To medical students applying for Anesthesiology. Advise from insight.

[maxdocby]

Well. I hate to start this topic but I feel like I have to. Future of your career ... I am CA-3 and graduating in June. me and my classmates are looking for jobs and can see that times you can go whereever you want are in the past. And actually...It Is DIFFICULT to find a job ! Suprise !? You can still find a job in the remote location but if you want to live close to civilization it is indeed a problem. Let's look at the statistic. last year it was around 1400 anesthesiology residents graduating ( which by the way makes us one of the most common specialties). More then that it was 2000 CRNA students graduating last year !!!!!!. Add up economics and declining number of available spots.... are you getting this. It is another crisis. We are producing too many anesthesiology residents and more then that production of CRNAs is out of control. I will not go to CRNAs threat.... don't wanna talk about this although it is serious.
Lat's talk about money...payments are going down. Right now if you do locum tenens anesthesia you are getting paid around 150$ per hour. If you do IM Hospitalist or Emergency Medicine thwy are paying 120-200 $ per hour !!!!!! Plus there are a huge shortage of ER docs and hospitalists. Did I make you to think ?!!!!!!!!!!!
Guys, it is a crisis, do not go to Anesthesiology unless you absolutely love it and don't see your life without Anesthesiology. ASA doesn't seem to be doing anything to fix the problem, they already have jobs. That is my advise. Welcome to discuss....

---

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[Mac4]

Just talked to an ortho-spine fellow and he is having difficulty of find a good job (great pay in great locations). Should people stop going to ortho just because they can not find a $600K job in New York?

I just graduated from a residency at one of most desirable cities and all my PP-bound classmates secured good positions and most of them joined LOCAL groups/hospitals. Yes, these jobs were never advertised and this may be the advantage doing residency in good locations because most groups hire locally. Perhaps you should look into groups/hospitals around your city? You might be surprised.

 

[Consigliere]

Here's my adviCe: get a better grasp of the English language and you won't have such a hard time finding a job. I'm gonna assume you're an FMG who did a residency in NY....

 

[sevoflurane]

Yes. Those times are gone.

But....

If you love what you do and are good at it, then there will be jobs...

It may not be in the exact location you desire... but sometimes living in the boon docks may offer some reasonable benefits. Higher income, more vacation, low cost of living, etc.

Keep in mind that a lot of anesthesiologists are holding on to their jobs as the stock market has hit their retirement plans.... but be assured that the 60+ y/o MD will retire soon. They have lived the good life.

As baby boomers get older and older. There will be more surgeries to go around as the baby boomers reach a median age of 65. Orthopedics and spine have already seen an increase in patient numbers.

Independent CRNA practice pose a serious risk.... especially to those hospitals that have been deemed to have "critical access" and have a full MD anesthesia team. Downward pressure can be pervasive in these situations. Keeping a happy relationship with administration is key.

Who decides what is "critical access" anyways? This needs to be regulated heavily.

Job security can be had with fellowships, but as more and more residents elect this path... subspecialty positions may also dry up.

Income will go down even further.

We are up to 16 opt out states. This needs to be kept in check and hopefully overturned. The ASA needs to wake up.

If you really need a job in a particular location, the Ivory Tower is a great place to work. I'm not much into research (doing it), but if I had to, I would do it and learn to like it.

Keep close contacts with your anesthesia and surgical resident colleagues. They may lend a hand to you at some time.... you may even be able to open up an ASC with enough effort. This is ideal and very possible. Then you hold the cards.

I will second Mac4's comment: Most good jobs do not need to advertise... and a lot hire locally.

There is plenty of sunshine out there... but I do believe that the matrix is slowly changing. Evolution.

 

[pgg]

You can still find a job in the remote location but if you want to live close to civilization it is indeed a problem.

Civilization is overrated. Less pay, higher cost of living, all those damn people.

You couldn't pay me enough to be a hospitalist. Well, maybe for 7 figures I'd suck it up ...

 

[maxdocby]

Thank you guys for answers. My point is somewhat different, I am not miserably looking for position, I am trying to get people to think about future and take some responsibilities. I think we are oversupplying anesthesia providers, although numbers of surgeries potentially could go up in the future, counting on that is like denying US national debt or real estate speculative bubble. I am not talking about "still" available positions ( by the way the word "still" speaks for itself), I am talking about the way we are going.
To Consigliere.... with all my respect...I appreciate you pointing out my language skills ))). Yes, I came to US 6 years ago and my English might not be perfect and as exceptional as yours, but at least I speak 2 languages fluently, and 2 ( including English) on acceptable level. Also I am very well traveled and saw a lot ). I wonder how many languages you speak ).

 

[imfrankie]

Civilization is overrated. Less pay, higher cost of living, all those damn people.

You couldn't pay me enough to be a hospitalist. Well, maybe for 7 figures I'd suck it up ...

Not sure I could do the hospitalist's job.

 

[Jack is Back]

Well. I hate to start this topic but I feel like I have to. Future of your career ... I am CA-3 and graduating in June. me and my classmates are looking for jobs and can see that times you can go whereever you want are in the past. And actually...It Is DIFFICULT to find a job ! Suprise !? You can still find a job in the remote location but if you want to live close to civilization it is indeed a problem. Let's look at the statistic. last year it was around 1400 anesthesiology residents graduating ( which by the way makes us one of the most common specialties). More then that it was 2000 CRNA students graduating last year !!!!!!. Add up economics and declining number of available spots.... are you getting this. It is another crisis. We are producing too many anesthesiology residents and more then that production of CRNAs is out of control. I will not go to CRNAs threat.... don't wanna talk about this although it is serious.
Lat's talk about money...payments are going down. Right now if you do locum tenens anesthesia you are getting paid around 150$ per hour. If you do IM Hospitalist or Emergency Medicine thwy are paying 120-200 $ per hour !!!!!! Plus there are a huge shortage of ER docs and hospitalists. Did I make you to think ?!!!!!!!!!!!
Guys, it is a crisis, do not go to Anesthesiology unless you absolutely love it and don't see your life without Anesthesiology. ASA doesn't seem to be doing anything to fix the problem, they already have jobs. That is my advise. Welcome to discuss....

Than. More than.

 

[Jack is Back]

Here's my adviCe: get a better grasp of the English language and you won't have such a hard time finding a job. I'm gonna assume you're an FMG who did a residency in NY....

True true.

Anyway, I think there is some truth to this post.

Medicine in general has become too bloated, a lot of the specialties that were making tons of $ with great lifestyle are going to be targeted. Think Rads/Gas, also even big $ specialties like Ortho are going to be in the cross-hairs. Derm and plastics are the only ones safe, Cash practice = win.

Were all going to get cut. The moral of the story is, if you are a medical student and won't be signing a contract for another 5-10 years, realize that we will be in a completely different environment and today's cash cow is tomorrows empty barrel.

Do what you find the most interesting. Pay will decrease for everyone, especially the most for the lucrative specialties.

MGMA: Ortho $524k; Rads $480k; Anesthesia $420k

Expect these to drop.

 

[aneftp]

Keep close contacts with your anesthesia and surgical resident colleagues. They may lend a hand to you at some time.... you may even be able to open up an ASC with enough effort. This is ideal and very possible. Then you hold the cards.

I will second Mac4's comment: Most good jobs do not need to advertise... and a lot hire locally.

There is plenty of sunshine out there... but I do believe that the matrix is slowly changing. Evolution.

Totally agree. Especially with keeping close contacts. Never burn bridges no matter how much you can't stand someone.

I have built a huge network with friends all over the country.

My buddy called me up if I wanted to join his practice in a very desirable part of Los Angeles just the other week before they look at other people. (my wife didn't want to move to the West Coast).

It always helps to network. The job market is very tight in desirable parts of the country. Jobs are available but it's going to take some work. Like Sevo said this ain't like the late 90s to early to mid 2000s where you can call your own shot.

 

[urge]

I wouldn't mull on the 90's much. That was an anomaly. ******s were even accepted into Harvard back then... Market is tight right now but I think it is a good thing. It keeps the riffraff away.

 

[El Dooderino]

anything not Columbia, Cornell, Sinai, or NYU in NYC should be shuttered

 

[davidjones]

You could seriously replace the word anesthesiology with radiology, or surgical sub-specialty and get the same rosy picture everyone thinks about their respective field. In fact, I've probably seen the exact quote by maxdocby with radiology replacing anesthesia in the radiology forums. Everything is getting slashed, even the PCPs, are under attack, and the main reason is that physicians spend their time on tasks not directly related to protecting their self-interests, i.e we're taking care of patients. We're the only group of "healthcare providers" without a union, and the only group for which the idea of going on strike is considered extremely unethical. On top of that each specialty fights with every other specialty etc, without joining together to protect ourselves.

I don't have a particular solution in mind, just wanted to say that the anesthesia is not unique in it's position and despite that, I see tons of people, particularly this year going into gas and rads (something like 18 and 20+, at the med school affiliated with my hospital). I still naively believe that if you do what you love, it's not going to affect you as much as the people going into a field for money or lifestyle. However, these kinds of threads are good because it will make us all aware of exactly what's going on. In the US, physicians are the only highly trained professionals (in fact, with the exception of things like astronauts, we are the highest trained with a minimum of 11 years of education to get to attending) who's salaries continually drop because our services continue to be devalued.

I don't exactly have a point, but this seemed like a good forum to vent while on call .

 

[Monty Python]

You could seriously replace the word anesthesiology with radiology, or surgical sub-specialty and get the same rosy picture everyone thinks about their respective field. In fact, I've probably seen the exact quote by maxdocby with radiology replacing anesthesia in the radiology forums. Everything is getting slashed, even the PCPs, are under attack, and the main reason is that physicians spend their time on tasks not directly related to protecting their self-interests, i.e we're taking care of patients. We're the only group of "healthcare providers" without a union, and the only group for which the idea of going on strike is considered extremely unethical. On top of that each specialty fights with every other specialty etc, without joining together to protect ourselves.

I don't have a particular solution in mind, just wanted to say that the anesthesia is not unique in it's position and despite that, I see tons of people, particularly this year going into gas and rads (something like 18 and 20+, at the med school affiliated with my hospital). I still naively believe that if you do what you love, it's not going to affect you as much as the people going into a field for money or lifestyle. However, these kinds of threads are good because it will make us all aware of exactly what's going on. In the US, physicians are the only highly trained professionals (in fact, with the exception of things like astronauts, we are the highest trained with a minimum of 11 years of education to get to attending) who's salaries continually drop because our services continue to be devalued.

I don't exactly have a point, but this seemed like a good forum to vent while on call .

My father-in-law was the only-doc-in-town physician for 50 years. He clearly remembers why the AMA was completely opposed to the introduction of Medicare in the 1960s. While the AMA was for the principle (medical care for the poor) they were against the introduction of big government into the payment mechanisms of medicine. They feared exactly the problems we're now seeing today.

Due to the public relations firestorm this caused the AMA backed down with it's opposition, and thus we have the mess of today.

My father-in-law was not infrequently paid in bushels of peaches, eggs, and the occasional goat or chicken. He gave away more free care than he could possibly calculate, and felt honored that he was in a position to do so. He still had no problem giving his four children very nice private college educations.

My point: the more we have government stick it's camel-nose under the tent, the more we become screwed. In any aspect of life.

 

[Jack is Back]

My father-in-law was not infrequently paid in bushels of peaches, eggs, and the occasional goat or chicken. He gave away more free care than he could possibly calculate, and felt honored that he was in a position to do so. He still had no problem giving his four children very nice private college educations.

So things are coming full circle!

 

[Consigliere]

Thank you guys for answers. My point is somewhat different, I am not miserably looking for position, I am trying to get people to think about future and take some responsibilities. I think we are oversupplying anesthesia providers, although numbers of surgeries potentially could go up in the future, counting on that is like denying US national debt or real estate speculative bubble. I am not talking about "still" available positions ( by the way the word "still" speaks for itself), I am talking about the way we are going.
To Consigliere.... with all my respect...I appreciate you pointing out my language skills ))). Yes, I came to US 6 years ago and my English might not be perfect and as exceptional as yours, but at least I speak 2 languages fluently, and 2 ( including English) on acceptable level. Also I am very well traveled and saw a lot ). I wonder how many languages you speak ).

3: English, Spanish and Polish.

 

[BLADEMDA]

My father-in-law was the only-doc-in-town physician for 50 years. He clearly remembers why the AMA was completely opposed to the introduction of Medicare in the 1960s. While the AMA was for the principle (medical care for the poor) they were against the introduction of big government into the payment mechanisms of medicine. They feared exactly the problems we're now seeing today.

Due to the public relations firestorm this caused the AMA backed down with it's opposition, and thus we have the mess of today.

My father-in-law was not infrequently paid in bushels of peaches, eggs, and the occasional goat or chicken. He gave away more free care than he could possibly calculate, and felt honored that he was in a position to do so. He still had no problem giving his four children very nice private college educations.

My point: the more we have government stick it's camel-nose under the tent, the more we become screwed. In any aspect of life.

I'm Still deciding between the Goat or the Chicken.

 

[cfdavid]

The general employment situation in the U.S. is dismal. Not only might this apply to other specialties within medicine, but it applies (with few exceptions) across the board. Relatively speaking, medicine will still offer a decent living. Future MD's may not get rich, but if you work hard and are somewhat flexible, you'll do fine.

 

[karizma098]

chicago is possibly one of the worst markets for an anesthesiologist..
( i'm guessing pay for work ratio is close to nyc or la, or less ) - and even here, reasonably trained, board certified grads are getting decent jobs. Are you going to make 400k for working 40 hours a week downtown? no. not even close. Is everyone getting a decent job within an hour of the city? yes, at both programs i rotated at.

it's funny ( and this is totally a non-racist comment, i'm south asian and have a family with plenty of FMG's, my old man included ), but the residents who complain the most about money/jobs are usually the older FMG's , are often having trouble passing oral boards or boards, speak awful english...and are moaning about job offers in chicago making 250k..they don't want to move to wisconsin or indiana to make more money, but they don't want to work more to stay in chicago. It may be a cultural thing, but the sense of entitlement is puzzling at times.

on that note, it's so frustrating to see residency programs give away spots to non-visa FMG's when there are so many american grads willing to take these anesthesia spots. I just don't get what program directors are thinking sometimes.

 

[RxBoy]

on that note, it's so frustrating to see residency programs give away spots to non-visa FMG's when there are so many american grads willing to take these anesthesia spots. I just don't get what program directors are thinking sometimes.

Some of them actually prefer the previously trained FMG. Its slave labor without having to teach. The previously trained FMG supply is going to dry up real quick in the next 5 years once they realize its just not worth the sacrifice for a diminishing return.

 

[anynoise]

My father-in-law was the only-doc-in-town physician for 50 years. He clearly remembers why the AMA was completely opposed to the introduction of Medicare in the 1960s. While the AMA was for the principle (medical care for the poor) they were against the introduction of big government into the payment mechanisms of medicine. They feared exactly the problems we're now seeing today.

Due to the public relations firestorm this caused the AMA backed down with it's opposition, and thus we have the mess of today.

My father-in-law was not infrequently paid in bushels of peaches, eggs, and the occasional goat or chicken. He gave away more free care than he could possibly calculate, and felt honored that he was in a position to do so. He still had no problem giving his four children very nice private college educations.

My point: the more we have government stick it's camel-nose under the tent, the more we become screwed. In any aspect of life.

tell us something we dont know..

 

[anynoise]

Thank you guys for answers. My point is somewhat different, I am not miserably looking for position, I am trying to get people to think about future and take some responsibilities. I think we are oversupplying anesthesia providers, although numbers of surgeries potentially could go up in the future, counting on that is like denying US national debt or real estate speculative bubble. I am not talking about "still" available positions ( by the way the word "still" speaks for itself), I am talking about the way we are going.
To Consigliere.... with all my respect...I appreciate you pointing out my language skills ))). Yes, I came to US 6 years ago and my English might not be perfect and as exceptional as yours, but at least I speak 2 languages fluently, and 2 ( including English) on acceptable level. Also I am very well traveled and saw a lot ). I wonder how many languages you speak ).

i speak JIVE. Ill give you a sample


I totally agree wid ya' about da damn job situashun> Anesdesia be not where its at. I totally kin be some hospitalist. Do ya' gots' any idea how many jobs dere are in hospitalist?

 

[Monty Python]

I'm Still deciding between the Goat or the Chicken.

They always had the most-neatly manicured lawn on the block. Goats are superb grass-cutters.

 

[Monty Python]

tell us something we dont know..

Post 13 mentioned something about having no union to represent the profession. The AMA's backing down in the 1960s when they initially were against Medicare is the historical backdrop for all of today's problems, IMHO.

 

[anynoise]

http://www.anesthesiapa.org/

 

[Monty Python]

http://www.anesthesiapa.org/

Nice; I'm sure the PAs on SDN interested in anesthesia will be pleased to see that. JWK can they start AA school in advanced standing?

 

[Cathyran]

Wow. Looks like you're two months too late. Your random anonymous post on an Internet forum could have overtaken several years of careful research and saved me from the impending doom that is a career in anesthesia.

 

[2win]

Well. I hate to start this topic but I feel like I have to. Future of your career ... I am CA-3 and graduating in June. me and my classmates are looking for jobs and can see that times you can go whereever you want are in the past. And actually...It Is DIFFICULT to find a job ! Suprise !? You can still find a job in the remote location but if you want to live close to civilization it is indeed a problem. Let's look at the statistic. last year it was around 1400 anesthesiology residents graduating ( which by the way makes us one of the most common specialties). More then that it was 2000 CRNA students graduating last year !!!!!!. Add up economics and declining number of available spots.... are you getting this. It is another crisis. We are producing too many anesthesiology residents and more then that production of CRNAs is out of control. I will not go to CRNAs threat.... don't wanna talk about this although it is serious.
Lat's talk about money...payments are going down. Right now if you do locum tenens anesthesia you are getting paid around 150$ per hour. If you do IM Hospitalist or Emergency Medicine thwy are paying 120-200 $ per hour !!!!!! Plus there are a huge shortage of ER docs and hospitalists. Did I make you to think ?!!!!!!!!!!!
Guys, it is a crisis, do not go to Anesthesiology unless you absolutely love it and don't see your life without Anesthesiology. ASA doesn't seem to be doing anything to fix the problem, they already have jobs. That is my advise. Welcome to discuss....

You are right. As I posted multiple times - in order to be successful ( money , fame and so on - or maybe just money - yo really have to be THE BEST - peds, ccm, heart, regional, pain. The order of the subspecialities is random. Take it as a challenge if you really like it.
Regarding the language skills that other poster(s) mentioned...
Don't get me started boys...
Do you really wanna hear big names in the US medicine that aren't US "natives"????
Besides that -
"open your mouth"
"Take a deep breath!"
that sounds like
"open your mouse"
"take a deep breast"
really makes a difference???
Cheers,
2win

 

[anynoise]

You are right. As I posted multiple times - in order to be successful ( money , fame and so on - or maybe just money - yo really have to be THE BEST - peds, ccm, heart, regional, pain.

being the best is not directly proportional to success. Being the best actor, the best politician, will get you places..

 

[PMPMD]

"open your mouse"

i know that guy!

 

[amyl]

The previously trained FMG supply is going to dry up real quick in the next 5 years once they realize its just not worth the sacrifice for a diminishing return.

it actually already has...

 

[WholeLottaGame7]

Regarding the language skills that other poster(s) mentioned...
Don't get me started boys...
Do you really wanna hear big names in the US medicine that aren't US "natives"????

You can't be a "big name" in any field without being an effective communicator. There are plenty of non-native English speakers or people with other handicaps who have learned the language or have otherwise learned to communicate effectively. Though it is interpretable, the OPs post is not effective communication, on multiple levels.

 

[owie]

I am one of those anesthesiologists who finished during the 90's glut. It was a nightmare. A complete embarrassment. Imagine going to parties and having people ask you what you're up to and you don't want to admit that you are unemployed.
BE VERY CAREFUL. This is not a specialty where you can just have lower volumes and see fewer patients if there is an oversupply. I am talking about the possibility of NO JOB at all, not even a low paying one. You will be exploited to the maximum. Even the rural areas had NO JOBS when I came out. We tried public health hospitals on native reservations out west, nothing. I finally started to look overseas when I got a spot at an academic hospital that needed to fill the vacant places that the residents did not take (when no one was going into the specialty because of the glut), I was the warm body.
Also, with the anesthesia assistants giving the CRNAs competetion, CRNA salaries will drop, making CRNAs will look more attarctive than MDs. We will all suffer.
I am very nervous. Stay away from this specialty unless you really LOVE it.
It could get to every 4th night call for 95K per year.
Your residency program will not warn you. Those attendings have jobs and don't care. They need the labor, so what happens to you afterwards is not their problem.

 

[jwk]

I'm Still deciding between the Goat or the Chicken.

Goat BBQ - don't knock it till you've tried it.

 

[imfrankie]

I am one of those anesthesiologists who finished during the 90's glut. It was a nightmare. A complete embarrassment. Imagine going to parties and having people ask you what you're up to and you don't want to admit that you are unemployed.
BE VERY CAREFUL. This is not a specialty where you can just have lower volumes and see fewer patients if there is an oversupply. I am talking about the possibility of NO JOB at all, not even a low paying one. You will be exploited to the maximum. Even the rural areas had NO JOBS when I came out. We tried public health hospitals on native reservations out west, nothing. I finally started to look overseas when I got a spot at an academic hospital that needed to fill the vacant places that the residents did not take (when no one was going into the specialty because of the glut), I was the warm body.
Also, with the anesthesia assistants giving the CRNAs competetion, CRNA salaries will drop, making CRNAs will look more attarctive than MDs. We will all suffer.
I am very nervous. Stay away from this specialty unless you really LOVE it.
It could get to every 4th night call for 95K per year.
Your residency program will not warn you. Those attendings have jobs and don't care. They need the labor, so what happens to you afterwards is not their problem.

"The sky is falling the sky is falling" BS

 

[El Dooderino]

"The sky is falling the sky is falling" BS

the guy is on his fourth username, I feel bad his career and personal life suck but at this point we get it, he's unhappy

 

[Quirk11]

Again, we miss the fundamental "bigger picture." Much of medicine is having some sort of "big issue", be it living on a fixed income model in the setting of a broken gov't / inflation/, midlevels, etc etc.

The medicare / insurance model is broken and will not get better in the monetary sense, and that affects us all. See the real world example from a new private practice opthamologist.

Ultimately, medicare is going to medicaid levels..


http://iballdoc.blogspot.com/search?...max-results=50
Math


"Beetles brought up the 30% SGR Medicare cut looming at the end of the year. I'm hoping that it will get "delayed" once again so that we end up facing a 50% cut in 2 years. However, if the cut does become permanent, there will definitely be some changes to the medical community.


So I've come to thinking about it and attempted a little math, and it looks like the large high overhead practices will be the first ones to take a hit. By the way, please correct any flaws in my math or logic.


Example 1


Let's say you have a small solo practice where your overhead is 45% and you see 20 patients a day. which I think is realistically possible. Using Ophthalmology Management's figure of $125 per patient after all is said and done, and assuming you work 5 days a week and 50 weeks a year, your current annual revenue would be $625K, overhead $281K, and take home pay $344K. An awesome deal.


Now, with the 30% SGR cut, your annual revenue would be $438K, overhead still $281K, and take home pay $157K. Not horrible, but much much less than the status quo.




Example 2


Now let's try this with a high overhead ophthalmic empire. Let's say you see 45 patients a day with 65% overhead (mostly attributing to more employees and larger office space rent). Using the same criteria, you would currently pull in $1.41 million a year, spend $914K in overhead, and take home $492K, which is nearly $150K more than example 1.


Enter the 30% SGR cut. Then you would bring in $984K, still spend $914K, and take home $70,000! In order to make the same post-cut $157K, the overhead will have to be between 58 and 59%, which I guess is possible.




The point I'm trying to make is that lower overhead will be key regardless of how big your operation is. And lower overhead will be even more important if the SGR cut goes through. I would imagine that the larger the practice you have, the larger the overhead will be. With the cuts in place, higher overhead practices will need to start cutting staff, including associate ophthalmologists. The job market for entry level ophthalmologists will probably be even more dismal. I wouldn't be surprised if some practices completely implode. That's why a lot of people are freaking out."

the guy is on his fourth username, I feel bad his career and personal life suck but at this point we get it, he's unhappy