EM to anesthesia

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agr285

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So I am currently a second year EM resident. In med school, I was debating between anesthesia and EM and ultimately chose emergency medicine. I love the pace of the ED and doing procedures, but I am getting burnt out on the drug seekers, entitled whiny needy patients. I also am frustated with all the bs negative work ups we do to cover our asses. I'm tired of doing cardiac rule outs on every person that's diabetic and hypertensive that presentes with CP. I don't feel like I actually accomplish anything at the end of the day, just move meat. I don't do as many procedures in EM as I thought I would. Long story short, I am looking to switching fields to anesthesia. I think being able to focus one patient at a time in the OR will be a better fit for me. I also want to be true expert at something as opposed to a jack of all trades.
So I have two questions.

1) How do I go about finding and contacting programs to see if they might have an open spot that I can directly match to, or do I need to go through the NRMP match agani?

2) assuming I complete two years of EM, do you think that programs will give me credit and let me start as a CA-1?

Appreciate any input.

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1 year left vs. potentially 3 more years. I'd stick to EM then switch if you want to if it doesn't pan out after a year or 2 in practice.
 
Sounds like you could be in a really sweet niche position. I don't know details, but there is considerable active talk about creating an EM/Anesthesia/Critical Care, X number of years resident pathway. Why not be that person, be one of the first to do that. Find out some info on that effort--Laureen Hill at Emory has an interest in the development of that program--and then become the person that has an interest in doing that. You've gone from being hat in hand to one of the folks that has their eye on becoming one of the first "elite-credentialed" Talk about awesome training too.
 
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Here is what I said in 2007:

Why I left Emergency Medicine
I considered going into both anesthesia and emergency medicine but chose to do an emergency medicine residency. During my residency I identified a number of issues with the specialty which I could not resolve. Thus, late in my residency as my fellow residents sought employment I searched for residency positions in anesthesia. What amazed me is that none of my established attendings tried to change my mind. When I discussed with them why I was choosing this path they agreed that this was a wise decision for me.

I have friends who continue to practice Emergency Medicine and seem to enjoy it. If you have the right personality, EM could be your field. In many ways Anesthesia and EM are similar. Both specialties require that you be able to quickly interact with a patient and identify pertinant historical and clinical features that apply to your management plan.

Things I dislike about emergency medicine:
The shift-work mentality does not build professional respect
Most of your working hours are during afternoons, evenings, weekends
holidays, etc. (I used to be away from home 16-18 nights/month)
Spent alot of time talking to people on the phone
Spent alot of time waiting for other people to do things (consults,
returns pages, admit pt, etc.)
Most of time is spent seeing stuff that could/should be seen in clinic
Rarely see a critically ill patient (the type of case that draws people to
the specialty)
Production pressure ("move the meat")
As an EP you are not a "specialist" in any discipline of medicine,
despite what you may think
The nature of the work is stressfull. The multi-tasking is comparable
to being an air-traffic controller or bonds trader
I rarely did procedures, despite being at one of the busiest ER's in the
country (>110,000 visits a year)

Things I like about Anesthesis:
You get to be an expert in a specialty
You get to see an effect from your actions (pharmacology,
physiology, critical care in action)
Better hours (Quality not Quantity)
More procedures
Better interactions with patients and physicians

I do not regret my training in Emergency Medicine. I achieved board certification but chose not to practice. My training was excellent preparation for anesthesia (much better than 1 year of transitional/medicine rotations). I can not recommend that those considering both fields follow my path. That would require 6-7 years of residency training.

The best thing you can do to assist your decision is to talk to as many practicing physicians in both fields as possible. This means trying to talk to those in the community as well. (Don't limit your discussions to the academic practioners alone.) Go shadow a community hospital EP or Anesthesiologist for a few days if you can. Do an elective in either specialty in a non-academic environement. Think deeply about what type of personality you have, what brings you professional fulfillment, and how you want to spend your professional time. Hope this helps....


I would recommend contacting programs directly. You may be able to find a position outside of the match. Otherwise, you will need to enter through the match. You may still have time to get your application and letters together for this years match. GME funding for a second residency will become an issue the longer you wait. Some programs will not want to take you and there are huge cuts expected in the future to GME training

You should get credit for a clinical base year and be able to start as a CA-1.

Good Luck
 
Things I like about Anesthesis:
You get to be an expert in a specialty
You get to see an effect from your actions (pharmacology,
physiology, critical care in action)
Better hours (Quality not Quantity)
More procedures
Better interactions with patients and physicians

I'm curious as to what you would say you DO NOT like about anesthesia. Your post has a lot of bias, you state what you don't like about EM, and state only what you do like about anesthesia.
 
Here is what I said in 2007:

Why I left Emergency Medicine
I considered going into both anesthesia and emergency medicine but chose to do an emergency medicine residency. During my residency I identified a number of issues with the specialty which I could not resolve. Thus, late in my residency as my fellow residents sought employment I searched for residency positions in anesthesia. What amazed me is that none of my established attendings tried to change my mind. When I discussed with them why I was choosing this path they agreed that this was a wise decision for me.

I have friends who continue to practice Emergency Medicine and seem to enjoy it. If you have the right personality, EM could be your field. In many ways Anesthesia and EM are similar. Both specialties require that you be able to quickly interact with a patient and identify pertinant historical and clinical features that apply to your management plan.

Things I dislike about emergency medicine:
The shift-work mentality does not build professional respect
Most of your working hours are during afternoons, evenings, weekends
holidays, etc. (I used to be away from home 16-18 nights/month)
Spent alot of time talking to people on the phone
Spent alot of time waiting for other people to do things (consults,
returns pages, admit pt, etc.)
Most of time is spent seeing stuff that could/should be seen in clinic
Rarely see a critically ill patient (the type of case that draws people to
the specialty)
Production pressure ("move the meat")
As an EP you are not a "specialist" in any discipline of medicine,
despite what you may think
The nature of the work is stressfull. The multi-tasking is comparable
to being an air-traffic controller or bonds trader
I rarely did procedures, despite being at one of the busiest ER's in the
country (>110,000 visits a year)

Things I like about Anesthesis:
You get to be an expert in a specialty
You get to see an effect from your actions (pharmacology,
physiology, critical care in action)
Better hours (Quality not Quantity)
More procedures
Better interactions with patients and physicians

I do not regret my training in Emergency Medicine. I achieved board certification but chose not to practice. My training was excellent preparation for anesthesia (much better than 1 year of transitional/medicine rotations). I can not recommend that those considering both fields follow my path. That would require 6-7 years of residency training.

The best thing you can do to assist your decision is to talk to as many practicing physicians in both fields as possible. This means trying to talk to those in the community as well. (Don't limit your discussions to the academic practioners alone.) Go shadow a community hospital EP or Anesthesiologist for a few days if you can. Do an elective in either specialty in a non-academic environement. Think deeply about what type of personality you have, what brings you professional fulfillment, and how you want to spend your professional time. Hope this helps....


I would recommend contacting programs directly. You may be able to find a position outside of the match. Otherwise, you will need to enter through the match. You may still have time to get your application and letters together for this years match. GME funding for a second residency will become an issue the longer you wait. Some programs will not want to take you and there are huge cuts expected in the future to GME training

You should get credit for a clinical base year and be able to start as a CA-1.

Good Luck


Masseter Spasm- I am EM and also have very seriously considered switching to anesthesia since the first couple of months of intern year (I am just finishing up my pgy-2 EM year). I am almost a 3rd year in a 4th year program, and figured I should just finish up my 4 year program and do anesthesia after so as to now waste a couple years of training. Since you ultimately finished up EM, do you think that is worthwhile? Or would you advise to switch mid residency?
 
I would advise you stick with EM. Anesthesiology is dead.
 
At the end of the day, you have to do what you feel is right and most of the time things always work out. You can have 100 docs make the same decision and 1/3 happy, 1/3 unhappy, 1/3 ok with the decision regardless of what you are switching out of/into.

I am a logical person and unless I was completely sure about this decisions, putting another 2-3 yrs of residency would really suck when your friends are out working 15 dys a month, taking nice vacations, making 300+K/yr while you are getting off you 24 hr call.

But devils advocate

Things I dislike about emergency medicine:
The shift-work mentality does not build professional respect - Makes no sense. Many fields do shift work. OB hospitalist, IM hospitalists, Trauma surgeons, Some radiologists. If shift work mentality is such a big deal, come to my shop and you can have all of the nights
Most of your working hours are during afternoons, evenings, weekends
holidays, etc. (I used to be away from home 16-18 nights/month) - You do work non banker hours, I will admit.
Spent alot of time talking to people on the phone - I do not talk on the phone as much as many other specialists. Look at how many calls the radiologists have to make. I do not call patients. I call specialists probably 4-6 times a shift. I texts all of my admissions.
Spent alot of time waiting for other people to do things (consults,
returns pages, admit pt, etc.) - You think Anesthesia is any better? Do you think a surgery happens when you say it should? You gotta wait on the surgeon, the cases before you, the nurses, etc.
Most of time is spent seeing stuff that could/should be seen in clinic - I like to see clinic stuff mixed in with sick pts. How would you like to run 4 rooms of all obese, diabetic, 90 yr old cardiac patients? Just like me, I like some easy money.
Rarely see a critically ill patient (the type of case that draws people to
the specialty) - Really? I would completely disagree with this.
Production pressure ("move the meat") - This is true, but you think other hospital based fields do not have the same issues? Ask your radiologist, anesthesiologist, hospitals friends about their metrics.
As an EP you are not a "specialist" in any discipline of medicine,
despite what you may think - I do not even want to debate this.
The nature of the work is stressfull. The multi-tasking is comparable
to being an air-traffic controller or bonds trader - I prefer to deal with a bunch of patients rather than running around 4 rooms while a CRNA runs the cases.
I rarely did procedures, despite being at one of the busiest ER's in the
country (>110,000 visits a year) - Procedures are great but IMO, overrated. After the 100's central line, 30 chest tubes, 1000 sutures, etc.... I can live without doing these again. For some reason I have never seen an anesthesiologists happy when I call them for a central line or blood patch.

Things I like about Anesthesis:
You get to be an expert in a specialty - ok
You get to see an effect from your actions (pharmacology,
physiology, critical care in action) - I guess so
Better hours (Quality not Quantity) - I would rather work my 35 hrs a week, get 15 dys off a month than wake up at 6am work til 4pm with call on top of that. Again debatable but to each its own.
More procedures - You will learn after about 3 yrs of working that IVs, central lines, intubations, blood patches, Epidurals are not much fun.
Better interactions with patients and physicians - I completely disagree with this.
 
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Some more devil's advocate:

Things I like about Anesthesis:
You get to be an expert in a specialty
Which one? Because very few people really care about your expertise in waking up patients. Especially since CRNAs are usually better at surgical arse-kissing.
You get to see an effect from your actions (pharmacology,
physiology, critical care in action)
And how is that different from EM? EPs just treat patients and send them home, without waiting to see if they are beginning to get better?
Better hours (Quality not Quantity)
When you'll have those better hours in an ASC, you'll be upset that they pay you peanuts for them.
More procedures
More procedures = more risks, usually poorly reimbursed (for the procedure per se). That's why you don't see anesthesiologists volunteering to do lines on the floors.
Better interactions with patients and physicians
Most physicians who work in the OR couldn't care less who's at the head of the bed, and most of the other ones have zero interactions with us. And let's not get started about the patients, most of whom think we are technicians or nurses, working under surgeons, a la Grey's Anatomy. What kind of "relationship" do 5 minutes with a patient build?
 
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It is very interesting to see that 2-3 same people are doing everything in their power to steer people away from anesthesia. I understand that one can be unhappy with a job, are you that miserable that you need rest of the world to know? Just find different job, do another residency (I know that would suck), but damn just quit bitching on every other post.
 
It is very interesting to see that 2-3 same people are doing everything in their power to steer people away from anesthesia. I understand that one can be unhappy with a job, are you that miserable that you need rest of the world to know? Just find different job, do another residency (I know that would suck), but damn just quit bitching on every other post.
Tell me something I haven't heard before. How about you actually contributing something to this discussion?

By the way, I am not trying to steer anybody in any direction, just correcting some misconceptions. It's called informed consent for a reason. I usually find it darn stupid to jump to anesthesia before finishing the EM residency, unless the person would rather be unemployed than see an ED again. An ED attending will get into much better anesthesia programs than an ED resident.

And I am not at all miserable; I am just not as happy as a clam, while on SSRIs, like some medical students. I am your average employed anesthesia attending. You should hear some of my colleagues bitching. ;)
 
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Tell me something I haven't heard before. How about you actually contributing something to this discussion?

It's called informed consent for a reason. ;)
I can't contribute because I am not boarded in both specialties and I am pretty sure neither are you. All you are contributing is bunch of whiny answers how nobody respect you and you hate your job. That's very helpful.
 
I can't contribute because I am not boarded in both specialties and I am pretty sure neither are you. All you are contributing is bunch of whiny answers how nobody respect you and you hate your job. That's very helpful.
I do not hate my job, and I do get respect from a good number of people. It's just not as rosy as tourists visiting ORs see it. I am also looking at my colleagues. I am by far not as arrogant as to draw conclusions from my n=1 experience.

People should stop thinking in a "4 legs good, 2 legs bad" pattern. There are many nuances of grey that they are missing. The grass is always greener...

Listen to all sides, draw an informed conclusion. You shouldn't just simply dislike people you disagree with, and assume the worst, you should try and understand where they are coming from, and assume that they might actually have good intentions. You can also assume that I am just trying to decrease the number of future anesthesia graduates and improve my market. Boo!
 
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I do not hate my job, and I do get respect from a good number of people. It's just not as rosy as tourists visiting ORs see it. I am also looking at my colleagues. I am by far not as arrogant as to draw conclusions from my n=1 experience.

People should stop thinking in a "4 legs good, 2 legs bad" pattern. There are many nuances of grey that they are missing. The grass is always greener...

Listen to all sides, draw an informed conclusion. You shouldn't just simply dislike people you disagree with, and assume the worst, you should try and understand where they are coming from, and assume that they might actually have good intentions. You can also assume that I am just trying to decrease the number of future anesthesia graduates and improve my market. Boo!

This. I bet FFP and Consigliere whistle all the way to work every morning. Don't let them fool you.
 
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This. I bet FFP and Consigliere whistle all the way to work every morning. Don't let them fool you.
Somehow I doubt this - with the increase in the number of med schools recently, there is no way that residency spots will be left unfilled.
 
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Some more devil's advocate:

More procedures = more risks, usually poorly reimbursed (for the procedure per se). That's why you don't see anesthesiologists volunteering to do lines on the floors.

Absolutely. Don't let the "procedures" thing seduce. Most of these patients, even the OB ones, don't want you touching them

Anyway, to the OP,
I tend to think a little differently. In my residency we had people who came from Surgery, IM, ortho, etc. I would first, decide if you are REALLY burned out from ER or just burned out from RESIDENCY, because it can definitely be the latter and the same burnout can occur in anesthesia residency. Let's be honest, in all fields, by the time we're 3rd and 4th years we're so tired of some old guy/gal telling us what to do that we've all just about had it (even though most of what they tell us is usually for our own good). There is something that definitely drew you to ER, I'd revisit that and ask yourself would it be different if you didn't have an attending breathing over your neck.

If at the end you're still like, "Nah, ER blows." If you can find an anesthesia residency position then jump on it. Yes, you'll have to start at CA-1 ( I don't believe you'd have to be an intern again especially since PGY-1 is the same from just about every field).

Just about everyday in my residency and even continuing into fellowship I would ask myself if my choice was correct but I stuck it out because I asked why I chose it in the first place and those choices outweighed changing to something else. Now I only ask myself about once every two weeks :)
 
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The "specialty" argument makes no sense. Unless you are an academic Anesthesiologist with multiple publications or the head of your group you are not an expert. You are a specialist with a distinct set of knowledge. Just like EM just like peds and just like FM. You know stuff they don't know they know stuff you don't know.
 
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