Mark J. Lema, M.D., Ph.D. Immediate Past President

ave you ever wondered why anesthesiology is now so popular with graduating medical students and top international graduates? Perhaps we have matured as a specialty to the extent that the daily challenges handled by anesthesiologists bring to prospective applicants an allure of never being bored.

Consider that anesthesiologists medically care for those who are pregnant, those who are under 1 year old, those who are the sickest, those in severe pain, those broken by trauma and those most vulnerable, all in the same work week. That fact, however, has been true of our specialty for the last 30 years, so why has it just been discovered by today’s graduates?

Consider, also, that those with Ph.D.s, M.B.A.s, M.P.H.s, M.Ed.s and numerous other health and business masters’ degrees are attracted to anesthesiology for the administrative, scientific and educational components to our practices. Is it possible that this era of graduating doctors seeks or demands balance between clinical and nonclinical professional activities that our hospital/facility-based specialty affords?

Consider, finally, that in recent years, supply and demand economics and the unanticipated upturn in the number of surgical and invasive cases have elevated anesthesiology salaries to among the top-earning medical specialties, often attained with one to three fewer residency training years. Can this change in potential salary levels motivate an entire medical graduating class to actively consider joining our field of medicine?

The Generation XYers are very sophisticated in planning their future career paths and intercalating them with life’s other activities (family, recreation, relaxation). As a department chair, I now receive more queries from first-year medical students and even college students about anesthesiology careers than in the previous 11 years. Have we done such a good public relations job in promoting our specialty to medical students who seldom encounter an anesthesiologist before their third-year rotations?

In thinking about the recent attraction to anesthesiology, I recalled the traditional reasons for selecting any occupation: power, prestige, money, interest. Add to that list: lifestyle, job security and job flexibility and one begins to understand the increased interest in our specialty.

Power, prestige and interest are personal decisions, based on core values and personality, which steer the candidate to investigate a few of the many medical specialties as possible career choices. The best and the brightest students can often choose among the traditional “premier” specialties with few residency spots. They are now opting to select our field. Lifestyle, job flexibility and job security are currently perceived as positive reasons for choosing anesthesiology, even though some who read this article may disagree.

Earning potential (money) has undoubtedly ranked among the highest reasons for selecting a particular career by graduating college seniors. Of those who select medicine, they must repeat the process by choosing a residency four years hence. Medical students have coined the acronym “ROAD to riches” to remind them of the top-earning specialties. This acronym “ROAD” stands for radiology, ophthalmology, anesthesiology and dermatology. That’s how we are currently perceived by today’s graduates — one of the money specialties.

Selecting any specialty exclusively for its earning potential puts the person at risk for being unsatisfied, bored and disinterested in his/her career choice, albeit at a high income. Many resident applicants, however, are faced with educational loan burdens in the $200,000 range. The average medical graduate in 2006 had an average loan burden of $130,000, or a payment of $1,878 per month for 10 years. It’s not hard to understand why they gravitate to the ROAD specialties in order to get a jump-start on loan repayment.

Thus, anesthesiology is perceived as being one of the “pop” specialties to consider as a career. Candidates evaluate our practices for those sites that pay well, have good flexibility (predictability) in work hours, provide challenging and satisfying work environments, offer many job opportunities, enjoy respect among medical colleagues, and provide job security. Recognizing the next generation’s motivations for selecting anesthesiology gives us a blueprint for maintaining and enhancing those elements of our practices in order to continue appealing to future medical graduates.

ASA leadership has developed our strategic plan to, among other key goals, maintain and advance these positive qualities to continue attracting residents into our specialty and ultimately keep our numbers adequate for the nations’ needs. Every anesthesiologist should view this strategic plan on the ASA “Member’s Only” section of the Web site to learn how he/she can help in advancing these objectives. While political action committee contributions are essential (only 11-12 percent donate), there are educational and scientific objectives that also need champions.

Even though we are enjoying a record number of highly qualified resident applicants into our training programs, complacency can easily reverse our successes. Earning potential may be the initial attraction for candidates to look at our specialty, but it will be the exciting daily activity of being an anesthesiologist that will hook them. We must work hard to keep what we do challenging and interesting for future applicants.

My three adult children could recite a simile I repeatedly conveyed to them ad nauseum that should guide our future efforts to remain successful:

“Continued success in life is like the childhood game of the ‘King of the Castle.’ You must fight like hell to get to the top… and fight twice as hard to stay there.”

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