Talk me out of... or into anesthesia.

[Anonsthesia]

So I'm an OMS-III and I'm on my seventh rotation. One that I surprisingly enjoyed was anesthsia. Below is a list of my pros and cons for the specialty.

Pros:

I enjoyed being a part of every procedure.

I like the mix of minor procedures and thinking. I got good at intubation. The blocks seemed very cool.

I enjoyed the mix of mostly chill and occasionally intense.

I like getting up early.


Cons:

I felt like the anesthesiologist was the side doctor and I didn't like that feeling at all.

The obvious issues with midlevels. (who also got to do a lot of the fun stuff).

All of the doom and gloom talk. Job security? Salary decreases? I plan on working in a community setting, so think that would help a bit.


Besides anesthesia a was interested in EM and surgery. Any input?

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[patriot6]

might want to change that signature my man.

 

[ERRES2288]

So I'm an OMS-III and I'm on my seventh rotation. One that I surprisingly enjoyed was anesthsia. Below is a list of my pros and cons for the specialty.

Pros:

I enjoyed being a part of every procedure.

I like the mix of minor procedures and thinking. I got good at intubation. The blocks seemed very cool.

I enjoyed the mix of mostly chill and occasionally intense.

I like getting up early.


Cons:

I felt like the anesthesiologist was the side doctor and I didn't like that feeling at all.

The obvious issues with midlevels. (who also got to do a lot of the fun stuff).

All of the doom and gloom talk. Job security? Salary decreases? I plan on working in a community setting, so think that would help a bit.


Besides anesthesia a was interested in EM and surgery. Any input?

Bolded is the biggest thing you will have to come to terms with to have a happy career in anesthesia. If it bothered you a lot then pick another field.

 

[bashwell]

So I'm an OMS-III and I'm on my seventh rotation. One that I surprisingly enjoyed was anesthsia. Below is a list of my pros and cons for the specialty.

Pros:

I enjoyed being a part of every procedure.

I like the mix of minor procedures and thinking. I got good at intubation. The blocks seemed very cool.

I enjoyed the mix of mostly chill and occasionally intense.

I like getting up early.


Cons:

I felt like the anesthesiologist was the side doctor and I didn't like that feeling at all.

The obvious issues with midlevels. (who also got to do a lot of the fun stuff).

All of the doom and gloom talk. Job security? Salary decreases? I plan on working in a community setting, so think that would help a bit.


Besides anesthesia a was interested in EM and surgery. Any input?

The above could be a big concern in anesthesia. If you really can't stand not being the captain of the ship, then you may not like anesthesia as a career. It could grate on you over time. For example, surgeries happen. You have to be there when you're asked to be there, and you can't leave if the surgery goes too long. That's not your call. You're there for the patient (and the surgeon and the rest of the team). Anesthesia is a service field. Some see that as very good (e.g. no long term responsibility for the patient), others not so much. You have to know yourself, and be true to yourself, IMO.

 

[Jimmy Chitwood]

Every field has its positives and negatives. I chose anesthesia for the following reasons:

1. I like being in the OR
2. I like doing procedures
3. I hate clinic

Period. Nothing fits those criteria the way anesthesia does.

Being the "captain of the ship" is overrated. Some people will value your opinion more than others, but while the surgeon will generally run the show, the surgeon also has to take care of the patient's nasty leaky wound for the next few days, then follow up with the patient in clinic over the next few months. And some of these patients are just tough personalities with unrealistic expectations, and some of them simply won't get better. They can have that all day every day as far as I'm concerned. And most of the people who really like surgery have no problem with that, so good for them.

Anesthesia is fun. You can also do pain or critical care if you decide that the OR stuff isn't quite for you after you get done.

My advice to you: don't overthink this. Do what you think you're going to like, whether it is anesthesia or something else. Good luck.

 

[Anonsthesia]

I definitely do not like rounding or draining abcesses, lol. As far as not being the captain goes, I'm sure I can get over it easily. I'm sure it just feels like a bigger deal now since I'm but a wee med student. 10 years down the road I'd probably be glad to not have all of that follow-up stuff.

Honestly, I would probably go into anesthesia if everything I read about the job market and encroachment didn't scare me so much. Is it really as bad as they say it is?

 

[bashwell]

I definitely do not like rounding or draining abcesses, lol. As far as not being the captain goes, I'm sure I can get over it easily. I'm sure it just feels like a bigger deal now since I'm but a wee med student. 10 years down the road I'd probably be glad to not have all of that follow-up stuff.

I don't like rounding either, but rounding as a med student vs resident vs attending (and in academia/university vs private practice) can be very different experiences!

Honestly, I would probably go into anesthesia if everything I read about the job market and encroachment didn't scare me so much. Is it really as bad as they say it is?

http://forums.studentdoctor.net/threads/future-anesthesia-job-market.1062141

 

[Nivens]

Others have/will capture my general feeling about the different fields, but I do want to make one comment as I also had a difficult time deciding and asked many of the same questions you are now. Now that I am a resident actually doing the work, I realize I was agonizing over differing degrees of happiness. I like being a doctor, and while the specialty I chose might be the difference between 95 and 92% satisfaction relative to one of the others I was considering, there probably isn't just one field that would have provided me with a satisfying career. The same is probably true for a lot of us. Rest easy friend.

 

[Spinach Dip]

1. Read this board and see how other anesthesiologists talk.

2. Ask yourself: is this who I really want to work with for the next 30-50 years?

 

[deleted171991]

Bolded is the biggest thing you will have to come to terms with to have a happy career in anesthesia. If it bothered you a lot then pick another field.

It bothered me a lot, so I went into critical care. It still bothers me on occasion in the SICU, but much less. Feeling like a real doctor motivates me to better myself every day, something that I did not feel while practicing only anesthesia.

 

[Nivens]

It bothered me a lot, so I went into critical care. It still bothers me on occasion in the SICU, but much less. Feeling like a real doctor motivates me to better myself every day, something that I did not feel while practicing anesthesia.

FFP are you 100% CC these days?

 

[deleted171991]

FFP are you 100% CC these days?

I edited the post. It's in italics.

The point I was trying to make is that one can feel treated like a real doctor as an anesthesiologist, too, but only if practicing CCM or Pain. Anything else, and one is seen by most patients (and not only) as just another member of the surgical team.

When I am in the MICU or on a medicine floor, it's even better: I get to feel like a surgeon.

 

[Mman]

1. Read this board and see how other anesthesiologists talk.

2. Ask yourself: is this who I really want to work with for the next 30-50 years?

I probably wouldn't use personalities on an anonymous internet forum to make judgments about future professions. I'd go spend some time with actual anesthesiologists in real life and see how their day is and how they interact with each other, surgeons, nurses, and patients.

 

[soorg]

Are you crazy? Quit medicine altogether!

 

[PainDrain]

You want job security then go into neurosurgery or cardiac surgery; those are the only two specialties that are completely immune to nurse "mission creep" in our lifetime.

 

[RapSeqInt]

You want job security then go into neurosurgery or cardiac surgery; those are the only two specialties that are completely immune to nurse "mission creep" in our lifetime.

Not nurses, but cardiac surgery is losing ground to interventional cardiology.

 

[Psai]

Not nurses, but cardiac surgery is losing ground to interventional cardiology.

Since when? Stents are for symptoms, there is no mortality benefit

 

[abolt18]

Every field has its positives and negatives. I chose anesthesia for the following reasons:

1. I like being in the OR
2. I like doing procedures
3. I hate clinic

Period. Nothing fits those criteria the way anesthesia does.

Being the "captain of the ship" is overrated. Some people will value your opinion more than others, but while the surgeon will generally run the show, the surgeon also has to take care of the patient's nasty leaky wound for the next few days, then follow up with the patient in clinic over the next few months. And some of these patients are just tough personalities with unrealistic expectations, and some of them simply won't get better. They can have that all day every day as far as I'm concerned. And most of the people who really like surgery have no problem with that, so good for them.

Anesthesia is fun. You can also do pain or critical care if you decide that the OR stuff isn't quite for you after you get done.

My advice to you: don't overthink this. Do what you think you're going to like, whether it is anesthesia or something else. Good luck.

This perfectly depicts my feelings. Love the OR, but I like watching as much as I like participating in the surgery (so I really just like the environment). I loathe clinic. All clinic. Every rotation that involved clinic, my wife always pointed out how miserable I was. Any day in the OR, I came home "beaming." I like that I get to quickly build a patient's trust in me. I love the hands on aspects of anesthesia. And it's nice not having to round at the buttcrack of dawn.

Really as was said above, I could be happy doing a lot of things, but anesthesia provides me the greatest number of things I like, while allowing me to avoid the things I dislike.

 

[kazuma]

Since when? Stents are for symptoms, there is no mortality benefit

They're losing ground on the TAVR front as well.

 

[WholeLottaGame7]

They're losing ground on the TAVR front as well.

Was going to say, all kinds of catheter-deployed valves out there now.

 

[Anonsthesia]

I've had about 5 people (med students and docs) tell me I should do gas over the last year. Every specialty quiz I take online puts gas and rads in top 3. Maybe that's a sign? I checked gaswork for my home state and found a good number of jobs that I would be interested in. Salary was solid ( I would be VERY happy with anything 300+), location was good (not big cities), decent vacation, etc... Surprisingly a couple were 80-100% solo cases. Thanks for your input and opinions so far!

 

[bigdan]

I realize things may change over time, but I do a combo of OR anesthesia (about 50% of that is cardiac) and critical care, and I love my job. I'd choose this path all over again in a heartbeat.

Regarding the TAVR thing, they are about to roll out the clinical trial for TAVR in low-risk SAVR patients...that could be a game changer, for sure. Within the next 10 years, we'll likely see the robust 60 y/o with progressive severe AS come into the hospital on a Monday and leave on a Tuesday or Wednesday without surgical scar nor pump run. Amazing. Let's hope the stroke rate isn't too bad.

 

[abolt18]

I realize things may change over time, but I do a combo of OR anesthesia (about 50% of that is cardiac) and critical care, and I love my job. I'd choose this path all over again in a heartbeat.

Regarding the TAVR thing, they are about to roll out the clinical trial for TAVR in low-risk SAVR patients...that could be a game changer, for sure. Within the next 10 years, we'll likely see the robust 60 y/o with progressive severe AS come into the hospital on a Monday and leave on a Tuesday or Wednesday without surgical scar nor pump run. Amazing. Let's hope the stroke rate isn't too bad.

This is my ideal. Are you in academics or pp?

 

[Mman]

Since when? Stents are for symptoms, there is no mortality benefit

ASDs, AVRs, probably soon to be MVRs, etc.

The realm of cardiac problems only fixable with surgery continues to shrink

 

[Arch Guillotti]

I probably wouldn't use personalities on an anonymous internet forum to make judgments about future professions. I'd go spend some time with actual anesthesiologists in real life and see how their day is and how they interact with each other, surgeons, nurses, and patients.

Coming from a likely premed no less.

 

[pgg]

You want job security then go into neurosurgery or cardiac surgery; those are the only two specialties that are completely immune to nurse "mission creep" in our lifetime.

You really worryabout being unemployed as an anesthesiologist?

You really think that a person strong and smart enough to make it through neurosurgery or cardiac surgery training couldn't squeeze out a living in anesthesia?

Do you tell minor league baseball players they should just play in the NFL instead?

 

[Consigliere]

Is it really as bad as they say it is?

No. It's worse.

 

[misteratoz]

No. It's worse.

You should ease up on simply telling everyone that what they like is a lost cause. After all, you're an Eagles Fan.

 

[Consigliere]

You should ease up on simply telling everyone that what they like is a lost cause. After all, you're an Eagles Fan.

Thanks, Captain Obvious....I already know being an Eagles fan makes me the patron saint of lost causes. Anywho, take my advice at face value. I am but one opinion of many.

 

[misteratoz]

Thanks, Captain Obvious....I already know being an Eagles fan makes me the patron saint of lost causes. Anywho, take my advice at face value. I am but one opinion of many.

Just trying to be funny. I think the only thing I've gotten from you is that Anesthesia sucks and the field is dead, which it very clearly is not. It does face many problems though and I'm very aware of those. That's what's making this decision difficult. You opinion has been noted.

 

[Mman]

Just trying to be funny. I think the only thing I've gotten from you is that Anesthesia sucks and the field is dead, which it very clearly is not. It does face many problems though and I'm very aware of those. That's what's making this decision difficult. You opinion has been noted.

the more people that stay away, the better it is for everybody that remains.

 

[jthedestroyr]

I realize things may change over time, but I do a combo of OR anesthesia (about 50% of that is cardiac) and critical care, and I love my job. I'd choose this path all over again in a heartbeat.

Regarding the TAVR thing, they are about to roll out the clinical trial for TAVR in low-risk SAVR patients...that could be a game changer, for sure. Within the next 10 years, we'll likely see the robust 60 y/o with progressive severe AS come into the hospital on a Monday and leave on a Tuesday or Wednesday without surgical scar nor pump run. Amazing. Let's hope the stroke rate isn't too bad.

On my cardiology rotation and the interventional cards guys are just salivating at this. The rep said he felt we might see this in next 4-5years. Although you'd be surprised at reimbursements rates in cards aren't as amazing as everyone thinks as my attending shared what he made for caths/tee. None the less they're still killing it for stents.

 

[Doctor4Life1769]

On my cardiology rotation and the interventional cards guys are just salivating at this. The rep said he felt we might see this in next 4-5years. Although you'd be surprised at reimbursements rates in cards aren't as amazing as everyone thinks as my attending shared what he made for caths/tee. None the less they're still killing it for stents.

Have you ever seen an Interventional Cardiologist NOT working like a dog?

 

[ZzzPlz]

Have you ever seen an Interventional Cardiologist NOT working like a dog?

Usually when I see them they are pacing back and forth sweating bullets while I'm resuscitating and securing their patient's airway after their "twilight" sedation goes south.

 

[GA8314]

I edited the post. It's in italics.

The point I was trying to make is that one can feel treated like a real doctor as an anesthesiologist, too, but only if practicing CCM or Pain. Anything else, and one is seen by most patients (and not only) as just another member of the surgical team.

When I am in the MICU or on a medicine floor, it's even better: I get to feel like a surgeon.

I would argue that the only thing stopping a general anesthesiologist from feeling like a real doctor is him/herself.

I DO understand that some specialties which involves a more specific/detailed care plan, with orders, and greater patient/doctor interaction (or family/doctor as in the case of ICU) can make you feel "different", much like I did while on SICU rotation during residency. But, how you view YOURSELF is the most important aspect of being doctorly. Not external factors. But, I get what you are saying.

 

[deleted171991]

I would argue that the only thing stopping a general anesthesiologist from feeling like a real doctor is him/herself.

I DO understand that some specialties which involves a more specific/detailed care plan, with orders, and greater patient/doctor interaction (or family/doctor as in the case of ICU) can make you feel "different", much like I did while on SICU rotation during residency. But, how you view YOURSELF is the most important aspect of being doctorly. Not external factors. But, I get what you are saying.

I respectfully disagree.

It's like saying that the only thing stopping a nurse (i.e. the way many people see us) from feeling like a doctor is him-/herself.

We are about twenty years and a couple more pulse ox-level inventions away from physician anesthesiologists becoming downright antiquated.

 

[BLADEMDA]

the more people that stay away, the better it is for everybody that remains.

Not true. Every single spot in every single anesthesiology residency program can be filled by a warm body who passed USMLE or its equivalence. Whether or not this med student decides to go into Anesthesiology won't alter the fact that there are more qualified applicants for these positions than there are openings.

The quality of the applicant is what is at stake for this specialty going forward not the quantity.

 

[soorg]

Yes, go into a surgical subspecialty. Bring patients (read: money) to the hospital, so the hospital kisses your butt instead of treating you like a necessary evil.

 

[Mman]

Yes, go into a surgical subspecialty. Bring patients (read: money) to the hospital, so the hospital kisses your butt instead of treating you like a necessary evil.

that used to be a reasonable idea, but now a days more hospitals are turning those surgeons into employees of the hospital.

 

[Doctor4Life1769]

Usually when I see them they are pacing back and forth sweating bullets while I'm resuscitating and securing their patient's airway after their "twilight" sedation goes south.

That's true, had plenty of those.

 

[Doctor4Life1769]

that used to be a reasonable idea, but now a days more hospitals are turning those surgeons into employees of the hospital.

Agreed. Hospital where I am bought the CT surgeons and cardiologists/interventional group. It's also happened at a few other local hospitals. The other subspecialists have managed to hold steady. Ortho here will never be bought out.

 

[Planktonmd]

May I suggest Psychiatry?

 

[jthedestroyr]

Cards bought out where I am too. Hell they're turning it into an assembly line. The techs even start Radial lines before the cardiologist gets there, although haven't seen one place a femoral (they're too afraid to).

 

[PainDrain]

You really worryabout being unemployed as an anesthesiologist?

You really think that a person strong and smart enough to make it through neurosurgery or cardiac surgery training couldn't squeeze out a living in anesthesia?

Do you tell minor league baseball players they should just play in the NFL instead?

I think you are missing my point. If you want a specialty with a high earning potential that will almost certainly be immune from nurse encroachment then go with a surgical specialty, the more specialized the better.

 

[sevoflurane]

G-eeeessus.... If you need to be talked into anesthesia then please don't go into it.
As for the specialty, a lot of us out there have had a great run at it and really enjoy the day to day work. I really find it to be a lot of fun with plenty of challenges.
I absolutely love my job.
This doom and gloom crap has been going on since the dawn of anesthesia.
The fact of the matter is that many in this field can retire before they hit their 50's, yet a lot choose not to because it's a way of life that is extremely rewarding.
2 most in demand specialties right now are CT and Urology. Spine cases are going to drop at some point but spine/nuerosurg kill it right now.
Just do what you like and be happy.

 

[Mman]

G-eeeessus.... If you need to be talked into anesthesia then please don't go into it.
As for the specialty, a lot of us out there have had a great run at it and really enjoy the day to day work. I really find it to be a lot of fun with plenty of challenges.
I absolutely love my job.
This doom and gloom crap has been going on since the dawn of anesthesia.
The fact of the matter is that many in this field can retire before they hit their 50's, yet a lot choose not to because it's a way of life that is extremely rewarding.
2 most in demand specialties right now are CT and Urology. Spine cases are going to drop at some point but spine/nuerosurg kill it right now.
Just do what you like and be happy.

Thank you. I have a colleague that has been at this for > 40 years and he says it's the same doom and gloom every 10 or 15 years.

 

[criticalelement]

Thank you. I have a colleague that has been at this for > 40 years and he says it's the same doom and gloom every 10 or 15 years.

You cant work 40 years in this environment. NO ******* I N way!!!! Unless you are glutton for punishment.. Maybe if you had a job where you called ALL THE SHOTS... Yes you can work until your 75 sure.... Pick your cases, Pick who you choose to work with, Pick the easy straight forward cases, take days off when you want.. There are partners out there that have that arrangemenet. When you have that... why would you ever give that up? But for the majority of us being basically micromanaged daily, weekly, yearly is a tough poison pill to swallow and couple that with the crna issue, reimbursement issues, obese non compliant patients that you cant cancel, vacations that you cannot take it turns into a living hell.. DO I care if anyone believes me? Not really it is their future.

 

[Mman]

You cant work 40 years in this environment. NO ******* I N way!!!! Unless you are glutton for punishment.. Maybe if you had a job where you called ALL THE SHOTS... Yes you can work until your 75 sure.... Pick your cases, Pick who you choose to work with, Pick the easy straight forward cases, take days off when you want.. There are partners out there that have that arrangemenet. When you have that... why would you ever give that up? But for the majority of us being basically micromanaged daily, weekly, yearly is a tough poison pill to swallow and couple that with the crna issue, reimbursement issues, obese non compliant patients that you cant cancel, vacations that you cannot take it turns into a living hell.. DO I care if anyone believes me? Not really it is their future.

He's been a regular joe in the group since the mid 70s. Takes the same call, does the same cases, gets the same vacation picks, etc. Nothing special and he still would rather keep doing it than retire.

 

[pgg]

You cant work 40 years in this environment. NO ******* I N way!!!! Unless you are glutton for punishment.. Maybe if you had a job where you called ALL THE SHOTS... Yes you can work until your 75 sure.... Pick your cases, Pick who you choose to work with, Pick the easy straight forward cases, take days off when you want.. There are partners out there that have that arrangemenet. When you have that... why would you ever give that up? But for the majority of us being basically micromanaged daily, weekly, yearly is a tough poison pill to swallow and couple that with the crna issue, reimbursement issues, obese non compliant patients that you cant cancel, vacations that you cannot take it turns into a living hell.. DO I care if anyone believes me? Not really it is their future.

Dude, you need to find a better job. If not for your health, for ours.

 

[GA8314]

I can think of many many worse ways to earn a good/great living. I think we often under appreciate what makes anesthesia cool and a good living, whether "good" means financially good, or just a good way to spend your time.