hospitals are willing to pay almost double for an EM doc (on an hourly basis).

Sort of true, but also sort of not. The ER is typically a glut of terrible payer mix (some combo of uninsured, Medicaid, hospital transfer dumps for poor insurance). Ask a surgeon, they typically hate ER consults for this reason - on average, the reimbursement will be awful. ERs are almost always seen as a total money hole, hospitals have no choice but to keep them running if not for coeric purposes. Plus for a solid surgical patient hitting the ER there are 10 or more drug seekers, frequent flyers, psych holds and non-emergent patients. Hospital admins MUCH prefer referrals from the community including PCPs, Urgent Care and (in some cases) free standing ERs.

Furthermore, if you think the AMC situation is suboptimal in Anesthesiology check out the horrendous situation they have in ER. It's much worse, Google the Summa situation sometime. Or just check out the EM forum.

Do they make more per hour? Yes, but in all honesty most ER shifts are insane busy running around seeing 30-40 patients per 8 hours (at a community center) plus overseeing PAs and NPs. Despite working less the burnout rate for Emergency Medicine consistently ranks at the highest of all specialties by a pretty wide margin. Finally, contrary to every other specialty the ER is the slowest in the mornings and busiest in the evenings so the majority of shifts will be afternoon/evening/nights.

I've been doing some moonlighting in a community ER during fellowship for some extra $, and I'm so glad after each shift that it's not my specialty. For the crap they have to deal with (literally NO ONE wants a consult from the ER making you a very unpopular provider, and almost everyone tries to pawn a consult to FM/IM), no wonder their burnout is high. I expect in the future they will be expected to work more shifts for the same salary or play more of a "collaborative" model with NPs/PAs.
 
Hospitals don't have to have EDs. There is no law requiring this AFAIK. They choose to keep them open, because EDs refer a ton of patients and overall are profitable. Plus a lot of the indigents use them, and non-profit hospital boards are full of local politicians and hacktivists.

Some for-profit hospitals have closed their EDs because they can make more money from elective admissions (which have to be preapproved). That's not the case for most hospitals in this country.

I wasn't saying that most people would like practicing EM, just that EDs are seen as profit (or electoral) centers while anesthesia is mostly just an expense.
 
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