Expert: JM Starkman, MD - 4/18/2010

Question
Hi,

I am a 3rd year medical student considering anesthesia as a career. My question is what do you think of the future of MD Anesthesiologists? With the rise of CRNAs and the new health care bill which may suppress physician salaries, it seems hospitals seem to switching over to using CRNAs rather than Anesthesiologists to save on expenses. Do you feel that the field will one give way to the CRNA putting the MD Anesth. out of business? Do you feel that it will become more and more difficult to find a job as a CRNA. I ask since I was reading a few articles online about the 15 states (including CA which is where I would eventually like to practice) that have already opted out of the Federal Supervision Requirement requiring that CRNAs be supervised by an MD Anesthesiologist and was worried what salary/job prospects will be like over the next 10, 20 or 30 years.

Also, is there anything I can do to help ensure job security in the field such as specializing in a fellowship past my residency in Anesthesiology? If so which ones are least likely to be taken over by CRNAs? Thanks for your help and I really appreciate any advice you can offer.

Sincerely,

Neil Kamdar, MS3

Answer
Greetings, and thanks for the provocative questions.   As patients get less and less 'attached' to medical decision-making and insurers and govt take over those duties, we'll see cost become the issue (commoditization) as opposed to quality of care...........and more CRNAs will be doing the actual anesthesia.  Groups like the American Society of Anesthesiologists don't whole-heartedly disagree with this plan as so many of their members are leveraging their income based on the supervision of CRNAs right now.   Salary and job prospects are good in the short term---but long term is anyone's guess as to how long this whole 'medicine' thing is going to be viable in any specialty.  Most of my peers feel that anything outside of federal/govt control that can be managed by patients and doctors without the middleman is a good bet: cosmetic surgery and derm, ophthalmology(LASIK and other direct payment treatments), anti-aging medicine, etc.

A fellowship won't ensure job security for you--only job security for those making money off your efforts during fellowship!  Unless you're looking for an academic/research position, an elective fellowship isn't worth too much.  Pain management fellows will learn the details of that subspecialty, but that area retains all the problems inherent in govt medicine.

Do as much research as you can to get a wide variety of answers and formulate your own picture of the future.  You might try the American Association of Physicians and Surgeons website (www.AAPSOnline.org) for some important input.  Best of luck.