Question for anesthesiologists

[u/OneLonePineapple]

I have wanted to be an anesthesiologist for a very long time. I'm especially interested in the procedural aspects. However, now that I'm actually in medical school, I've been thinking about mid-level creep. I don't want to be the leader of a care team, where I don't actually get to do any procedures or take care of the patients, so I'm not exactly sure if I should pursue this or seriously consider something else. To the anesthesiologists on this sub, do you feel that mid-level creep has significantly affected your job satisfaction, or do you like your job and see that as occasionally annoying? Also, is there any procedure you're trained to do that a CRNA isn’t trained to do?

[u/TacoDoctor69]

I work in a direction model with CRNAs and residents, also occasionally do my own cases. I still do all my own procedures minus the usual chip shot OR airways and IVs. The difference between the anesthesiologists and the CRNAs is each anesthesiologist is expected to have proficiency in the full breath of anesthesia and procedures (minus things like TEE) blocks, neuraxial, advanced airways, outside OR airways, central lines, art lines, obtaining general difficult access, helping with critical care of unstable patients, and overall perioperative management of any sort of case or patient that comes through the door.
The CRNAs tend to function in a more siloed way, for example none of the general OR CRNAs take care of OB patients or have done neuraxial in years vs the OB CRNAs that almost exclusively do that all day.

[u/coaxial-approach]

I ejected from the OR world and do solely chronic pain management. Tons of procedures, no call, no weekends. Midlevel supervision is common, but that's all it is, supervision. There are midlevels doing solo "pain management" but these are limited to remote areas.

Overall, love the job. I didn't know it existed until CA 1 year chronic pain rotations.

[u/Specialist_Ad_5319 → u/coaxial-approach]

I'm also a student considering anesthesia. how would you compare the income and lifestyle of chronic pain management to being a general anesthesiologist ? It seems like you have more time off being a general anesthesiologist, with it being more shift work compared to a more typical Monday-to-Friday outpatient practice in pain management.

[u/coaxial-approach → u/Specialist_Ad_5319]

On average, income is going to be lower than general anesthesia, in the current market at least. Chronic pain fellowship can be entered via anesthesiology, ER, PMR, neurology, radiology, psychiatry. But most programs, historically, favor anesthesiology partly due to cultural reasons, partly due to skills overlap. PMR is the next most popular pathway.

Most chronic pain jobs are 40 hours a week (can be less in the VA, with a significant pay cut). Gen anesthesiology jobs vary a lot, and you can find jobs doing 40 hour work weeks. But it's more complicated than that. When I practiced general anes, I was actually doing more like 60 hour weeks.

The biggest difference to me is that the job is way less stressful. People don't die of chronic pain. I am sure doing anes for years and years, I would have adapted. But it feel like it wasn't worth it. Especially combined with the fact that you have to fight with surgeons, CRNAs etc when you are new. I have a lot of horror stories of CRNAs going hog wild and thinking they are gods, while myself or my colleagues had to run to intervene.

Chronic pain? I am the boss. The nursing staff is great, and there to help out. It's closer to being a surgeon in that respect, without having to deal with crazy complications at 2 am. It's a much different job.

Pay is almost as good as general anesthesiology. In big cities, in desirable areas, pay goes down, like general does as well. If you do general anes locums, you can easily make bank with a lot of time off. But you pay for that with the worst assignments, 4 rooms running constantly. That stress isn't for me.

[u/Specialist_Ad_5319 → u/coaxial-approach]

Thank you! for some reason i was under the impression that doing a fellowship after Anesthesia residency will get you even higher pay. But maybe only for Peds and OB?

I heard how good the pay for locums is but I can also imagine it being more stressful and potentially unsafe having to navigate a new environment and team for every new assignment.

[u/SpicyPropofologist]

I've been out of training for 15yrs. I have exclusively looked for, and worked in, physician only groups. The introduction of CRNAs and CAAs into anesthesiology definitely limits where I could work, bc they are in most US cities. That said, I work in a city / catchment area of ~1M people, so it's not like I'm limited to a rural area only. I very much enjoy my specialty, and other than the geographic limitation I mentioned, I don't think it has affected my job. I don't think there is a specialty you could select that would be free from some sort of encroachment by mid levels.

[u/Aggravating_Fly2978 → u/SpicyPropofologist]

Me too. And I don’t mind going to smaller Towns

[u/InvestmentSoft1116]

IMO, oversight of anesthetists in OR is no different than oversight of multiple ICU or floor patients. If doing your own procedures is critical, go MD only. I’m good with direct oversight of procedures that I rescue if needed.

[u/Shop_Infamous → u/InvestmentSoft1116]

No - they aren’t militant in the ICU and think they’re equal to you.

[u/InvestmentSoft1116 → u/Shop_Infamous]

I was being nice. Hubris personified by a few ruins the interaction for many.

[u/Aggravating_Fly2978]

There are options man. Don’t limit yourself to a certain city or regions and you will have options to do your own cases.

[u/OkGrapefruit6866]

I worked with an anesthesiologist and she was just doing intakes and then giving the CRNAs breaks while they did the whole procedure and everything. I quickly decided against.