Anesthesiologist Career Guide: Education and Salary Overview

There’s a reason anesthesiology is one of the highest-paying fields of medicine in the United States. These highly trained healthcare professionals perform a crucial medical function.

Anesthesiologists administer anesthesia to control pain and keep patients appropriately anesthetized during surgery. While surgeons may apply their expertise in the operating room with a scalpel, positive surgical outcomes wouldn’t be possible without the collaboration of an expert anesthesiologist.

In this guide, we take a deep dive into the education and training required to become an anesthesiologist, along with job duties, salary and career outlook, and the skills needed to succeed in this vital healthcare role.

Anesthesiologists are highly trained medical doctors who specialize in sensation and pain management. They typically administer and monitor local, regional, or general anesthesia (or sedation) before, during, or after medical procedures, like surgery. Unlike many other medical specialists who split their time between private offices and operations, these professionals spend most of their day in the operating room.

Anesthesiologists commonly work alongside nurse anesthetists, surgeons, and other doctors. In addition to administering anesthesia, these professionals are also responsible for creating patient-specific care plans, monitoring patient vital signs during medical procedures, and supporting patients through recovery.

There are many anesthesiologic techniques, with local, regional, general, and epidural anesthesiology being the most common. Anesthesiologists working with patients who are undergoing major procedures, like joint replacement or open heart surgery, usually administer full sedation. Anesthesiologists typically administer regional anesthesia for childbirth and surgeries of the extremities or abdomen.

Anesthesiologists typically work in rural and urban hospitals, clinics, private offices, and ambulatory care facilities.

An anesthesiologist’s schedule varies considerably, even across similar settings. Some private practices offer traditional Monday-Friday hours, but most anesthesiologists work 40-60 hours per week, either on-call or on rotational, night, and weekend shifts. Anesthesiologists can also work in universities, training the next generation of professionals.

Anesthesiologists must be dedicated and detail-oriented. They also need to work well under pressure and have excellent problem-solving skills. Because patient satisfaction with anesthesia is a key measure of quality healthcare, anesthesiologists also need strong interpersonal and communication skills.

Becoming an anesthesiologist involves several stages of training. In general, anesthesiologists must complete:

Next, they must pass the national board exam, complete a fellowship program or spend two years in private practice, acquire certification, and take a licensing exam. Once licensed, you can begin your career as an anesthesiologist. Below, we take a deeper dive into each step.

Physicians who specialize in anesthesiology begin their academic journey with an undergraduate degree from an accredited college or university. Since you can’t major in anesthesiology at the undergraduate level, you may be wondering, “What bachelor’s degree should I get to become an anesthesiologist?” You have several options.

Many students choose science-related majors — like pre-med, chemistry, or biology — to build a strong foundation for medical school. However, most medical schools do not require applicants to have a bachelor’s degree in any of these majors for admission. The most important thing, regardless of major, is that you complete a pre-med track, which includes the prerequisites for medical school.

The reason why many students choose science-related degrees is that these majors feature courses in biology, calculus, chemistry, and physics, all of which help prepare you for the Medical College Admission Test (MCAT) and medical school.

The MCAT is required for admission to medical school. Along with evaluating your analytical skills, it tests your knowledge of biology, chemistry, psychology, and sociology. With MCAT scores in hand, you can then apply to medical school, where you must earn either a doctor of medicine (MD) or a doctor of osteopathic medicine (DO) degree.

Both MDs and DOs can specialize in anesthesiology. You should consider whether you want to receive training in whole-person patient care and preventive medicine, as in a DO program, or whether you prefer the conventional Western medicine training in an MD program.

Once you’ve completed two years of coursework, you take a test called Step 1 — often referred to as “boards.” Boards are required by the United States Medical Licensing Examination (USMLE) for MDs and by the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) for DOs to obtain a medical license and practice medicine.

After your boards, you must complete two years of clinical training, which involves working with patients with a variety of conditions under the supervision of an experienced physician. Clinical training concludes with the Step 2 test, which has two parts:

To qualify and enroll in a residency program, you must:

On an annual Match Day, a computer program aligns you with residency programs based on your preferences and performance. Once a match is made, you can expect to spend four years completing your residency program. The first year is a “base year” of non-anesthesia training, followed by three years of focused clinical anesthesia training.

At the end of your base year, you’ll take the final boards exam or Step 3. This exam involves both a written portion and case simulations, testing whether you can apply your training in ambulatory settings while treating a wound or diagnosing a patient.

Anesthesiologists must earn a national board license and meet state-specific requirements to practice. This usually involves 1-4 years of postgraduate training. To practice within a specialty, you need specialist certifications.

The American Board of Anesthesiology (ABA) certification requires a one-year internship, a fellowship or two years in private practice, and passing three exams: basic (after year one), advanced (after residency), and a final applied exam. The American Board of Physician Specialties (ABPS) also offers certification, with its own set of eligibility requirements and exams.

Physicians must also continue education courses to maintain certifications. ABA requires 125 continuing medical education (CME) credits by year five and 100 more by year ten. ABPS also requires CMEs, plus self-assessment and ethics courses.

Becoming an anesthesiologist is a time-consuming and expensive process, so it makes sense to wonder, “how much do anesthesiologists earn?” The answer varies by location and employer, but the median anesthesiologist salary is around $336,000 per year.

Anesthesiologist salaries can vary by industry. The table below highlights employment numbers and mean annual wages across top-paying sectors where anesthesiologists commonly work, including physician offices, outpatient centers, and hospitals.

Anesthesiologists earn the most in Minnesota ($465,340) and Montana ($459,360). The lowest salaries are in West Virginia ($193,830), Georgia ($244,430), and Texas ($254,010), based on BLS data. The table below shows the 10 highest-paying states.

Nearly one-third of all anesthesiologists practice in California, Texas, and Florida. The table below highlights the top five states with the highest number of employed anesthesiologists, along with their average salaries (when available).

If you’re interested in anesthesiology but exploring other options, consider these four related careers. Each offers strong job prospects, high salaries, and rewarding medical roles.

To understand what a career in anesthesiology looks like, we have interviewed an expert in the field. Learn more about his experiences.

Most patients are healthy and perform well under anesthesia. Usually, the patient is “put to sleep,” the surgery is started, nothing happens while they are asleep, the surgery is concluded, and the patient is woken up. This process reflects the adage that anesthesiology is 99% boredom and 1% extreme stress.

When issues do happen in anesthesia (i.e., the 1% stress), seconds can make the difference between health and irreversible injury or death. The expertise of a physician anesthesiologist comes into play here.

Such issues can happen at many points during the surgery, such as “putting a patient to sleep” (i.e., induction of general anesthesia), placing a breathing tube or ventilating for a patient, maintaining appropriate blood pressure and heart function, or traumatic bleeding. The anesthesiologist needs to monitor the proper function of all systems continuously and be able to swiftly and appropriately react when something is wrong.

As a result, an anesthesiologist needs to be present at all times during a surgical procedure and when anesthesia is administered.

Anesthesiologists need to think on their feet and have a robust foundation of medical science to rely upon when analyzing, diagnosing, and treating a patient. They need to be confident.

Anesthesiologists often have much less time to diagnose, decide on a treatment plan, and administer medication. They must rely on themselves for the steps of placing orders and be confident in the decision-making process — able to react on the fly.

Moreover, anesthesiologists ought to be agile and dexterous with their hands. Daily, anesthesiologists place IVs, arterial cannulas, and breathing tubes through endotracheal intubation, and they use ultrasounds for nerve blocks and regional anesthesia. In order to do these tasks correctly and efficiently, anesthesiologists need to have done them many times and be able to rely on their own skill set.

Finally, anesthesiologists need to have charisma and should be able to establish a rapport with patients quickly. For many patients, the unknowns of general anesthesia present one of the most insecure moments of their lives. Anesthesiologists often have 10 minutes or less to talk to the patient, gather appropriate information, and establish trust that everything will be done correctly and that the patient will arrive safely in the recovery room.

Anesthesiologists are often called the “quarterbacks” of the operating room. They help direct timing for the room: when the patient arrives, when s/he goes to sleep, how long s/he stays asleep, and when s/he wakes up.

Successful anesthesiologists ensure the day runs smoothly and on time, and that all patients have the best care possible — including alleviating anxieties, maintaining oxygen and blood flow delivery to tissues, effectively treating pain, and making sure the patient wakes up from anesthesia on time.

In medical school, you must absorb a wealth of information in a short period of time that you formulate into clinical decision-making skills while working in a hospital with patients. During this time, you also worry about making sure your grades, test scores, and performance will be good enough to get accepted to the specialty of your choice at a suitable residency program.

Residency is as grueling as medical school. You work 60-80 hours a week for a paycheck that frequently amounts to minimum wage or less per hour — when factoring hours worked per month. By the end of this arduous process, you should be adequately trained for something that is exceedingly important: taking care of human beings. There is a reason there is so much training to get to this point.

Two board exams are required for being able to practice as a board-certified anesthesiologist: the basic and advanced anesthesia exams, in addition to the completion of the three-part USMLE Step exams. At this point, the resident physician is fully certified and credentialed for working as an anesthesiologist.

Residency prepares a medical student to become a competent physician. It can be a grueling 3-7 years of training, depending on the field, but most physicians come out extremely competent on the other side. By graduating from an accredited anesthesiology residency, you signify to employers that you are an exceptional candidate prepared to work in the field. From there, certain attributes like work ethic and charisma can make you shine.