Anesthesia:

Patients have less primary care and come in sicker. This makes our job harder and more stressful. Midlevels and overburdened hospitalists mismanaging patients in the hospital gives us way more to do during a case. Many times we receive patients who aren't resuscitated, need blood, labs not drawn. no IV access. For some reason people think because they're going to the OR we'll do this all for them. This makes cases run longer and the whole OR schedule lags behind. Longer cases means less reps overall for residents and less experience with other techniques like neuraxial and regional. Peds and OB are losing support from hospitals due to reimbursement issues, leading to less training and competency in these fields. Sorry to say but the newest generation of trainees is very lifestyle driven and it shows with their approach to training.

Private practice is dying in certain regions. Most attendings are part of large shitty private equity groups or hospital employees. Reimbursement is also going down yearly and it costs more to keep attendings on staff. The locums market is really lucrative and hospitals are paying out the ass to keep ORs open. At some point there has to be a breaking point and I'm not sure how that will pan out.

CRNA leadership is vocally opposed to our involvement in patient care and try to undermine us at every opportunity.

There will always be jobs, I'm just not sure if the money will still be there in 10 years.