Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Going Under: Anesthesia Answered is a podcast with renowned physician and anesthesiologist Dr. Brian Schmutzler. Together with Award-Winning Co-Host and television journalist, Vahid Sadrzadeh, the podcast aims to answer not only your most pressing anesthesia questions but to provide the most up-to-date medical data available.
This weekly medical podcast will release a new episode every Thursday at 5 am. Thanks in advance for being a listener.
Don't forget to send your questions to Dr. Brian Schmutzler on social media and his website at www.drbrianschmutzler.com.
Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Should You Become A Doctor In 2026?
In the Season 4 Finale of Going Under: Anesthesia Answered, we weigh how rising premiums, AI advances, and shifting reimbursement shape the choice to enter medicine in 2026. We compare cognitive vs procedural specialties, outline durable paths in anesthesia and surgery, and share practical steps to future‑proof a medical career.
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This is going under anesthesia answer with Dr. Brian Schmutzer. I'm Vahid Sodder Zade. We're brought to you by the Butterfly Network, and we are remote today, Dr. Brian Schmutzer.
SPEAKER_00:We are remote today. Alright, I'm going to let you in on something that's completely changed the way that I practice. I've been using Butterfly probes for years. It's a portable ultrasound that plugs right into my compatible smartphone or tablet so I can start scanning at the bedside in seconds. If you've used the older versions, or even if you're new to the handheld ultrasound game, let me tell you why this new IQ3 is a game changer and really impressive. First off, having an ultrasound that literally fits in my pocket means I can move faster, whether it's vascular access, procedural guidance, or just getting real-time insights from my patients. And the tech and tie this tiny device is pretty incredible. Biplane imaging lets me see short and long access simultaneously, which is huge for procedural guidance and a great tool for learners. The new needle out of plane preset even shifts the scan plane digitally so I can see the needle tip sooner, which makes a real difference when precision matters. And the image quality, honestly, the IQ3 holds up against some of the cart-based systems I've used. That's impressive for something that is portable. If you're looking for a device that supports your practice, I can't recommend the Butterfly IQ three enough. And right now they're running a special offer. You can get$750 off the IQ3. Check it out at ButterflyNetwork.com. And I am coming to you from beautiful, beautiful Phoenix, Arizona. Zoom freaks me out when it does that.
SPEAKER_01:It does? Oh, I'm sorry.
SPEAKER_00:It's good. It's good. We'll back up. How warm is uh is it there in uh Phoenix? 70. 70. It's about 70 right now.
SPEAKER_01:All right, 30 degrees warmer than it is here. Not too bad. Um we're definitely not in Phoenix here, but uh, you know, we're inside, so it's warm. Yeah. But we're we following up on our conversation last week, obviously there was a lot of interest in Obamacare and what's gonna happen, what may not happen. And uh you have an update on that quickly before we get to our main topic.
SPEAKER_00:Yeah, it sounds like it's not gonna pass. Uh the the uh even though some of the some of the um congressmen tried to kind of push it through, it sounds like it's not even gonna pass the House. Even if it does, it's probably not gonna pass the Senate. So the subsidies are gonna run out in in January. Um, you know, again, we don't we're not a political podcast, so we're not making any comment on that. But the way that that's going to affect medicine is that the cost of insurance is gonna be more expensive, and and therefore the cost of care is probably gonna end up being more expensive. So that kind of leads into our discussion today about it's 2026. If you're thinking about it, is it a good time to go into medicine?
SPEAKER_01:Well, I mean, and I posed this question to you last week during our podcast because I was like, well, with all these things happening, with you know, with insurance costs, with the um rise of private doctors, right? And medical care, and it seems that MD VIP kind of care is so big right now that if you're and looking at the statistics of anesthesia and you know it's decreasing, right? The the stats are kind of falling off.
SPEAKER_00:Where can doctors we're under yeah, we we don't have enough for sure, yeah. Well, and AI is AI is the other thing that we we gotta talk about too, yeah.
SPEAKER_01:So I mean in simple, right? I mean, we're gonna talk about this. Is it a good time? Is 2026 a good time to become a doctor? Anesthesiologist.
SPEAKER_00:So I'll couch that as I couch everything. It depends what you're gonna go into, right? So do I think it's a great time to go into radiology or primary care? I would say the answer to that is no, because compared to inflation, the the compensation for those two practices is going way down compared to inflation. Um, and there's a big chance of getting replaced by AI. And you're in those in those practices, you're heavily dependent on insurance, paying for little things, right? We kind of talked about this before, right? So if I'm a if I'm a trauma surgeon, I'm I'm expecting insurance is gonna pay for that. There's gonna have a they're gonna have a hard time denying my trauma surgery, right? When I got shot by whatever, right? Primary care, probably a lot of denials. Uh radiology, did you really need that x-ray or MRI? So I I think there's I think the the qualified answer is yes. I mean, we talked about this before. Are you gonna make enough money to survive? Yeah, of course, right? You're gonna make a really good income no matter what area of medicine you're in. Now, some of the areas of medicine you might not be able to live where you want to live because everybody wants to live in, you know, Chicago, New York City, Austin, Texas. You also might not make as much as you thought you were gonna make. And taking out student loans, again, we're talking about this, right? So there's another part of the um big beautiful bill was that uh loans were only given up to, I think it's like$200,000. Well, the average medical school loan for a private school is like half a million, I think, at this point. So you're taking a ton of student loan debt. How are you gonna pay that back if your salary is not what you expect it to be? Now, if you're going into surgery, honestly, you're going into anesthesia, you're going into um a lot of these procedural things. So even like uh like interventional radiology, a procedural specialty, um, general surgery or orthopedic surgery, all these hands-on things, you're you're probably fine. I mean, I I don't see robots for a while, at least not good robots. You look at all these AI-based robots out there, I would not trust them to do surgery on me at this point.
SPEAKER_01:Um I mean, we wrote about this when we were when we were at the bariatric uh conference. Yeah, you know that a lot of the bariatric surgeons are now turning to AI to do surgery. Help, help, help, help do surgery, help pre surgery, yes. And they're even talking about help from across continents, right? I mean, those are the kind of conversations that we're having. Now we know how touchy the subject of AI is, right? And with people's jobs, and what other jobs are they gonna take, what jobs are they not gonna take, what can they do? What can they you know, but I think you're right. I mean, when it comes to there's certain things that you really don't want AI to take over, right? I mean, I'm guessing medicine is one of those things where you're like, yes, it can help you do the job, but do you really want, when it comes down to it, do you really want a robot administering anesthesia?
SPEAKER_00:No, and I and I so so okay, maybe this is just my own, you know, internal bias, but if you look at the studies, the studies actually show that AI is better than primary care at diagnosis and better at reading um radiographs, so so MRIs, uh CTs, and and X-rays than radiologists. So maybe you do want AI there with maybe a backup of a of a of a person, of a physician kind of checking through things. Uh but yeah, if as far as I know, there's no study out there showing the the administration of anesthesia by an AI robot. Now, this it's a long time ago, it's probably 15, 20 years ago, there was a company who manufactured something that we that gave propofol and measured blood levels of the propofol and and did it without any physical person there doing it. Um from what I recall, there were some complications from that. So uh so but I don't know any studies out there that that talk about surgery or anesthesia, anything procedural, right? I just don't think we're at the point. We we may be getting to the point where AI is very good in the actual, you know, um the chat bot, right? And and diagnosing and that sort of stuff. I don't think AI is quite to the point where we can put it in a robot, and a robot can reliably do a procedure.
SPEAKER_01:Well, I mean, the and the reality, you know, I mean, as you look at anesthesiologist, anesthesiology compared to other specialties, I mean you're looking at uh uh, you know, this it's a very stable choice in medicine, right? To where others, you know, I mean, just look at primary care and where that's come over the last 30 or 40 years, right? Primary care is really in danger of kind of being the first victim of our age and our new age care. But if you look at uh CRNAs and AAs, how are those affecting like if people are if students are listening to this podcast or watching this podcast and looking at hey, I want to go into the anesthesia field because A, you've got more demand now, uh you know, the demand is double. Salaries are up. But how are how are AAs and CRNAs affecting the job market specifically for anesthesiologists?
SPEAKER_00:Yeah, so I I mean I think that even if you took every AA, every CRNA, and every anesthesiologist in the country, we're still short tens of thousands, right? So that's not a problem we're gonna fix. And and if somebody's looking at going to school now, I'm pretty confident that they're gonna have an entire career where they're not gonna have a hard time finding a job. Now, uh, my grandkids, if they went into anesthesia, maybe they will, right? I don't know what's gonna happen, but I would say somebody right now, if they're in, let's say, undergrad or medical school and is thinking about anesthesia or even nursing school and thinking about CRNA, 100%. I would absolutely recommend it. And uh, and I I think, you know, obviously AI is, I don't think AI is gonna be a huge issue. I think there's still gonna be a shortage. I was just actually on a panel earlier today, so check it out. I was Becker's had a uh, you know, issues with staffing and modeling and that sort of stuff. So I was one of the panelists for that. And this is what I talked to.
SPEAKER_01:We'll link it below, by the way.
SPEAKER_00:We'll link it below, yeah, yeah, yeah, yeah. So so this is what we're talking about. Uh, I mean, uh, you know, we're gonna be 12,500 provider short by 2033. We talked about this before. Uh of course, if there's that much of a supply shortage and demand keeps going up, I think it's a great, it's a great place to be. But I mean, you you don't go we talked about this before too. Don't go into it just because you you want to make a lot of money, you won't be happy, but you're gonna make a great living in anesthesia for the next 30, 40, 50 years.
SPEAKER_01:And that's anesthesia, but you know, again, the other specialties may differ, right? Yeah, and in terms of ebbs and flows, has the medical industry ebbed and flowed with jobs and careers, uh, kind of like the supply and demand of those over the years?
SPEAKER_00:They have, yeah. Um, I mean, so I I know anesthesia well and not necessarily all the other specialties, but so there was a big drop off uh late 80s, early 90s, because of just the pay for anesthesia, and it was it was pretty dangerous actually until the the um entitled CO2 monitor came along. So insurance premiums were high, lots of patients get died or had major morbidity until that happened. So there was a big drop then, and and it was actually a lot of foreign medical grads that actually supported you know the the anesthesia industry for about 10 years, 10, 15 years. And then, you know, compensation caught up, monitoring caught up, it got very safe, shift work started, which is not something that happened in anesthesia until probably the late 90s, early 2000s. And so it, you know, now now there are a lot of people who want to go into it. But again, we talk about the federal government supports it, and the federal government isn't gonna isn't gonna increase the number of spots.
SPEAKER_01:So I know you don't give advice, but if you were to give advice to medical students today who are not on the specialty path, who have decided or are considering, hey, do I go into you know general practice? Do I not? What is your best piece of advice for those students?
SPEAKER_00:So you need to make sure you have something else. So whether that's doing there's there's fellowships out of out of family medicine, right? So you can do a fellowship in um OB, you can do a fellowship in sports medicine. So do a fellowship or figure out the business side and help run a practice. Those are the two things you can do. And then and then internal med is primary care too, right? There's tons of specialties out of internal med that you could pick. Um pick one that has some procedure to it, right? I mean, I'm not saying you have to be a GI doc where you're doing procedures all day long, but there's a there's some areas out of internal medicine where you at least do some procedures. So I think that's helpful as well. Um but the but yeah, you've you've gotta you've gotta knit yourself. I just don't think there's probably gonna be much of a need for just primary care physicians, just a family practice or internal medicine doc who just does the office, goes in every day, sees 30 patients a day, and goes home. I just don't think there'll be a need for that in the next 20 or 30 years. It's gonna fundamentally change. And and whether that fundamental change is AI, whether that fundamental change is supervising AI, whether that fundamental change is, hey, if you want to be successful now, you have to see 70 patients a day. Like, I don't know what the change is gonna be, but it's gonna be so different that it I think it's gonna be hard to find people to do it.
SPEAKER_01:Well, and just remember, this is the start of the healthcare conversation, too, right? The healthcare versus the health cover insurance.
SPEAKER_00:Yeah, exactly.
SPEAKER_01:Yeah, I I and this is totally random and totally separate with people that were not aware that we did a podcast last week. We were talking about health insurance premiums. Literally on the phone with somebody last night who said, Hey, save your money for health insurance, just buy your health insurance plan because really that is gonna be the way moving forward with how it's going in today's age, which really should have an indication of if I am if I'm in broadcasting and I knew a certain part was in danger and was not paying as well, and said, Hey, like, you know, AI is gonna take part of these. My focus is gonna go somewhere else, then, right? Yeah, I mean, I'm gonna go where I'm needed, you know. Yeah, um, and so it's happening in today's world. I mean, it's happening with everybody that AI is taking jobs, it's um it's a scary place to be, but if you know how to use it to your advantage, yeah, you're in a better place.
SPEAKER_00:If you know how to use it as a tool instead of it using you, you're gonna be fine. Um, but yeah, with the health insurance premiums thing, I'm actually seeing a lot of people, and and I follow some of this stuff just peripheral online, talking about how they are getting off their employer plan, if possible, and getting off of any ACA plans and just doing the pre pre-Obamacare plans. Now, they don't cover everything and they can charge you for pre-existing conditions, but the price of those hasn't skyrocketed like everything else. So it's um it's gonna be interesting to see what happens. And and I, you know, the the current Congress is talking about replacing it with something else. I mean, I you know, I I don't have a great answer for what you replace it with, but there's gotta be something better. I mean, for me personally, what I like is I like having a high deductible plan with a health savings account. And like we talked about, you you don't expect insurance to pay for your primary care visits and your, you know, whatever. It pays for the bigger things. Um, but if you're saving, you know, you can put, I think it's like eight grand a year, 8,500 bucks a year in a health savings account. You know, for for most people under the age of 55, that's enough money to cover the majority of your expenses for the year.
SPEAKER_01:So yeah, I think that's sound advice. And this is the exact conversation I had with this person yesterday, too, is hey, do the high deductible, stock away, pay for the coverage, and you know, majority of the time you're not going to be using that, right? And then the help of it, yeah, right. Yeah, I mean, you know, I have glasses, so yes, is it is it different for me? Yeah, but guess what? If I stock away X amount of dollars every single year in an HSA plan, that pays for 10 pairs of glasses, right? Right, right. You know, I mean, so you got to look at those things and where you're at in it. And and this person specifically said it should not be tied to your job. Again, we said that last week. We said that last week, and I said, Hey, did you watch our podcast? She's like, I haven't watched your podcast. This is exactly what we said, should not be tied to your job. Um, but again, it I I think a lot of people have questions out there related to is this a good time to get into your field? Is this a good time to become a doctor? So many things are changing.
SPEAKER_00:It's it will be, I believe it will be a stable profession. You will make money, you will make enough money to live. Will it be some of the areas of medicine will not be what they are now? They won't be that the daily practice of them will change and the finances will change. I can't tell you exactly how, but I I would just say anything that's not procedural, there's a high chance it will, it's already undervalued, right? Because we pay for procedures. That's why proceduralists, anesthesiologists, surgeons make more money, because the way that insurance companies and the government pay is for procedures. So you're already undervalued there, and then if AI takes more of it, I think that it's risky.
SPEAKER_01:AI is uh continues to, and just remember this. This is also another conversation I had. We're pretty much five to ten years behind the AI bubble, right? Like if you look at what they're releasing to we're in the infancy, yeah, we're in the infancy.
SPEAKER_00:But yeah, what is the what does the government have? Yeah, yeah.
SPEAKER_01:What are they testing? What do they have? Just remember, we're always five to ten years behind. So the next step is always gonna be bigger and better, and maybe even scarier. And you know, I mean, it's it's always ahead of what we have and what the reality is today.
SPEAKER_00:Yep, yeah, I agree, I agree. So, I mean, yeah, advice uh make sure, make sure that you have some other angle in medicine. Don't just be uh W-2 take a job, but or you're gonna ask.
SPEAKER_01:No, no, no. This was this is perfect. I mean, it I didn't mean to interrupt you, so no, no, you're good.
SPEAKER_00:Yeah, I did just make sure make sure you have a niche of doing something. You you're either the best at something or you run the practice or you have a fellowship in something. I mean, I for the last 15 years said don't do a fellowship. You don't need a fellowship. Well, now I'm changing my tune in some areas, might be worth it for that extra year. Merry Christmas, happy new year. We'll see you in 2026 with some new stuff.
SPEAKER_01:Sounds good. Dr. Brian Schmonserved by Heed Sadrzadi. This has been going under, brought to you by the Butterfly Network. We'll see you in the new year.
