Choosing a Specialty

I recently got a great comment from a medical student interested in anesthesia but concerned about the future of the specialty. There is a worry that with independent nurse anesthetists and the development of big business in medicine, anesthesiologists may have a loss of independence, longer hours, and lower salaries. How does someone contemplating a medical specialty factor in these uncertainties into their decision?

I have no crystal ball and have no idea what the future portends in anesthesiology, any other specialty, or medicine in general. Even more, I don't think anyone does. There are many instances in the last few decades where very smart people have made very wrong predictions about medicine's future, changes in supply and demand of the workforce, and the economics of medicine. In fact, within this field, an incorrect prediction in the mid-90s that supply would exceed demand led to a shortage of anesthesiologists.We went through a spell when residencies didn't fill, and jobs were fighting to hire any anesthesiologist. Today, the pendulum has swung to the other side; we have become one of the more competitive fields and the job market isn't wide open. But I've also read predictions that surgical volume will continue to increase, and the demand for anesthesiologists will grow in the future. I honestly don't have the background or skill set to guess what will happen on the business side of things.

When I talk to medical students about this issue (or to undergraduates contemplating medicine as a whole), I have a particular take. I put in the caveat that I have managed to pay off my debt, that I don't have a lot of financial obligations, and that money was never a particular priority. I also don't mind putting in the hours, and I'm generally content wherever I am. If I had the chance to redo everything, I would go back into anesthesia here at Stanford in a heartbeat. I love what I do, I am privileged with the opportunities I get, and I live a very happy life.

But I get the concerns prospective residents have. It's a big commitment, a long road, a lot of work, and the payoff is not monetary. These days, it's not even social status. There used to be a lot of respect given if you were a doctor; where I am, though, it's not a big deal. Medicine has changed; a well-respected occasionally-lucrative specialty two generations ago, it has now lost that appeal.

To those looking at anesthesia in particular, I feel that you have to be okay with long days and hard work. We will see more and more surgeries in the future in patients who are older with more comorbidities. There will be more complex and innovative procedures - today, I was in a robotic pancreatectomy - and we're seeing more out of OR anesthetics in places like interventional radiology. The anesthesiologist's life will not get easier. There will also be a bigger push for things like efficiency and throughput, which might feel constraining on our specialty. Furthermore, pay will not increase; with the huge spotlight on the cost of medicine in America, it's unlikely that Medicare's poor reimbursements for anesthesia services will change. Along the same vein, independent practitioners like nurse anesthetists may encroach upon our specialty. And there are other downsides - patients don't consider us "their" doctor, malpractice insurance can be exorbitant, and larger anesthesia groups are slowly absorbing the older partner model.

Nevertheless, anesthesia is a specialty unlike any other. The things I love about what I do are timeless. Patients come in anxious, terrified, at a crossroads in their life. Though brief, the interactions I have with patients endear them to me, and for some, endear me to them. It can be an intense time for them, and you become their lifeline. Anesthesia is the only specialty where you act as a physician, pharmacist, and nurse all at once. We get immense instant gratification in what we do. We have to multitask in acute situations. We have to be adept at procedures and familiar with every disease state. Other physicians turn to us in true acute crises, and we get that adrenaline, excitement, and terror when a life-threatening situation arises. I love all of those things, and I don't know that many other jobs have the same milieu. Will all that excitement fade away? Perhaps but perhaps not. I think that most physicians who are burnt out and regret going into medicine have lost that magic in what they do. But I also see plenty of physicians - mostly my mentors and teachers here - who are excited and thrilled to go to work every day.

There is no perfect specialty, but certainly some are more suited for particular people than others. I am lucky to have made the right choice for me, and I wish the best for those trying to figure out their life paths. I hope this blog helps.