Hard to feel bad for anesthesia when they have 400,000+ reasons to love their jobs.
Lol, that's true anesthesia still making lots of money, but to be fair the question wasn't about money but about "future proof". I think a specialty could be making tons of money today, but have a less than bright future. Look at pathologists, they make on average around $350,000-$400,000, for a nice lifestyle, but only if they can find a job!
(To be fair to pathologists, it seems like it's really the pathologists who are IMGs who are the ones having the most difficulty finding jobs. Or those who are geographically limited. US MDs/DOs graduating from good academic or university programs seem to be able to get a job. Starting salaries are low, around $200,000 I have heard, but when they become partner it's much better, closer to $350,000 or $400,000.)
Looking at the anesthesia forum, a lot of them are recommending med students think twice about anesthesia. They make a lot of money, as do most procedural specialties, but they're saying if you have a choice, then pick a better specialty. Not all of the anesthesiologists are saying this, some are very optimistic about anesthesia, but there are enough saying it that's it's kind of worrying. And most the surgical specialties, several of the IM subspecialties (cards, GI, pulm/cc, hematology/oncology) also make at least as much as anesthesia $400,000+. This is an older MGMA from 2016, but probably approximately accurate enough:
Also look at other things besides money like hours worked overall, RVUs, medical liability, etc.
If you like being "the boss", anesthesia often isn't regarded that way in the OR. That's usually the surgeon. And even in private practice, where anesthesiologists and surgeons get along, everyone including anesthesioloigsts have to wait for the surgeon. If the surgeon wants to operate on a weekend, or wants to stay late for an add-on case, even though you want to be home, then an anesthesiologist will have to cover them. Surgeons are the ones that bring in the patients and the money so hospitals give them a lot of respect, but anesthesiologists don't have their own patients and are seen more as someone who is necessary to facilitate the surgical case. Anesthesiologists are like the IT department of the company/hospital, no one really appreciates their true value (which is very valuable), but they're regarded more as closer to a "necessary evil" to be able to do business. I'm not saying this is right, I think anesthesiologists deserve far more respect etc. for everything they do, but that's how it seems to be for them, even though it's not right. On the plus side, anesthesiologists don't always have to carry a pager like often surgeons do. They don't have to take their work home, once they are done, they are done. But when they are on call, it's often in-house call, but the older anesthesiologists seem to be saying it's not always pleasant taking in-house calls and being in the hospital and away from your family once you're married or have kids or are just older. Surgery is horrible during training, and when you're establishing yourself for the first few years, but you can build your surgical practice how you want. I think it's usually the "big" surgeries like general surgery, trauma, neurosurgeons, and cardiothoracic that are always intense throughout your career, with a much worse lifestyle than anesthesia. But others like ophtho, ENT, uro, plastics seem to do better. Of course that's why they're so competitive.
And of course there are CRNAs. The anesthesia forum a lot of them are saying the future is supervising CRNAs. That's already true for the majority of anesthesia groups or practices according to Richard Novak at Stanford (see his website the Anesthesia Consultant I believe it's called). And it's likely only going to increase. So their job isn't always getting to do their own cases, but managing 2-4 CRNAs who are doing the cases, and going around the OR putting out fires. I guess how easy or hard your job is as an anesthesiologist depends on how good your CRNAs are and how much you trust them. I think the West coast is still largely independent practice for anesthesiologists, they are still sitting their own cases for the most part, but much the rest of the country seems to be gradually taken over by CRNAs. And eventually it might hit the West coast too. Plus there are many states where CRNAs can practice independently, and even where they can't, CRNAs can be supervised by a surgeon rather than an anesthesiologist since my understanding is the requirement is they have to be supervised by a physician, it doesn't say which type of physician. So people have to mind not being in a more supervisory role as an anesthesiologist (except for places like the West coast), and jumping in when there's something the CRNA can't handle.
And look at Trends for the Future of Anesthesiology from a Stanford anesthesiologist:
What can we expect in theuture of anesthesiology? I’m writing this in January 2016. God willing, we’ll all be alive and well to reread this in 2026.
theanesthesiaconsultant.com
But all that said I really still like anesthesiology as a specialty. The problems are mostly related to things not inherent to the specialty, like politics, CRNAs, etc., but the specialty itself is really cool. You do have to have the personality for it though (e.g. remain calm when patients are crashing). It's not for the feint of heart, and some would argue they'd be willing to take less money for less stress, liability, being their own boss, etc. But that's subjective and person-dependent. Some people would be bored by doing clinics all day for example.
So I guess every year there might be different actors but we're all playing the same roles and saying the same things in the same drama. It's interesting.
