How to become an anesthesiologist

1. 1Earn a bachelor's degree with premed courses

   Time: 4 yearsCost: Varies by collegeSources 1

   Any major works, but you need the courses medical schools require, which usually include biology, general and organic chemistry, physics, biochemistry and English, with labs. Grades matter: medical school admissions weigh science GPA heavily. Build clinical experience by volunteering or working in a hospital, shadow physicians including an anesthesiologist, and get research experience if you can. Most applicants apply during the summer after junior year.

2. 2Take the MCAT and apply to medical school

   Time: About 1 year (application cycle)Cost: $360 MCAT registrationSources 7, 1

   The MCAT is a computer-based exam covering biology, chemistry, physics, psychology and reasoning. Standard registration for the 2027 testing year is $360, or $145 with AAMC Fee Assistance. You apply to MD schools through AMCAS and to DO schools through AACOMAS, then complete secondary essays and interviews. Many applicants apply to a long list of schools because admission is competitive.

3. 3Complete medical school (MD or DO)

   Time: 4 yearsCost: AAMC median 4-year cost: $297,745 public, $408,150 privateSources 5, 6, 8

   The first two years cover anatomy, physiology, pharmacology and disease; the last two are clinical rotations in hospitals and clinics. Take an anesthesiology rotation, plus any electives in critical care or pain, and seek letters from anesthesiologists. MD students take USMLE Step 1 and Step 2 CK during school; DO students take COMLEX-USA Levels 1 and 2-CE. You apply for residency in your final year through the national match.

4. 4Finish a 4-year anesthesiology residency

   Time: 4 yearsCost: Paid as a residentSources 3, 4, 2

   Residency includes 12 months of broad clinical training, often an internship year in medicine or surgery, followed by 36 months of clinical anesthesia (CA-1 to CA-3 years). You rotate through general, cardiac, obstetric, pediatric, neuro and regional anesthesia, critical care and pain medicine. The ABA encourages residents to take the BASIC Exam at the end of the CA-1 year. Residents take Step 3 or COMLEX Level 3 early in residency.

5. 5Get a state medical license

   Time: During or right after residencyCost: State license fees varySources 9, 1

   Every state requires a medical license to practice. State medical boards generally require graduation from an accredited medical school, passing all USMLE steps or COMLEX levels and a period of accredited residency training, along with background checks. Rules on how much residency you need before full licensure differ by state. Use the CareerOneStop License Finder or your state medical board's site for the details.

6. 6Earn ABA board certification

   Time: 1-2 years after residencyCost: $975 + $975 + $2,500 (2026)Sources 2, 3

   After residency and the BASIC Exam, you take the ADVANCED Exam on clinical anesthesia, then the APPLIED Exam, which pairs a Standardized Oral Examination of two 35-minute sessions with a seven-station OSCE. Passing all three makes you a board-certified anesthesiologist. To stay certified you join the ABA's MOCA program, which carries a $350 annual fee in 2026.

7. 7Optional: complete a subspecialty fellowship

   Time: Usually 1 yearCost: Paid as a fellowSources 3

   Anesthesiologists who want to focus can train further in an ACGME-accredited fellowship. The ABA offers subspecialty exams in critical care medicine, pain medicine, pediatric anesthesiology, adult cardiac anesthesiology, hospice and palliative medicine, sleep medicine, neurocritical care, and health care administration, leadership and management. Obstetric and regional anesthesia fellowships are also common choices for those who want to focus on those areas.

Programs, tuition and graduates’ earnings

U.S. Department of Education, College Scorecard (most recent cohorts, released 2026-10-15). Scorecard groups programs by 4-digit field, so a row can include related programs. Tuition is the median published undergraduate tuition and fees of the colleges offering the program (shown only for undergraduate credentials); debt is the median of programs’ median federal loan debt at completion; earnings are the national median for the field and credential four years after completion.

Requirements differ by state. Check your state’s rules in the CareerOneStop License Finder (U.S. Department of Labor) before you enroll.

Calm decision-making under pressure

When oxygen levels fall or blood pressure crashes mid-operation, the anesthesiologist has seconds to identify the cause and act.

Pharmacology knowledge

Every anesthetic is a balance of drugs that affect the heart, lungs and brain, adjusted for each patient's age, weight, illnesses and other medications.

Procedural skill

Placing breathing tubes, arterial lines, epidurals and nerve blocks quickly and safely is a daily part of the work.

Vigilance

Long cases require steady attention to monitors so that small changes are caught before they become emergencies.

Team leadership and communication

Anesthesiologists coordinate with surgeons and nurses and often direct several nurse anesthetists or residents at once.

O*NET 31.0 rates these skills as most important for the occupation: critical thinking, reading comprehension, monitoring, active listening, writing.

Training cost

$305K–$415K

Before financial aid

Time

12-13 years

Typical path

Median pay

$391,490

All US jobs: $50,980

Payback once qualified

0.9–1.2 yrs

Pay above the all-jobs median vs. cost

Low: AAMC median 4-year cost of attendance at a public medical school (Class of 2026), $297,745, plus MCAT $360 (2027 testing year), USMLE Step 1 $695, Step 2 CK $695 and Step 3 $955, and ABA BASIC $975, ADVANCED $975 and APPLIED $2,500 = $304,900. High: private-school median $408,150 plus MCAT and COMLEX Level 1 $745, Level 2-CE $745, Level 3 $950 and the ABA exams = $415,400. Cost of attendance includes living expenses. Not included: undergraduate costs, application and interview costs, or state license fees. Residents are paid during training. Median federal loan debt for medical graduates in our data is $208,644.

Rough guide only: ignores taxes, aid, interest and earnings given up during training. How we calculate it.

• Pain medicine or critical care anesthesiologist

  A one-year ACGME fellowship and the ABA subspecialty exam lead to work in pain clinics or intensive care units.

• Department chair or medical director$123,860 median

  Experienced anesthesiologists move into leading an anesthesia department or perioperative services; some add an MBA or MHA.

• Academic anesthesiologist$82,250 median

  Faculty at medical schools teach residents, run research and often hold a fellowship or research training.