Anesthesiology residency is a four-year training program that starts early, moves fast, and gradually shifts you from supervised novice to independent decision-maker in the operating room. The first year is a broad clinical foundation, and the remaining three years are spent mastering anesthesia across increasingly complex cases. Most residents arrive at the hospital between 5:30 and 6:30 a.m., spend their days managing patients through surgery, and work roughly 65 hours per week on average.
How the Four Years Break Down
The training consists of a clinical base year (CBY) followed by three clinical anesthesia years designated CA-1, CA-2, and CA-3. During the clinical base year, you rotate through foundational specialties like internal medicine, surgery, and emergency medicine, with one to two months in a critical care unit and at most one month of actual anesthesia. The purpose is to build the medical knowledge base you’ll rely on when managing patients under anesthesia.
Once you enter your CA-1 year, you’re in the operating room full time. Over the CA-1 through CA-3 years, you complete a minimum of 29 months of clinical anesthesia, four months of dedicated critical care rotations, and three months focused on pain medicine. The ACGME requires at least two one-month rotations each in obstetric anesthesia, pediatric anesthesia, neuroanesthesia, and cardiothoracic anesthesia. These are the subspecialty areas where the physiology, patient populations, and risks differ enough that each demands concentrated time.
By the CA-3 year, many programs offer elective time where you can pursue deeper training in areas like regional anesthesia, cardiac anesthesia, or chronic pain, depending on what you want your career to look like after residency.
What a Typical Day Looks Like
Your morning start time depends on the rotation. Cardiac surgery days often begin at 5:30 a.m. Outpatient surgery and general OR rotations usually start around 6:00 to 6:30. You arrive before the first case to set up your room: drawing up medications, checking the anesthesia machine, reviewing your patient’s history, and forming a plan for how you’ll manage their airway, IV access, and anesthesia technique.
Before the patient rolls in, you’ll meet with your attending (the supervising physician) to discuss the anesthetic plan. For a straightforward case, you might propose general anesthesia with a standard induction. For an obstetric patient, you might suggest a spinal or combined spinal-epidural. Pediatric cases often start with a mask induction, putting the child to sleep with inhaled anesthetic before placing an IV. The variety is one of the defining features of the specialty: your approach changes with every patient, every surgery, and every set of medical problems.
Once the case is underway, you’re monitoring vital signs, adjusting anesthetic depth, managing fluids and blood pressure, and staying ready for anything unexpected. Between cases, you set up for the next patient, grab food when you can, and handle documentation. Days typically end in the late afternoon or early evening when you sign out your patients to the on-call team, walking them through each active case and any outstanding concerns.
Wednesdays at many programs include protected time for didactic lectures, often starting at 7:00 a.m. before clinical duties begin.
Call Shifts and Weekly Hours
Across the three clinical anesthesia years, residents average about 64 to 66 hours per week in the hospital, with individual weeks ranging from 43 to over 100 hours depending on call schedules and case volume. Call structures vary by program. Some use traditional 24-hour overnight call where you cover emergency surgeries, trauma, transplants, and labor epidurals through the night. Others have moved toward night-float systems where one resident covers nights for a stretch of days while the rest maintain a daytime schedule.
Overnight call in anesthesiology can be unpredictable. You might spend most of the night managing a liver transplant that runs eight hours, or you might handle a series of emergency C-sections and trauma cases back to back. The intensity of call nights is one of the most commonly cited challenges of the residency.
Skills You’re Expected to Build
Anesthesiology is a procedural specialty, and a significant portion of your training involves hands-on skill development. You’ll learn to intubate patients (place breathing tubes), establish arterial and central venous lines, perform spinal and epidural anesthetics, and place peripheral nerve blocks using ultrasound guidance. Early in CA-1, almost everything is new and closely supervised. By CA-3, you’re expected to handle routine cases with minimal guidance and manage complications with increasing independence.
Critical care rotations teach you to manage ventilators, titrate vasoactive medications, and make decisions about patients who are physiologically unstable. These months in the ICU are some of the most demanding but also where residents report the steepest learning curve. Pain medicine rotations introduce you to chronic pain evaluation, interventional procedures like nerve blocks and spinal injections, and the complexities of managing patients with long-term pain conditions.
Board Exams During and After Training
The American Board of Anesthesiology administers a staged exam process. The BASIC exam is taken during residency and covers fundamental sciences: pharmacology, physiology, anatomy, and the physics behind anesthesia equipment. The ADVANCED exam comes after you’ve completed residency and passed the BASIC exam. It tests clinical judgment and decision-making across the full scope of anesthesia practice. Studying for these exams runs parallel to clinical duties, which means evenings and weekends often include review questions, reading, and simulation prep on top of an already full schedule.
Compensation During Training
Resident salaries are standardized across specialties at most institutions, meaning anesthesiology residents earn the same as surgery or internal medicine residents at the same hospital. For 2025-2026, typical annual salaries range from roughly $61,000 at the PGY-1 level to about $68,500 at PGY-4, with modest increases each year. Given the hours worked, this translates to an effective hourly rate that many residents find sobering, particularly when compared to what attending anesthesiologists earn after training.
Burnout and Mental Health
Anesthesiology residency carries real psychological weight. A national U.S. survey found that about 24% of anesthesiology residents are at high risk of burnout, and 15% experience depression. Those numbers have actually improved over the past decade. A 2013 survey put high burnout at 41%, and by 2023 it had dropped to 23%, likely reflecting changes in duty-hour policies and wellness initiatives that many programs have adopted.
The specialty does carry a disproportionate risk of substance use disorders compared to other fields, partly because of daily proximity to potent medications. Programs are increasingly open about this risk and often include substance abuse education and monitoring as part of training. Anesthesiologists also face higher rates of suicide than physicians in many other specialties, a statistic that has driven more programs to build mental health resources directly into the residency experience.
Despite these challenges, many residents describe the work itself as deeply satisfying. The combination of pharmacology, physiology, and procedural skill, along with the immediate feedback of seeing a patient wake up safely, creates a training experience that feels tangibly rewarding on a case-by-case basis. The difficulty is sustaining that satisfaction across years of long hours, high-stakes decisions, and the relentless pace of surgical schedules.