How to Become an Anesthesiologist

by TBS Staff
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Anesthesiology requires years of education and training, but practitioners often build rewarding careers spent helping people.

Anesthesiologists help patients manage pain through medications, especially during and after surgical procedures. Successful anesthesiologists must be experts in the field of pharmacology, which is the study of the human body's response to certain drugs.

This page explores the skills, training, and experience required to become an anesthesiologist. It also includes an interview from an anesthesiologist who explains the ins and outs of a typical day in this profession. Finally, this guide also covers compensation rates for the field.

What Do Anesthesiologists Do?

Anesthesiologists are physicians 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. Other responsibilities include creating patient-specific care plans, monitoring patient vital signs during medical procedures, and supporting patients through recovery.

There are many anesthesiological techniques, with local, regional, general, and epidural anesthesiology being the most common. Full sedation is usually provided for patients undergoing major procedures, like joint replacement or open heart surgery, while regional anesthesia is typically provided for childbirth and surgeries of the extremities or the abdomen.

Depending on the technique, anesthesiologists may use tools like masks or needles, along with monitors to track patient vitals. Anesthesiologists typically work alongside surgeons, nurse anesthetists, and other doctors.

Where Do Anesthesiologists Work?

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

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.

Skills

Prospective anesthesiologists need to 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.

How to Become an Anesthesiologist

Becoming an anesthesiologist involves several stages of training, each described in detail below. In general, anesthesiologists must complete a four-year bachelors' degree, a four-year medical degree, and four years of residency. 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, all anesthesiologists must regularly complete continuing education courses to maintain and update their skills.

Education

Physicians who specialize in anesthesiology begin their academic careers with an undergraduate degree from an accredited college or university, typically majoring in pre-med or science. They take courses in biology, calculus, chemistry, and physics, which all prepare students for the Medical College Admission Test (MCAT) and medical school.

However, most medical schools do not require applicants to take these courses nor have a bachelor's degree in any of these subjects for admission. Successful physicians could have undergraduate degrees in any number of subjects, including anthropology, English, or pre-law. Instead, MCAT scores are the main determining factor.

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

At the end of two years of coursework, students 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 the Boards, anesthesiology students must complete two years of clinical training, working with patients suffering a variety of ailments under the supervision of an experienced physician.

Clinical training concludes with the Step 2 test, which has two parts: a written test on internal medicine, gynecology, preventive medicine, and surgery; and an assessment of clinical skills, including communication and interpersonal skills and proficiency in English.

Residency

To enroll in a residency program, prospective anesthesiologists must complete an application that highlights their competitive USMLE or COMLEX scores, perform well during anesthesiology rotations, and provide strong letters of recommendation. On an annual Match Day, a computer program aligns candidates with residency programs based on the preferences and performances of both.

Once a match is made, residency programs for anesthesiologists take four years to complete. The first year is a "base year" of non-anesthesia training, followed by three years of focused clinical anesthesia training.

Residents take the final exam of Boards at the end of their base year. This Step 3 exam involves both a written portion and case simulations, which test whether physicians can apply their training in ambulatory settings, while treating a wound or diagnosing a patient.

Certification and Licensure

Like all physicians, anesthesiologists must earn and maintain a national Board license and meet any state-specific requirements before they can practice, which generally requires 1-4 years of postgraduate training. To practice within a specialty, anesthesiologists must earn additional specialist certifications.

Anesthesiologists have a couple options when it comes to earning certifications. One certifying body is the American Board of Anesthesiology (ABA). Its process requires a one-year internship in anesthesia, followed by a fellowship program or two years in private practice and successful completion of three exams.

Prospective anesthesiologists take the first written exam — the Basic exam — after the first year of their internship and the second — the Advanced exam — at the end of their residency. The final exam is the Applied exam, and it has two elements: a standardized oral examination and an objective structured clinical examination.

A second certifying body is the American Board of Physician Specialties (ABPS). To earn this certification, candidates must meet eligibility requirements and complete both a written and an oral exam.

Once licensed, an anesthesiologist's schooling is not over. All physicians must regularly complete continuing education courses to maintain and update their specialized certifications.

To maintain valid certification with the ABA, anesthesiologists must earn 125 continuing medical education credits (CMEs) by the end of their fifth year and another 125 by the end of their tenth. ABPS license renewal requirements also include CMEs, plus completed self-assessment questions and medical ethics courses.

What to Look for in a Program

When selecting an MD or a DO, prospective anesthesiologists should only consider accredited programs. Attending an unaccredited program will not qualify you for licensure.

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

Prospective medical students should also weigh the reputation, location, and cost of potential medical schools, along with the benefits of programs with online components.

Career Information

Becoming an anesthesiologist is a time-consuming and expensive process, so it makes sense to wonder, "how much does an anesthesiologist make?" The answer varies by location, but all that that required training translates into a median anesthesiologist salary rates of well over $200,000. In major cities, anesthesiologist salaries can top $300,000 annually.

Salary and Job Growth for Anesthesiologists

Median Salary

$261,730

Job Growth (2019-2029)

4.3%

Source: Bureau of Labor Statistics

Highest Paying Cities for Anesthesiologists

Similar Careers

Surgeons

Like anesthesiologists, surgeons are specialized physicians who perform operations to treat disease or correct injuries. Some work as general surgeons, while others specialize in areas like orthopedics, neurology, or plastic surgery.

Surgeons make diagnoses, perform operations, and provide post-operative care. They often work alongside anesthesiologists, operating room nurses, and physician assistants. The residency period for surgeons typically lasts 3-8 years, and they are among the most highly paid professionals in the medical field.

Nurse Anesthetists

Certified registered nurse anesthetists (CRNAs) are advanced practice nurses who work alongside anesthesiologists. Typical responsibilities include administering anesthesia or analgesics before, during, and after medical procedures; providing pain management; and offering emergency services.

Becoming a CRNA requires a master's degree from an accredited program, which takes 2-3 years to complete. CRNAs are in high demand, especially in rural areas, and are among the most highly paid healthcare professionals. Depending upon where they work, CRNAs may be their facility's only anesthesia provider.

General Practitioners

General practitioners are also known as family doctors or primary care physicians (PCPs). These physicians have earned either an MD or a DO and have completed their residencies, typically while working in family or internal medicine. As a result, their medical knowledge base is broad.

Like anesthesiologists, general practitioners can work in a variety of settings, including private practice and hospitals. General practitioners see patients for acute or short-term care, preventative medicine, and general health maintenance. They are responsible for making diagnoses, prescribing treatments, ordering tests, and interpreting results, and they often refer patients to specialists after making an initial diagnosis.

Ask an Expert

To understand what a career in anesthesiology looks like, we have interviewed an expert. Read about his experiences below.

Dr. Taylor Graber is an MD with a background in anesthesiology. Born and raised in Arizona, Dr. Graber attended Arizona State University and received a bachelor's degree in biomedical engineering. He completed medical school at the University of Arizona College of Medicine - Phoenix and residency training in anesthesiology at the University of California - San Diego.

Dr. Graber founded ASAP IVs because he wanted to help patients receive the benefits of IVs without the time, cost, and energy of going to the emergency room. When not working, he enjoys staying active by running, golfing, hiking, playing basketball, and enjoying all of the sun San Diego has to offer.

Why Become an Anesthesiologist?

What are some challenges and high points in this role?

Anesthesiologists are critical to the evaluation and care of patients in the operating room. We are responsible for making sure patients are relaxed before the procedure/surgery begins. We make sure the patient is asleep without formation of memories (anesthetized with amnesia), that pain is controlled, and that appropriate blood flow and oxygen are delivered to tissues during the surgery. For the majority of cases, this is all easily accomplished with intraoperative monitoring (e.g., blood pressure, heart rate, blood oxygen, and temperature) and reliable medications.

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 for 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.

What type of person does well in this role?

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.

When most physicians place orders in a hospital, they write an electronic order in the computer, which is checked by the computer before it is routed to a pharmacist (who again checks the order). This order is subsequently routed to a nurse, who either has the order verified by another colleague or has it verified by an electronic medication dispensing system. Finally, it is scanned into the computer and verified again before administered to the patient.

Anesthesiologists often have much less time to diagnose, decide on a treatment plan, and administer a 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 life. 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.

Who does this role help? How does this role impact others?

Anesthesiologists are often called 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. Anesthesiologists are assisted by the nurses in the room and help to optimize surgical conditions for the surgeon to carry out the scheduled procedure properly and efficiently.

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.

Why do we need more anesthesiologists?

There will always be a need for surgeries, and as long as that need exists, we must make sure patients undergo these procedures safely with anesthesia.

Even as intraoperative monitoring improves, nothing can replace the split-second decision-making of anesthesiologists and anesthesia personnel. They are the critical care physicians of the operating room, making decisions every minute that impact patient care. As more surgical procedures are performed each year, there too needs to be a greater supply of anesthesiologists to meet this growing demand.

How to Get Hired

What was your experience like pursuing certification after completing your degree?

The process is a long road. Four years of undergraduate studies prepare you academically and extracurricularly (e.g., shadowing physicians, volunteering) to apply successfully for medical school.

Once in medical school, the process accelerates. 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 gruelling 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.

How long does it usually take graduates with a degree, completed residency, and Board certification to get hired?

Anesthesiologists are extremely well-trained, and their services are always in demand. Most graduates will find a job waiting for them upon graduation. Finding "the perfect job" in "the perfect city" may make this job hunt more difficult, but it is usually quickly accomplished.

What skills do employers look for?

The same characteristics that make an anesthesiologist an excellent job candidate are many of the same attributes as any general job application. Employers want a physician who is a professional, who arrives early, and who is willing to work hard. Additionally, they want someone with a firm work ethic and who is willing to help others work well; after all, anesthesiologists are constantly surrounded by people every day.

On top of these characteristics, an excellent candidate is versed in the clinical medicine involved in perioperative care, including a firm grasp of human physiology, pharmacology, and anatomy. Finally, s/he should have excellent procedural skills.

Subspecialty positions within the field of anesthesiology — cardiac anesthesiology, obstetric anesthesiology, pain management, regional anesthesiology, pediatric anesthesiology, and critical care medicine — are achieved by additional fellowship training. There will always be specific demands and job opportunities for those who are subspecialized in any field.

What can students do to make themselves look better to employers?

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.

Anesthesiologist Professional Organizations

ASA is a medical association focused on education and research related to anesthesiology. It is dedicated to improving standards of patient care and supporting anesthesiologists in their careers. AMA is the largest association of physicians in the United States. Its mission is to drive medicine "toward a more equitable future, removing obstacles that interfere with patient care, and confronting the nation's greatest public health crises. This nonprofit organization provides low-interest loans to support residents pursuing anesthesiology who need financial assistance. It also supports research and development projects related to anesthesiology.

Frequently Asked Questions

true Are Anesthesiologists Doctors?

Yes, anesthesiologists are specialized doctors. They must hold an MD or DO degree, making them a doctor or a physician, and they must complete medical residencies in anesthesiology and a series of exams and certifications in order to practice.

What Is the Difference Between an Anesthesiologist and a Nurse Anesthesiologist?

A nurse anesthesiologist or nurse anesthetist — commonly known as a CRNA — provides sensation and pain management care for patients before, during, and after medical procedures, usually under the supervision of an anesthesiologist, who is a licensed doctor. However, some CRNAs can also administer anesthesia independently; laws vary by state.

Is Becoming an Anesthesiologist Worth It?

Deciding whether to pursue a medical degree and a specialization in anesthesiology is highly personal, but benefits include the high salaries that anesthesiologists enjoy and having meaningful, patient-focused work.

How Hard Is It to Become an Anesthesiologist?

As with all medical professions, becoming an anesthesiologist is a rigorous process. Prospective anesthesiologists must hone their science, math, and critical thinking skills through medical school, clinical rotations and residencies. They must also pass several series of written, oral, and practical exams to earn a medical license and certification, and they must maintain their skills through continuing education and skills testing.

How Long Does It Take to Be an Anesthesiologist?

It typically takes 12-14 years to become a licensed anesthesiologist: four years of undergraduate study, four years of medical school, and four years of residency, followed by one year in a fellowship program or two years in private practice.

Header Image Credit: SDI Productions | Getty Images

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