Would you choose anesthesiology again?

[anbuitachi]

This is true. Pre-NAPA NSLIJ folks we’re making 600-700k+ in the 1980s. They had airplanes, Ferraris, and mansions in Sands Point. That’s not possible on $600-700k nowadays.

after inflation thats like 2.2M a year

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[anbuitachi]

Absolutely true. My income in 2000 was much greater than today in absolute dollars adjusted for inflation. CRNA costs are 2.5 X what they were in 2000. IN addition, CMS reimbursement is down by a ton adjusted for inflation. That said, the average person coming out of residency can literally earn great money without a partnership track at all. So, even though I was making more money in 2000 I still think the overall environment to be treated fairly from day one is better today. If one were to equate sunshine with making money the weather is still looking pretty good out there circa 2022.

If I were to work just as hard today as I was doing in 2000 I would guess my income to be in the $750K range in 2022.

its a double punch. less money adjusted for inflation, and everything is expensive as hell now compared to income. house, education, kids, cost a fortune

 

[Angus Avagadro]

I'd do anesthesia again. My only regret was living in a state that ranked 48 out of 50 in medicaire reimbursement

 

[anbuitachi]

I'd do anesthesia again. My only regret was living in a state that ranked 48 out of 50 in medicaire reimbursement

i wonder where ny ranks in medicare reimbursement

 

[vector2]

I guess I like anesthesia, but when I see how some interventional cardiologists have it...


1. Fellow or PA sees the structural patient in clinic, orders all the tests, follows up on all the results, and makes all the consult phone calls. IC writes an "Agree with fellow/PA" attestation.
2. Anesthesia and the cathlab staff do all the work to prep the patient the day of procedure while IC drinks coffee in the lounge
3. IC sticks a groin vessel, puts in a sheath, and then hits the "DEPLOY" button on the TAVR, mitraclip, watchman (or whatever toy the rep is telling him how to use)
4. IC collects $800,000+ while making all the non-structural guys take STEMI call


Only problem is I'd never be able to make it through a medicine residency.

 

[anbuitachi]

I guess I like anesthesia, but when I see how some interventional cardiologists have it...


1. Fellow or PA sees the structural patient in clinic, orders all the tests, follows up on all the results, and makes all the consult phone calls. IC writes an "Agree with fellow/PA" attestation.
2. Anesthesia and the cathlab staff do all the work to prep the patient the day of procedure while IC drinks coffee in the lounge
3. IC sticks a groin vessel, puts in a sheath, and then hits the "DEPLOY" button on the TAVR, mitraclip, watchman (or whatever toy the rep is telling him how to use)
4. IC collects $800,000+ while making all the non-structural guys take STEMI call


Only problem is I'd never be able to make it through a medicine residency.

really? we already almost do 1 year of medicine as an intern, plus ICU months. i dont know about you but my roommate was medicine and his life was way better than mine as a resident. we only saw the inpatient rotations side of it. but his outpatient days were great in terms of hours. also he had some 'research/elective' months that were chill as hell. i think you can make it thru 2 more years of it

 

[1halfMVsquared]

I would definitely choose anesthesiology again. Even more so right now in this climate. Anesthesiologists are in high demand with very competitive contracts.

 

[blackbolt]

Absolutely true. My income in 2000 was much greater than today in absolute dollars adjusted for inflation. CRNA costs are 2.5 X what they were in 2000. IN addition, CMS reimbursement is down by a ton adjusted for inflation. That said, the average person coming out of residency can literally earn great money without a partnership track at all. So, even though I was making more money in 2000 I still think the overall environment to be treated fairly from day one is better today. If one were to equate sunshine with making money the weather is still looking pretty good out there circa 2022.

If I were to work just as hard today as I was doing in 2000 I would guess my income to be in the $750K range in 2022.

How hard were you working in 2000 in terms of hours/wk + # of wks vacation?

 

[BLADEMDA]

How hard were you working in 2000 in terms of hours/wk + # of wks vacation?

65 hours per week. 4 weeks vacation.

 

[BLADEMDA]

The good old days. Let me tell you today is really good and you will look back on this time frame 2022- with fond memories of this job market.

 

[IMGASMD]

really? we already almost do 1 year of medicine as an intern, plus ICU months. i dont know about you but my roommate was medicine and his life was way better than mine as a resident. we only saw the inpatient rotations side of it. but his outpatient days were great in terms of hours. also he had some 'research/elective' months that were chill as hell. i think you can make it thru 2 more years of it

Just different patch of grass you’re seeing. Outpatient can take a lot out of you. If you’re like me hate doing paperwork, you’d hate outpatient. If you don’t like to listen to peoples life stories, even chill hours without production pressure, it can be depressing. I did my IM at a very resource rich community, but getting any speciality to see my clinic patients required a lot of calling, sometimes begging. You think talking to surgeons in the OR is bad, try to talk to some of their ancillary staff, who are basically there just to say no.

I enjoyed my icu months, at the end I did about a year, much more than my OP months.

Also cardiology fellowship is not easy to come by, plenty of people did a chief admin year just to get a spot. A lot of ass kissing, a lot of persistence or you’re just exceptionally good.

I suppose that’s why I am doing what I am doing now. I can shut them up when I don’t like them, I don’t really have to coordinate care, occasionally I can show up in the icu. To each their own.

 

[Twiggidy]

I would do medicine again but I would probably pick a different ROAD specialty or try to find the most ROADist of surgical specialties. The MONEY factor of medicine is changing everything and I think it's hitting the "service" specialties the hardest in different ways. One example would be, I would think harder about Radiology as it's more behind the scenes which sort of suits my style, but even that field has it's problems and now you have to do like 3 fellowships to get a normal job and the hospital still may sell the contract. I definitely would want something where I had more control over my work hours, even my at work hours. As @vector2 said above, it must be nice to have someone else get all your stuff prepared for you while you sit and have coffee.

 

[BLADEMDA]

@vector2 said above, it must be nice to have someone else get all your stuff prepared for you while you sit and have coffee.

Where have I heard this comment before?

 

[nimbus]

Just different patch of grass you’re seeing. Outpatient can take a lot out of you. If you’re like me hate doing paperwork, you’d hate outpatient. If you don’t like to listen to peoples life stories, even chill hours without production pressure, it can be depressing. I did my IM at a very resource rich community, but getting any speciality to see my clinic patients required a lot of calling, sometimes begging. You think talking to surgeons in the OR is bad, try to talk to some of their ancillary staff, who are basically there just to say no.

I enjoyed my icu months, at the end I did about a year, much more than my OP months.

Also cardiology fellowship is not easy to come by, plenty of people did a chief admin year just to get a spot. A lot of ass kissing, a lot of persistence or you’re just exceptionally good.

I suppose that’s why I am doing what I am doing now. I can shut them up when I don’t like them, I don’t really have to coordinate care, occasionally I can show up in the icu. To each their own.

Not to mention more networking, more butt kissing, more “research”, and moving all over the country in order to get the structural interventional super fellowship. Those docs need at least 95th percentile talent, 99th percentile drive and some luck in order to get where they are.

There are many budding cardiologists who enter IM residency.

 

[Twiggidy]

@vector2 said above, it must be nice to have someone else get all your stuff prepared for you while you sit and have coffee.

Where have I heard this comment before?

I hear where you're coming from, but I'm a stool sitter and it's getting old timing my morning coffee with the length of my case so I don't code brown in the OR and sneaking food in the rooms so I don't starve.

 

[sevo00]

if not anesthesia I would choose radiology. They still have a lot of true private groups with fair partnership tracks. Not taken over by private equity to the same extent as anesthesiology

 

[voxveritatisetlucis]

Also cardiology fellowship is not easy to come by, plenty of people did a chief admin year just to get a spot. A lot of ass kissing, a lot of persistence or you’re just exceptionally good.

I thought that basically any USMD from a mid tier university IM residency could get a cardiology fellowship? Of course, it may not be in California or NYC but I didn’t think it was that hard to get one

 

[sevo00]

I thought that basically any USMD from a mid tier university IM residency could get a cardiology fellowship? Of course, it may not be in California or NYC but I didn’t think it was that hard to get one

True. I don’t get why everyone thinks cardiology is so competitive lol. If you look at the match statistics there are literally more spots than there are US applicants. If you’re a US grad you should have no problem becoming a cardiologist. The dumbest person in my undergrad went to to Carib med school and is now a IC fellow.

 

[vector2]

@vector2 said above, it must be nice to have someone else get all your stuff prepared for you while you sit and have coffee.

Where have I heard this comment before?

I don't think the analogy to CRNAs really holds (assuming that's what you're getting at). Even before surgeons or proceduralists ever had midlevels no one expected them to set up their own instruments or prep the patient.

 

[vector2]

Not to mention more networking, more butt kissing, more “research”, and moving all over the country in order to get the structural interventional super fellowship. Those docs need at least 95th percentile talent, 99th percentile drive and some luck in order to get where they are.

There are many budding cardiologists who enter IM residency.

Luckily for them the consolation prize for not matching IC is still a non-invasive job making as much as us, but with bankers hours and less stress. One of the cards echo staff here was telling me even in some metro areas there are "read echo for 8hrs a day" jobs where the going rate is 550-600.

 

[OptionOffense]

This is why you dont do an anesthesia residency.

Nurse Anesthetists

www.asahq.org

The ASA is actively undermining the specialty for money

 

[ToKingdomCome]

This is why you dont do an anesthesia residency.

Nurse Anesthetists

www.asahq.org

The ASA is actively undermining the specialty for money

Or do a meaningful fellowship to prevent mid levels creep

 

[Dantrolene FC]

If I had it to over again I’d be a pilot - it’s a Cush job and a great market at the moment.
If I couldn’t I’d be a vet… if I still had to do medicine I would be an anesthesiologist again.

Pilots get a lot more respect by their passengers and the general public than do physicians.

 

[OptionOffense]

Or do a meaningful fellowship to prevent mid levels creep

which fellowship would that be?

 

[IMGASMD]

True. I don’t get why everyone thinks cardiology is so competitive lol. If you look at the match statistics there are literally more spots than there are US applicants. If you’re a US grad you should have no problem becoming a cardiologist. The dumbest person in my undergrad went to to Carib med school and is now a IC fellow.

I think there’s a lot of self selection at the residency level. If you aren’t going to match, you may just not apply?

It’s a three year fellowship, IC is at least another year. EP even more. At some point there may also be a research year, and/or chief year to wait for your turn.

So the shortest way to get there is 7 yrs after med school, long way can be 9+. We, at this sub, also like to talk opportunity cost for 1 year fellowship….. it’s at least 3 years more than ours. How many times posters answer by saying “only do it if you really want it….”

To OP’s original question, yes, still anesthesia.

 

[JiPo]

Not to mention more networking, more butt kissing, more “research”, and moving all over the country in order to get the structural interventional super fellowship. Those docs need at least 95th percentile talent, 99th percentile drive and some luck in order to get where they are.

There are many budding cardiologists who enter IM residency.

But structural heart is so cool that it is worth it, imo. If I could start medical school over again, that is exactly what I would do.

Heck, you do 5 TAVRs by 7:30pm, and most of them go home the next day and totally functional. How awesome is that?

 

[drdan4]

Definitely would not go into Medicine again. If I did, I sure wouldn't pick this garbage field. Pick something with leverage. Enjoy the market while it lasts. Medicare reimbursement, mid-level encroachment, AMCs...there are no solutions. Increase in demand only means you will do more for less. Ignorance is bliss though..there will always be a sucker that picks Anesthesia.

 

[Twiggidy]

I think there’s a lot of self selection at the residency level. If you aren’t going to match, you may just not apply?

It’s a three year fellowship, IC is at least another year. EP even more. At some point there may also be a research year, and/or chief year to wait for your turn.

So the shortest way to get there is 7 yrs after med school, long way can be 9+. We, at this sub, also like to talk opportunity cost for 1 year fellowship….. it’s at least 3 years more than ours. How many times posters answer by saying “only do it if you really want it….”

To OP’s original question, yes, still anesthesia.

This would also be my issue with radiology…among others

 

[BLADEMDA]

Definitely would not go into Medicine again. If I did, I sure wouldn't pick this garbage field. Pick something with leverage. Enjoy the market while it lasts. Medicare reimbursement, mid-level encroachment, AMCs...there are no solutions. Increase in demand only means you will do more for less. Ignorance is bliss though..there will always be a sucker that picks Anesthesia.

Let's review the facts then we can add opinions. FACT: You don't need stellar step scores or honors to match anesthesiology. FACT: the residency is shorter than most in terms of duration. FACT: there is shortage of providers in the USA FACT: You can easily get a job as a general anesthesiologist FACT: Pay for this field is above average for medicine FACT: the job isn't that difficult to do as shown by the relative ease advanced practice nurses do the job on their own in some locations

 

[Dr. Rude]

This is why you dont do an anesthesia residency.

Nurse Anesthetists

www.asahq.org

The ASA is actively undermining the specialty for money

Awhile back the ASA published the number of CRNA affiliate members of ASA. It was fewer than 10.

 

[drdan4]

Let's review the facts then we can add opinions. FACT: You don't need stellar step scores or honors to match anesthesiology. FACT: the residency is shorter than most in terms of duration. FACT: there is shortage of providers in the USA FACT: You can easily get a job as a general anesthesiologist FACT: Pay for this field is above average for medicine FACT: the job isn't that difficult to do as shown by the relative ease advanced practice nurses do the job on their own in some locations

Nothing you posted is any more reassuring other than the temporary and always cyclical shortage. I guess if you're dumb, lazy and OK with being easily replaced it's a decent choice. Don't forget the extra pay is for onerous call responsibilities...evenings, nights, weekends, holidays...all the stuff no one else wants to do. The work is definitely more unpleasant with sicker and fatter patients. Someone's gotta do it, doesn't have to be you if you are smart enough to go into something else.

 

[Dr. Rude]

Nothing you posted is any more reassuring other than the temporary and always cyclical shortage. I guess if you're dumb, lazy and OK with being easily replaced it's a decent choice. Don't forget the extra pay is for onerous call responsibilities...evenings, nights, weekends, holidays...all the stuff no one else wants to do. The work is definitely more unpleasant with sicker and fatter patients. Someone's gotta do it, doesn't have to be you if you are smart enough to go into something else.

You and BLADE are both right. Right now the money is very good. As always off hours pay lots more. But who knows how long the money will be good.

The work is also often not fun. Production pressure, Fatter, sicker, less well taken care of patients, lots of disrespectful CRNAs, surgeons, and administrators who don’t value us at all.

 

[BLADEMDA]

You and BLADE are both right. Right now the money is very good. As always off hours pay lots more. But who knows how long the money will be good.

The work is also often not fun. Production pressure, Fatter, sicker, less well taken care of patients, lots of disrespectful CRNAs, surgeons, and administrators who don’t value us at all.

I never said the field doesn't have a list of negatives. In fact, there a lot of negatives but for the average med student who can't match a top 5 specialty the field is a reasonable choice. I actually don't mind the work portion of my field and any field becomes a "job" after 5-10 years. The luster wears off pretty quickly in just about any specialty.

Off hours? You can still make very good money and never spend a night or weekend in the hospital- just ask our CRNA "colleagues."

 

[BLADEMDA]

Nothing you posted is any more reassuring other than the temporary and always cyclical shortage. I guess if you're dumb, lazy and OK with being easily replaced it's a decent choice. Don't forget the extra pay is for onerous call responsibilities...evenings, nights, weekends, holidays...all the stuff no one else wants to do. The work is definitely more unpleasant with sicker and fatter patients. Someone's gotta do it, doesn't have to be you if you are smart enough to go into something else.

But, the kicker is you need to be "smart enough" to pick another specialty. So, list the options the med student is likely to match into with his/her scores plus grades then pick the one he/she likes the best. The list may not be very long as competitive as the MATCH is these days.

 

[Gilakend]

I never said the field doesn't have a list of negatives. In fact, there a lot of negatives but for the average med student who can't match a top 5 specialty the field is a reasonable choice. I actually don't mind the work portion of my field and any field becomes a "job" after 5-10 years. The luster wears off pretty quickly in just about any specialty.

Off hours? You can still make very good money and never spend a night or weekend in the hospital- just ask our CRNA "colleagues."

But, the kicker is you need to be "smart enough" to pick another specialty. So, list the options the med student is likely to match into with his/her scores plus grades then pick the one he/she likes the best. The list may not be very long as competitive as the MATCH is these days.

I'm just a med student, but from my perspective, there really doesn't seem to be many better options than anesthesia given the downsides of surgery. Could just be the institutions I've been at (large academic medical center and a medium sized community hospital) but I have never seen more unhappy and regretful attendings than the surgeons.

It's one of the major reasons I'm not doing surgery. I always said that if I met 1 surgeon who had a lifestyle I would want for myself, I would feel comfortable doing it. I never met one. I would be happy with 95% of the lifestyles I've seen in my time in anesthesia.

If you remove the surgical specialties, really the only other two specialties that are harder to match and have it better than anesthesia are derm and ophtho. And I think most people who pick anesthesia would not be able to stomach the clinic and note writing of those specialties.

 

[BLADEMDA]

Anesthesiology Is Still One Of The Most Competitive Residencies

anesthesiaexperts.com

 

[BLADEMDA]

 

[BLADEMDA]

View attachment 356338

If a med student fails to MATCH then the SOAP stats show he/she won't likely be getting a spot in Anesthesiology; please notice Emergency Medicine is clearly no longer in favor as the number of SOAP spots demonstrates.

 

[kidthor]

If a med student fails to MATCH then the SOAP stats show he/she won't likely be getting a spot in Anesthesiology; please notice Emergency Medicine is clearly no longer in favor as the number of SOAP spots demonstrates.

It's crazy that rad onc and EM were both wildly competitive 10 years ago and now the tides have complete changed.

 

[Dr. Rude]

It's crazy that rad onc and EM were both wildly competitive 10 years ago and now the tides have complete changed.

Supply and demand tend to oscillate out of synchrony. Long pipeline. Med students pick a specialty by the end of their third year.

 

[BLADEMDA]

We are thrilled to share our 2022 residency match results! We matched 20 top students (16 categorical, two advanced, one Panther Research Scholar, and one combined anesthesiology/pediatrics) from over 1,700 candidates who applied to our program. Our 2022 match class has an average USMLE Step 1 score of 250 and includes many members of the Alpha Omega Alpha national medical honor society and the Gold Humanism Honor Society.

We are excited to welcome the Class of 2026 and look forward to growing alongside them as clinicians and as a specialty over the next four years!

2022 Anesthesiology Residency Match Results | Department of Anesthesiology & Perioperative Medicine

www.anesthesiology.pitt.edu

 

[nimbus]

No shortage of Enemies...Ungrateful Surgeons, militant CRNAs, Exploitive Administrators and Private Equity. It's sad that the field has to crash and burn every decade for people to understand our value. That is squarely on Leadership and Marketing...which is probably the worst in Anesthesia. And Reimbursement reflects these two factors. If you want to practice on your own terms...aka not work with useless CRNAs or AMCs...then don't plant roots...be able to pick up and leave in 90 days.

I've never Supervised..always done my own cases...actually think CRNAs should not even exist. Currently a partner in PP making over 900k but it's been a tough road. My take after several jobs...is that Private Practice 1099 Solo Anesthesia is best gig.and truly wish all Anesthesiologist had access to this. AMCs just can't compete..if you're not making money because of payor mix, subsidy etc they can't either. I don't care if they can extract a better subsidy or get better rate from insurers. Trust me, you as an Anesthesiologist ain't seeing any of those profits with their overhead...and plus...you were always disposable for them anyway.

50 hr week. Ofcourse decent payor mix 🙂. You seem to know...and no offense but most of you are DUMB. If you don't know the the total units you generated and what either the blended unit was or what the unit rate that each of your insurers pays, then I have no sympathy for you. You are doing the work anyway, you might as well know what you are generating as a Slave for your Overlord AMC or Hospital. For you employed guys (academic and definitely AMC), most of this info is shrouded in secrecy because as soon as you know...you will DEFINITELY bail. Sorry...but even with a garbage Medicare percentage of greater than 60%, we still made more in my last PP than the scumbag AMC the Hospital tried to replace us with.

Definitely would not go into Medicine again. If I did, I sure wouldn't pick this garbage field. Pick something with leverage. Enjoy the market while it lasts. Medicare reimbursement, mid-level encroachment, AMCs...there are no solutions. Increase in demand only means you will do more for less. Ignorance is bliss though..there will always be a sucker that picks Anesthesia.

Must be tough

Anesthesia has treated you badly.

Somehow you manage to make over 900k doing your own cases with >60% Medicare and still bitter 🤔


The problem for anesthesia is not leadership and marketing but a shallow moat and low barrier to entry. Many training spots, easy to match, short and relatively painless training path, and a large pool of labor including AAs and CRNAs. Thus, no leverage. It’s not interventional cardiology or neurosurgery.

 

[sevo00]

Must be tough

Anesthesia has treated you badly.

Somehow you manage to make over 900k doing your own cases with >60% Medicare and still bitter 🤔


I think the problem for anesthesia is not leadership and marketing but a shallow moat and low barrier to entry. Many training spots, relatively easy to match, short training path, and a large pool of labor including AAs and CRNAs. It’s not interventional cardiology or neurosurgery.

lol nice find. Damn if I was making over 900k I def wouldn’t be complaining.

 

[BLADEMDA]

Must be tough

Anesthesia has treated you badly.

Somehow you manage to make over 900k doing your own cases with >60% Medicare and still bitter 🤔

I have been around 30 years in this field. What I can tell you for a fact is that the job market has ebbs and flows. There has been bad times and good times. Today, is very good time. Is it as good as say 1986 or 2000? No. The money indexed for inflation was much higher. But, is the money good today vs the work level involved and vs. the other specialties? You bet it is. A med student needs to be realistic about the MATCH as that is your future career. Will you end up not Matched at all? A lot of med students didn't MATCH in 2022 into the top specialties.

With a Step 2 of 250 Anesthesiology remains a good choice for many med students. For those with a 260+ there may indeed be better options.

 

[BLADEMDA]

lol nice find. Damn if I was making over 900k I def wouldn’t be complaining.

People love to b#tch no matter how much money they make

 

[nimbus]

I'm just a med student, but from my perspective, there really doesn't seem to be many better options than anesthesia given the downsides of surgery. Could just be the institutions I've been at (large academic medical center and a medium sized community hospital) but I have never seen more unhappy and regretful attendings than the surgeons.

It's one of the major reasons I'm not doing surgery. I always said that if I met 1 surgeon who had a lifestyle I would want for myself, I would feel comfortable doing it. I never met one. I would be happy with 95% of the lifestyles I've seen in my time in anesthesia.

If you remove the surgical specialties, really the only other two specialties that are harder to match and have it better than anesthesia are derm and ophtho. And I think most people who pick anesthesia would not be able to stomach the clinic and note writing of those specialties.

There are a lot of surgeons with great lifestyles and more control over their lifestyle than anesthesiologists. Don’t want to miss your kids soccer game on Saturday? Schedule it after.

 

[BLADEMDA]

There are a lot of surgeons with great lifestyles and more control over their lifestyle than anesthesiologists. Don’t want to miss your kids soccer game on Saturday? Schedule it after.

From what I have seen of new surgery residency graduates they need a lot more time in the OR and less on the soccer field.

 

[Neopolymath]

This would also be my issue with radiology…among others

Everyone in rads does 1 fellowship and fellowships are very uncompetitive. The job market is killer and no one has done two fellowships for a good job almost ever (it's not path). Honestly, the biggest difference when evaluating non-work areas of the two specialties is definitely the 6 year versus 4-5 year training pathway. It's one of the few obvious negatives before you even commit.

 

[nimbus]

lol nice find. Damn if I was making over 900k I def wouldn’t be complaining.

Same

 

[nimbus]

From what I have seen of new surgery residency graduates they need a lot more time in the OR and less on the soccer field.

But they get better.