Expert: Ronald Levy, M.D. - 1/7/2010

Question
QUESTION: Dr. Levy: I hope this question reaches you in good health. I have outstanding grades at USF in Florida, and I have been looking into attending medical school since Freshman semester. I am now second semester Junior, with a 3.93, and everything lined up to be competitive at getting into Harvard, or top schools if I choose. I have been shadowing a group of Anesthesiologists in my home town, and love it. I met with an Anesth. Assistant, and he told me about a two year program, in which his classmates of 40, all got jobs, lowest offer 115k, highest 150k. He said that Anesthesiologists generally start off making 250K. I love the field. The stability, and job are generally the same. But AA requires 6 years less schooling, and about 1/4th of the loans to attend school. AA's average here about 40 hours a week, while MDs 60+. I am just trying to compare the two. No offense, but it almost seems crazy to want to go into more debt, and a ton more schooling, (me being 25, instead of 30 when I start the job). I tried to formulate a basic living plan of mortgage, car, student loans, etc. But I need real statistics that you may know. On the web there are so many sources and they very so much. Some say Anest start making 90-180k a year. This would seem, insane, for that is on par, for less schooling and less debt being an AA.
So please, give me a basic run down of the positives and negatives for going down each path. And what expenditures do Anesthesiologist doctors truly have. How much is malpractice insurance for example, and how much would one expect to pay per month?, etc.

I'd also like to be able to formally greet you, and establish a connection. I tried looking up your email, but was unable to find it on the Texas website. You can send me an email to .

Thank you so much!

Respectfully,

John Q.

ANSWER: Which track you choose is up to you. There are several differences that need to be considered:

1) Knowledge: AAs and CRNAs may do the same job but they have a lot less knowledge of the underlying physiology, etc. It's a crude analogy but it's like car. Both laypeople and engineers can drive a car but only the engineer will know what to do when things go very wrong. IN GENERAL, AAs and CRNAs don't do the most challenging cases. It's a matter of what interests you.

2) Independence: AAs and CRNAs must work under the supervision of an MD. While in some smaller communities CRNAs have some independence, technically they must carry out the plans of the anesthesiologist. Do you want to work for someone or have independent thinking.

3) Compensation: Salaries vary and while CRNAs probably top out at 150-200, anesthesiologists (MDAs) can make (rarely) upwards of 500-600K. Generally in private practice they can expect between 240 and 450K. While you may have higher loans, once those are paid off, the difference is really noticable.

4) Quality of Life: Here CRNAs and AAs have the edge because they do shift work. Unfortunately, medicine is not a 9-5 job. If a difficult case is going poorly, the CRNA might decide to hand it off to the evening crew more easily than an MDA who willl finish what they start. People go into medicine not for the money but for the good they do for the community, etc.

5) Professional standing: In general, CRNAs are seen as workers while MDAs are seen as collegues. That professional respect is something you don't see in many fields.

In summary, it's more than just an equation of ins and outs. There are many layers to your decision and if you are competitive for medical school and truly enjoy it, then why settle for anything less.

I hope this helps,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

P.S. As far as establishing a connection, I feel that would be inappropriate and would prefer to keep the communications through AllExperts so that others may also benefit from the answers.

---------- FOLLOW-UP ----------

QUESTION: Thank you for the information. Can you briefly explain the fellowships that an MDA can obtain? I know there are only separate boards for Pain Management and ICU, and not for the others, (i.e. Cardiothoracic), and you've answered in another post that for the most part MDAs are all the same. Are you given preference on specific cases with those subspecialties? While your in the process of earning your fellowship are you working as a regular MDA?

Other then being board certified, is there a reason you might want to pursue fellowship in ICU/PM instead of the non-board subspecialties?

Thanks again.

Answer
Currently the only board-eligible subspecialites are Pain and ICU but by the time you get there, likely cardiac, pediatrics and/or neuro will also be there. In academic practices, subspecialists preferentially do those cases but in private practice, that is not necessarily the case. During your fellowship you are an MDA but you are functioning halfway between a resident and faculty. You tend to supervise residents on routine cases but the resident is ultimately under the supervision of the faculty. You form an intermediate layer.

As for why pursue a fellowship, it increases your knowledge in a particular area and that can never be bad. If you do an ICU or cardiac fellowship, you will be better prepared to handle the most critically ill patients. People do pain fellowships because it is an area that can be very lucrative, allows you to form your own practice and many MDAs don't like pain so they are happy to refer to you.


Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston