Is Anesthesiology still a good choice for Medical Students?

[badasshairday]

I really liked Anesthesiology when I started med school. I even did some research in it during the summer between M1 and M2 year. Then I started getting turned off because of all the sky is falling stuff I read on here. However, I just had my clerkship in it, and I enjoyed the hell out of it.

The only other thing I am really thinking seriously about is Radiology. I don't know if I would enjoy Radiology more as you can't really get a taste of it as a student. But I did an elective in it, and could see myself doing it, plus IR gets you back into the traditional doc/patient relationship.

I had an awesome attending for Anesthesiology, and he was very hands off and let me do a lot. So I was able to really get a feel for Anesthesiology and totally enjoyed it. Probably something I can do for a career...... but still the politics is a turn off.

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[BLADEMDA]

I really liked Anesthesiology when I started med school. I even did some research in it during the summer between M1 and M2 year. Then I started getting turned off because of all the sky is falling stuff I read on here. However, I just had my clerkship in it, and I enjoyed the hell out of it.

The only other thing I am really thinking seriously about is Radiology. I don't know if I would enjoy Radiology more as you can't really get a taste of it as a student. But I did an elective in it, and could see myself doing it, plus IR gets you back into the traditional doc/patient relationship.

I had an awesome attending for Anesthesiology, and he was very hands off and let me do a lot. So I was able to really get a feel for Anesthesiology and totally enjoyed it. Probably something I can do for a career...... but still the politics is a turn off.

Medical Students today are bright and realistic. Where do you stand in terms of Grades and Board Scores (Step1 ans 2)? What is the likelihood of you matching to Specialty X vs. Y? How much money do you owe? What do you prefer to do for a living for at least 2-3 decades after Residency?

I am a firm believer that with Academia's help we can win the War. The problem is that Academia has just come to realize the gravity of the issue.
When will the studies needed to win actually take place?

 

[GasEmDee]

Medical Students today are bright and realistic. Where do you stand in terms of Grades and Board Scores (Step1 ans 2)? What is the likelihood of you matching to Specialty X vs. Y? How much money do you owe? What do you prefer to do for a living for at least 2-3 decades after Residency?

I am a firm believer that with Academia's help we can win the War. The problem is that Academia has just come to realize the gravity of the issue.
When will the studies needed to win actually take place?

Did you expect academic anesthesiologists to run studies that show anesthesiologists are superior? How is this different than nurses who run their own studies showing their equivalence to MDs?

It's like a beauty contest. You cannot judge yourself the winner. A respected third party must make the decision for you, in this case perhaps a respected health economist who is from a well-known institution and who didnt received $ from anesthesiologists or CRNAs

And besides, academic anesthesia is about advancing the SCIENCE of anesthesia, not about waging political battles. Political battles are the domain of the ASA.

Again, academic anesthesiologists have not sold out the profession. Academic anesthesiologists DID NOT milk the CRNA cash cow. Academic anesthesiologists have residents and junior faculty to abuse. Private practice anesthesiologists are the ones that sold us out to CRNAs.

Edit: I am a former academic attending who is now in an MD-only private practice.

 

[BLADEMDA]

Did you expect academic anesthesiologists to run studies that show anesthesiologists are superior? How is this different than nurses who run their own studies showing their equivalence to MDs?

It's like a beauty contest. You cannot judge yourself the winner. A respected third party must make the decision for you, in this case perhaps a respected health economist who is from a well-known institution and who didnt received $ from anesthesiologists or CRNAs

And besides, academic anesthesia is about advancing the SCIENCE of anesthesia, not about waging political battles. Political battles are the domain of the ASA.

Again, academic anesthesiologists have not sold out the profession. Academic anesthesiologists DID NOT milk the CRNA cash cow. Academic anesthesiologists have residents and junior faculty to abuse. Private practice anesthesiologists are the ones that sold us out to CRNAs.

Edit: I am a former academic attending who is now in an MD-only private practice.

1. Yes, I expect Academia to run well conducted studies comparing knowledge and skill of Residents vs. SRNAS. Why not? The fate of the Medical Specialty hangs in the balance.

2. Those studies should be fair and balanced and involve senior CRNA staff. Test Scores don't lie.

3. Blame- there is more than enough to go around. Academia rushed to open more CRNA Schools in the late 90s to increase their bottom lines.
Pimping/pumping out more SRNAS/CRRNAs adds fuel to the fire. Academia has added a ton of fuel.

4. Academia won't need to worry about advancing the Science of Medical Anesthesiology if there is NO Specialty left to advance. Sometimes you need to put the book down or get off the computer when your home is on fire. The AANA is torching our home.

We need to play in the sand box we have and not the one we want.

 

[BLADEMDA]

 

[GasEmDee]

1) According to FREIDA there are 131 anesthesia residency programs in the United States. Of those institutions hosting an anesthesia residency program, 30 of them also host a CRNA program. That translates to about 23% -- hardly the "rush" that you claim. "Academia" cannot be blamed for the all those other schools that were opened and that accept anyone with a pulse and a suitable bank account.

Anesthesia residencies listed on FREIDA: https://freida.ama-assn.org/Freida/user/programSearchSubmitDispatch.do

CRNA programs: http://www.all-crna-schools.com/crna-schools.html



2) At the academic institutions where I worked and trained, there were a handful of CRNAs amongst hundreds of faculty anesthesiologists. Academic anesthesiologists don't need CRNAs to abuse, when they have residents to abuse. The blame lies in the private practice anesthesiologist who sat on his ass in the lounge, while "supervising" 4 CRNAs. The anesthesiologists shows up to sign paperwork and disappears. How can you expect CRNAs not to demand independence. Just think about what you thought of your attendings in residency who never showed up except to sign the paperwork.



3) And finally, there will ALWAYS be an academic specialty left to advance. The science needs to advanced, because the practice of anesthesia will always be relevant, no matter who is practicing it. The nurses aren't going to do it. They haven't contributed an iota to it. The real question is how many JOBS there will be in the private practice world, and that is a completely separate issue!

Stop blaming academia for this issue.

1. Yes, I expect Academia to run well conducted studies comparing knowledge and skill of Residents vs. SRNAS. Why not? The fate of the Medical Specialty hangs in the balance.

2. Those studies should be fair and balanced and involve senior CRNA staff. Test Scores don't lie.

3. Blame- there is more than enough to go around. Academia rushed to open more CRNA Schools in the late 90s to increase their bottom lines.
Pimping/pumping out more SRNAS/CRRNAs adds fuel to the fire. Academia has added a ton of fuel.

4. Academia won't need to worry about advancing the Science of Medical Anesthesiology if there is NO Specialty left to advance. Sometimes you need to put the book down or get off the computer when your home is on fire. The AANA is torching our home.

We need to play in the sand box we have and not the one we want.

 

[GasEmDee]

]
I think people are concerned about no longer being able to do a residency and then go work at a GIs outpatient office and bank. This may be so. But we are nowhere near anesthesiology becoming a dead specialty. There will be hospital based and private practice for a long time. Its going to become increasingly important to spend that extra year doing a fellowship afterwards: things like pediatrics, regional, cardiac, OB/GYN, pain, critical care are all going to stay relatively safe from CRNAs.

Agree. The physicians who want to have that cush pp practice job doing surgicenter crap are the ones in real danger -- not those of us who are doing our own major cases on ASA 4 patients, e.g., CABG/AVRs in frail, elderly patients with critical AS and renal failure, thoracotomies in patients with severe COPD, contributing to ICU care, etc.

Over on the nurse anesthesia website, there is this former AANA president who boldly claims that she would be willing to compare her skills to our own. The laughable part is that she states her practice is purely outpatient cosmetics. Those patients are by definition ASA 1 and 2 patients, undergoing MINOR surgery. The last time I worked in a surgicenter for, I felt like I was growing dumber by the moment. Everything became rote: versed, propofol, LMA. My physician knowledge became totally irrelevant.

If you want to compete with CRNAs in that environment, you will be facing a losing battle. Your knowledge and skills are not required there, and yet you are more expensive. However, if you want to take care of critically ill patients, you will face little competition. Their vocal minority claims equivalence, but I doubt most of their numbers want to be involved in the big whacks on sick people. A large percentage of their numbers was attracted to anesthesia for the easy buck. Another large percentage just do not have the adequate exposure in their training to do these cases on their own.

The problem is, it is really not fair to allow them to get paid so well for taking all the easy, low-hanging fruit.

 

[BLADEMDA]

1) According to FREIDA there are 131 anesthesia residency programs in the United States. Of those institutions hosting an anesthesia residency program, 30 of them also host a CRNA program. That translates to about 23% -- hardly the "rush" that you claim. "Academia" cannot be blamed for the all those other schools that were opened and that accept anyone with a pulse and a suitable bank account.

Anesthesia residencies listed on FREIDA: https://freida.ama-assn.org/Freida/user/programSearchSubmitDispatch.do

CRNA programs: http://www.all-crna-schools.com/crna-schools.html



2) At the academic institutions where I worked and trained, there were a handful of CRNAs amongst hundreds of faculty anesthesiologists. Academic anesthesiologists don't need CRNAs to abuse, when they have residents to abuse. The blame lies in the private practice anesthesiologist who sat on his ass in the lounge, while "supervising" 4 CRNAs. The anesthesiologists shows up to sign paperwork and disappears. How can you expect CRNAs not to demand independence. Just think about what you thought of your attendings in residency who never showed up except to sign the paperwork.



3) And finally, there will ALWAYS be an academic specialty left to advance. The science needs to advanced, because the practice of anesthesia will always be relevant, no matter who is practicing it. The nurses aren't going to do it. They haven't contributed an iota to it. The real question is how many JOBS there will be in the private practice world, and that is a completely separate issue!

Stop blaming academia for this issue.

As I have posted before there is more than enough "blame" to go around for the "Independent" CRNA.

We are all in this boat together. We will all sink together albeit a few will drown early while the remainder will drown later.

The first "model" of anesthesia private practice to fall victim to the CRNA/AANA onslaught for Independent Practice will be the all "MD" practices. Once Obamacare takes hold at the end of this decade we will see just how economically viable a 100% Medicare practice really is.

 

[pgg]

Agree. But, you won't be satisfied at $175K per year unless you have the following:

1) no debt
2) trust fund or large inheritance
3) spouse who earns over $100K
4) LOW EXPECTATIONS

Well, of the 4 above only (1) applies to me and that's because I'm in the military. Here, in the institution that invented the independent CRNA, I earn roughly $150K as an O4 anesthesiologist. I make a little extra moonlighting for the locals, but still far less than the average academic anesthesiologist, and far far less than the average PP anesthesiologist. And yet I'm basically satisfied with my pay; it's all the other crazy **** the military does that's driving me out the door. (Today I'm rewriting the hospital's Uniform Instruction so that people in my department don't get yelled at if we wear scrubs but no lab coat outside the operating room. How ridiculously dysfunctional is that?)

That's not to say I won't leap eagerly at a higher salary when I get out, or that spending a decade+ of my life to get board certified in something medical was the best path to a $150-175K salary, given that investment banking or white-collar crime (is there a difference?) or plumbing were other options.

Just that it's possible to be happy without making upwards of a quarter million per year after loans.

 

[BLADEMDA]

Well, of the 4 above only (1) applies to me and that's because I'm in the military. Here, in the institution that invented the independent CRNA, I earn roughly $150K as an O4 anesthesiologist. I make a little extra moonlighting for the locals, but still far less than the average academic anesthesiologist, and far far less than the average PP anesthesiologist. And yet I'm basically satisfied with my pay; it's all the other crazy **** the military does that's driving me out the door. (Today I'm rewriting the hospital's Uniform Instruction so that people in my department don't get yelled at if we wear scrubs but no lab coat outside the operating room. How ridiculously dysfunctional is that?)

That's not to say I won't leap eagerly at a higher salary when I get out, or that spending a decade+ of my life to get board certified in something medical was the best path to a $150-175K salary, given that investment banking or white-collar crime (is there a difference?) or plumbing were other options.

Just that it's possible to be happy without making upwards of a quarter million per year after loans.

And you live in a high TAX State. That money would go much further in a low cost State with no State income tax.

 

[pgg]

And you live in a high TAX State. That money would go much further in a low cost State with no State income tax.

Yeah, tell me about it ... we're not going to be in CA for the long haul.

I get a break on the state income tax though, since I'm a nonresident in the military. CA gets a cut of my non-military income, in a convoluted way via my VA state return.

The state sales tax is very high, but I don't buy a lot of stuff.


If I lived on the coast I'd probably feel differently. Out here in central California cow-town the cost of living is a lot less. We have 8+ year old cars that we paid cash for. I just don't have a lot of expenses.

$300-400+/month on my daughter's gymnastics classes and tournaments is the only thing that really marks me as a 'rich' doctor ... she better get herself a full ride someplace nice.

 

[RussianJoo]

Yeah, tell me about it ... we're not going to be in CA for the long haul.

I get a break on the state income tax though, since I'm a nonresident in the military. CA gets a cut of my non-military income, in a convoluted way via my VA state return.

The state sales tax is very high, but I don't buy a lot of stuff.


If I lived on the coast I'd probably feel differently. Out here in central California cow-town the cost of living is a lot less. We have 8+ year old cars that we paid cash for. I just don't have a lot of expenses.

$300-400+/month on my daughter's gymnastics classes and tournaments is the only thing that really marks me as a 'rich' doctor ... she better get herself a full ride someplace nice.

$300 a month damn who teaches these things? Béla Károlyi?

 

[RT2MD]

$300 a month damn who teaches these things? Béla Károlyi?

No joke! I was already balking about spending $60/month on my daughters gymnastics!

I guess that's part of the difference between a medical student and an attending!

 

[BeddingfieldMD]

I really liked Anesthesiology when I started med school. I even did some research in it during the summer between M1 and M2 year. Then I started getting turned off because of all the sky is falling stuff I read on here. However, I just had my clerkship in it, and I enjoyed the hell out of it.

I don't want to sound too naive, though I know some will accuse me of it. I'm just an intern at this point, but I'm very happy with my choice of anesthesiology. I, too, was on the fence between a few specialties. Anesthesiology is such a great blend of medicine and surgery (and even OB...take it or leave it), procedures and cognitive skills, physiology and pathology and pharmacology, and one in which you get to see all sorts of patients every day with no two days being quite the same.

You're not stuck in clinic all day once a week talking about prostate cancer or incontinence. You're not driving between hospitals and rushing from patient to patient in the morning to make rounds. And you're not prescribing pills patients won't take and trying to get them to quit smoking until you're blue in the face. In fact, I've found in my limited experiences that surgery is often the "big motivator" that patients need, and in anesthesia you can actually affect as much change with brief discussions as you can with years of primary care counseling.

Granted, the politics can be mind-numbing, if for no other reason than the fact that it's so repetitive and has been going on for so long. My experience is still that it mostly occurs in Washington, Park Ridge, and on online forums. Yes, it's still going on day by day. But I don't think it has to dominate your day-to-day working life if you don't let it.

I have no regrets at this time, though of course I again have to say to take that with a grain of salt since I'm still early in my residency training and obviously don't have the experience that some of the attendings on here do. You'll ultimately have to make your own choice.

But for me, I really enjoy the subject matter, day-to-day workflow, and colleagues in the field of anesthesia. They really are a diverse, fun loving group of people.

And I think all of us entering the field in the last several years are acutely aware of the political scene and are entering the field without any false pretenses. I expect ASAPAC contributions to continue increasing dramatically over the next 10-15 years and for leaders in the field to become increasingly active in anticipating the future of anesthesia--whatever it looks like--and making sure we have a voice in shaping it and a continued leadership role.

If you love your rotations in it as much as you suggest, I would say you shouldn't write it off just yet--not just because of what you read on any online forum.

Just try to keep your loans as small as possible so you can pay them off as quickly as possible. Plan on doing a fellowship. Don't expect to make $500k in that perfect PP gig. Don't expect to work 8-3 pushing propofol for boob jobs all day.

If you go into it expecting that we may have an increasing role in ICU care, full perioperative management, and most likely in an anesthesia care team, I don't think you'll have any huge regrets.

 

[karizma098]

Blade,

with all due respect, it's really easy to say " I would have done Neurosurgery, Ortho, ENT, etc"

but you have to take into consideration how much more competitive these specialties are than Anesthesia - Sure, for our step 1 245+ superstars matching at hopkins and mass general for anesthesia, these are options; but realistically the average anesthesia applicant of today does not have as impressive a resume as an ortho, ENT, or neurosurg applicant. Especially if the program isn't in the middle of nowhere.

I'll be the first to say that i'm a fairly average anesthesia applicant, but with my step 1 score i don't think i'd be competitive for ortho or neurosurg.

As you stated earlier, a lot of it boils down to expectations. My old man is an anesthesiologist in his early 50's and is still banking in the high six figs with his practices; i don't expect to make half that much, or have half that lifestyle, hence if my salary persists in the 200-300k arena i'll be okay with that.

 

[MCAT guy]

So what is the consensus?

That the worst it could get is 175k or so, or will the specialty be taken over by nurses and MDA have no options in pp?

I too will have 200k+ debt I believe... I guess that sucks. So exciting to get in but then all these downers, lol.

 

[link2swim06]

Nobody has considered the lifestyle difference between gas and neurosurgery. I think it is fair to say that the typical neurosurgeon busts their ass more in med school, residency, and practice than the typical anesthesiologist.

There gets to be a point where who cares the difference between 300K and 600K if you lose 20-30 hours of your week to enjoy it.

I'd rather "get by" on 300K in emergency med and work 35 hours a week than work 60+ hours in neurosurgery and make 600K. But to each their own....

 

[MCAT guy]

Hello. Welcome to a Pro-MD and Pro ASA stance. My views are my own and in no way represent the ASA or any other professional organization. However, we can make a difference and over time change attitudes. Join the battle to save the Medical Specialty of Anesthesiology. Blade

This statement by you seems to contradict your stance in this thread.

 

[WhateverMang]

From Medscape Med Students > Choosing a Specialty
The Time Is Right to Opt for Anesthesiology

http://www.medscape.com/viewarticle/741892

 

[deleted126335]

From Medscape Med Students > Choosing a Specialty
The Time Is Right to Opt for Anesthesiology

http://www.medscape.com/viewarticle/741892

The author is faculty at a major training program. Such individuals would be cutting their own throats to suggest that it is ever a bad time to go into anesthesiology. I'll never forget the comments from some academic faculty during the terrible market of the mid 90s.

Taking advice from academic faculty on the wisdom of a med student entering anesthesia is like taking advice from a realtor on buying a house...it's always a good time to do so.

 

[hivoltage]

Taking advice from academic faculty on the wisdom of a med student entering anesthesia is like taking advice from a realtor on buying a house...it's always a good time to do so.

LOL very true.. very true...

I always discourage people from going into anesthesia because of the political climate, practice environment, and the outlook. The political climate is such that people(politicians, hospital admins, etc) will marginalize your skills and judgement constantly. You are viewed as a inter changeable COG. (Insert Anesthesia provide A here) (anesthesia provider C on vacation). They dont care who it is.. If you dont play ball. They will get another one or many at a lower price. They dont care. hard to stay in one spot for a while when you are dealing with **** like this. Its ridiculous. Until something catastrophic happens... then where is the anesthesiologist..
2) the practice environment. The anesthesiologist has to keep too many people happy.. surgeon,,, colleagues.... crnas.... nurses... surg tech...... on a daily basis.. can be exhausting in the face of dealing with critical tricky patients. very hard to develop the skill of being diplomatic and getting what you want at the same time.. Residency will not teach you this. Just wont. My attendings in residency tried to explain this to me. Went over my head. really did. Most never develop this skill. You have to plant ideas into peoples heads and make believe it was their idea.. wierd to explain.

3) I think the outlook is dismal because of the mid level providers which are essential to our practice otherwise there would not be enough providers. The problem is when they are claiming independence and in the future its looking you will be competing with CRNAs for the same exact job.

4) add to the mix.. greedy ass anesthesia management companies, corrupt lazy partners who set you up for failure., the temptation for drug abuse, early mornings, late calls, threats of career ending lawsuits looming over you daily, the aba threatening to revoke your certifications every year if you dont follow MOCA to a "T". ALl this for a salary that people think you are doing nothing for anyway. somtimes it is just too much to stomach. its hard to come in to work sometimes.

I just think there are many other specialties that are far better than anesthesiology for a bright graduating medical student.

 

[MCAT guy]

LOL very true.. very true...

I always discourage people from going into anesthesia because of the political climate, practice environment, and the outlook. The political climate is such that people(politicians, hospital admins, etc) will marginalize your skills and judgement constantly. You are viewed as a inter changeable COG. (Insert Anesthesia provide A here) (anesthesia provider C on vacation). They dont care who it is.. If you dont play ball. They will get another one or many at a lower price. They dont care. hard to stay in one spot for a while when you are dealing with **** like this. Its ridiculous. Until something catastrophic happens... then where is the anesthesiologist..
2) the practice environment. The anesthesiologist has to keep too many people happy.. surgeon,,, colleagues.... crnas.... nurses... surg tech...... on a daily basis.. can be exhausting in the face of dealing with critical tricky patients. very hard to develop the skill of being diplomatic and getting what you want at the same time.. Residency will not teach you this. Just wont. My attendings in residency tried to explain this to me. Went over my head. really did. Most never develop this skill. You have to plant ideas into peoples heads and make believe it was their idea.. wierd to explain.

3) I think the outlook is dismal because of the mid level providers which are essential to our practice otherwise there would not be enough providers. The problem is when they are claiming independence and in the future its looking you will be competing with CRNAs for the same exact job.

4) add to the mix.. greedy ass anesthesia management companies, corrupt lazy partners who set you up for failure., the temptation for drug abuse, early mornings, late calls, threats of career ending lawsuits looming over you daily, the aba threatening to revoke your certifications every year if you dont follow MOCA to a "T". ALl this for a salary that people think you are doing nothing for anyway. somtimes it is just too much to stomach. its hard to come in to work sometimes.

I just think there are many other specialties that are far better than anesthesiology for a bright graduating medical student.

wow.

 

[Nooblet]

well thats depressing...

 

[QuickKat]

wow.

Please forgive my arrogance, as I'm sure I am missing a vital piece of information, but please answer me why this hasn't already happened. You know, in the midst of this depression and everything? Why haven't CRNAs already squeezed out MDAs? For that matter, why, if this is all in the sake of saving money, haven't hospitals hired an overwhelming amount of PAs or NPs in somewhere like an ER? Wouldn't it be saving the hospital a substantial amount of money if say a group of 20 physicians each making $250,000/yr were replaced by 6 physicians making $250,000/yr and 14 PAs/NPs making $80,000/yr? This is unheard of (and for good reason).

Some of you may be pleased to know that the ER I work at openly advertises the fact that we have absolutely no mid-level practitioners. "Every patient sees a board-certified physician." Furthermore, I can't say this is directly related, but the same physician group who left the hospital x (across the street of hospital y) drove up the yearly amount of patients seen at hospital y substantial amounts while the hospital x dropped by the same amount. (sorry I can't remember the actual numbers here.) I constantly hear of patients who complain about hospital x's inadequate care---as you may have guessed it, they do employ NPs and PAs. Food for thought.

 

[bronx43]

From Medscape Med Students > Choosing a Specialty
The Time Is Right to Opt for Anesthesiology

http://www.medscape.com/viewarticle/741892

Any article about anesthesiology as an option for medical students that doesn't talk about CRNA encroachment is straight up rubbish.

 

[hivoltage]

You know, in the midst of this depression and everything? Why haven't CRNAs already squeezed out MDAs?I constantly hear of patients who complain about hospital x's inadequate care---as you may have guessed it, they do employ NPs and PAs. Food for thought.

You have to follow trends like anything else. Crnas are not going to replace physicians over night. Its a gradual process like anything else. You have to follow trends. I think it will come with the death of private practice. Once the corporations are in charge.. to increase the bottom line they have to do something. Physician expertise is a liability to the bottom line.

 

[hivoltage]

The author is faculty at a major training program. Such individuals would be cutting their own throats to suggest that it is ever a bad time to go into anesthesiology. I'll never forget the comments from some academic faculty during the terrible market of the mid 90s.

Taking advice from academic faculty on the wisdom of a med student entering anesthesia is like taking advice from a realtor on buying a house...it's always a good time to do so.

i wasnt able to open this article for some reason would love to read it

 

[Stank811]

You have to follow trends like anything else. Crnas are not going to replace physicians over night. Its a gradual process like anything else. You have to follow trends. I think it will come with the death of private practice. Once the corporations are in charge.. to increase the bottom line they have to do something. Physician expertise is a liability to the bottom line.

"Its a gradual process like anything else" I was unaware that this process has started? Please elaborate...or even better give me some concrete data that shows that this is happening. Because from what I hear (on a regional level) the opposite is happening. By opposite I mean replacing a CRNA that is retiring or leaving with AA's or another MD.

 

[Doctor4Life1769]

Honestly, it seems to me that hivoltage is out to discourage everyone. I don't know what his/her experience was like in residency... but, holy batman.

 

[hivoltage]

Honestly, it seems to me that hivoltage is out to discourage everyone. I don't know what his/her experience was like in residency... but, holy batman.

I can lie lie and lie more. I can say anesthesiology is the greatest specialty known to man. I can vomit sunshine as the management company takes 35 percent of what we make(take it or leave it), as the administration make us work longer for less pay at the same time marginalizing our value by hiring more and more anesthetists, as non boarded docs( good docs) cant find jobs but CRNA practices proliferate. i can tell you that I love working late inghts and weekends on call taking care of sicker and sicker patients bowel obstructions, dead guts, bring back t onsils, the parturient who needs an epidural and you show up 5 mins late and are written up by the nurse manager. I love our service being blamed for the inefficiency of the OR. Its just a tough, tough life. It would be a different story if we got paid a lot of money for this hassle... but our salaries arent as great as people think for the responsibility we shoulder and is being decreased every year. Even if you get a job at a GI center there is significant stress associated with that job.

Im just a realist and calling it like it is. If you want to go into anesthesia thats fine. Just dont go into it blindly, thinking its a great lifestyle specialty. We are going to need great anesthesiologists in the future. I dont know how many, but right now the job market is depressed.

 

[pgg]

hivoltage - there are shades of truth to everything you're saying, but obviously there is a continuum of practice environments ranging from horrible to excellent.

Sounds like you need to relocate and find a job on the other side of the bell curve.

But I'd put even money on the notion that the job hunt that landed you where you are was geography-driven first, and job-driven second ... and that you're reluctant to leave for the same reason.

 

[scudrunner]

To anyone becoming discouraged by the incredible amount of negativity in this thread, just remember the universal truth that negative voices are always the loudest.

Just know that there are plenty of anesthesiologists out there who are very happy with their career choice.

 

[RT2MD]

To anyone becoming discouraged by the incredible amount of negativity in this thread, just remember the universal truth that negative voices are always the loudest.

Just know that there are plenty of anesthesiologists out there who are very happy with their career choice.

Very good point...

 

[Doctor4Life1769]

hivoltage - there are shades of truth to everything you're saying, but obviously there is a continuum of practice environments ranging from horrible to excellent.

Sounds like you need to relocate and find a job on the other side of the bell curve.

But I'd put even money on the notion that the job hunt that landed you where you are was geography-driven first, and job-driven second ... and that you're reluctant to leave for the same reason.

I have to agree with the above points. Hivoltage, I'll be going into the specialty as I start my CA-0 this July. Yes, I know it's not perfect. Yes, I know the field isn't a lifestyle specialty. However, I have NOT met an unhappy anesthesiologist. Everyone (in priv practice and in academia) was happy. I'd like to know which part of the US you are located. As pointed above, you likely took a job at a really nice but expensive place and in a saturated market. If that is true, then it's your fault for looking at location first and job second. For me, I don't care if I end up in the midwest or some undesirable location in the southeast/west as long as the job isn't as malignant as yours.

No specialty is perfect. I find that complainers will always complain about something, and think the grass is always greener elsewhere. I remember you talking wonderful things about radiology... trust me, the grass isn't green there, either. From my colleagues that have posted here on SDN, I can say we're all ready for the challenge. We've worked hard to make it where we are. We understand the downsides of the specialty, as well. It still hasn't phased us one bit.

 

[Arch Guillotti]

Anesthesiology is great and I would do it again in a heartbeat. Let the haters hate.

I can lie lie and lie more. I can say anesthesiology is the greatest specialty known to man. I can vomit sunshine as the management company takes 35 percent of what we make(take it or leave it), as the administration make us work longer for less pay at the same time marginalizing our value by hiring more and more anesthetists, as non boarded docs( good docs) cant find jobs but CRNA practices proliferate. i can tell you that I love working late inghts and weekends on call taking care of sicker and sicker patients bowel obstructions, dead guts, bring back t onsils, the parturient who needs an epidural and you show up 5 mins late and are written up by the nurse manager. I love our service being blamed for the inefficiency of the OR. Its just a tough, tough life. It would be a different story if we got paid a lot of money for this hassle... but our salaries arent as great as people think for the responsibility we shoulder and is being decreased every year. Even if you get a job at a GI center there is significant stress associated with that job.

Im just a realist and calling it like it is. If you want to go into anesthesia thats fine. Just dont go into it blindly, thinking its a great lifestyle specialty. We are going to need great anesthesiologists in the future. I dont know how many, but right now the job market is depressed.

 

[hivoltage]

There is always going to be people who like negatives in anything they are sado masochists. If you like all the negatives that i pointed out, thats fine. and those negatives are not unique to practices that are in saturated markets

 

[MCAT guy]

I have to agree with the above points. Hivoltage, I'll be going into the specialty as I start my CA-0 this July. Yes, I know it's not perfect. Yes, I know the field isn't a lifestyle specialty. However, I have NOT met an unhappy anesthesiologist. Everyone (in priv practice and in academia) was happy. I'd like to know which part of the US you are located. As pointed above, you likely took a job at a really nice but expensive place and in a saturated market. If that is true, then it's your fault for looking at location first and job second. For me, I don't care if I end up in the midwest or some undesirable location in the southeast/west as long as the job isn't as malignant as yours.

No specialty is perfect. I find that complainers will always complain about something, and think the grass is always greener elsewhere. I remember you talking wonderful things about radiology... trust me, the grass isn't green there, either. From my colleagues that have posted here on SDN, I can say we're all ready for the challenge. We've worked hard to make it where we are. We understand the downsides of the specialty, as well. It still hasn't phased us one bit.

Everyone keeps saying how anesthesia isn't a lifestyle specialty, but when comparing it to something like general slavery, isn't it much better?

Or is it the same?

What happened to all the ROAD talk?

 

[MCAT guy]

For those who do see a lot of midlevel encroachment, do you think that Anesthesia will move more to a supervisory role?

For those of us who like the procedural aspects of this specialty, does this mean we would get out of practice by playing the supervisor role too much?

 

[Doctor4Life1769]

Everyone keeps saying how anesthesia isn't a lifestyle specialty, but when comparing it to something like general slavery, isn't it much better?

Or is it the same?

What happened to all the ROAD talk?

It is better than Gen Surg/IM, etc. Heck, to me it's better than EM b/c I hate shift work and the pt pop involved. I get to interact w/ pts to a degree, so better than path and rads. Lots of diversity. Procedures and acute medicine. Be in the OR. To me, it was the best bang for my buck in terms of hours, too. I think the lifestyle bit as an attending likely varies based on your practice. It seems hivoltage has a ****ty lifestyle. Jet's and others here appear to be on the other end of the lifestyle continuum. I'm not terribly concerned over mid-levels.

 

[MCAT guy]

It is better than Gen Surg/IM, etc. Heck, to me it's better than EM b/c I hate shift work and the pt pop involved. I get to interact w/ pts to a degree, so better than path and rads. Lots of diversity. Procedures and acute medicine. Be in the OR. To me, it was the best bang for my buck in terms of hours, too. I think the lifestyle bit as an attending likely varies based on your practice. It seems hivoltage has a ****ty lifestyle. Jet's and others here appear to be on the other end of the lifestyle continuum. I'm not terribly concerned over mid-levels.

Agreed. EM constantly revolving shift work seems awful as does the pt population due to all the primary care. EM would be very cool if it were more emergency, less primary care, and less altering your circadian rhythm. I'm not bashing EM though, very cool specialty just wish it had less FM.

Anesthesia is on my short list.

 

[muhali3]

You have to plant ideas into peoples heads and make believe it was their idea.. wierd to explain.

...Inception.

 

[miamidc]

I don't want to sound too naive, though I know some will accuse me of it. I'm just an intern at this point, but I'm very happy with my choice of anesthesiology. I, too, was on the fence between a few specialties. Anesthesiology is such a great blend of medicine and surgery (and even OB...take it or leave it), procedures and cognitive skills, physiology and pathology and pharmacology, and one in which you get to see all sorts of patients every day with no two days being quite the same.

You're not stuck in clinic all day once a week talking about prostate cancer or incontinence. You're not driving between hospitals and rushing from patient to patient in the morning to make rounds. And you're not prescribing pills patients won't take and trying to get them to quit smoking until you're blue in the face. In fact, I've found in my limited experiences that surgery is often the "big motivator" that patients need, and in anesthesia you can actually affect as much change with brief discussions as you can with years of primary care counseling.

Granted, the politics can be mind-numbing, if for no other reason than the fact that it's so repetitive and has been going on for so long. My experience is still that it mostly occurs in Washington, Park Ridge, and on online forums. Yes, it's still going on day by day. But I don't think it has to dominate your day-to-day working life if you don't let it.

I have no regrets at this time, though of course I again have to say to take that with a grain of salt since I'm still early in my residency training and obviously don't have the experience that some of the attendings on here do. You'll ultimately have to make your own choice.

But for me, I really enjoy the subject matter, day-to-day workflow, and colleagues in the field of anesthesia. They really are a diverse, fun loving group of people.

And I think all of us entering the field in the last several years are acutely aware of the political scene and are entering the field without any false pretenses. I expect ASAPAC contributions to continue increasing dramatically over the next 10-15 years and for leaders in the field to become increasingly active in anticipating the future of anesthesia--whatever it looks like--and making sure we have a voice in shaping it and a continued leadership role.

If you love your rotations in it as much as you suggest, I would say you shouldn't write it off just yet--not just because of what you read on any online forum.

Just try to keep your loans as small as possible so you can pay them off as quickly as possible. Plan on doing a fellowship. Don't expect to make $500k in that perfect PP gig. Don't expect to work 8-3 pushing propofol for boob jobs all day.

If you go into it expecting that we may have an increasing role in ICU care, full perioperative management, and most likely in an anesthesia care team, I don't think you'll have any huge regrets.

I think your on the money here. I am one year into attending world, and I got to say that I love it. We are the happiest doctors in the hospital. I honestly dont see our proffesion in danger so long as you are willing to treat asa 3/4s and do a little bit of everything or multiple things ( I do general/regional/ob/trauma) I am very high in demand for my skill set in my hospital/practice. Im in Miami and mostly MD ( 15MD, 3 CRNA). No way the hospital is going to allow CRNAs to practice independent with this subset of patients and believe me they don't want to). The ASA 1/2, plastic surgery practice, etc...the real easy stuff. That will be the domain of the CRNA. I am fine with that, don't mind not doing lots of those. You became a physician to be able to manage the tough stuff as well as provide optimal peri-operative care. If you are good, you will have a good paying job for 30+ years. Just my 2 cents. BTW the gloom and DOom on this board is rediculous. Just scaring lots of potential people from entering this great specialty

 

[hivoltage]

No way the hospital is going to allow CRNAs to practice independent with this subset of patients and believe me they don't want to)

LOL... that mentality is what got us in this mess in the first place.. NO way the hospital is gonna let crnas put in central lines. (they are doing it).. no way the hospital is gonna let crnas put in epidurals( theyare doing it all over. ... no way the hospital is gonna let crnas in the heart roomm. they are doing it.

My point is.. CRNAS are doing it all even pain in some places.. EVEN FLORIDA. when a hospital is sucking air and imminent bankruptcy is near.. it may be appealing to hire advanced nurses over docs. Happening all over. and is becoming more prevalent.

 

[Doctor4Life1769]

LOL... that mentality is what got us in this mess in the first place.. NO way the hospital is gonna let crnas put in central lines. (they are doing it)possible, not seen it yet.. no way the hospital is gonna let crnas put in epiduralsive only seen this at small rural hospitals. I had to do my rotations at big centers where they DIDNT and small rural hospitals where they DID( theyare doing it all over. ... no way the hospital is gonna let crnas in the heart roommagain not seen this yet. they are doing it.

My point is.. CRNAS are doing it all even pain in some places.. EVEN FLORIDA. when a hospital is sucking air and imminent bankruptcy is near.. it may be appealing to hire advanced nurses over docs. Happening all over. and is becoming more prevalent.

They have their niche in small-town rural community hospitals. Besides that, I've not seen them do much except easy ASA 1/2 cases....

Those rotations were for med school, BTW. I'm currently a CA-0, but I've rotated through a variety of settings.

 

[miamidc]

LOL... that mentality is what got us in this mess in the first place.. NO way the hospital is gonna let crnas put in central lines. (they are doing it).. no way the hospital is gonna let crnas put in epidurals( theyare doing it all over. ... no way the hospital is gonna let crnas in the heart roomm. they are doing it.

My point is.. CRNAS are doing it all even pain in some places.. EVEN FLORIDA. when a hospital is sucking air and imminent bankruptcy is near.. it may be appealing to hire advanced nurses over docs. Happening all over. and is becoming more prevalent.

No specialty is immune from midlevel enchroachment, except for surgery, for now. We happen to be more adept to deal with it since we have been dealing with it for 30 years. I don't know what to say other than if your worried about stuff like this, just don't go into medicine. I can say with 100% certainty the people on this board that are doom and gloom are NOT happy where they are working or they have unreasonable expectations of the field. And don't ever forget, the grass is ALWAYS greener on the other side. That goes for other professions and other specialties. If gas is the specialty you enjoyed the most on the little experiment we call medical school then by all means do it. The only thing you can be sure about in medicine is whether you do or do not like a certain specialty. Everything else, in every specialty, is UP IN THE AIR. Good luck, I love my job. All I can say is make sure you get Board Certified ASAP, if not you unfortunately arn't worth a damn, whether thats valid or not.

 

[miamidc]

They have their niche in small-town rural community hospitals. Besides that, I've not seen them do much except easy ASA 1/2 cases....

Those rotations were for med school, BTW.

It all comes down to location. You will not see CRNAs in large metropolitan cities ( where most people want to live) working alone. The surgeons, hospitals, and patients don't want it. One bad outcome and the hospital is ruined. Why take the risk. Small rural hospital is all they got, whats a bad outcome if its the only hospital 50 miles away, just a bad outcome, hosp is not going anywhere. There you go. As far as MD/CRNA ratio that is completely up to the group and the hospital. But the unsupervised thing in a hospital (not a plastics center) will never materialize in a large city. There will always be at least a few MDs needed, even in 10-20 years, I believe. We may need to cut back on the residency output though, just to keep our incomes from being diluted by excessive supply. Just my 2 cents again. Just can't stand the gloom/doom I see on this board, that is not based on reality. Having said that, we cannot become complacent and please contribute to your ASA PAC.

 

[Doctor4Life1769]

It all comes down to location. You will not see CRNAs in large metropolitan cities ( where most people want to live) working alone. The surgeons, hospitals, and patients don't want it. One bad outcome and the hospital is ruined. Why take the risk. Small rural hospital is all they got, whats a bad outcome if its the only hospital 50 miles away, just a bad outcome, hosp is not going anywhere. There you go. As far as MD/CRNA ratio that is completely up to the group and the hospital. But the unsupervised thing in a hospital (not a plastics center) will never materialize in a large city. There will always be at least a few MDs needed, even in 10-20 years, I believe. We may need to cut back on the residency output though, just to keep our incomes from being diluted by excessive supply. Just my 2 cents again. Just can't stand the gloom/doom I see on this board, that is not based on reality. Having said that, we cannot become complacent and please contribute to your ASA PAC.

I wholeheartedly agree. Not a fan of the doom and gloom that some propagate in this subforum. I can't wait to get started in a year!

 

[DrVanNostran]

Would you guys consider Gas almost a hybrid of IM and EM? I feel like Gas gives a good combo of each.

 

[OB1🤙]

Would you guys consider Gas almost a hybrid of IM and EM? I feel like Gas gives a good combo of each.

Absolutely. We spend a lot of time on rounds discussing the asymptomatic hypokalemia of homeless people requesting dilaudid IVP.

 

[PistolPete]

Looking for some advice here:

Have a couple more weeks of gen surg left before end of 3rd year, then I'll be doing 4 weeks of anesthesia. Still unsure if I want to pursue anesthesia for residency. I've had the opportunity to do 4 weeks of ICU/pulm, and I have to say that I did not particularly enjoy it. I didn't enjoy the critical nature of the patients, but I'm wondering if it's simply because I do not know enough yet to appreciate it (infectious disease is still a weak point for me).

Is this a red flag? I've heard that if you don't enjoy ICU, anesthesia may not be the right specialty choice, since you're basically running your own ICU in the OR. This has got me thinking, and I'd be nice to get some more input from residents.