Ask an anesthesiologist live!...or here. Whatever.

[MilkmanAl]

Update 6/17/23: It has been a rough ride recently, but things are settling down now after getting MiniMilk #2 old enough to sleep on her own reliably. I'll be back to my old schedule of streaming Wednesday and Sunday nights 8-10P Central starting tomorrow, 6/18. Come one, come all!

Update: Since I've kind of kept up with this video media stuff, I figured I'd update this post with better ways to get in touch with me. I'm now streaming regularly on Wednesdays and Sundays from 8-10 Central on Twitch and posting videos on YouTube. Links below.
YouTube: https://www.youtube.com/user/MilkmanAl
Discord: Join the MilkmanAlTV Discord Server!
Twitch:


I slapped this up in the pre-med forum previously, and several people rightly opined that it was better suited here, since my med school dealings comprise most of the video below. Years ago, I was here most of the day, every day, and after a long break, it's good to see that the pre-med forum during application silly season is still exactly that: silly. Good times! Through the early days of my medical journey, the SDN community was a huge help to me, so you guys are very lucky to have found this place. I've been meaning to come back and give some perspective on my journey through medical education for some time, but I honestly just haven't gotten around to it. I even went as far as starting to type up my story a few months back, but I frankly forgot about the project, causing it to die in the water. Life intervenes in side projects far too often these days, it seems.

Anyway, I suppose I should give you some brief background on myself. I started my journey into medical education somewhat aimlessly and ultimately applied with a GPA of 3.1-3.2 or something and an MCAT of 35 (no idea what that translates to these days, but it was like 93-95th percentile at the time). I applied to 28 schools, got 1 interview, was waitlisted, and got accepted off the waitlist at the University of Arkansas for Medical Sciences back in 2008. I did my residency in anesthesiology at the University of Kansas, and I've been in private practice in an independent group at a medium-sized hospital for the past (almost) 5 years.

I'm a gigantic nerd and recently started live streaming as a hobby to all the main platforms: Twitch, YouTube, Facebook, and Twitter, namely. I try to talk about medical issues while I'm gaming, so it's a bit of an esoteric production. Recently, I've been trying to step my game up and actually edit some of the medical portions into proper videos, and my first attempt was a talk outlining what's required for applying to and getting through med school. The pre-med info is obviously irrelevant to most of you, but I definitely knew none of the med school stuff prior to actually getting thrust into it, myself. Regardless, it occurred to me that some might find the video helpful, so here it is, in all its glory! This is my first attempt at video editing of any kind, and I did it Saturday while on call so was interrupted often. Also note that the video volume is pretty wonky since this was one of my earlier broadcasts. Judge me gently.

Edit: Note that this video is possibly NSFW due to swearing.

Also, please feel free to ask me anything you like here. I have fairly frequent short breaks during the day, so I'll try to stay on top of your questions. If you want to catch me and ask questions live, when I stream, I'm usually on from about 8-10 PM Central time. All relevant links are in the above video's description. Bring on the questions!

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[whataschool_classof24]

What do you think about the future of anesthesiology? Would you recommend pursuing an IM subfield like cards/gi/pulm vs anes

 

[MilkmanAl]

What do you think about the future of anesthesiology? Would you recommend pursuing an IM subfield like cards/gi/pulm vs anes

My impression is that anesthesiology as a specialty is perfectly fine, assuming you're referring to encroachment by midlevel providers. Remote rural locations will continue to largely be staffed by CRNAs, but larger hospitals doing more complex surgeries will always have a need for a care team model, if for no other reason than it provides more capable hands on deck during crises. In the Kansas City area, many medical centers just outside the metro have waffled between using locums and/or part-time anesthesiologists vs. CRNA temp services because they've had noticeably worse experiences with the CRNAs, for various reasons. Obviously, that's a huge win for anesthesiology as a profession since these tiny hospitals are effectively saying that they would rather pay twice the price for better care.

As for the specialty in terms of marketplace desirability, we are 100% set. An efficient, stable anesthesia department is crucial to a profitable OR and thus a profitable hospital. There are tons of new developments in technology and techniques that allow us to provide better patient care and improve patient throughput. Sugammadex, for example, despite much initial sticker shock in pharmacies around the country, has proven to be a gigantic cost saver due to reduced length of PACU stays and improved patient outcomes (fewer reintubations, decreased incidence of post-op respiratory distress, etc.). It's very easy for us to demonstrate our worth from both financial and patient care perspectives. We good.

Of the medical specialties you mentioned, the only one that I would consider strongly instead of anesthesia would be cardiology. GI and cards are both potentially a lot more lucrative than anesthesia - the cards guys here make almost double my salary - but only cardiology has the cool factor. Let's be real, GI might make you a boatload of cash, but you're scoping butts for a living and basically doing the same procedures all day, every day. If you're interested in anesthesia for the style of work, that's not going to be your thing at all. We're much more generalized and have to manage all sorts of insane comorbidities and situations on a daily basis and have to be ready to rock and roll for life-threatening emergencies at the drop of the hat. Cardiology falls somewhere between those two extremes but probably closer to anesthesia, especially for the interventional guys. That is probably what I'd choose if I had to cross off anesthesia and choose another specialty.

Pulmonology is pretty cool, but I feel like it's basically anesthesia lite, especially in the critical care venue. If you're wanting to have your own patient population and follow really sick people longitudinally, it's a good choice. You can also go full freak and devote yourself to niche stuff like CF patients or obesity hypoventilation if you're really looking to dig deep into zebra conditions. I'm honestly not sure what the pay scale for pulm looks like, but I can tell you that the critical care pulm guys at my training institution make substantially less than I do, despite having an extra 2 years of training between fellowship and residency.

Ultimately, just make sure you choose something you enjoy. You don't have to LOVE it or be passionate about it, but if you don't at least like what you do, life will be pretty tough. I'm a work-to-live type, and while I definitely like my job a lot, I'd be out of here if I won the lottery. I have an incredible working environment with some seriously amazing and safe anesthetists, a fabulous group of partners, and great OR staff, but man, I'd rather be watching sports, having a beer, and playing video games any day of the week.

 

[WheezyBaby]

Can you stream POE in the OR

 

[MilkmanAl]

Can you stream POE in the OR

Only when the patients are asleep. Duh. Gotta maintain professionalism.

 

[lawrencewellsbourne]

if you want to be an intensivist would you recommend doing residency in anesthesia then go work in the ICU or internal medicine then ICU?

 

[Gilakend]

Ultimately, just make sure you choose something you enjoy. You don't have to LOVE it or be passionate about it, but if you don't at least like what you do, life will be pretty tough. I'm a work-to-live type, and while I definitely like my job a lot, I'd be out of here if I won the lottery. I have an incredible working environment with some seriously amazing and safe anesthetists, a fabulous group of partners, and great OR staff, but man, I'd rather be watching sports, having a beer, and playing video games any day of the week.

What a refreshing perspective vs the "medicine is your entire life" group.

What's your lifestyle life?

 

[MilkmanAl]

if you want to be an intensivist would you recommend doing residency in anesthesia then go work in the ICU or internal medicine then ICU?

My personal opinion is that anesthesia is the better route, for three main reasons. First and most objective is that anesthesia is less training. It's 4 years (or 5 if you do a critical care fellowship) instead of 6 for IM+pulm, so you save yourself a few hundred grand in opportunity costs. Second is I feel like you're just straight better prepared to be an intensivist. As an anesthesiologist, you're forged in the fires of the OR, constantly battling the worst disasters a giant tertiary medical center can throw at you. High-level emergency management is just second nature, so you're plenty prepared for that. You're also extremely proficient at placing lines, recognizing impending medical disasters, administering some pretty hardcore drugs, airway management, electrolyte monitoring and replacement, and organizing resuscitation. Clearly, the pulm folks get up to speed in those departments and can function safely, but they'll never be quite as good as someone trained in anesthesia. They just don't get the reps. Third is that it seems to me that the national trend for ICU management is favoring anesthesiology. It really just makes sense that someone with profound surgical and critical care experience manages the surgical and cardiac ICUs. We're the ones dealing with those patients in the OR, so there's a continuity of care bonus there, too. Many large hospitals have recognized those benefits and are leaning into them, it seems.

To be clear, I don't mean to dump on non-anesthesia specialties. The pulm guys have their advantages. For instance, they're better at longitudinal care and step-down planning than we are, which is a big part of ICU throughput. They also seem to recognize zebra conditions a little more readily and think more broadly about patients' medical conditions than anesthesiologists. They also are more accustomed to having difficult conversations with patients and family members, since that's something that basically doesn't happen in anesthesia unless you want it to. Anesthesia training leads you to a "fix it now" approach to pretty much everything, so it'll take a little extra effort (and training) to recognize the bigger picture for most patients.

With those opinions in mind, I'll tell you how things go in my practice. As I mentioned previously, I'm in a medium-sized (200 bed?) community hospital on the edge of the city. We have a small heart program and 2 neurosurgeons who are somewhat busy. Our ICU has only recently started hiring intensivists of any kind, so we, the anesthesia department, still get called regularly to do lines and intubations for critical care patients. In fact, we did all the intubations and lines for every COVID patient who rolled through, which was a whole lot due to the number of nursing homes around. Sometimes the intensivists will place lines for their non-COVID patients, but sometimes they won't. I haven't quite figured out the pattern yet, but suffice it to say that we get called pretty often to do some fairly fundamental work in the unit. If there was an anesthesiologist up there running things, those calls wouldn't be happening. My impression is that the newer docs - pulm, critical care folks - make an effort to secure the lines/tubes/whatever on their own, but the expertise difference is quite evident. That is to say, if you choose the pulmonology route to critical care, be prepared to really hustle for procedural experience.

What a refreshing perspective vs the "medicine is your entire life" group.

What's your lifestyle life?

My lifestyle is quite good, I would say. I'm typing this from work as I try to run out the clock on a 24h call, actually. My work weeks average somewhere in the high-40s in terms of hours, but that's not really telling the whole story. We only have 7 people taking call, so we average 1 24h call per week, and we try to cluster those calls as much as possible. For example, we'll take call on Friday, Sunday, and Thursday on the lead-up to a vacation, so we technically ring in something around 80-85 hours during those weeks. That said, we typically sleep most of the night, maybe getting up once or twice for OB. The OR ends by 7 most days, and it's very rare to have a non-OB case between then and the next day. We have 10 weeks of vacation and make somewhere around the regional median and a bit above the local median, which is actually probably a bit undercompensated given our productivity (85th percentile-ish nationally) and call burden. In any case, it's plenty of cash for me to pay my exorbitant student loans, large house payment (no down payment - urgh), invest healthily, and still have plenty left over for vacations, expensive nerd hobbies like Warhammer 40k and computer building, house decor for the wife, etc. Put another way, I have plenty of income to do all the responsible adult stuff plus get all the toys I want, and I have the time to use them. I just bought my dream home, a big redone old place on a dead-end street in the middle of the city and overlooking a park, a couple years ago, and I'm cruising. Yeah, there are more lucrative specialties, but this is perfectly fine, financially.

One thing I really enjoy about anesthesia is how detached you are from patients. Some see that as a downside, but I find it very comforting to leave work at work and have very little long-term emotional investment in the people I'm treating. In this business, you see death and other catastrophic bad outcomes all the time, and being around sleeping people all day makes that reality quite a lot easier to handle. I want to worry about my job as little as possible when I'm not here, so the single-serving patient model is a huge plus.

I alluded to it earlier, but my group kicks ass. The anesthetists are all very competent and safe, which is a HUGE determinant in how your days go (and also one of many reasons why academic medicine is not my cup of tea), and they also happen to be very cool people. Similarly, my partners are great. We all work together to get each other home as efficiently as possible, without sacrificing care quality, of course. We also have a very good relationship with the hospital administration and OR staff, and that clearly helps the day go smoothly, too.

Lifestyle TL: DR recap: Nerdy doc works 40-ish hour weeks (accounting for sleep) in a good environment, leaves work stress at work, and goes home to 2+ months of vacation at awesome house to play with expensive toy soldiers and beep-boops. I'm gonna say life is pretty good.

 

[whataschool_classof24]

Could you speak more on anes fellowships like pain and cardiac?

 

[Matthew9Thirtyfive]

If there was an anesthesiologist up there running things, those calls wouldn't be happening.

Not sure this is actually true. There is an anesthesiologist CC doc on the gas forum who says she still calls anesthesia to do that stuff because she’s too busy. Maybe it depends on how busy the unit is.

 

[MilkmanAl]

Could you speak more on anes fellowships like pain and cardiac?

Certainly. Both pain and cardiac are great opportunities to further specialize and improve your employability. As I understand it, reimbursement for pain procedures has gotten pummeled and looks to be getting chopped even further in the not-so-distant future, but with all the back pain (and other chronic pain) in the U.S., there's still a huge demand for the specialty. Similarly, our obesity epidemic constantly supplies patients to cardiac ORs, so that's a high-demand option, as well. Personally, I would avoid OB, neuro, and regional fellowships since you can basically just do more of those things if you choose to. I suppose dedicated OB (or regional or neuro) anesthesia positions probably exist, but I don't know of any in this city. That is to say that you're spending a year for minimal benefit in terms of marketability, and your improvement in knowledge and skills likely won't make you much more functional than anyone else. I don' think that's worth the opportunity cost, but don't let me stop you if you're truly that passionate about doing nerve blocks all day.

I didn't mention them above specifically, but peds and critical care are also value-added fellowships that'll open a lot of doors for you. If you like those subspecialties, go for it!

Now, here's the eternal question: do you choose a residency that has a fellowship in whatever specialty you're interested in, hoping to get your foot in the door, or do you deliberately go somewhere without that fellowship so there aren't fellows to syphon off the relevant experience? In my opinion, making connections is a whole hell of a lot more important than getting some extra reps - who you know over what you know - but if you're sort of waffling on that fellowship, perhaps some hands-on experience will help inform your decision.

Not sure this is actually true. There is an anesthesiologist CC doc on the gas forum who says she still calls anesthesia to do that stuff because she’s too busy. Maybe it depends on how busy the unit is.

Fair enough. It's dependent on workload, culture, agreements between departments, etc. whether the lines and such get farmed out, but in my experience, the anesthesia critical care people are much more likely to do things on their own. That was even the case at my training institution where there were residents readily available to punt work to. I'm sure there are also some individuals who'd rather not do those sorts of procedures and get out of them as able. Perhaps it's also a regional thing? I've never practiced outside of the Midwest, so it's possible that things are done differently on the coasts.

 

[Matthew9Thirtyfive]

Fair enough. It's dependent on workload, culture, agreements between departments, etc. whether the lines and such get farmed out, but in my experience, the anesthesia critical care people are much more likely to do things on their own. That was even the case at my training institution where there were residents readily available to punt work to. I'm sure there are also some individuals who'd rather not do those sorts of procedures and get out of them as able. Perhaps it's also a regional thing? I've never practiced outside of the Midwest, so it's possible that things are done differently on the coasts.

It’s also one data point. Could just be her preference.

 

[MilkmanAl]

Hey all, I recently took part in a panel Q&A that ended up being mostly me. The video is a little awkward since I showed up late, struggled with audio for a little at the beginning (streaming at work: ugh), and had to leave for about 20 min to do a labor epidural. It was a good session, nonetheless! I figured resurrecting this thread was better than getting a new one going. As before, beware of potential NSFWness. Hopefully you guys find this useful!

 

[MilkmanAl]

Hey all, if you're interested in some general interview advice, I'll be doing a talk/Q&A on that topic on Wednesday 8/25 at 830 PM EST. It'll be through a Discord server which I'm not quite sure how to link, but you can watch on Twitch, too. Twitch

 

[Chelsea FC]

It's nice to see people like u in medicine. Alot of times I feel like an outsider because seems like everyone else thinks med is gonna be their entire life.

 

[odyssey2]

Are there any medical specialties you would advise medical students to avoid?

 

[ChiDO]

Why is it always anesthesia's fault?

 

[MilkmanAl]

Dang, guys, I'm sorry for the late response. I thought I had notifications set up for this thread and just assumed nobody loves me anymore. Hopefully everyone who wanted to see the interview talk was able to be there live, but here's the VOD for anyone still interested. The actual discussion starts at 29 min thanks to some technical glitches on the Discord admins' side

It's nice to see people like u in medicine. Alot of times I feel like an outsider because seems like everyone else thinks med is gonna be their entire life.

I'm glad you enjoy my takes! Realistically speaking, you're going to be spending a gigantic proportion of your life doing medicine regardless of how you approach it, but I find it unrealistic to expect that you're going to find something that is so engrossing for you that you would rather be at work than anywhere else. That's not going to be the case for the VAST majority of people. A job is a job.

Are there any medical specialties you would advise medical students to avoid?

Not really in terms of subject matter, but I would definitely advise caution if looking into Radiology, Emergency Medicine, and Pathology. Rads and Path have long been borderline flooded with applicants, and EM seems to be hardcore feeling the sting of the mid-level practice push. Automation and remote practice gaining traction have reduced the demand for rads and Path, at least in my area. That is to say, employability in those fields may suffer, so you'd do well to dig a little deeper into how difficult it is to find a job in those fields where your want to practice.

Why is it always anesthesia's fault?

Your case is cancelled.

 

[JustintheDoctor]

What's your take on CRNA's vs physician anesthesiologists, as in, do you think CRNAs are competent enough to provide independent care, and if not, how come? Coming from an outsider, why isn't 3 years of CRNA school with a few thousand hours of clinical efficient vs a MD/DO residency?

(Not trying to start an argument or anything, I'm about to finish my BSN, and I have to work ICU for 2 years before getting to apply to CRNA school, or I can do med school prereqs during that time, and im trying to see what is the better option for me as Anesthesia is 100% what I want to do. One example is I follow multiple independent CRNA providers on IG, but also follow multiple people who work in the team model, and I just wonder what makes them so different, like I doubt you remember majority of the random micro from your med school classes, right lol?)

 

[MilkmanAl]

What's your take on CRNA's vs physician anesthesiologists, as in, do you think CRNAs are competent enough to provide independent care, and if not, how come? Coming from an outsider, why isn't 3 years of CRNA school with a few thousand hours of clinical efficient vs a MD/DO residency?

(Not trying to start an argument or anything, I'm about to finish my BSN, and I have to work ICU for 2 years before getting to apply to CRNA school, or I can do med school prereqs during that time, and im trying to see what is the better option for me as Anesthesia is 100% what I want to do. One example is I follow multiple independent CRNA providers on IG, but also follow multiple people who work in the team model, and I just wonder what makes them so different, like I doubt you remember majority of the random micro from your med school classes, right lol?)

Generally speaking, independent CRNAs are fine for healthy patients having small, low-risk surgeries. That's how a sizable chunk of rural America gets by. Once you start getting to more complex patients having bigger surgeries, though, the knowledge and experience gap becomes obvious. What little high-quality evidence we have supports that statement, but it's tough to compare apples to apples. That is, there really aren't many places - or any at all, that I'm aware of - that have independent CRNAs doing high- or even medium-risk surgeries on ASA 4s routinely that would allow us to measure an outcomes difference.

Let's be real, here; you could train a tech to do anesthesia for outpatient elective surgery in a couple months, tops, and decrease the supervision ratio to 1:2 or 1:3 or something. Anesthesia is extremely safe and pretty damn easy to do when you have a healthy, robust patient. It'd probably be fine. That's not where we earn our cash. My take is that I get paid to dig someone out of a medical gutter, manage a host of conflicting issues, and do it at all hours of the night on 5 minutes of notice. CRNAs are very highly trained and educated, no doubt, but when you put them in those sorts of high-intensity situations, most of them splutter a bit. Anesthesia is a broad enough field that the holes in their training show. They also don't get a whole lot of reps being the point man in those scenarios and spend proportionally much more time wrangling lower-acuity cases than residents (and full-fledged physicians) do. Anecdotally, the 3 people I've known who went from CRNA to anesthesiologist (for some unfathomable reason) mentioned how vastly different and more rigorous the MD training was, but again, the sample size for that event is exceptionally small.

I've been asked on many occasions whether I'd choose the MD route for anesthesia again, and for me personally, assuming I'd go into health care at all, the answer is definitely "yes," despite the immense opportunity cost and rigors of training. Authority and independence are the primary reasons why. I want to be able to run around managing my rooms and triage as necessary instead of sitting in an OR. I want to be the one in charge of intense, life-threatening situations. I like being in a respected position. Long-term income is also a factor. If you don't really care about being in charge or an authority in your field, then the anesthetist route is awesome. It's better for short-term income, professional liability, and employment flexibility, to name a few things.

Last but not least, let me introduce you to the Anesthesiologist Assistant track. It's a career path that limits you a bit more than the CRNA route since they can only practice in 18(?) states, but in my observation, the two are functionally equivalent. By the time you finish your ICU requirements you'd be 6 months away from being an anesthetist if you go for AA. With how needlessly inflated nursing education is (nursing theory: lolz), that's a lot of opportunity cost (roughly $600,000 for those extra 3 years) that you'll almost certainly never recoup. Unless you're aiming at practicing independently in a rural location where the salaries are inflated, there's not going to be a financial advantage for you going to CRNA path. Choose wisely!

 

[Aheadbyacentury]

What's your take on CRNA's vs physician anesthesiologists, as in, do you think CRNAs are competent enough to provide independent care, and if not, how come? Coming from an outsider, why isn't 3 years of CRNA school with a few thousand hours of clinical efficient vs a MD/DO residency?

(Not trying to start an argument or anything, I'm about to finish my BSN, and I have to work ICU for 2 years before getting to apply to CRNA school, or I can do med school prereqs during that time, and im trying to see what is the better option for me as Anesthesia is 100% what I want to do. One example is I follow multiple independent CRNA providers on IG, but also follow multiple people who work in the team model, and I just wonder what makes them so different, like I doubt you remember majority of the random micro from your med school classes, right lol?)

I would say research both professions thoroughly before making a decision. One is a Medical Doctor, and one is a Registered Nurse..

 

[Aheadbyacentury]

Generally speaking, independent CRNAs are fine for healthy patients having small, low-risk surgeries. That's how a sizable chunk of rural America gets by. Once you start getting to more complex patients having bigger surgeries, though, the knowledge and experience gap becomes obvious. What little high-quality evidence we have supports that statement, but it's tough to compare apples to apples. That is, there really aren't many places - or any at all, that I'm aware of - that have independent CRNAs doing high- or even medium-risk surgeries on ASA 4s routinely that would allow us to measure an outcomes difference.

Let's be real, here; you could train a tech to do anesthesia for outpatient elective surgery in a couple months, tops, and decrease the supervision ratio to 1:2 or 1:3 or something. Anesthesia is extremely safe and pretty damn easy to do when you have a healthy, robust patient. It'd probably be fine. That's not where we earn our cash. My take is that I get paid to dig someone out of a medical gutter, manage a host of conflicting issues, and do it at all hours of the night on 5 minutes of notice. CRNAs are very highly trained and educated, no doubt, but when you put them in those sorts of high-intensity situations, most of them splutter a bit. Anesthesia is a broad enough field that the holes in their training show. They also don't get a whole lot of reps being the point man in those scenarios and spend proportionally much more time wrangling lower-acuity cases than residents (and full-fledged physicians) do. Anecdotally, the 3 people I've known who went from CRNA to anesthesiologist (for some unfathomable reason) mentioned how vastly different and more rigorous the MD training was, but again, the sample size for that event is exceptionally small.

More on this shortly via edit. My toddler is getting antsy.

I would not be so glib about how easy anesthesia is. Some of the more sensational anesthesia adverse outcomes in the news have happened on totally healthy patients. How do y ou explain that? It is not that easy.

 

[JustintheDoctor]

I would say research both professions thoroughly before making a decision. One is a Medical Doctor, and one is a Registered Nurse..

Yeah, I mean having actually been in clinical now, seeing how everyone interacts, I would definitely prefer the medicine side. So now, I think I'm just gonna hang on and see. If I can keep straight As now, work my 2 years in the ICU, by the first year in ICU i'll know if I want to take the premed prereqs or not. Heck, if I don't well in those prereqs for some odd reason ( if i decide to do med school), then id just do CRNA school to skip the fluff of prereqs.

I've researched both very much as well, but I just think in the long run it would suck being a CRNA with 5-20 years of experience being doubted by the physician anesthesiologist resident or attending. I've also been a pharm tech for all of nursing school, so I really love drugs haha, so if Anesthesia is my goal I think I should just take it all the way to the top (aka med school)

 

[MilkmanAl]

I would not be so glib about how easy anesthesia is. Some of the more sensational anesthesia adverse outcomes in the news have happened on totally healthy patients. How do y ou explain that? It is not that easy.

Don't get me wrong, I'm not saying we *should* get techs. That's an awful idea. My point is that anesthesia for healthy people is very safe and that the CRNAs claiming equivalent care because they have good outcomes with these patients is a totally hollow assertion that sounds really awesome to admins who know nothing about the field but actually means nothing.

Yeah, I mean having actually been in clinical now, seeing how everyone interacts, I would definitely prefer the medicine side. So now, I think I'm just gonna hang on and see. If I can keep straight As now, work my 2 years in the ICU, by the first year in ICU i'll know if I want to take the premed prereqs or not. Heck, if I don't well in those prereqs for some odd reason ( if i decide to do med school), then id just do CRNA school to skip the fluff of prereqs.

I've researched both very much as well, but I just think in the long run it would suck being a CRNA with 5-20 years of experience being doubted by the physician anesthesiologist resident or attending. I've also been a pharm tech for all of nursing school, so I really love drugs haha, so if Anesthesia is my goal I think I should just take it all the way to the top (aka med school)

I edited above with some info you may want to consider, re: AA training.

 

[Aheadbyacentury]

it would suck being a CRNA with 5-20 years of experience being doubted by the physician anesthesiologist resident or attending.

These are things you should think about. Some find it easier to just lobby congress to just make everyone equal irregardgless of training or education taking a page out of the woke playbook.

 

[JustintheDoctor]

Don't get me wrong, I'm not saying we *should* get techs. That's an awful idea. My point is that anesthesia for healthy people is very safe and that the CRNAs claiming equivalent care because they have good outcomes with these patients is a totally hollow assertion that sounds really awesome to admins who know nothing about the field but actually means nothing.

I edited above with some info you may want to consider, re: AA training.

"Last but not least, let me introduce you to the Anesthesiologist Assistant track. It's a career path that limits you a bit more than the CRNA route since they can only practice in 18(?) states, but in my observation, the two are functionally equivalent. By the time you finish your ICU requirements you'd be 6 months away from being an anesthetist if you go for AA. With how needlessly inflated nursing education is (nursing theory: lolz), that's a lot of opportunity cost (roughly $600,000 for those extra 3 years) that you'll almost certainly never recoup. Unless you're aiming at practicing independently in a rural location where the salaries are inflated, there's not going to be a financial advantage for you going to CRNA path. Choose wisely!"

Thank you for taking your time to help answer my boring questions! I have also looked into AA but will have to pass as I'm trying to stay local with either CRNA or MDA - which would be where I have lived my whole life (NYC, but would be willing to work/move to PA/NJ). And yes, being real and thinking about long term income which a lot of people ignore for some reason, debt for CRNA and med school is the same in these areas, CRNA here will be MAXED at 250k but likely a little lower, and then MD will have a residency yes, but the salary will likely be doubled or close to doubled.
I think my goal is to work my 3 12s and do some OT to save around 200k-250k that could pay for either school, and once the time comes if my GPA and prereqs are As or B+s, i'll study for the MCAT and see lol.
Much love for the advice.

 

[JustintheDoctor]

These are things you should think about. Some find it easier to just lobby congress to just make everyone equal irregardgless of training or education taking a page out of the woke playbook.

I definitely do. Although I'm about to be an RN and I'm more likely to defend CRNAs due to them being one of us or even a future me, I do know that the training and education will always include *less* material (didnt know how else to word this lol), so if I want to maximize my capacity to provide amazing Anesthesia care, I should go to med school, even if it takes an extra year of schooling.

 

[MilkmanAl]

I definitely do. Although I'm about to be an RN and I'm more likely to defend CRNAs due to them being one of us or even a future me, I do know that the training and education will always include *less* material (didnt know how else to word this lol), so if I want to maximize my capacity to provide amazing Anesthesia care, I should go to med school, even if it takes an extra year of schooling.

Maybe I'm missing something, but isn't the MD route 3 extra years? 2 of ICU experience and 3 of CRNA school vs 4 of med school and 4 of residency?

 

[Aheadbyacentury]

I should go to med school, even if it takes an extra year of schooling.

If you say so!! Why dont you write Obama and Biden and ask for an exemption because you are an icu nurse during covid and you should be automatically granted a Medical Doctor.It might work, sadly!

 

[JustintheDoctor]

If you say so!! Why dont you write Obama and Biden and ask for an exemption because you are an icu nurse during covid and you should be automatically granted a Medical Doctor.It might work, sadly!

Not sure if you're trying to insult me for some odd reason or?

 

[JustintheDoctor]

Maybe I'm missing something, but isn't the MD route 3 extra years? 2 of ICU experience and 3 of CRNA school vs 4 of med school and 4 of residency?

I don't really count residency since you're making money during it and I've heard at a lot of places you're able to float and make more money. Where as in both programs you're basically living on loans

 

[MilkmanAl]

I don't really count residency since you're making money during it and I've heard at a lot of places you're able to float and make more money. Where as in both programs you're basically living on loans

Oh man, I'm glad you mentioned that. In my last year of residency, the highest-paid year, I made about $15/hr *after* a 20% raise. It wasn't enough to cover the interest on my loans. I wouldn't really consider residency much of a paid position. It'll get you by, but that's about it.

Moonlighting during residency is one of those mythical things that med students place a lot of value on, for some reason, but realistically never do. When you work 70+ hour weeks and have to study in addition to that, where's the time for more work? More importantly, where's the motivation for more work? Even if they're dropping you $100/hr, you've got to sleep sometime.

 

[MilkmanAl]

I got around to editing that interview Q&A session so that it's a little less painful to watch. I figure residency interview season is right around the corner, so this might be useful to a lot of you. Holler if you have questions!

 

[MilkmanAl]

Hey all, I'll be live talking about the extreme basics of finance for med students, residents, and young docs, like myself, at 8 PM Central, or in roughly half an hour. Sorry for the late notice, but I frankly forgot about this thread. Also, I'm pretty damn far from a finance expert, so this will be largely you (hopefully) learning from my mistakes. If you have actual financial savvy and/or experience, your input would be GREATLY appreciated. If you can't make it, I'll likely edit the stream down to a YouTube video in the very near future. Come one, come all:

 

[MilkmanAl]

Here's that YouTube video, as promised. I also updated the original post with my now-regular streaming times (8-10 PM Central on Wednesdays and Sunday, Twitch link in the post above) and general YouTube page (https://www.youtube.com/user/MilkmanAl).

 

[Himynameisnynameis]

What do you think about the outlook for AA? I've seen people say the job is growing due to a greater need for anesthesiology related personnel and others say that the profession will crash and burn with the push from CRNAs and even PAs trying to gain access to the field of anesthesiology.

 

[MilkmanAl]

What do you think about the outlook for AA? I've seen people say the job is growing due to a greater need for anesthesiology related personnel and others say that the profession will crash and burn with the push from CRNAs and even PAs trying to gain access to the field of anesthesiology.

Hey there, sorry for the delayed response. I think AA school is a great route. 2.5 years to a $180k+ salary is an excellent path to go down, but be aware that you're limited to practicing in 18(?) states. There's no crash and burn to be had, I don't believe. If anything, I see AAs gaining strength as time goes on and CRNAs push to be more independent, leaving vacancies at larger institutions as they move rurally.

Edit: Also, it looks like I discussed AAs a bit more above, so reading back through that may be helpful to you.

 

[MilkmanAl]

I'll be live tonight talking about things to consider after getting accepted to med school. Some of the info will apply to med students, so it might be useful to listen in, if you're looking for some practical advice regarding setting yourself up for being a real adult after medical education. Also, it'd be nice to have some perspective from people who've gone through the application process more recently than I have, so please feel free to contribute your experiences.

Come join in at 8 PM Central (9 EST) at MilkmanAl1 - Twitch

 

[jstwannagraduaaate!!!]

I'll be live tonight talking about things to consider after getting accepted to med school. Some of the info will apply to med students, so it might be useful to listen in, if you're looking for some practical advice regarding setting yourself up for being a real adult after medical education. Also, it'd be nice to have some perspective from people who've gone through the application process more recently than I have, so please feel free to contribute your experiences.

Come join in at 8 PM Central (9 EST) at MilkmanAl1 - Twitch

Hello, current M2 interested in anesthesia as well as IM. Would want to either pursue cardio or pain in anesthesia or cardio in IM. What would you say the pros and cons of each field are? How are the personalities? I'm a pretty laid back guy who likes to have fun outside of studying and would like to go into a field where my colleagues are similar. Thanks!

 

[MilkmanAl]

Physicians aren't really known for being laid-back, but anesthesia seems to have a fair few who fit that mold. It helps to have a chill baseline when you're expected to be at your best when badness goes down, right? Medicine docs, at least in private practice, seem to be fairly relaxed, too. They don't typically have emergencies to respond to and keep pretty good hours. Pay is quite a bit better for anesthesia than IM. Both specialties require a broad knowledge base, but anesthesia is a lot more hands-on, which I obviously like. I discussed anesthesia vs. pulm/crit care in a little more depth earlier in the thread, so that'd be good to read over, too. Did that hit what you're looking for?

 

[MilkmanAl]

Here's an edited version of last night's talk, if anyone is interested.

 

[MilkmanAl]

For those of you still pounding down the interview trail, I'll be on tonight talking about - you guessed it - interviewing...again. 8 PM Central, AMA as always. See you there!

 

[MilkmanAl]

Here's the edited talk from Wednesday, if anyone is interested:

 

[username456789]

Just checking in to say that MilkmanAl is a real G.

I remember toiling in the Step I forum with you over a decade ago…..pretty sure we took the test right around the same time. My screen name was different back then.

Anyway, carry on with the good advice. Glad to see you’re doing well.

 

[MilkmanAl]

Just checking in to say that MilkmanAl is a real G.

I remember toiling in the Step I forum with you over a decade ago…..pretty sure we took the test right around the same time. My screen name was different back then.

Anyway, carry on with the good advice. Glad to see you’re doing well.

Huge praise, man. Thanks! Good to see some of the old folk still around. Obviously things worked out pretty damn well for you, too. Cheers!

 

[Dr. Anonymouss]

Hello and thank you for doing this. I am a current MS2 who is still trying to decide what specialty I fit into. I am certain I want to be hands on so that narrowed down my search quite a bit. I would say right now I am between surgery, anesthesiology, and emergency medicine. I am assuming you are someone who also chose anesthesiology because you wanted something procedure based where you could learn a skill and use your hands, but did you find yourself in a similar dilemma as me and if so how did you narrow it down to anesthesiology?

 

[MilkmanAl]

Hello and thank you for doing this. I am a current MS2 who is still trying to decide what specialty I fit into. I am certain I want to be hands on so that narrowed down my search quite a bit. I would say right now I am between surgery, anesthesiology, and emergency medicine. I am assuming you are someone who also chose anesthesiology because you wanted something procedure based where you could learn a skill and use your hands, but did you find yourself in a similar dilemma as me and if so how did you narrow it down to anesthesiology?

Hey there! Sorry for the incredibly delayed response. It seems I'm still struggling with getting SDN notifications. Apologies!

Anyway, I chose Anesthesia over EM mainly for lifestyle reasons - pay and hours, that is. I also didn't want to deal with as many crazies. I'm glad I made that call now, because it sure sounds like EM job security is suffering a bit due to mid-level creep. I'm not on the inside of that situation, though, so it's hard for me to really say just how bad the situation is. Surgery also got the boot for lifestyle reasons and also because I hate clinic.

Overall, I really like the "usually easy but studded with panic" workflow anesthesia offers. That occasional adrenaline shot is groovy. I also like how cerebral the job is with some minor procedures thrown in. Pacing is great (fast), and at least where I work, efficiency is king, which I love. I chose very wisely!

 

[Anakinmemer]

Is compensation for a cardiac fellowship trained anesthesiologist higher? If so, does this come with more hours worked, meaning the per hour comp isnt actually any better?

 

[MilkmanAl]

Is compensation for a cardiac fellowship trained anesthesiologist higher? If so, does this come with more hours worked, meaning the per hour comp isnt actually any better?

The answer isn't straightforward, as it depends on what the structure of the practice you're joining is. For instance, the cardiac guy in my group makes the same as everyone else. If you're at a place where cardiac is all you do, though, the pay structure may be different for the cardiac and non-cardiac folks. There's a chance you get stuck working more, but if the heart program is slow and/or the surgeons are really fast, it might be a sweet deal, too.

In any case, a cardiac fellowship makes you a more desirable candidate, which is value in its own right. Even if you don't actually make more cash directly, opening doors for work opportunities is a really big deal.

 

[MilkmanAl]

In case it wasn't obvious, hospitals are a total mess right now. Here's some insight into the extreme staffing shortages we're facing. This is the world you're all signing up for. Hopefully the critical, acute issues will be resolved by the time most of you are intimately involved, but this has been a problem years in the making.