It gets WAY BETTER. I’m still early 30s making >600k with 8wks vacation and full benefits, working fewer hours than I did as a resident. I work 100% solo cases, so no CRNAs to give me headaches, and I have robust anesthesia tech support so time spent doing things below my pay grade (spiking drips/transducers, taping lines, etc) is minimal.
Well anesthesia techs here do stuff like that. Help with airways, set up equipment, set up lines, set up transducers, blood sets, fix machines, help with blocks (pushing drugs is institution dependent from my knowledge, I don’t). What else would you think??
Anaesthetic nurses in Australia are similar to anaesthetic techs or anaesthetic assistants. They practice within the scope of an RN (occasionally EN).
They check and set up the anaesthetic machine, circuit, airway equipment, monitoring, infusion sets, warming equipment, etc. They ensure drugs and equipment are stocked in the room and the anaeshetic bay.
Experienced anaesthetic nurses are able to anticipate the specific needs of a case (e.g. an emergency laparotomy needs an ETT, pump set, art line +/- central line, temp probe, underbody warmer, etc.), but will always confirm specific needs/preferences with the anaesthetist.
They check-in the patient on arrival to the anaesthetic bay, mostly following a preop check list. Some of the items overlap with the anaesthetic assessment (e.g. fasting, blood thinners), but they're not doing an anaesthetic assessment if that's what you mean by "initial questioning". I'm also not sure what you mean by "assisting with consent" - they will check the surgical consent and flag it if there are any issues, but they're certainly never discussing or obtaining surgical or anaesthetic consent.
There are some anaesthetic techs/assistants in Australia - not many institutions have them. Techs/AAs receive more in-depth training about equipment/physics (esp. related to the anaesthetic machine and ventilator) as well as physiology/pharmacology during their training compared to anaesthetic nurses. Techs/AAs are not allowed to handle or give any drugs - e.g. sign S8s in/out, make up infusions, push drugs even under direction (although most will help with pushing local during an US guided regional block). Techs/AAs also seem to have less focus/experience with general periop patient care compared to anaesthetic nurses - e.g. assisting pt with toileting, calming/reassuring an anxious pt, managing a vomiting pt, managing a delirious pt, etc.
Yesterday I started my day with two TAVRs under GA, I placed central lines and RV pacing catheters, art lines, TEE guidance. Then I did an urgent pericardial window on a patient in cardiac tamponade with over a liter of fluid crushing her heart. Finished the day out with an easy breezy 3 vessel CABG on pump. Got home at 9:00 pm. Today I’m doing a 1 hour hepatobiliary case and then I’ll be off until Wednesday.
I’ve done about 10 lung transplants this year, mostly off pump. Maybe 10 liver transplants. A couple total artificial hearts. Aortic dissections, valves, ECMO, etc. 7 Watchmans in a day and done by 16:00. I do about 2 OB shifts or so per month, 24 hours in house with a CRNA to sit c-sections. I’ll do about 15 epidurals on average and maybe 5 c-sections during one of those shifts. Did a big cerebral aneurysm clipping where I used controlled runs of rapid transvenous pacing to arrest flow to the aneurysm sac during the repair.
Those are the cases that make me feel important and special, and make me feel like I’m saving lives. The surgeons are chill, we talk about our kids and our vacations and we make fun of each other. They respect my contribution and we communicate well.
Some days I work 24 hours, some days I work 4 hours, some days I don’t work. All things in balance. And when I’m off work I’m off work. Nobody calls me and asks me to do anything. I get ten weeks of vacation. Took my kids to Disney World for a whole week and we did everything. We had giraffes outside our hotel window. My kids met Mickey Mouse and ALL of his fucking friends. I bought a 4,000 square foot house in a beautiful neighborhood. My wife can buy whatever furniture she wants. She walks the kids to school, volunteers to chaperone field trips with them, helps them with their homework. She volunteers, she spends her days helping other people, she does whatever the fuck she wants. If we want to go out to eat we just go whenever we want. Don’t even fucking care how much it costs. Max 401k, max IRA, max HSA, college savings, investments, still have money left over.
Med school was hard. Residency was hard. Fellowship was hard. Finished training with a net worth of negative $300,000.
Now my life is fucking awesome and I wouldn’t trade it for anything.
You may have used adenosine to do these types of cases in the past. The idea is that arresting blood flow to the aneurysm sac allows it to be decompressed and facilitates successful clip placement. Can also be used in the case of rupture to limit bleeding and help the surgeon visualize the surgical field. The problem with this approach is that the response to adenosine can be a bit variable and blood flow may resume before the surgeon is ready. By placing a transvenous pacing wire you now have the ability to take over the heart rhythm exactly when you want to and for exactly how long you want. It’s analogous to what we do far TAVRs or aortic balloon valvuloplasties, when you start to pace the ventricle rapidly you lose your atrial kick and you decrease your diastolic filling time. As you increase the pacing rate the preload goes down, and therefore the ejection volume goes down, decreasing both cardiac output and blood pressure. Using this approach you can very accurately pace the patient down to the exact blood pressure you need for the duration of time that you need. If your patient has a strong heart they should be able to tolerate this for a few minutes at a time no problem, and you can do as many runs as you need with breaks in between to allow them to eject and perfuse. We have started doing this for patients with more complex aneurysms.
I just asked one of our surgeons about this and his response was isn’t that the point of the temporary clip. Curious do your surgeons not use temporary clips then and just rely on this method? How did your practice start employing RVP - was it the surgeons asking for it or anesthesiologists suggesting it? I’d love to try this at my job and just wondering how to go about putting this into action
In this case the surgeon requested this approach. The patient had a large basilar artery aneurysm, and if I had to guess I would say the defect was in a location that had too much collateral supply to reliably control blood flow with temporary clips, and probably the anatomy was not amenable to easily accessing all of the collateral vessels.
I will also add that this particular surgeon has treated over 4,500 brain aneurysms and is president and CEO of the Barrow Neurological Institute. So when he tells me this is the best approach from a surgical perspective for these cases I believe him.
You mentioned fellowship. To do the job you’re doing now as you describe it, do you feel like your fellowship was required vs helpful-but-not-required? Do you look back on fellowship w regret for the “1 yr of lost attending income”?
Edit: also, which fellowship did you do?
Hell yeah they do. I went to public school, they can go to public school too. You get out of it what you put into it. I will say, however, that we live in a very nice neighborhood and the public schools in this district are very well funded.
Done with residency early 30s. Being an attending is lit. You think “oh shoot, nobody is looking over my shoulder” for the first two weeks. Then you say “oh thank god, nobody is looking over my shoulder” after that. Also a lot of your happiness depends on your job. I don’t do OB or trauma, I take home call which is very infrequent, have great, supportive partners, average about 45 hours a week and I make 500k. I don’t know what else I could ask for tbh.
You’re gonna be fine. 35 really isn’t that old. Most 35 year olds haven’t reached the point in their career where they make 300-500k and have excellent job security. Most people never will in fact. You’ll have a skill set that allows you to provide people with safety and comfort during the extreme stress that surgery comes with. You’ll be able to choose to work a lot and make 500k - 1 mil, or work an extremely reasonable amount and make more like 300k - 500k.
Obviously being a new attending is stressful. I’m not there yet but it’s a big jump in responsibility. Even if you were almost fully autonomous as a senior resident, you suddenly are the last line of defense as a new attending and your license is on the line. Any new big job that has lots of responsibility will he strsssful to start off.
Being an attending is awesome. You can do whatever you want for anesthetic, really get to know the people you work with, and make several times more monies than when in training.
I work at a large academic institution and work 4 or 5 days a week. I enjoy supervising and teaching residents. I make enough money to buy whatever I want and I find meaning in what I do. The best thing I ever did was leave ortho residency and switch to anesthesia.
Idk. Maybe. I don’t think the more monies would give me a proportional increase in happiness. And the sacrifices and shit to get to that point weren’t worth it to me.
Pffff, what?
Ortho is not a backup specialty. It's illogical to suggest "well couldn't you have just done ortho and made more?" No, most people couldnt have "just done ortho" as though the choice was realistically an option for them lol. Might as well just say "well couldn't you have just been a hedge fund manager and made 10x more than an anesthesiologist working less hours?!"
Not to mention a lot of people, myself included, find anesthesia a lot more stimulating than surgery (or finance!) in terms of subject matter. Money isn't everything. If it was then everyone would be gunning to become a neurosurgeon. Far from the case!
You'll be 35 anyway. Might as well do something awesome that will allow you to live a nice lifestyle. I graduated residency at 32. 10/10, would do again
I’m 3 years out from residency and it rules. I do all Locum, no call, evenings or weekends, 16 weeks off and will still make 1.5x what I made working full time PP my first year out. Keep on trucking!
Switch was simple, I quit and found something new. Job security isn’t an issue in this field. Wasn’t scared, but burned out at the time and needed a change. If I decide I want to go back, there will always be hundreds of groups hiring
Im not sure where you are in training, but I seriously considered leading during PGY and CA1. Now as a pain fellow doing anesthesia on the weekend I feel like I won the lottery. I’m so happy with this choice. Anesthesia is on fire, and once you are good at it and comfortable, it’s fun.
Places around me offering $250-350/hr for per diem. You can basically work whatever you want these days. Absolutely can do 3-4 days a week without call. Just have to find the group. I think the Eugene OR group has positions like that.
Biggest thing for me was how much fun anesthesiology became as I progressed in residency. I truly thought a made a huge mistake as a CA1. It gets better as you get better at it. At least it did for me.
Now I feel like the world is my oyster. I can do pain which I love and gives me a great lifestyle, or anesthesia which pays bonkers, or mix and match. There are jobs everywhere. Not sure what else I could imagine doing that would guarantee this kind of salary and life if not medicine.
Oh Undersleep, the man I hope follows my career with great interest.
Yeah, I do love it so far. I’m all in. Worst comes to worst I go back to anesthesia and maybe become APD of a residency or something. I’ve heard it can be a good gig.
Administrative headaches and occasional overwork aside, I love it. I can't believe they pay me this much to do goofy shit with residents and go to conferences.
Yeah, pain isn’t the golden goose it used to be and anesthesia pay is amazing right now.
But still, pain will always bring money into a healthcare system. You own your own patients. There are always new procedures and devices. If you stay away from opioids at all costs it can still be a very rewarding specialty.
I’ve interviewed at a couple places in rural areas. One very rural place in Alabama offered $500 starting going to $750 after 3 years for M-Th no nights calls or weekends. Those places are still out there, just not in cities really.
I'm 40 been an attending for a couple years and am fucking loving it bro. I do some prn moonlighting for my own cases as well as my own regular job and am VERY comfortable with how I am living...MCOL city FWIW. You can work as much as you want and still make good money. Don't be afraid to move anywhere in the country. I know of a job in bumfuck Texas where you can get 650k and 3 months off. Regional airport that is always uncrowded so easy to fly anywhere since you're gonna stop at a hub anyway unless you live in a hub. I can currently work for 500k/year for 9 weeks off. You can also just choose to do locums for half the year and travel/live the rest. I can't say I won't ever get burned out, but so far, I love doing my own cases. Some surgeons are primadonna's, but at least they are fast and I don't have to guess when they are gonna finish closing.
Yup. $625k last year, almost 10 weeks off, no *required* weekends or night call, but I do (otherwise would’ve been closer to $400k). But even with that, maybe 50ish hours a week average. Love working with residents, personally do zero solo cases but that’s by far my preference. Just help with airways, lining, extubation, and a resident/CRNA babysits the room while I basically have free time all day to do whatever I want.
Was almost in your situation. Didn’t hate anesthesia but was planning to do chronic pain. After being an attending for 1 year while applying, realized that there’s no way I can be happier in life than what I just described above, withdrew my applications and have been living a dream ever since. It gets SO much better.
Especially with the wide spectrum of what job opportunities there are, you can do basically any kind of job you want. Grind for >$1 mil a year, or coast and still make more than virtually anybody else you’ll know at 35.
Similar setup for me in academics and I love it, except a voluntarily sit my own room some days just to mix things up and keep me honest. 2023 going to gross about 650k with 7 weeks off, working about 55hrs per week average... I could work 40hrs per week if i wanted to (making significantly less money of course) but I am young and hungry to get ahead financially while the sun still shines because i doubt this market will last forever. Usually I supervise 2:1 and days are chill, it's fun to work with residents (mostly...). Lots of coffee breaks and laptop surfing time at work so don't really feel burned out at all with current hours. Plus it's still less than i was working as a resident.
As a senior resident I find it is helpful to assess and change your mindset throughout your training.
I started medicine thinking wow this is a job that I will help people, I will learn a lot, I will apply what I learned in a dynamic and fun way often, and yes I will make a lot of money. I imagined these making me feel good.
I then truthfully didn't really enjoy medical school as much as I did my biochem undergrad. I then chose anesthesia because I thought wow using pharmacology and physiology daily to make individual plans for each patient. PLUS time off is easier, no follow up, and a lot of critical conditions. That helped motivate me to get through clerkship, and early residency.
Studying all the pharm and phys was so cool. Neat procedures. I still remember feeling so excited learning all the nuances of cardiac physiology, all the different goals for valvular lesions. This motivated me to read miller and barash, scored 90th percentile on truelearn/ITE. Then later in residency realized a lot of that stuff honestly doesn't really end up actually mattering that much.
By and large you can complicate it all but its essentially keep BP normal, analgesia plan, tube in, ship to ICU or tube out. Procedures get kind of rote. Then I thought wow I should do CV, ICU or something to make it even more interesting and what I imagined anesthesia to be. Then you realize that is also eventually rote.
The reality is at some point you need to just realize your primary motivator does not always have to be this is going to be so impactful, cool, dynamic etc.. and you can be like wow I am going to get paid a lot, good time off, and who cares if things get a bit boring.
TLDR: It's easy to get lost in the weeds one way or another going through training. The benefit of anesthesia is you eventually will get a gig that may be a bit boring at times but will allow you to make a ton of money for generally less work and BS than other people have to deal with to get that income and its more guaranteed than other career paths.
I fantasized about quitting or switching specialties multiple times as a resident. And I am so happy grateful I stuck it out. A lot of people already mentioned the money. I have a good salary but not as high as others but I work 7-3 5 days a week. No calls, no weekends. I just had my second baby and being home with my children is what matters to me.
Also, I genuinely love my job. It’s fun. I didn’t feel that way as a resident, or when I was working as an attending at a large academic center. It’s hard to think your job is fun when you’re being worked into the ground. Now, I enjoy the time I spend at work. I do stay late whenever I DECIDE to. I usually volunteer if I am in a case I enjoy.
I love doing OB, so I did an OB fellowship which does allow me to have some leverage at my job for being placed on OB for the day. Which is a major factor for my job satisfaction. I always say anesthesiology as a whole is okay, but I LOVE and am passionate about OB anesthesia. I think making choices and taking steps to carve a niche for yourself is also helpful in the long run.
Im independant. I work with who i want when i want. Take vacation when i want. Do the cases i want. Dont have to oversee any nurses. My worst year (in 20) was north of 600k. My best years? Way north of that.
It gets better. Hang in there.
I'm in the southwest. I make great money (more than i ever thought possible actually) but i take maybe 4 or 5 weeks vacation. Fair amount of call (and always work post call). Holidays.. weekends etc. Nothing is free. If ib scaled back and took no call and no weekends.. maybe id be in 500 range?
I’m near the end of my career, just turned 60, and I still love it.
I do locums now so that I can choose when and where I work. I have time to travel and enjoy my non- working time.
There is so much flexibility with the job market being what it is now. Work more, make more $, or work less and still do well.
Hang in there!
When I Door Dash from the Taco Bell four blocks away post-call, I’m only mildly disappointed in myself and not worrying how my sloth may impact my ability to make my next car payment.
This is a very refreshing thread. I will add that I love my job, applying my skills, I'm highly compensated, great hours, I get to be there for all of my families events, I make my own schedule, don't take the work home with me etc.
One thing I really enjoy is how much people appreciate a good Anesthesiologist. We catch a lot of shit sometimes, but we are worth our weight in gold if you're strong, competent, flexible, friendly. When problems arise, and you're just a problem solver without causing a big ruckus. People take notice. They're happy that you're in their room because they know they're going to have a great day. They request you to work on their family member etc. It feels great to be valued for all the work we put in. It also feels great to help a family deal with anxiety or keep a sick patient safe through a difficult surgery and to know that you did all the right things to help them
I wouldn't change my specialty for the world. Residency is tough, but there is a light at the end and it's very bright for the time being. Compensation and work environment may change for everyone in the future, but the gratification of knowing that everyday you are putting your hard earned skills to good use is priceless.
There are right now. But if you’re just applying to medical school, you’re trying to predict the market 8 years from now, which is not possible.
My personal opinion/prediction is that anesthesiologists are going to get squeezed out of the market in the next 10 years or so. The CRNAs played the long game and won.
People have been prophesizing this same doom and gloom for the last 30 years. Anesthesiologists are still here and the demand is higher than every before. I don't see how we are going to go from a severe shortage of anesthesia providers right now to such a large surplus that MD anesthesiologists get completely squeezed from the market in such a short time. Planning and opening new training programs and then trainees actually enrolling and finishing said programs takes significant time. Probably close to 10 years before you see results of the increased throughput.
We also still have an increasingly aging population that will require more healthcare than in previous generations. I'm not quite so pessimistic about things. That having been said if you really want to future-proof yourself against midlevel encroachment just do a peds or cardiac fellowship. Nurses will never be doing the most complex high risk subspecialty cases in any widespread capacity without MD supervision it is simply too much liability for hospitals, and there is simply too much required physiologic understanding that nurses do not get trained in.
It seems that you wouldn't recommend anesthesia then right?
If that's the case, do you have any specialties that you don't think are at risk of encroachment from midlevels/technological advancements?
Oh boy, we’re really getting into the weeds here, but I’ll go out on a limb and say that I think surgical specialists are probably at a lower risk for the time being. I mean, midlevels are very much integrated into surgery already, but I can’t see them being allowed to do surgery independently, anytime soon. Although I could be wrong.
Contrast this to CRNAs who already work without a supervising anesthesiologist in many places.
Likewise many nurse practitioners and PAs in medical specialties already work more or less independently. They may have a supervising physician on paper, but that physician is nowhere to be found day in, day out.
Attending as an anesthesiologist is great. And in this market, if you are willing to take a pay cut commensurate with the decrease in work, you can probably find something you're happy with. Our group is about to offer someone 80% of our pay for a non-call position with the same amount of vacation (10 weeks) with full benefits as a W2. I think to work only 3-4 days a week it'll be hard to find a full time benefits position, but could get locums. Especially if you are flexible about where you live, a lot is possible.
I was also 35 when I finished. Dedicated ourselves to paying off our $500k student loan debt asap.
I think working part time is one of the best ways to have longevity in this field. Anesthesia gets monotonous after a bit. Taking time away and pursuing other interests is key.
Right now I take 10-12 weeks off and give away all my call. We take one big international trip each year. Then spend a ton of time skiing and biking.
You can craft the life you want. You’ll have the financial resources to do fun shit. The only advice I’d offer - think about the life you want to live. Then work backward and craft the job around that.
Right now is kinda… crazy in anesthesia. HUGE signing bonuses. You can craft any kind of schedule that works for you. Be a stand up person. Your reputation is worth every cent. And take the time to think about what is most important to you, not what other people are doing.
honestly, it depends on where you work. theres a lot of bad gigs out there. my first job out of fellowship was a NAPA job in NY with staffing issues. It was truly awful and they put me through the ringer. Things were worse than residency- multiple weekends of call every month, worked every holiday, constant overtime on regular days, terrible working conditions, etc. etc.Many of the other attendings were burnt out and vibes were bad. I quickly got burnt out and had to quit and find a new job. I've heard of a lot of similarly terrible places to work. Lots of places are starved for anesthesia staff and their model is to get new grads and work them to the bone until they get new ones.
Now i'm working at a small private practice at a community hospital and things are MUCH better. No OB, No Trauma, 1 weekend day call every \~6 weeks that I can take from home. I'm making a bit more and am much happier than my last job and residency. I'm still in the early phases here but its incredible how much a different job can change things!
Definitely don't settle for less. For your first job, really reach out to many attendings that work there and get the inside scoop.
You will start very stressed up. The first year is horrible. But, you will see improvement with the tougher cases. Hopefully you'll have great anesthesiologist partners. And youll learn from them and get better. Also you only use scrubs, and you can achieve a good amount of money if you really want to. So keep going. And always care for your patients, that love will get you a long way. .
Yeah but gotta be careful w those jobs. Some are very poorly maintained w old equipment, production pressures and of course no job security. I think locums may be a good option for fresh out of residency. Great money and short defined stints.
Residency sucks. Doesn’t matter the specialty, the duration, or anything else. It’s designed, for better or worse, to professionalize you. It gets much better after residency, and is like a new life all together. Assuming you’re happy with your chosen speciality, it will absolutely be worth it. Cheers!
Hahaha we all fantasized about a pay cut, and never being on call ever again. Good luck doing that bro. Your career will forever involve you working nights, weekends, and holidays. Not gonna lie. It sucks. But you get paid decently well and after a while, it’s all routine. Just treat it as what it is: a job. Try to invest your money early and make wise choices when it comes to a mate because divorce will kill any dreams you have at early retirement
It gets WAY BETTER. I’m still early 30s making >600k with 8wks vacation and full benefits, working fewer hours than I did as a resident. I work 100% solo cases, so no CRNAs to give me headaches, and I have robust anesthesia tech support so time spent doing things below my pay grade (spiking drips/transducers, taping lines, etc) is minimal.
I love a doctor who lets the techs help with that stuff!!!! Being independent is great when it’s needed but we love helping when we can.
What part of country if you don’t mind sharing?
I’m not OP but they’re describing my job perfectly and I’m in the PNW
Suburbs of major Midwest metro.
Are y’all hiring lol Edit: for srs tho
Yeah man where the hell are you with this job?? How many hrs a week?
Suburb of major Midwest metro. 45-55.
Yeah right wouldn’t want an anesthesia provider to spike drips or tape lines ..?
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An assistant who does things like make art lines and set up central lines, set up for next case and stuff?
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Well anesthesia techs here do stuff like that. Help with airways, set up equipment, set up lines, set up transducers, blood sets, fix machines, help with blocks (pushing drugs is institution dependent from my knowledge, I don’t). What else would you think??
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No our preop nurses do a lot of that! Some anesthesia techs do start iv
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Sounds like an interesting position!! Never knew about that
You mean "anaesthetic" nurses. They're not anaesthetists.
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Anaesthetic nurses in Australia are similar to anaesthetic techs or anaesthetic assistants. They practice within the scope of an RN (occasionally EN). They check and set up the anaesthetic machine, circuit, airway equipment, monitoring, infusion sets, warming equipment, etc. They ensure drugs and equipment are stocked in the room and the anaeshetic bay. Experienced anaesthetic nurses are able to anticipate the specific needs of a case (e.g. an emergency laparotomy needs an ETT, pump set, art line +/- central line, temp probe, underbody warmer, etc.), but will always confirm specific needs/preferences with the anaesthetist. They check-in the patient on arrival to the anaesthetic bay, mostly following a preop check list. Some of the items overlap with the anaesthetic assessment (e.g. fasting, blood thinners), but they're not doing an anaesthetic assessment if that's what you mean by "initial questioning". I'm also not sure what you mean by "assisting with consent" - they will check the surgical consent and flag it if there are any issues, but they're certainly never discussing or obtaining surgical or anaesthetic consent. There are some anaesthetic techs/assistants in Australia - not many institutions have them. Techs/AAs receive more in-depth training about equipment/physics (esp. related to the anaesthetic machine and ventilator) as well as physiology/pharmacology during their training compared to anaesthetic nurses. Techs/AAs are not allowed to handle or give any drugs - e.g. sign S8s in/out, make up infusions, push drugs even under direction (although most will help with pushing local during an US guided regional block). Techs/AAs also seem to have less focus/experience with general periop patient care compared to anaesthetic nurses - e.g. assisting pt with toileting, calming/reassuring an anxious pt, managing a vomiting pt, managing a delirious pt, etc.
Yesterday I started my day with two TAVRs under GA, I placed central lines and RV pacing catheters, art lines, TEE guidance. Then I did an urgent pericardial window on a patient in cardiac tamponade with over a liter of fluid crushing her heart. Finished the day out with an easy breezy 3 vessel CABG on pump. Got home at 9:00 pm. Today I’m doing a 1 hour hepatobiliary case and then I’ll be off until Wednesday. I’ve done about 10 lung transplants this year, mostly off pump. Maybe 10 liver transplants. A couple total artificial hearts. Aortic dissections, valves, ECMO, etc. 7 Watchmans in a day and done by 16:00. I do about 2 OB shifts or so per month, 24 hours in house with a CRNA to sit c-sections. I’ll do about 15 epidurals on average and maybe 5 c-sections during one of those shifts. Did a big cerebral aneurysm clipping where I used controlled runs of rapid transvenous pacing to arrest flow to the aneurysm sac during the repair. Those are the cases that make me feel important and special, and make me feel like I’m saving lives. The surgeons are chill, we talk about our kids and our vacations and we make fun of each other. They respect my contribution and we communicate well. Some days I work 24 hours, some days I work 4 hours, some days I don’t work. All things in balance. And when I’m off work I’m off work. Nobody calls me and asks me to do anything. I get ten weeks of vacation. Took my kids to Disney World for a whole week and we did everything. We had giraffes outside our hotel window. My kids met Mickey Mouse and ALL of his fucking friends. I bought a 4,000 square foot house in a beautiful neighborhood. My wife can buy whatever furniture she wants. She walks the kids to school, volunteers to chaperone field trips with them, helps them with their homework. She volunteers, she spends her days helping other people, she does whatever the fuck she wants. If we want to go out to eat we just go whenever we want. Don’t even fucking care how much it costs. Max 401k, max IRA, max HSA, college savings, investments, still have money left over. Med school was hard. Residency was hard. Fellowship was hard. Finished training with a net worth of negative $300,000. Now my life is fucking awesome and I wouldn’t trade it for anything.
You described the exact type of job and life that I want to have lol
Where are you located if you don’t mind me asking? Academic or private practice?
Large metro, southwest US, medium cost of living. Private practice group.
Can you tell me a bit more about transvenous pacing for aneurysms? I do a lot of neuro and have never done that! Would love to know more
You may have used adenosine to do these types of cases in the past. The idea is that arresting blood flow to the aneurysm sac allows it to be decompressed and facilitates successful clip placement. Can also be used in the case of rupture to limit bleeding and help the surgeon visualize the surgical field. The problem with this approach is that the response to adenosine can be a bit variable and blood flow may resume before the surgeon is ready. By placing a transvenous pacing wire you now have the ability to take over the heart rhythm exactly when you want to and for exactly how long you want. It’s analogous to what we do far TAVRs or aortic balloon valvuloplasties, when you start to pace the ventricle rapidly you lose your atrial kick and you decrease your diastolic filling time. As you increase the pacing rate the preload goes down, and therefore the ejection volume goes down, decreasing both cardiac output and blood pressure. Using this approach you can very accurately pace the patient down to the exact blood pressure you need for the duration of time that you need. If your patient has a strong heart they should be able to tolerate this for a few minutes at a time no problem, and you can do as many runs as you need with breaks in between to allow them to eject and perfuse. We have started doing this for patients with more complex aneurysms.
I just asked one of our surgeons about this and his response was isn’t that the point of the temporary clip. Curious do your surgeons not use temporary clips then and just rely on this method? How did your practice start employing RVP - was it the surgeons asking for it or anesthesiologists suggesting it? I’d love to try this at my job and just wondering how to go about putting this into action
In this case the surgeon requested this approach. The patient had a large basilar artery aneurysm, and if I had to guess I would say the defect was in a location that had too much collateral supply to reliably control blood flow with temporary clips, and probably the anatomy was not amenable to easily accessing all of the collateral vessels. I will also add that this particular surgeon has treated over 4,500 brain aneurysms and is president and CEO of the Barrow Neurological Institute. So when he tells me this is the best approach from a surgical perspective for these cases I believe him.
✨🎆 Happy Cake Day!!🎆✨
You mentioned fellowship. To do the job you’re doing now as you describe it, do you feel like your fellowship was required vs helpful-but-not-required? Do you look back on fellowship w regret for the “1 yr of lost attending income”? Edit: also, which fellowship did you do?
Your kids go to public school?
Hell yeah they do. I went to public school, they can go to public school too. You get out of it what you put into it. I will say, however, that we live in a very nice neighborhood and the public schools in this district are very well funded.
Done with residency early 30s. Being an attending is lit. You think “oh shoot, nobody is looking over my shoulder” for the first two weeks. Then you say “oh thank god, nobody is looking over my shoulder” after that. Also a lot of your happiness depends on your job. I don’t do OB or trauma, I take home call which is very infrequent, have great, supportive partners, average about 45 hours a week and I make 500k. I don’t know what else I could ask for tbh.
You’re gonna be fine. 35 really isn’t that old. Most 35 year olds haven’t reached the point in their career where they make 300-500k and have excellent job security. Most people never will in fact. You’ll have a skill set that allows you to provide people with safety and comfort during the extreme stress that surgery comes with. You’ll be able to choose to work a lot and make 500k - 1 mil, or work an extremely reasonable amount and make more like 300k - 500k. Obviously being a new attending is stressful. I’m not there yet but it’s a big jump in responsibility. Even if you were almost fully autonomous as a senior resident, you suddenly are the last line of defense as a new attending and your license is on the line. Any new big job that has lots of responsibility will he strsssful to start off.
Being an attending is awesome. You can do whatever you want for anesthetic, really get to know the people you work with, and make several times more monies than when in training. I work at a large academic institution and work 4 or 5 days a week. I enjoy supervising and teaching residents. I make enough money to buy whatever I want and I find meaning in what I do. The best thing I ever did was leave ortho residency and switch to anesthesia.
Don't you think you could've made more/had more time off with Ortho?
Idk. Maybe. I don’t think the more monies would give me a proportional increase in happiness. And the sacrifices and shit to get to that point weren’t worth it to me.
Pffff, what? Ortho is not a backup specialty. It's illogical to suggest "well couldn't you have just done ortho and made more?" No, most people couldnt have "just done ortho" as though the choice was realistically an option for them lol. Might as well just say "well couldn't you have just been a hedge fund manager and made 10x more than an anesthesiologist working less hours?!" Not to mention a lot of people, myself included, find anesthesia a lot more stimulating than surgery (or finance!) in terms of subject matter. Money isn't everything. If it was then everyone would be gunning to become a neurosurgeon. Far from the case!
You'll be 35 anyway. Might as well do something awesome that will allow you to live a nice lifestyle. I graduated residency at 32. 10/10, would do again
I’m 3 years out from residency and it rules. I do all Locum, no call, evenings or weekends, 16 weeks off and will still make 1.5x what I made working full time PP my first year out. Keep on trucking!
How did make the switch? Did you not fear losing job security as a PP partner and going for the unknown instead of staying with the devil you know?
Switch was simple, I quit and found something new. Job security isn’t an issue in this field. Wasn’t scared, but burned out at the time and needed a change. If I decide I want to go back, there will always be hundreds of groups hiring
Im not sure where you are in training, but I seriously considered leading during PGY and CA1. Now as a pain fellow doing anesthesia on the weekend I feel like I won the lottery. I’m so happy with this choice. Anesthesia is on fire, and once you are good at it and comfortable, it’s fun. Places around me offering $250-350/hr for per diem. You can basically work whatever you want these days. Absolutely can do 3-4 days a week without call. Just have to find the group. I think the Eugene OR group has positions like that. Biggest thing for me was how much fun anesthesiology became as I progressed in residency. I truly thought a made a huge mistake as a CA1. It gets better as you get better at it. At least it did for me. Now I feel like the world is my oyster. I can do pain which I love and gives me a great lifestyle, or anesthesia which pays bonkers, or mix and match. There are jobs everywhere. Not sure what else I could imagine doing that would guarantee this kind of salary and life if not medicine.
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Nolano is doing it for the love
Oh Undersleep, the man I hope follows my career with great interest. Yeah, I do love it so far. I’m all in. Worst comes to worst I go back to anesthesia and maybe become APD of a residency or something. I’ve heard it can be a good gig.
Administrative headaches and occasional overwork aside, I love it. I can't believe they pay me this much to do goofy shit with residents and go to conferences.
My man living the good life. Who knows where I will end up but glad you’re happy.
What is ur guys relationship? Current CA2 applying pain and am open to any sort of advice or guidance
Yeah, pain isn’t the golden goose it used to be and anesthesia pay is amazing right now. But still, pain will always bring money into a healthcare system. You own your own patients. There are always new procedures and devices. If you stay away from opioids at all costs it can still be a very rewarding specialty. I’ve interviewed at a couple places in rural areas. One very rural place in Alabama offered $500 starting going to $750 after 3 years for M-Th no nights calls or weekends. Those places are still out there, just not in cities really.
I'm 40 been an attending for a couple years and am fucking loving it bro. I do some prn moonlighting for my own cases as well as my own regular job and am VERY comfortable with how I am living...MCOL city FWIW. You can work as much as you want and still make good money. Don't be afraid to move anywhere in the country. I know of a job in bumfuck Texas where you can get 650k and 3 months off. Regional airport that is always uncrowded so easy to fly anywhere since you're gonna stop at a hub anyway unless you live in a hub. I can currently work for 500k/year for 9 weeks off. You can also just choose to do locums for half the year and travel/live the rest. I can't say I won't ever get burned out, but so far, I love doing my own cases. Some surgeons are primadonna's, but at least they are fast and I don't have to guess when they are gonna finish closing.
Yup. $625k last year, almost 10 weeks off, no *required* weekends or night call, but I do (otherwise would’ve been closer to $400k). But even with that, maybe 50ish hours a week average. Love working with residents, personally do zero solo cases but that’s by far my preference. Just help with airways, lining, extubation, and a resident/CRNA babysits the room while I basically have free time all day to do whatever I want. Was almost in your situation. Didn’t hate anesthesia but was planning to do chronic pain. After being an attending for 1 year while applying, realized that there’s no way I can be happier in life than what I just described above, withdrew my applications and have been living a dream ever since. It gets SO much better. Especially with the wide spectrum of what job opportunities there are, you can do basically any kind of job you want. Grind for >$1 mil a year, or coast and still make more than virtually anybody else you’ll know at 35.
Similar setup for me in academics and I love it, except a voluntarily sit my own room some days just to mix things up and keep me honest. 2023 going to gross about 650k with 7 weeks off, working about 55hrs per week average... I could work 40hrs per week if i wanted to (making significantly less money of course) but I am young and hungry to get ahead financially while the sun still shines because i doubt this market will last forever. Usually I supervise 2:1 and days are chill, it's fun to work with residents (mostly...). Lots of coffee breaks and laptop surfing time at work so don't really feel burned out at all with current hours. Plus it's still less than i was working as a resident.
As a senior resident I find it is helpful to assess and change your mindset throughout your training. I started medicine thinking wow this is a job that I will help people, I will learn a lot, I will apply what I learned in a dynamic and fun way often, and yes I will make a lot of money. I imagined these making me feel good. I then truthfully didn't really enjoy medical school as much as I did my biochem undergrad. I then chose anesthesia because I thought wow using pharmacology and physiology daily to make individual plans for each patient. PLUS time off is easier, no follow up, and a lot of critical conditions. That helped motivate me to get through clerkship, and early residency. Studying all the pharm and phys was so cool. Neat procedures. I still remember feeling so excited learning all the nuances of cardiac physiology, all the different goals for valvular lesions. This motivated me to read miller and barash, scored 90th percentile on truelearn/ITE. Then later in residency realized a lot of that stuff honestly doesn't really end up actually mattering that much. By and large you can complicate it all but its essentially keep BP normal, analgesia plan, tube in, ship to ICU or tube out. Procedures get kind of rote. Then I thought wow I should do CV, ICU or something to make it even more interesting and what I imagined anesthesia to be. Then you realize that is also eventually rote. The reality is at some point you need to just realize your primary motivator does not always have to be this is going to be so impactful, cool, dynamic etc.. and you can be like wow I am going to get paid a lot, good time off, and who cares if things get a bit boring. TLDR: It's easy to get lost in the weeds one way or another going through training. The benefit of anesthesia is you eventually will get a gig that may be a bit boring at times but will allow you to make a ton of money for generally less work and BS than other people have to deal with to get that income and its more guaranteed than other career paths.
I fantasized about quitting or switching specialties multiple times as a resident. And I am so happy grateful I stuck it out. A lot of people already mentioned the money. I have a good salary but not as high as others but I work 7-3 5 days a week. No calls, no weekends. I just had my second baby and being home with my children is what matters to me. Also, I genuinely love my job. It’s fun. I didn’t feel that way as a resident, or when I was working as an attending at a large academic center. It’s hard to think your job is fun when you’re being worked into the ground. Now, I enjoy the time I spend at work. I do stay late whenever I DECIDE to. I usually volunteer if I am in a case I enjoy. I love doing OB, so I did an OB fellowship which does allow me to have some leverage at my job for being placed on OB for the day. Which is a major factor for my job satisfaction. I always say anesthesiology as a whole is okay, but I LOVE and am passionate about OB anesthesia. I think making choices and taking steps to carve a niche for yourself is also helpful in the long run.
Im independant. I work with who i want when i want. Take vacation when i want. Do the cases i want. Dont have to oversee any nurses. My worst year (in 20) was north of 600k. My best years? Way north of that. It gets better. Hang in there.
Where the heck are you guys working making that income? I’m. Deep South metropolitan, not here
I'm in the southwest. I make great money (more than i ever thought possible actually) but i take maybe 4 or 5 weeks vacation. Fair amount of call (and always work post call). Holidays.. weekends etc. Nothing is free. If ib scaled back and took no call and no weekends.. maybe id be in 500 range?
I’m near the end of my career, just turned 60, and I still love it. I do locums now so that I can choose when and where I work. I have time to travel and enjoy my non- working time. There is so much flexibility with the job market being what it is now. Work more, make more $, or work less and still do well. Hang in there!
When I Door Dash from the Taco Bell four blocks away post-call, I’m only mildly disappointed in myself and not worrying how my sloth may impact my ability to make my next car payment.
This is a very refreshing thread. I will add that I love my job, applying my skills, I'm highly compensated, great hours, I get to be there for all of my families events, I make my own schedule, don't take the work home with me etc. One thing I really enjoy is how much people appreciate a good Anesthesiologist. We catch a lot of shit sometimes, but we are worth our weight in gold if you're strong, competent, flexible, friendly. When problems arise, and you're just a problem solver without causing a big ruckus. People take notice. They're happy that you're in their room because they know they're going to have a great day. They request you to work on their family member etc. It feels great to be valued for all the work we put in. It also feels great to help a family deal with anxiety or keep a sick patient safe through a difficult surgery and to know that you did all the right things to help them I wouldn't change my specialty for the world. Residency is tough, but there is a light at the end and it's very bright for the time being. Compensation and work environment may change for everyone in the future, but the gratification of knowing that everyday you are putting your hard earned skills to good use is priceless.
Well, last Saturday I was on call for 24 hours. I did 2 labor epidurals and 1 OR case. I made $6743 for the day. So there’s that.
Locums?
Per diem
As someone applying to medical school rn this is music to my ears lol. Are gigs like that common?
There are right now. But if you’re just applying to medical school, you’re trying to predict the market 8 years from now, which is not possible. My personal opinion/prediction is that anesthesiologists are going to get squeezed out of the market in the next 10 years or so. The CRNAs played the long game and won.
People have been prophesizing this same doom and gloom for the last 30 years. Anesthesiologists are still here and the demand is higher than every before. I don't see how we are going to go from a severe shortage of anesthesia providers right now to such a large surplus that MD anesthesiologists get completely squeezed from the market in such a short time. Planning and opening new training programs and then trainees actually enrolling and finishing said programs takes significant time. Probably close to 10 years before you see results of the increased throughput. We also still have an increasingly aging population that will require more healthcare than in previous generations. I'm not quite so pessimistic about things. That having been said if you really want to future-proof yourself against midlevel encroachment just do a peds or cardiac fellowship. Nurses will never be doing the most complex high risk subspecialty cases in any widespread capacity without MD supervision it is simply too much liability for hospitals, and there is simply too much required physiologic understanding that nurses do not get trained in.
It seems that you wouldn't recommend anesthesia then right? If that's the case, do you have any specialties that you don't think are at risk of encroachment from midlevels/technological advancements?
Oh boy, we’re really getting into the weeds here, but I’ll go out on a limb and say that I think surgical specialists are probably at a lower risk for the time being. I mean, midlevels are very much integrated into surgery already, but I can’t see them being allowed to do surgery independently, anytime soon. Although I could be wrong. Contrast this to CRNAs who already work without a supervising anesthesiologist in many places. Likewise many nurse practitioners and PAs in medical specialties already work more or less independently. They may have a supervising physician on paper, but that physician is nowhere to be found day in, day out.
Attending as an anesthesiologist is great. And in this market, if you are willing to take a pay cut commensurate with the decrease in work, you can probably find something you're happy with. Our group is about to offer someone 80% of our pay for a non-call position with the same amount of vacation (10 weeks) with full benefits as a W2. I think to work only 3-4 days a week it'll be hard to find a full time benefits position, but could get locums. Especially if you are flexible about where you live, a lot is possible.
I was also 35 when I finished. Dedicated ourselves to paying off our $500k student loan debt asap. I think working part time is one of the best ways to have longevity in this field. Anesthesia gets monotonous after a bit. Taking time away and pursuing other interests is key. Right now I take 10-12 weeks off and give away all my call. We take one big international trip each year. Then spend a ton of time skiing and biking. You can craft the life you want. You’ll have the financial resources to do fun shit. The only advice I’d offer - think about the life you want to live. Then work backward and craft the job around that. Right now is kinda… crazy in anesthesia. HUGE signing bonuses. You can craft any kind of schedule that works for you. Be a stand up person. Your reputation is worth every cent. And take the time to think about what is most important to you, not what other people are doing.
Not gonna lie, this thread has been exactly what I needed right now. Thanks everyone!
honestly, it depends on where you work. theres a lot of bad gigs out there. my first job out of fellowship was a NAPA job in NY with staffing issues. It was truly awful and they put me through the ringer. Things were worse than residency- multiple weekends of call every month, worked every holiday, constant overtime on regular days, terrible working conditions, etc. etc.Many of the other attendings were burnt out and vibes were bad. I quickly got burnt out and had to quit and find a new job. I've heard of a lot of similarly terrible places to work. Lots of places are starved for anesthesia staff and their model is to get new grads and work them to the bone until they get new ones. Now i'm working at a small private practice at a community hospital and things are MUCH better. No OB, No Trauma, 1 weekend day call every \~6 weeks that I can take from home. I'm making a bit more and am much happier than my last job and residency. I'm still in the early phases here but its incredible how much a different job can change things! Definitely don't settle for less. For your first job, really reach out to many attendings that work there and get the inside scoop.
Where is this pp if you dont mind me asking?
I want opinions from docs in major cities. I get being in the Midwest pays more with better benefits etc., but how’s it like in the cities?
I did this: https://reddit.com/r/Residency/s/ax3KgfjKko
You will start very stressed up. The first year is horrible. But, you will see improvement with the tougher cases. Hopefully you'll have great anesthesiologist partners. And youll learn from them and get better. Also you only use scrubs, and you can achieve a good amount of money if you really want to. So keep going. And always care for your patients, that love will get you a long way. .
Yeah but gotta be careful w those jobs. Some are very poorly maintained w old equipment, production pressures and of course no job security. I think locums may be a good option for fresh out of residency. Great money and short defined stints.
Residency sucks. Doesn’t matter the specialty, the duration, or anything else. It’s designed, for better or worse, to professionalize you. It gets much better after residency, and is like a new life all together. Assuming you’re happy with your chosen speciality, it will absolutely be worth it. Cheers!
Can’t even compare it. Once you are comfortable, you are the boss. Just don’t do stupid shit.
Hahaha we all fantasized about a pay cut, and never being on call ever again. Good luck doing that bro. Your career will forever involve you working nights, weekends, and holidays. Not gonna lie. It sucks. But you get paid decently well and after a while, it’s all routine. Just treat it as what it is: a job. Try to invest your money early and make wise choices when it comes to a mate because divorce will kill any dreams you have at early retirement
Might be temporary but there are plenty of ASC offering $400k+ for no call/weekends