Anesthesiologist Career Guide,
Salary, Licence & Jobs 2026

About twelve years after high school: four years of undergraduate study, four years of MD or DO school with the USMLE or COMLEX exams, and a four-year anesthesiology residency (one clinical base year plus CA-1 through CA-3). A subspecialty fellowship — cardiac, pediatric, pain or critical care — adds one more year. Board certification through the American Board of Anesthesiology is usually completed in the first year or two of practice.

The BLS OEWS May 2025 median for anesthesiologists (SOC 29-1211) is $391,490 a year — $188.22 an hour. The published 10th percentile of $101,460 mostly captures residents-adjacent academic posts and part-time work, not typical attendings; the 75th percentile is $490,530 and the 90th $557,130. Private-practice partners with heavy call frequently exceed the published top decile.

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An anesthesiologist is a physician — MD or DO, four-year residency, ABA board certification — with the full scope for the sickest patients and the most complex cases, and often the supervising role in a care team. A CRNA is an advanced-practice nurse with a nursing doctorate and certification who administers anesthesia, in many states with physician supervision and in some independently. Training time, scope, liability and pay ceiling all differ substantially.

Yes — it has become one of the more competitive specialties in the Match, driven by the pay-to-lifestyle ratio. Successful applicants typically bring strong USMLE Step 2 scores, solid clinical grades, research or quality-improvement work and good letters from anesthesia rotations. DO applicants match in meaningful numbers, and a backup plan (often internal medicine or a preliminary year) is standard advice.

The American Board of Anesthesiology certifies through three stages: the BASIC written exam taken mid-residency, the ADVANCED written exam after graduation, and the APPLIED exam combining oral boards with an objective structured clinical examination. Certification is technically voluntary — a state license is what makes practice legal — but most hospitals and anesthesia groups require board certification or active candidacy for privileges, so skipping it closes most doors.

Pain medicine and cardiothoracic anesthesiology generally lead: interventional pain physicians run procedure-heavy clinics with their own revenue streams, and cardiac anesthesiologists command premiums for TEE skills and high-acuity call, pushing earnings toward and past the $490,530 75th percentile. Critical-care, pediatric and obstetric fellowships trade some income for academic and lifestyle fit — all add one year of training after residency.