Just a lowly 4th year applying to Anesthesiology in less than 2 months. I know I have always wanted to do Anesthesiology ever since I was just a lowly 1st year, kept my eyes wide open during 3rd year, talked to as many attendings and residents as I could. All told me that Anesthesiology is still a great choice with good prospects and a good fit for my personality. These include: ACS Surgeon, CT Surgeon, OBs, Anesthesiologists, Interventional Cardiologist, Internists. Talked to them extensively about the CRNA issues, especially the surgeons, the oldest among them, a CT surgeon (probably in his 60s) told me he heard the same thing when he was going through the process, yet here we are and he appreciates having a competent Anesthesiologist in his room all the time and wouldn't have it any other way. All told me compensation is going down but it's not an issue exclusive to Anesthesiologists. I have no reason to doubt any of them lied to me, they have no reason to and we discussed both the perceived ups and downs.
I flirted with the idea of IM --> Cardiology but I hate rounding, social work and clinic with a passion. I also met an Internist-turned-Anesthesiologist who told me she was doing more IM during her Anesthesiology residency than she did for the entire 3 years of her IM residency. So happy with the specialty switch.
Anyway, the reason I am quoting your post is because I personally know at least 2 of my close friends who were deciding between IM and Anesthesiology, ended up picking IM because of the things they read on here and they are worried about not having a job in the future due to the CRNA takeover. Bright people with great board scores, hate rounding, continuity of care and social work but willing to compromise for 3 years to get into fellowships. Knowing them, I think they won't be happy at all if somehow they got stuck doing IM. While I appreciate reading all about the pros and cons regarding the field so I can go in with my eyes wide open, I think we need more positive guidance instead of just doom-and-glooming, which at times feels like fear-mongering. Your words have a much bigger impact on impressionable medical students than you think. You can't attract the good ones if you actively try to scare them away. In addition, medical students often have very little exposure to the specialty unless they actively try to get involved more. I hate it so much when my classmates tell me "you guys don't do anything, the CRNA does all the work," my comeback usually is "well, same **** in IM/EM/Neurology, the NP/PA does everything."
Anyway, for me, it's full-speed-forward for Anesthesia. 100% will be doing CT/Peds/CCM fellowship to satisfy the Canadian 5 year requirement. I have no geographical constraints and will move where the best jobs are. If the sky ended up finally falling, I am ok with working for CRNA salary for their 36-40 hours work-week with similar responsibilities or better yet move to Canada or Australia. I have no desire to own any patients, get involved with any continuity of care, getting paged while off-duty, I am fine with call as long as the pay reflects that. I am absolutely ok being just a consultant