Showing posts with label ROAD. Show all posts
Showing posts with label ROAD. Show all posts

Wednesday, March 31, 2021

Anesthesiology Is An Elite Residency


It doesn't get much more competitive than this. Match Day 2021 has come and gone and anesthesiology has once again shown itself to be an elite residency. Out of 1,893 PGY1 and PGY2 positions available in the NRMP Match for anesthesiology, there were only three unfilled spots. That's a match rate of 99.8%. This is an improvement from 99.4% last year.

How difficult is it to match in anesthesiology? Let's compare it to other programs that are considered extremely competitive. Dermatology had six unfilled spots in the match. Emergency Medicine had fourteen unfilled positions. Radiology, part of the previously exclusive ROAD programs, had eleven.

This news is even better (or worse if you're applying for an anesthesiology residency) when you consider that the number of residency positions has been increasing every year. This year, there were 1,460 PGY1 spots available in the match. That compares with 1,370 last year and only 1,202 in 2017. 

The reason there are so few unfilled positions is that anesthesiology is becoming more popular with medical school students. This year, 5.6% of US MD seniors went into anesthesiology. That compares with 5.2% last year and only 4.6% in 2017. Despite the fact that there are more anesthesiology residency programs offering more positions than ever before, there doesn't appear to be any oversupply of residency spots yet.

The anesthesia residents aren't having any trouble finding a job either when they graduate. The job market right now for anesthesiologists is hotter than ever. From our own personal experience, we can't hire anesthesiologists fast enough, even as we're hiring CRNA's at the same time.

So congratulations to all the medical students who matched into anesthesiology. You have accomplished one of the most difficult tasks in med school. You're on your way to becoming one of the most highly sought after physicians in the medical field. You're not going to regret it.

Wednesday, April 26, 2017

The Myth Of The Anesthesia Work Life Balance

Many people have the impression that anesthesiology is an "easy" medical field, that it's all about the lifestyle. That's why it's been consistently one of the more popular specialties to go into, right up there with the other ROAD fields like dermatology or radiology. Well let me tell you, it's not. Anesthesiologists face work life balance issues just like any other intensely focused professional.

I once read that there are only three really important factors in your life: your work, your family, or yourself. The cruel irony is that you can only do two of those three things well. One of the three has to be sacrificed to make room for the others.


Most of the time for physicians, work takes precedence over everything else. That's why the subject of physician burnout is a staple of medical websites like KevinMD the way the Kardashians are all consuming on TMZ. All those missed dinners, getting called into the hospital, answering pages takes a toll on one's physical and personal life. Even if one manages to make it home at a "decent" hour, usually right after everybody else already finished dinner, the time is spent doing homework with kids, reading bedtime stories, or listening to the spouse complain how hard her day has been. What little Me time left is used up to pay the bills and, if I'm lucky, catching up on the day's news before hitting the sack for my nightly six hour power sleep. There is hardly any Me time for hitting the gym, binge watching TV, or tuning out and relaxing. That's the reality of being an anesthesiologist.


Occasionally cases get cancelled in the OR and I actually get out of the hospital while the sun is still out. Those days are all too infrequent and highly treasured. There is enough time in the day to watch the kids play their after school sports, maybe even go out for a nice relaxed dinner. Afterwards, I actually have the energy to make good use of the expensive gym membership that sucks my bank account dry because I'm in too much denial to cancel. Yes those are good days.

The impossibly balanced life
Some people do achieve a near perfect work life balance. You know who those people are? They are the doctors who only work part time. They may work only two or three days per week. They are the ones who organize the social calendar for the medical group, putting together retirement parties and social get togethers. These people are noticeably fitter and cheerier than everybody else since they've got time to go to their pilates class and volunteer for their school's PTA. They're also usually married to other highly paid professionals so they don't need to bust their butts to make ends meet. They're married to their safety net.

So for anybody thinking about going into anesthesiology because of the so called lifestyle, I'm just warning you that it's a total myth. Anesthesiologists work long irregular hours just like any other physician. While at work, the stress is constant as a life is on the balance every time you enter the operating room. There is little time to decompress once you get home before it's time to get up to face another day.

But it sure still beats general surgery.

Friday, March 18, 2016

Is Anesthesiology At The End Of The ROAD?

For nearly two decades, anesthesiology was considered one of the elite fields that medical students aspire to. Along with the other ROAD specialties (radiology, ophthalmology, and dermatology), anesthesiology was associated with intellectual stimulation, good income, and a humane lifestyle. But the specialty may be peaking, or even already peaked and heading back down to the ignominy of the 1990's.

Click to enlarge
Match Day 2016 results were released today to thousands of innocent and hopeful medical students this morning. For nearly everybody, there was news worth cheering. However the results for the anesthesiology match was less than sensational. Sure the anesthesia residency programs can tout that over 95% of their spots were filled this year. But as the NRMP chart shows,  that leaves the highest number of vacancies unfilled in the past five years.

Worse, the number of PGY1 positions being offered are increasing even though the number of U.S. seniors applying to anesthesiology has not, staying roughly in the mid 700's. This year, there were 1,127 PGY1 spots offered. Back in 2012, there were only 919, a 22.6% increase. Consequently the percentage of positions being filled by U.S. seniors has dropped to only 68.7%. This compares to a fill rate by U.S. educated seniors of 78.9% in 2012.

How bad is 68%? That's a number that feels more at home with the primary care fields which offer thousands more residency jobs than anesthesiology. Pediatrics has 2,689 positions and 68% filled by U.S. seniors. Internal Medicine has 7,024 jobs and 46.9% acceptances. Family Medicine has 3,238 and 45.3%. Meanwhile more desirable fields like Emergency Medicine managed to fill 78.4% of their spots with U.S. seniors. Orthopedic Surgery, 90.7%. Even General Surgery (categorical), supposedly a field nobody wants to enter because of the terrible lifestyle, filled 76.4% of their positions.

What about the other ROAD specialties? As usual, Dermatology was able to offer 100% of their jobs to U.S. seniors. Ophthalmology, though not in the official NRMP match, usually matches around 90%. Unfortunately for Radiology, it is also suffering the same kind of loss of prestige, with 61.6% of its PGY1 jobs going to U.S. students.

Is there any hope for anesthesiology? First we have to stop increasing the number of residency positions offered. We want the best and brightest medical students to go into the field, not try to fill residency positions out of a sense of desperation. Besides, many people already feel the anesthesia market is saturated and all the graduates have to do an extra year of fellowship just to find a job. Next, the ASA needs to find a future direction for the field besides the Perioperative Surgical Home. Yes the leadership feels that is the most compelling vision for the specialty. But frankly I didn't sign up for this gig to become an internist and compete with the hospitalists for a job. Finally, we need to make anesthesiology exciting again. This field has made some of the greatest contributions to the advancement of medicine. Why does anesthesiology feel like it's stuck in a rut? Why aren't there any smart companies developing exciting new technology to improve patient safety and monitoring? Why is the most talked about anesthesia tech in the past five years related to how to remove anesthesiologists from the procedure room? Why does the anesthesiology match every year feel more and more like a sinking ship and nobody wants to be stuck as the last one out?

Wednesday, May 28, 2014

The Sweatshop In The Radiology Department

I was talking to a good buddy of mine who is a radiologist at another hospital. To put it mildly, he was really bummed out. The radiologists in his group are all employees of the hospital. It seems the hospital has been telling them they need to crank up their productivity to maintain the hospital's efficiency goals. Otherwise they will not receive any bonuses at the end of the year. All films must have an official reading the day they are taken, even if there is a huge order of MRI's and CT's that got put in late in the afternoon. To save money, the hospital got rid of the transcriptionists so the doctors have to type in their reports themselves. This has been an enormous inconvenience for some of the older radiologists who can't type well. With all the work, my friend says he barely has time to grab a sandwich for lunch before heading back to his office to read more films.

I told him that my impression of radiologists was a bunch of guys who sit together in the darkroom joking around and drinking coffee while they leisurely review images on the lightbox. He said that may have been true a couple of decades ago but not now. He sits alone in his office all day in front of the computer monitor with hardly any interaction with his colleagues. If he had an MI in the office, nobody would notice until the cleaning crew comes in that night. He hasn't seen some of his fellow radiologists in months. Everybody is so busy that people are scheduling more sick time just so they can get a mental break from their work.

This certainly wasn't the future of radiology that I envisioned when I was in medical school. If it wasn't for the fact that I found radiology deadly dull as a medical student, I would have gone into this field. Being one of the ROAD specialties, it still carries great appeal with students who want to practice medicine with a perceived better lifestyle. In the latest Medscape Physician Compensation report, radiologists came in as the fifth highest paid specialty with an average salary of $340,000, ranking just above anesthesiologists.

But radiologists face unique challenges that don't afflict other doctors. The digitalization of radiographic images has made the job extremely portable. Teleradiology makes it easy for hospitals to outsource the job across town or across the country if a group is unable or unwilling to take on the responsibilities that is expected of them. The commoditization of radiology has made it possible for some hospitals to drop their radiology programs completely.

As reimbursements for all physicians fall, radiologists are supposed to compensate by increasing the pace of their readings. Unlike anesthesiologists who really can't work faster than the pace of the slowest surgeon, radiologists are expected to read a few more films each day to justify their income. Medscape's survey shows that radiology is one of the few specialties whose salaries actually dropped last year, by 2%.

I felt bad for my friend. I remember how excited he was when he matched into a radiology residency. I felt a twinge of envy at that time too. Who wouldn't want to sit around, talk to good friends, and look at pictures all day while getting paid extremely well for it? Now every time I talk to him, he sounds more depressed as he complains about his job. I told him he needs to take some time off so he could feel rejuvenated. He said he would, as soon as the twenty other guys ahead of him get their sick leaves first.

Wednesday, April 16, 2014

Anesthesiology Compensation 2014. Same Old Same Old

Here we go again, the latest physician compensation report from Medscape. I was once again one of over 24,000 doctors who filled out the survey that Medscape emailed out. Unfortunately, just like last year, I didn't win the iPad Mini for taking ten minutes to answer all the questions. Curse you Medscape.

Let's get right to the point here. Anesthesiologists reported a ZERO change in compensation last year. Nada. A big fat goose egg. On average anesthesiologists made $338,000, the same as the year before. That put the field in sixth place behind Orthopedics, Cardiology, Urology, Gastroenterology, and Radiology. Following close behind are Plastic Surgery, Dermatology, General Surgery, and Ophthalmology. Once again the ROAD specialties are well represented in the top echelons of physician incomes. At the bottom of the list are the usual primary care fields: Infectious Disease, Family Medicine, Pediatrics, Endocrinology, and Internal Medicine.

Male anesthesiologists made much more than female colleagues, $350,000 to $295,000. And that has nothing to do with female wage discrimination. From personal experience, male doctors work their butts off while the women tend to work shorter days or part time. So don't go spouting liberal Democrat propaganda on me.

The sections of the country with the highest salaries were in the North Central and South Central states. The least generous compensation was in the Pacific Northwest, followed by the West and the Northeast. Coincidentally or not, the highest paying regions also happen to be where the economies are the strongest due to increased oil drilling activity. Hmm. You think there's a link there somewhere? Maybe doctors should advocate more oil fracking as a matter of self preservation.

Overall, fifty percent of anesthesiologists were satisfied with their jobs, with 54% content with their income and 48% who said they would choose the same specialty if they had to start over again. That compares to an appalling 27% of IM and 32% of FM who would choose their line of work again.

Anesthesiologists also happen to spend the most amount of time seeing patients. Nearly eighty percent said they saw patients at least forty hours per week. That is actually a good thing since we get paid based partly on the amount of time we are treating patients. By comparison, only 27% of dermatologists saw patients for more than forty hours. And they were number eight in total compensation of $308,000. Again, that's part of the allure of ROAD.

This report is the last one that can be compared directly with previous years. From here on out the shadow of Obamacare will loom large in the compensation of physicians. To what extent won't be known until the next few years' worth of survey results are in. Until then, anesthesiologists better enjoy the good thing they have going right now.

Wednesday, January 29, 2014

The Worst Lifestyle in Medicine

Thanks to the latest Medscape survey, dermatologists were crowned as having the best lifestyle in all of medicine, confirming what every medical student, resident, and attending physician already knew. On the flip side, who did Medscape consider to lead the worst lifestyle? It probably comes as a surprise to no one that family medicine and internal medicine were singled out as having the worst quality of life in the medical field.

What makes FP and IM so lacking in appeal? First of all, they appear to be the unhappiest doctors at work. Only 36% of FP's were satisfied at work, tying with emergency medicine at the bottom of the list. IM was not far behind, with a 37% satisfaction rate, tied with radiology for third/fourth worst positions. All this misery carries over to the home life too, with only 61% of FP's being happy when they leave work. This leaves them below the median of doctors surveyed.

Perhaps primary doctors would feel better if they got away from all that stress at the office. But unfortunately, only 13% of FP's and internists took four or more weeks of vacation last year, near the bottom of the list. By comparison, anesthesiologists were the most generous at giving themselves some R&R, with almost half getting at least four weeks of time off. This has contributed to FP's being the second heaviest group in the survey. Forty-eight percent of FP's say they are overweight or obese, being outweighed only by the other stressful field, general surgery.

To make things even worse, the terrible reimbursements given to primary doctors for talking and listening to patients have left their finances in shambles. FP and IM rank at the very bottom of physicians who feel they have adequate savings stored up. By comparison, the ROAD fields all rank near the very top in amount of money saved up for future retirement. That is not good news for policy makers who are trying to recruit more medical students into primary care.

So all this talk about training more primary care doctors to treat the tsunami of sick patients with their new Obamacare insurance cards is quixotic at best. The law's promise of paying Medicare rates for all these new Medicaid patients for a very temporary two years is laughable. Nobody plans his career for only the next two years. All these patients will still have nowhere to go when they get sick except the emergency room because there won't be enough doctors to see them for the money they are getting paid.

Tuesday, January 28, 2014

Revenge Of The Dermatologists

The New York Times may have been trying to discredit the work of dermatologists with its recent page one character assassination article. However, I think it only highlighted the reasons so many medical students want to go into that field. The paper may fault dermatologists for making over $500,000 per year performing Mohs surgeries, but they are only filling a need that is demanded by the patient population.

Now Medscape has released its physician lifestyle survey for 2014 and guess what? Dermatologists come out on top as having the best lifestyle in all of medicine. Better than gastroenterology, radiology, or even anesthesiology. Dermatologists were found to be the second happiest at home and at work, second only to ophthalmologists. They were also the least likely to be overweight. Over 70% of normal weight dermatologists exercise at least twice a week. They were the most likely to consider themselves to be in good health. And for the icing on the cake, dermatologists were near the top in having an adequate amount of money saved in their bank accounts.

So the New York Times may have thought they were exposing a shameful scandal when they wrote about dermatologists. But I think they did the field a great favor. Though their intent may have been to shame the doctors by exposing their income, I think most medical students will only see all those big fat zeroes at the end of the dollar sign. And if the doctors do a good job, most patients will not begrudge them of their fees. So here is a big fat middle finger to the Grey Lady for trying to smear a medical profession that is only trying to do its job. Next time maybe they should pick on professionals who truly have outrageous incomes, like sports figures and bank executives. But of course they might lose big advertisers if they did which means they never will.


Sunday, January 19, 2014

Doctors Under Siege--Dermatology

The vilification of physicians by the New York Times continues. In the past few months we have seen the specter of gastroenterologists, obstetricians, and emergency physicians being accused of greed and, well, more greed. They have been unfairly targeted as the drivers of exorbitant medical costs in this country. The spotlight now shines on the next medical specialty that will drive the downfall of American medicine--dermatology.

In today's issue of the Times, the paper attacks dermatologists for providing the life saving service of skin cancer removal. Specifically they target dermatologists for overcharging patients for Mohs surgery, a specialized procedure where skin cancers are meticulously removed thin layers at a time so that there is minimal cutting and scarring. The paper highlights the ordeal of one patient, Kim Little of Arkansas, who went to her dermatologist for removal of a basal cell cancer and wound up with medical bills of over $25,000. According to Ms. Little, her dermatologist took 15 minutes using Mohs to remove the tumor. He then directed her to another office for the wound to be closed by an ophthalmologist because it was close to her eye. There she was sedated by an anesthesiologist and given two dozen stitches on her cheek. Her bill included $1,800 for the Mohs, $14,000 for the plastic surgery, $1,000 for the anesthesia, and $8,700 for hospital charges. She claims she felt railroaded into undergoing such an extensive procedure for a small lesion and that she felt drowsy from the anesthesia for five days afterwards. She complains that she didn't feel like she had any choice except to accept what the doctors directed.

Oh my. These statements practically blame her doctors for fraud for charging so much money. It isn't until much later in the article does the paper say how much she ultimately paid for her care, $3,000 out of pocket according to her insurance policy. The piece doesn't bother mentioning that practically no one pays the full cost of a hospital bill. These bills are almost always negotiated down by insurance companies, as the ophthalmologist's 90% reduction in his charges attests to.

The Grey Lady blames dermatologists for stuffing their pockets by doing too many Mohs surgeries. It states that the number of Mohs has increased over 400% in the last decade. Never mind that people have been covering less and less of their bodies in public over the last few decades, leading to higher incidences of skin cancers. But it wasn't enough for the paper to blame dermatologists for America's high medical costs. They go on to wage class warfare by blaming all doctors who make more money than the paper's editors. Of course primary care doctors continue their saintly image by being the lowest paid physicians.

They don't begrudge the huge average salaries of spine surgeons, and neurosurgeons because they can only perform a couple of complex cases a day. They must work REALLY hard for their $800,000 plus annual income. The usual suspects are again indicted: the ROAD specialties. Dermatologists, ophthalmologists, (and gastroenterologists by default because of their high salaries), are accused of padding their incomes by performing multiple minor procedures a day, justified or not. Anesthesiologists and radiologists are lumped into this rogue's gallery of doctors mainly for what appears to be a humane lifestyle. In other words we don't work hard enough for our money. Apparently we specialty physicians fill the majority of seats on the AMA's review board on physician compensation while leaving the poor primary care doctors to pick up the crumbs.

Is it really a sin for doctors to make money? Nobody cares, and they even applaud, when internet companies produce thousands of millionaires practically overnight. Do most of those employees deserve that money? No. They just happened to luck into a job that was anointed the hot company on Wall Street. Meanwhile doctors, who are some of the smartest people in the country, are berated for using their smarts to make money taking care of patients instead of writing lines of code. We keep thousands of people employed at medical offices, hospitals, insurance companies, pharmaceutical companies, and myriad other industries. We don't just make our hard earned money to buy new toys.

The newspaper seems to feel that doctors should return to the age where we accepted chickens and homemade canned goods for compensation. If Bill Gates can have a net worth of over $70 billion for charging money on computer software that is a necessity for almost all computers in the world, well he is the smartest person on earth and deserves his wealth. But it's just not fair that physicians should be making any kind of income on a service that should be universal and almost free of charge.

Friday, March 29, 2013

You Can Kiss The R's Goodbye

This is sobering news from the New York Times for the radiology profession. According to the paper, radiology had one of the fastest decline in income among all medical fields. I guess we can now leave the R out of the ROAD to happiness in medicine.

The paper used the example of St. Barnabas Hospital, which is canceling its radiology residency program. The hospital is outsourcing its diagnostic radiology functions to a teleradiology outfit, which can do the same job for less money. Understandably, the new radiology servicing company refused to carry on the residency program. In its attempt to sound politically correct, St. Barnabas said it was shifting the government's residency training money from the radiology department to the primary care residencies, opening up more spots to train internists. Uh huh.

Now the poor radiology residents at St. Barnabas are scrambling to find another residency position, anywhere. They have even been directed to other hospitals where they have to pay for their own salaries and insurance but can continue their training until they graduate. That only adds about $65,000 per year to their six figure medical school debt. What a deal.

Of course many people have seen this coming for some time ever since medical imaging turned all digital. With digital files, anybody anywhere in the world can quickly review a film and type a quick read back to the source. If there is nobody willing to read a CT at 3:00 AM in one hospital, there is probably somebody who will do it in a different time zone for probably less money. Therefore there is less incentive for smaller hospitals to pay for radiologists to staff the costly night shifts.

As a result, radiologists' salaries have dropped ten percent in one survey. This probably isn't going to end well as more hospitals hire teleradiology sweat shops to read their X-rays for them at a lower cost. Without the need for having a living breathing radiologist present in the building, there really is little incentive for hospitals to keep paying the huge salaries currently commanded by the specialty.

Wednesday, November 3, 2010

ROAD To Riches Goes Through Anesthesiology

The recent issue of the Archives of Internal Medicine made headlines with an article about the wage disparity between medical specialties.  As expected, primary care physicians made less money than their surgical and specialty counterparts.  Internists and pediatricians were found to make about $50 per hour while medicine subspecialists made about 36 percent more money and the surgeons made about 48 percent more. The highest paid physicians were in neurosurgery, dermatology, ophthalmology, and orthopedics. They make about $50 more per hour than general surgeons who in turn make about $24 per hour more than internists.

What's shocking to me isn't the large difference in salaries between physicians, which is not a surprise. It is how little primary care doctors make. Fifty dollars an hour after four years of college, four years of medical school, and three years of residency? The internist salaries also don't take into account all the time they spend calling in pharmacy prescriptions, taking questions over the phone, arguing with insurance companies, filling out paperwork, and hundreds of other mundane but necessary tasks of being an internist. My accountant charges me more than that on an hourly basis answering my emails. And he expects to get paid too--none of this refusal to pay your copays or insurance denials to ding his income.

One interesting result of the study comes towards the end. The authors specifically excluded the salaries of radiologists and anesthesiologists because the wage disparity between primary care and specialists would have been even greater. Anesthesiologists' salaries would have skewed the results so badly that they were deliberately left out of their study! Got that? We make so much money that they can include the salaries of neurosurgeons in their study but not ours. Is it any wonder that medical students are flocking to the ROAD specialties while abandoning Internal Medicine to their selfless or masochistic classmates?