Options for dissatisfied/stressed anesthesia resident

[lemmonhead]

So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety that is through the roof right now. I am working with a therapist which helps. I can barely get myself out of bed in the morning but the train keeps chugging ahead. I am seriously considering switching specialities, specifically to psychiatry (I was deciding bw gas and psych as an MS3) or pursuing pain management. This is not the ideal choice for me as I am non-traditional, still single and in my mid-30s and just want to move on with my life and start working and find a partner. However, I am really struggling to imagine any situation in which OR anesthesia is a viable career path for me at this point and the thought of suffering through CT, transplant, neuro etc over the next 2.5 years is almost unbearable.

Those of you who felt similarly, how did you deal with it? What did you do? What are my options for non-clinical work? I have pretty sizable debt. Are the fellowships/career paths I am not thinking of?

For those in pain, how easy is it to take chunks of time off? Did anyone pursue pain bc they felt similarly? Does locums exist? Is telehealth an option? Would ideally like a career with flexibility but understand I am not going to get it all.

Thanks for your input.

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[GassYous]

Being a ca-1 sucks. This time of year is especially bad since you go in before the sun is up and go home after the sun goes down. It's cold and depressing and life sucks. No one knows you, no one trusts you, you were great at being an intern and now you're basically an intern again.

There's a light at the end of the tunnel. Everyone is way more respectful and nice when you're an attending and the big paychecks help too. Usually there aren't any life or death situations and most days are pretty mundane. I was worried about if I'd find someone and stuff but then suddenly by the end of residency I had a wife and a kid. I actually enjoyed cardiac anesthesia and seriously considered doing the fellowship.

I think it'll get better and I'd try to stick it out a little more.

 

[markneil]

I suggest you switch at this point if CA-1 cases are already bothering you this much where you need a therapist. Residency is supposed to be a time where you learn the basics and search out the sickest patients and most complex cases and learn from those. Unless you miraculously have a change of heart, do your mental self a favor and re-evaluate your priorities (first should be yourself).

So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety that is through the roof right now. I am working with a therapist which helps. I can barely get myself out of bed in the morning but the train keeps chugging ahead. I am seriously considering switching specialities, specifically to psychiatry (I was deciding bw gas and psych as an MS3) or pursuing pain management. This is not the ideal choice for me as I am non-traditional, still single and in my mid-30s and just want to move on with my life and start working and find a partner. However, I am really struggling to imagine any situation in which OR anesthesia is a viable career path for me at this point and the thought of suffering through CT, transplant, neuro etc over the next 2.5 years is almost unbearable.

Those of you who felt similarly, how did you deal with it? What did you do? What are my options for non-clinical work? I have pretty sizable debt. Are the fellowships/career paths I am not thinking of?

For those in pain, how easy is it to take chunks of time off? Did anyone pursue pain bc they felt similarly? Does locums exist? Is telehealth an option? Would ideally like a career with flexibility but understand I am not going to get it all.

Thanks for your input.

 

[Mman]

Being a ca-1 sucks. This time of year is especially bad since you go in before the sun is up and go home after the sun goes down. It's cold and depressing and life sucks. No one knows you, no one trusts you, you were great at being an intern and now you're basically an intern again.

that is literally the opposite of my experience as a resident. The CA1s thought they were the hottest stuff in the hospital. No more being an intern. Actually getting good at anesthesia, taking people from preop holding through big surgeries and waking up safe in PACU, putting in lines, doing blocks, etc. You aren't quite getting the finer points of the subspecialty rotations, but you actually feel like you are starting to get good at the anesthesia thing.

If I was hating life as a CA 1 in the winter, I would ponder whether interventional pain was my future or if I needed to change specialties.

 

[amyl]

If this isn’t for you do yourself and your future patients a favor….. switch. A few people do every year with ease.
Being a doctor is hard…. It’s often a stressful thankless job.
To quote eat pray love- “you gotta want it like you want a tattoo on your face.”
If this isn’t for you don’t spend one minute more - go talk to your program director - mine moved people around as they wished it’ll work out

 

[Blockit]

The other posters have given you very good advice. I will give you some more very good advice. Look into switching residencies to something that better fits your desires and anxiety level. But do it professionally and in a careful manner, because if you let on that you are having trouble in any way and let on to “others” besides your therapist and your close personal friends you run a big risk. And I mean for your future career.
There are so many sharks in these waters you can’t even begin to imagine.

Figure out what would better suit your life. Figure out what’s going to be tolerable to you at the age of 45. Because that’s what you need to be aiming for. Once you figure out what that is, go confidentially to the program director of that program and see about making a switch. See about making a switch with other program directors in the same specialty at other institutions. Do not mention anything psychiatric. That is for you to work on with your therapist. All another program director needs to know is that you have evaluated anesthesia as a specialty and you feel that maybe your aptitudes and strengths are better utilized in their specialty.

There is no shame here. Ultimately, this is about your life and your future and you must protect yourself against the sharks at all times. This can be done successfully.

My best wishes to you.

 

[anbuitachi]

So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety that is through the roof right now. I am working with a therapist which helps. I can barely get myself out of bed in the morning but the train keeps chugging ahead. I am seriously considering switching specialities, specifically to psychiatry (I was deciding bw gas and psych as an MS3) or pursuing pain management. This is not the ideal choice for me as I am non-traditional, still single and in my mid-30s and just want to move on with my life and start working and find a partner. However, I am really struggling to imagine any situation in which OR anesthesia is a viable career path for me at this point and the thought of suffering through CT, transplant, neuro etc over the next 2.5 years is almost unbearable.

Those of you who felt similarly, how did you deal with it? What did you do? What are my options for non-clinical work? I have pretty sizable debt. Are the fellowships/career paths I am not thinking of?

For those in pain, how easy is it to take chunks of time off? Did anyone pursue pain bc they felt similarly? Does locums exist? Is telehealth an option? Would ideally like a career with flexibility but understand I am not going to get it all.

Thanks for your input.

sorry to hear that stuff! must be difficult.

my advice is either switch to psych (you can find a partner in residency time in psych) or if you decide to stay, try to find a GOOD mentor. perhaps speak to your program director (i dont know the culture of your program), and see if any attending is willing to help you

 

[dabears505]

Switch to psych and initiate it as fast as you can. Life is too short to go through it dreading the stress of the job.

 

[Zekchar]

Some will tell you to stick it out. Some will urge you to switch. It's a personal decision but I would encourage you to switch. I always think back to residency and I suspect my experience is not unique. The following blurb probably applies to many more residents than we care to admit.

I had a classmate who was smart, funny, scored highly on all the tests, came from a good college, and med school. She also was not cut out to do anesthesia. She could not get comfortable in the OR without a senior or an attending being available to "help out." She continued through residency as my peer and it was no longer a secret that she was weak. Scored great on ITEs and knew all the answers to pimping questions. She just could not handle the intra-operative pressures of responding timely to critical situations and making on-the-spot decisions. She could not shoulder the magnitude of the decisions, leaving her indicisive and an emotional mess. My program graduated her. She has bounced around from private practice to academics to fellowship, but cannot hold down a job for any stretch of time. Her partners do not trust her, the surgeons are wary of her being in the room, and patients sense her unease.
At some point, residency ends and you are the end of the line. There is no attending over you and when ****t hits the fan, everyone looks at you. If you cannot be that person ... switch and switch as soon as possible. The patients you will not main, hurt, or kill in the future will thank you. So will their families. Get out now.

 

[Realgassy]

Sounds like you need to switch for your own well-being and happiness. I recall feeling overwhelmed as a ca1 and questioning my decision to pursue anesthesia early on. But, by mid year my confidence had increased and I was working my butt off preparing for the ite. As an attending the patients/cases regularly keep me on my toes, and some days can be very stressful.

You should reach out to your PD asap to discuss your concerns and feelings about switching. But leave the details about therapy out of the conversation. I expect you may need to put in a good amount of legwork to make the switch happen, but it is doable.

 

[anaesthetic]

I may be biased, but almost every day there are at least a few patients who require that extra mindfulness and taking extra precautions is the difference between a good day and a very bad day. Providing a smooth/safe anesthestic for sick patients is a challenge I enjoy (for now), but I can see how the job can be extremely stressful to people who don’t view it in that light.

You need to switch out. Plenty of my peers have done it at various stages of training, and I think most programs would rather have an empty spot than graduate somebody who might struggle for the rest of their lives (seen it multiple times).

 

[coffeebythelake]

So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety that is through the roof right now. I am working with a therapist which helps. I can barely get myself out of bed in the morning but the train keeps chugging ahead. I am seriously considering switching specialities, specifically to psychiatry (I was deciding bw gas and psych as an MS3) or pursuing pain management. This is not the ideal choice for me as I am non-traditional, still single and in my mid-30s and just want to move on with my life and start working and find a partner. However, I am really struggling to imagine any situation in which OR anesthesia is a viable career path for me at this point and the thought of suffering through CT, transplant, neuro etc over the next 2.5 years is almost unbearable.

Those of you who felt similarly, how did you deal with it? What did you do? What are my options for non-clinical work? I have pretty sizable debt. Are the fellowships/career paths I am not thinking of?

For those in pain, how easy is it to take chunks of time off? Did anyone pursue pain bc they felt similarly? Does locums exist? Is telehealth an option? Would ideally like a career with flexibility but understand I am not going to get it all.

Thanks for your input.

It's important to reframe what we do.
Over the years I've had patients with bad outcomes and some of them have died.
I sleep well at night knowing I did everything that was appropriate, and that there are things that we cannot control.

Its hard to kill a healthy patient.
For sick patients, you do your best.
For emergency cases with moribund patients, you do your best under extreme circumstances.

Accept that you even when you have a well planned out anesthetic you can still have bad outcomes. There is risk with everything.
Just make sure your patient understand their risks and document.

Talk to your colleagues/classmates/attendings. What you are feeling isn't unique to you.

 

[shepardsun]

For emergency cases with moribund patients, you do your best under extreme circumstances.

In a weird way these are some of my favorite and least stressful cases. It's not that I don't try my best, it's that there's nowhere to go but up. Come in bleeding out from penetrating chest trauma? I'm going to work my tail off and do some cool procedures and resuscitate you to the best of my ability but at the end of the day I wasn't the one who shot you with a shotgun and I won't lose sleep over that case.

Accidentally nick someone's lip with the laryngoscope during an ASA 1 lap appy? I'll feel terrible for days.

 

[coffeebythelake]

In a weird way these are some of my favorite and least stressful cases. It's not that I don't try my best, it's that there's nowhere to go but up. Come in bleeding out from penetrating chest trauma? I'm going to work my tail off and do some cool procedures and resuscitate you to the best of my ability but at the end of the day I wasn't the one who shot you with a shotgun and I won't lose sleep over that case.

Accidentally nick someone's lip with the laryngoscope during an ASA 1 lap appy? I'll feel terrible for days.

Yes, exactly agree.

 

[Barleycorn]

So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety that is through the roof right now. I am working with a therapist which helps. I can barely get myself out of bed in the morning but the train keeps chugging ahead. I am seriously considering switching specialities, specifically to psychiatry (I was deciding bw gas and psych as an MS3) or pursuing pain management. This is not the ideal choice for me as I am non-traditional, still single and in my mid-30s and just want to move on with my life and start working and find a partner. However, I am really struggling to imagine any situation in which OR anesthesia is a viable career path for me at this point and the thought of suffering through CT, transplant, neuro etc over the next 2.5 years is almost unbearable.

Those of you who felt similarly, how did you deal with it? What did you do? What are my options for non-clinical work? I have pretty sizable debt. Are the fellowships/career paths I am not thinking of?

For those in pain, how easy is it to take chunks of time off? Did anyone pursue pain bc they felt similarly? Does locums exist? Is telehealth an option? Would ideally like a career with flexibility but understand I am not going to get it all.

Thanks for your input.

If its not completely obvious, if you quit make sure you have an open spot ready and waiting for you that you have thoroughly vetted. Do not quit without a meticulously detailed exit plan that ends in ACGME accredited residency with a board certification.

 

[Agast]

I really enjoyed psychiatry except for the occasional dangerous psych patient. Probably part of the reason why I chose to go into Pain Management. Psychiatry is a hidden gem of the ability to have a thriving practice, low overhead, cash pay. And with a background in anesthesia you might be more comfortable with ketamine infusions for depression. The barrier to entry is that most people don’t like listening to other people complain.

Some of your dislike of anesthesia may be coming from a lack of confidence in your fund of knowledge, or imposter syndrome where you think you’re the wrong doctor to take care of a critically ill patient. I think that’s normal in your first year. If you knew the solution to every problem would you enjoy it more? No one starts their residency with all the answers.

 

[hiyaman]

A lot of CA1s are feeling some degree of stress during this part of the year. By now your probably getting bigger and sicker cases or getting introductions into more advanced anesthetics like thoracic cases etc. I would say the degree to which the stress is affecting you should determine if you should seek a diff specialty. I had a lot of stress during this part of the year but as I learned and got better at obtaining central and arterial access the stress improved and anesthesia got fun again. Residency is gonna be a series of peaks and valleys of stress. By end of CA1 I was confident, but by beginning of CA2 I realized I had to learn a new skill which was training and managing the new CA1s.

 

[CHARLESTONMMM]

Everyone feels stress during residency. There were times during CA1 where I was like what have I got myself into. But there was never a time where I thought about leaving to do another residency. There were palm trees where I did residency which helped me get through the grind of CA1 and CA2 year. I do think if you can envision a different path in life then you are still early enough to do it. Gut feelings are usually right.

 

[vector2]

I say switch. If you are a CA-1 and you don't look forward to each day the same way a Marine fresh out of basic is looking to get into the ****, you're probably in the wrong specialty.

Every resident hates the residency stuff like being a subordinate or the bad hours, but you damn well better like the source material and the actual prospect of giving anesthesia to all-comers. The first few months of CA-1 were some of the fondest I had as a trainee. Dreaded intern year was over, and as soon as we all had put in a few tubes we thought we were big swinging anesthesia studs ready to dunning-kruger ourselves into a liver transplant or an awake fiber on a bout-to-crash angioedema. And that's the kind of enthusiasm I would expect from trainees, so if that's not how you feel, just remember life is too short to wake up every day and dread going to work.

 

[kidthor]

Hard to know what to do... Some of the lack of respect stuff resolves when you're an attending, but stress from critically ill patients would continue. it would be reasonable to switch, and luckily you're suggesting a switch into a non-competitive field. Even better that psychiatry is a great field where you can be your own boss and help people while not necessarily fussing with insurance.

Have you discussed your thoughts with any trusted attendings in both anesthesia and psychiatry? I bet someone from here would discuss with you if you're uncomfortable speaking with someone in your program (e.g. I would).

 

[OptionOffense]

Everyone is way more respectful and nice when you're an attending

Not really!

 

[bigdan]

As a CA1 or 2, I would have (and did) give the advice to stay to those who felt this bad. I’m scarred by the suicide that occurred my Chief year, by a CA1 with not-dissimilar complaints. I am much more realistic now.

This here life is *not* worth hating anesthesiology and persisting. It’s just not.

The asshats at NRMP massively complicated my junior’s attempts to swap into another specialty, so be emboldened to fight. Tell your PD now. Right now. Get support.

I wish you the very best of luck.

 

[hiyaman]

Also I think it would be a big risk to suffer through anesthesia training just to do pain (unless you genuinely enjoy anesthesia). I'm pain trained but went back to anesthesia. I would not be able to do this if I hated anesthesia and would be stuck in pain (which has its own sets of stress and worries) and is not for everyone.

 

[IMGASMD]

Not sure if it’s where I am right now, (weather cold, pandemic bad, fighting COVID) or OP is a good writer. The description feels different to me.

My first reaction is to get out. You seem to have thought about it. Know how you feel about anesthesia. Maybe the therapy really helped to let you verbalize your feelings.

Just realize as a doctor you will be bearing the responsibilities for a lot of decisions. Even in psychiatry there will be tough decisions. Read an account that a resident who discharged a patient who he deemed stable; pt completed suicide right after he left the hospital…. Resident was devastated.

The reason why anesthesia residency is four years, other than learn to push the stretchers, to learn to accept responsibilities, that’s part of the deal.

Good luck.

 

[waterhammer]

Sounds cliched, but do you work to live or live to work? I can put up with the bs parts of anesthesia, because it allows me a nice life outside the hospital. When I was younger and more idealistic, I thought the job had to be my calling or something like that.

Ways to deal - exercise, yoga, meditation, spending time with friends & family, having an artistic outlet or hobby, catching up on sleep when possible!

Take care!

 

[venacontracta]

It honestly sounds like you know switching is the right answer and you are apprehensive about pulling the trigger on such a big decision. Do it. Be smart about who you talk to and how you approach things but the odds are very good that everyone including your PD will be more supportive than you might initially expect.

 

[AnonymousPD]

So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety that is through the roof right now. I am working with a therapist which helps. I can barely get myself out of bed in the morning but the train keeps chugging ahead. I am seriously considering switching specialities, specifically to psychiatry (I was deciding bw gas and psych as an MS3) or pursuing pain management. This is not the ideal choice for me as I am non-traditional, still single and in my mid-30s and just want to move on with my life and start working and find a partner. However, I am really struggling to imagine any situation in which OR anesthesia is a viable career path for me at this point and the thought of suffering through CT, transplant, neuro etc over the next 2.5 years is almost unbearable.

lemmonhead,

From the responses here, I hope you can see that many people have felt similarly to you and that all of us are empathetic to your situation. And because there might be someone out there reading this who feels similarly to the OP, I will rehash some of the advice that I sent to you privately.

First of all, it is a great thing that you are making use of available mental heath resources around you. Keep doing that and lean on your support system. Don't be afraid to ask for help and let your program administration know that you are not okay. More than anything I hope that they will be fully supportive of you right now.

Given what you have shared with all of us. My advice to you is to start the process on switching specialties immediately. Talk to your program director, tell them everything that you just told us here. If you feel you might be stigmatized because you are seeing a therapist, leave that out for now. If you start the process immediately, it MIGHT be possible for you to get last minute interviews for psychiatry match for this year's cycle. Certainly you might be able to get one at your home institution. You and your PD will have a lot of phone calls to make and not a lot of time to make them.

Last year, there were about 2900 applicants for about 1900 spots, and only 3 went unfilled. It will be difficult to find a spot in via SOAP. But with that many positions offered every year, there could be programs with open spots. Finding one of those is going to take time.

It is very common for CA1s to have some moments of doubt. This actually happens in every specialty, simply because as a med student you are largely shielded from the downsides of residency. But what you have described isn't the normal, "I have some doubt about my clinical skills" or "how do I deal with prima donna surgeons who don't respect us" or "it is drives me crazy that nurses can't call me by my name" sort of thing. You know that you don't enjoy taking care of the critically ill. You know you don't enjoy being in rapidly evolving emergency situations. All of that is central to what anesthesiologists do. It is a great thing that you recognize this now. Furthermore, it is affecting your mental health and well-being.

The things you don't like about your current job are only going to get worse. You will deal with progressively sicker and sicker patients as you progress to advanced rotations. You will assume more responsibility in the ICUs as a team leader. You are going to become responsible for emergency airway and codes throughout the hospital while on call. Sucking things up for the next 2.5 years hoping to find a soft landing in pain management is a terrible idea. For sure, don't stay out of duty to your program or because you don't want to disrupt the schedules of your classmates. While that would be admirable, what you've described is way more important than that. The program and your classmates will be fine.

Switching careers is much more common than you think. Every single case of a resident I've had switch out of anesthesiology into something they felt they were better suited for, resulted in the resident THRIVING both professionally and personally. Don't worry about the debt...the extra time is a small price to pay for 40 years of satisfying career and more importantly a gratifying and enjoyable life.

Don't hesitate to reach out if I can be of more assistance.

 

[Precedexx]

I'm sorry OP. I'm an intern, so I don't really have good advice. I do think that switching residencies is a daunting task, but worth it if you truly decide anesthesiology. Better to deal with the challenges of switching now than to spend a career in a field you don't enjoy and is bad for your mental health.

Also, I'm happy to see all the thoughtful responses to this post. Nice to see the community like this.

 

[DirtDocMD]

It sounds like you’ve thought about this quite a lot. It’ll take a little doing, but don’t be afraid to switch, if you REALLY think anesthesia isn’t a “fit”.

Obviously, we all have varying levels of “anxiety” about big cases and sick patients. Some of that is “confidence”, some “knowledge level”, and some, just whether they like the work or not.

The one thing I would ask you to do, is to “picture” yourself as someone “fully trained” or educated , with ALL the knowledge you think it would take to be a competent anesthesiologist. Then, “ask” yourself, “If I had all this knowledge, would I STILL have this anxiety about doing this??”.

If this is about MORE than just your current knowledge level (and it sounds like it is), then do yourself a favor, and move on.

Also, keep an open mind, and consider other specialties (if they might interest you). PM&R, pathology, occupational med, etc. These are all specialties that don’t require “snap” life/death decisions, where you can crack a book and think about things.

I agree with some others, above. While I would be honest with YOURSELF, I wouldn’t necessarily tell just ANYONE that you’re having serious anxiety or other issues regarding what you’re doing (unless you’re really afraid it’s affecting your treatment of patients). Just start out telling your director/etc that anesthesia is just not a “fit” for you, and you don’t see yourself being happy/content doing it for the next 25-30 years. Just because anesthesia causes you anxiety, doesn’t mean MEDICINE (other specialties) causes it. Most understand this, but you don’t want someone who DOESN’T (attending/program director/etc), possibly “black-balling” you in recommendations, as if you have more serious psych issues. (I’m going to ASSUME you’re “depressed” (your word) BECAUSE of this situation, rather than depression CAUSING this situation.)

Not for the same reasons, obviously, but I changed TO anesthesia. I thought all through med school I’d be a “country doctor”, and got a residency at a fabulous FM program. Within a month and a half, after dealing with way more clinic, and patient personalities, and calls about anything/everything all night while on call (and starting out on a surg rotation, where I spent mornings with a great Anesthesiologist), I KNEW I had picked the wrong specialty. I called a buddy who had picked anesthesia, and asked if he could ask HIS program director if there were any open positions in their anesthesia program. Thank you, John!!! Luckily, there were, and I lined up a position before going to my Family Practice director, and letting them know that I just couldn’t see myself doing FP for 30 years. With the exception of only 1-2 attendings, they were all very understanding, and I finished out my intern year, there.

Good luck with whatever you choose, and do the students/residents who visit this forum a favor, and follow up in this thread. You might really help others who face such a decision in the future.

 

[nimbus]

One of the big advantages of going to medical school instead of CRNA school is that you can switch specialties. I believe your job should bring you JOY. There’s no shame in switching.

 

[deleted875186]

I do pain, it is mostly clinic with a few days of procedures. I will repeat what someone said above, I was very rarely stressed about critically ill patients with anesthesia, there’s nowhere to go but up, and often we make the hemodynamics better and “fix” a lot of stuff, anesthesia usually feels like hitting a home run. Complication like a accidental dural puncture in the pain clinic makes me feel much worse.

 

[lemmonhead]

I appreciate everyone's input. I am overwhelmed by the amount of thoughtful feedback on this forum. I took some steps a few days ago and reached out to a trusted attending who runs wellness for us and she was very understanding. She shared similar sentiments about her training early on. (ie nightmares about missing an emergent airway etc) We're working on sorting out a plan for me.

As alluded to, I think there is some component of a knowledge deficit which causes me anxiety. Upon further reflection, what I am struggling with most is whether I will be able to get comfortable with those problems as my knowledge fund increases. As mentioned I have baseline anxiety which I am learning to manage but I wonder if that is compatible with the field. I am capable of making snap decisions, and do, but is it something I enjoy? I don't know.

I will say that I loved my acute pain rotations and found it very gratifying to provide regional and neuraxial anesthesia for patients and actually ENJOYED and looked forward to coming to work those days in a way that I didn't feel during intern year. Unfortunately, all regional, all the time and rounding on epidurals is not a full time attending job (I don't think). The attendings I work with round on the acute pain service q6wks. And thinking back further, when I am taking care of ASA1s and 2s the stress is not quite as bad.

In anycase, I am currently reaching out to some friends in other fields, including psychiatry, and exploring my options. Thank you again for all of your support and thoughtful commentary.

 

[PpfSuxTube]

After a few years there is no emotional difference between looking after a critically ill person and any other job.

Its something you'll have done 100s possibly 1000s of times.

 

[OptionOffense]

After a few years there is no emotional difference between looking after a critically ill person and any other job.

I would not go that far.

 

[woopedazz]

My wife and I both had doubts about what fields we were in. She switched, I didn't. Both of us made the right call.

She used to come home crying every day and dread going to work. That's normally a strong indication.

 

[Creed_Bratton]

Hey OP, you sound like me. I was very unhappy after I started my CA1 and actually just recently quit and switched specialties. DM me if you want to chat more about what I did to get out/switch or just vent.

Everyone told me that as the knowledge base increases and the technical skills improve things become easier. As Ca1 progressed they did a bit, but Regardless of that I continued to be miserbale and hated everything, from the anxiety of dealing with critically ill patients, to the smallest and most mundane things like wearing scrubs every day, waking up at 4am, being in windowless ORs and not seeing the sun for days on end in fall/winter, dealing with rude surgical teams, emptying foleys, suctioning copious amounts of snot and saliva etc etc etc.
I share your sentiments about being an older non-trad medical graduate and wanting to move on with my life and I was not ok with spending my 30s on the job I hate. This is the time I will never get back, regardless of how much money I can possibly retire with. As I heard and observed with many young attendings, life immediately after residency has its own challenges with possibly juggling supervising multiple rooms, constantly being the guy who is called when ***t hits the fan, and ultimately carrying the full burden of responsibility. I did not see myself being that guy, and for me it was much better to quit earlier rather than later. On the other hand some of my upper classmen said they felt similarly in CA1 but felt much better and happier later on in CA2.

Its a very challenging and very personal decision, but I just wanted you to assure you that if you do decide to switch, you are not alone and the possibilities are there! Happy to help/discuss the options if you ever need it!
Regardless of what you decide hang in there and good luck!





So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety that is through the roof right now. I am working with a therapist which helps. I can barely get myself out of bed in the morning but the train keeps chugging ahead. I am seriously considering switching specialities, specifically to psychiatry (I was deciding bw gas and psych as an MS3) or pursuing pain management. This is not the ideal choice for me as I am non-traditional, still single and in my mid-30s and just want to move on with my life and start working and find a partner. However, I am really struggling to imagine any situation in which OR anesthesia is a viable career path for me at this point and the thought of suffering through CT, transplant, neuro etc over the next 2.5 years is almost unbearable.

Those of you who felt similarly, how did you deal with it? What did you do? What are my options for non-clinical work? I have pretty sizable debt. Are the fellowships/career paths I am not thinking of?

For those in pain, how easy is it to take chunks of time off? Did anyone pursue pain bc they felt similarly? Does locums exist? Is telehealth an option? Would ideally like a career with flexibility but understand I am not going to get it all.

Thanks for your input.

 

[dabears505]

Hey OP, you sound like me. I was very unhappy after I started my CA1 and actually just recently quit and switched specialties. DM me if you want to chat more about what I did to get out/switch or just vent.

Everyone told me that as the knowledge base increases and the technical skills improve things become easier. As Ca1 progressed they did a bit, but Regardless of that I continued to be miserbale and hated everything, from the anxiety of dealing with critically ill patients, to the smallest and most mundane things like wearing scrubs every day, waking up at 4am, being in windowless ORs and not seeing the sun for days on end in fall/winter, dealing with rude surgical teams, emptying foleys, suctioning copious amounts of snot and saliva etc etc etc.
I share your sentiments about being an older non-trad medical graduate and wanting to move on with my life and I was not ok with spending my 30s on the job I hate. This is the time I will never get back, regardless of how much money I can possibly retire with. As I heard and observed with many young attendings, life immediately after residency has its own challenges with possibly juggling supervising multiple rooms, constantly being the guy who is called when ***t hits the fan, and ultimately carrying the full burden of responsibility. I did not see myself being that guy, and for me it was much better to quit earlier rather than later. On the other hand some of my upper classmen said they felt similarly in CA1 but felt much better and happier later on in CA2.

Its a very challenging and very personal decision, but I just wanted you to assure you that if you do decide to switch, you are not alone and the possibilities are there! Happy to help/discuss the options if you ever need it!
Regardless of what you decide hang in there and good luck!





So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety that is through the roof right now. I am working with a therapist which helps. I can barely get myself out of bed in the morning but the train keeps chugging ahead. I am seriously considering switching specialities, specifically to psychiatry (I was deciding bw gas and psych as an MS3) or pursuing pain management. This is not the ideal choice for me as I am non-traditional, still single and in my mid-30s and just want to move on with my life and start working and find a partner. However, I am really struggling to imagine any situation in which OR anesthesia is a viable career path for me at this point and the thought of suffering through CT, transplant, neuro etc over the next 2.5 years is almost unbearable.

What did you switch into?

 

[Creed_Bratton]

What did you switch into?

Messaged you

 

[Gern Blansten]

lemmonhead,

From the responses here, I hope you can see that many people have felt similarly to you and that all of us are empathetic to your situation. And because there might be someone out there reading this who feels similarly to the OP, I will rehash some of the advice that I sent to you privately.

First of all, it is a great thing that you are making use of available mental heath resources around you. Keep doing that and lean on your support system. Don't be afraid to ask for help and let your program administration know that you are not okay. More than anything I hope that they will be fully supportive of you right now.

Given what you have shared with all of us. My advice to you is to start the process on switching specialties immediately. Talk to your program director, tell them everything that you just told us here. If you feel you might be stigmatized because you are seeing a therapist, leave that out for now. If you start the process immediately, it MIGHT be possible for you to get last minute interviews for psychiatry match for this year's cycle. Certainly you might be able to get one at your home institution. You and your PD will have a lot of phone calls to make and not a lot of time to make them.

Last year, there were about 2900 applicants for about 1900 spots, and only 3 went unfilled. It will be difficult to find a spot in via SOAP. But with that many positions offered every year, there could be programs with open spots. Finding one of those is going to take time.

It is very common for CA1s to have some moments of doubt. This actually happens in every specialty, simply because as a med student you are largely shielded from the downsides of residency. But what you have described isn't the normal, "I have some doubt about my clinical skills" or "how do I deal with prima donna surgeons who don't respect us" or "it is drives me crazy that nurses can't call me by my name" sort of thing. You know that you don't enjoy taking care of the critically ill. You know you don't enjoy being in rapidly evolving emergency situations. All of that is central to what anesthesiologists do. It is a great thing that you recognize this now. Furthermore, it is affecting your mental health and well-being.

The things you don't like about your current job are only going to get worse. You will deal with progressively sicker and sicker patients as you progress to advanced rotations. You will assume more responsibility in the ICUs as a team leader. You are going to become responsible for emergency airway and codes throughout the hospital while on call. Sucking things up for the next 2.5 years hoping to find a soft landing in pain management is a terrible idea. For sure, don't stay out of duty to your program or because you don't want to disrupt the schedules of your classmates. While that would be admirable, what you've described is way more important than that. The program and your classmates will be fine.

Switching careers is much more common than you think. Every single case of a resident I've had switch out of anesthesiology into something they felt they were better suited for, resulted in the resident THRIVING both professionally and personally. Don't worry about the debt...the extra time is a small price to pay for 40 years of satisfying career and more importantly a gratifying and enjoyable life.

Don't hesitate to reach out if I can be of more assistance.

Lots of good advice. Thanks for sharing your wisdom with this resident. I usually say hang in there, but this detailed description of how they feel makes me think that they picked the wrong specialty.

 

[Candidate2017]

So I am half way through my CA-1 year and I am miserable. I am unhappy with anesthesia for many of the standard reasons mentioned on this forum, ie. lack of respect, being beholden to someone else's schedule, difficult surgeons, call etc, but the thing that keeps me up most is the stress of taking care of critically ill people. I really do not think I am cut out to handle life or death situations and the stress of that grates on me daily. I feel very depressed and have a baseline anxiety that is through the roof right now. I am working with a therapist which helps. I can barely get myself out of bed in the morning but the train keeps chugging ahead. I am seriously considering switching specialities, specifically to psychiatry (I was deciding bw gas and psych as an MS3) or pursuing pain management.

I'm going to guess you're not seeing a real therapist, i.e., someone who has a PhD or MD. It would be worth the money to see a psychiatrist who does therapist, for both therapy and a viewpoint of medical training.

The grass is always greener. No matter the specialty, it is still medicine and life and death is part of the job. Which is why getting control of depression and anxiety is important.

Psychiatry can actually be one of the more anxiety inducing specialties because it is not a hands on specialty, and we have less control but are expected to be responsible for heavy situations. Imagine yourself being the psychiatrist of a nice 50 y.o. anesthesiologist who you've been seeing a while for depression. He hates his job, just got served with divorce papers, and BTW in the last 5 minutes of the appointment, he admits to diverting and using opioids while at work and has been thinking about ODing or killing his wife and kids.

 

[deleted875186]

I'm going to guess you're not seeing a real therapist, i.e., someone who has a PhD or MD. It would be worth the money to see a psychiatrist who does therapist, for both therapy and a viewpoint of medical training.

The grass is always greener. No matter the specialty, it is still medicine and life and death is part of the job. Which is why getting control of depression and anxiety is important.

Psychiatry can actually be one of the more anxiety inducing specialties because it is not a hands on specialty, and we have less control but are expected to be responsible for heavy situations. Imagine yourself being the psychiatrist of a nice 50 y.o. anesthesiologist who you've been seeing a while for depression. He hates his job, just got served with divorce papers, and BTW in the last 5 minutes of the appointment, he admits to diverting and using opioids while at work and has been thinking about ODing or killing his wife and kids.

Yes, too heavy for me, I agree this would be more mentally draining for me than anesthesia.

 

[IMGASMD]

I'm going to guess you're not seeing a real therapist, i.e., someone who has a PhD or MD. It would be worth the money to see a psychiatrist who does therapist, for both therapy and a viewpoint of medical training.

The grass is always greener. No matter the specialty, it is still medicine and life and death is part of the job. Which is why getting control of depression and anxiety is important.

Psychiatry can actually be one of the more anxiety inducing specialties because it is not a hands on specialty, and we have less control but are expected to be responsible for heavy situations. Imagine yourself being the psychiatrist of a nice 50 y.o. anesthesiologist who you've been seeing a while for depression. He hates his job, just got served with divorce papers, and BTW in the last 5 minutes of the appointment, he admits to diverting and using opioids while at work and has been thinking about ODing or killing his wife and kids.

What’s your obligation there?
If he’s “only” diverting?
If he’s “only” thinking of suicide?

I had therapy with social worker, PHD candidates, PHD and MD. Hands down MD was the best….. but this was after med school and some residency training. Related much better than other therapists.

 

[chudat]

as someone who felt exactly the same way and switched (rads), I encourage you to do it and do it asap.

life is too short to be doing something youre not happy about.

you dont want to finish anesthesia and then realize it's not for you.

 

[IMGASMD]

That's really interesting. The high pressure situations are what excite me about a possible career in this field. I currently work in a smaller ER, but when crap hits the fan I get an adrenaline rush and love doing CPR, calling the STEMI doc, whatever I can to get involved and make it happen in my humble role as a tech.

When I was younger, this may have been true. Your perspective will change with age and experience.

Simply put, you don’t know what you don’t know. Not a dig at you, there are still lots of things I don’t know either.

Even the two examples you provided seems to be exciting and important….. but in reality, they’re just a smart part of patients care. There will be things, even as an attending physician, will have no control over, but ultimately still responsible. That’s why med school is long, and residency and fellowship is longer. To make the “right” decisions, just like everything else takes lots of practice.

I wish you luck in your journey.

 

[lemmonhead]

Update: After a lot of soul searching, speaking with mentors and acquiring more experience, I've decided to continue with anesthesia residency. I was going through an incredible rough patch at the time of my previous post and needed to take a step back from things. I am very grateful for the different perspectives and insights everyone offered. Good to see that people on this forum still want to help. Thank you all.

 

[IMGASMD]

Update: After a lot of soul searching, speaking with mentors and acquiring more experience, I've decided to continue with anesthesia residency. I was going through an incredible rough patch at the time of my previous post and needed to take a step back from things. I am very grateful for the different perspectives and insights everyone offered. Good to see that people on this forum still want to help. Thank you all.

Glad you’re through the rough patch. It does get better. Even with all the bickering, name calling (sometimes), out right moaning about the how bad the field is becoming. All of us (at least the most of us) want people to succeed and enjoy the this field.

 

[Gern Blansten]

Update: After a lot of soul searching, speaking with mentors and acquiring more experience, I've decided to continue with anesthesia residency. I was going through an incredible rough patch at the time of my previous post and needed to take a step back from things. I am very grateful for the different perspectives and insights everyone offered. Good to see that people on this forum still want to help. Thank you all.

Glad to hear things are better. Hang in there.

 

[dabears505]

Good luck to you. I hope you made the right move.

 

[zizzer]

Good luck. I'm not sure if it's been mentioned, but a tremendous amount of one's joy as any type of physician is feeling like you're good at it. Studying hard, learning the book stuff, finding ways to get slick at procedures, finding your own preferences in the gray areas of challenging anesthesia cases will lead to confidence and with luck, pride and joy. At the end of CA-1 year I was still worthless at placing IVs even. At the end, I took about as challenging of a job as there is in MD-only private practice in a tertiary care center and feel great.

I didn't suffer from anxiety, but the point still stands that learning things well in residency may help. Many attendings are bad teachers, so make them teach you since you're stuck there anyway. "Dr. Whatever, why did you choose this instead of this for your plan? What do you think of this? Have you ever seen blah blah blah?" Studying for your oral boards early before you're out of residency will help solidify your decision making. Knowing what you would do in different situations front and back eases anxiety.

 

[deleted875186]

Life gets infinitely better after residency.