IM or Anesthesia

I'm torn. I just don't know. Both fields have interesting points and possible downsides. I appreciate if the attendings out there can give me some real wisdom on what internal med or anesthesia is like outside of residency. I can say that M4 year will be the last time I will be really free, but I just want some input about the lifestyle primarily hours per week (goal of 50-55), not big on big cash. Also it would be great if somebody switched from one to the other at any point in their life. I guess that person could help me choose my destiny somewhat.

M3 year😳 M4 year😕 Residency 🙁?

Will be waiting for messages....

mm78 said:

I'm torn. I just don't know. Both fields have interesting points and possible downsides. I appreciate if the attendings out there can give me some real wisdom on what internal med or anesthesia is like outside of residency. I can say that M4 year will be the last time I will be really free, but I just want some input about the lifestyle primarily hours per week (goal of 50-55), not big on big cash. Also it would be great if somebody switched from one to the other at any point in their life. I guess that person could help me choose my destiny somewhat.

M3 year😳 M4 year😕 Residency 🙁?

Will be waiting for messages....

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What are the aspects of Medicine that appeal to you and what are the aspects of Anesthesia that appeal to you? What aspects don't appeal to you?

My friend is interviewing for anesthesia attending jobs right now. Some of the practices work 60-70 hours/week, but they make lots of money (300k even). Some work less like 50-60. One could certainly do locum tenens or probably work less hours if you wanted. Anesthesia makes significantly more money than IM...maybe double what IM makes, or so.

If you do IM and you like outpatient medicine, you could make yourself into a straight outpatient doc and not take any call. You would still make OK money. Still, with the office hours and paperwork it would likely be a 50 hour/week job or so. You can do hospitalist which would probably fit your average hours/week desires (though usually they work 5 days on/5 off or 7 on/7 off, shifts of 12 hours or so). Be aware that outpatient medicine is full of paperwork and the "worried well" and chasing down endless studies and lab results, returning phone calls, etc. Hospitalist has sicker patients, but when you leave work...you leave. You don't take it home with you. Some hospitalist services do tend to be a dumping ground for other specialties (surgical, etc.) that sometimes don't want to admit their own patients. This is true during medicine residency as well.

From what I hear, one of the most stressful things about anesthesia is that things can suddenly go from normal to bad in the OR...when things go bad, they can go really bad (i.e. from normal to emergent/crashing quickly). Anesthesia is of course also more procedure oriented. Pain management is a popular subspecialty of anesthesia currently - they likely have better hours, make good money and get to do procedures (injections to the back ,etc.) which many people think is fun.

You still have a while to decide what you want to do. I suggest if you are a 3rd year, try and take both anesthesia and internal med rotations in the middle to last part of your year. That way you get the lay of the hospital and how to write notes, act with the team/residents, etc. before you get on those rotations. It's not such a big deal though if you can't alter your schedule.

If you are 4th year, you still have a few months left to decide on what you want to do. Best thing is to rotate through both specialties again if not sure. Decide if you want to pick by just lifestyle, or if you truly like one of the specialties better. You want to do something you halfway like if you are going to be doing it for 20+ years...

Wow...how funny. I'm in the same exact boat as you. I'm a third year finishing up my first rotation (surgery, no chance in hell ill do that one) and have my tentative eye on either IM with a fellowship or anesthesia.

On the one hand, I find IM really interesting (especially cardio and GI) and love the fact that you really learn about a little of everything out there, but anesthesia also seems really interesting and I like the fact that they do all those little procedures that seem lots of fun. Of course if I were to go into interventional cards or GI there are procedures involved there too. I like the OR, but would never want to be the surgeon in charge of steering the ship and standing there for hours on end, working 80 hour weeks. Internal medicine has its mix of characters from what I've seen, from the very nice to a-holes that could very easily fit into surgery just as well. EVERY anesthesiologist i've met is super chill, funny and overall seems like a great person to have as a coworker. Everyone in that specialty seems to be happy with what they do. In medicine this varies. Pay is more or less equal if I were to do anesthesia or one of those two IM fellowships so this is not a big factor to consider. Hours in medicine seem to be worse, and work can haunt you long after you drive home, whereas in anesthesia you are DONE once you leave the hospital for the day. I think I really like that. In medicine you sit and have time to think about what comes next...in anesthesia as mentioned above things can change in mere seconds and it requires quick action on your behalf to keep an easy case from crashing terribly. I kind of like both, although sometimes I wonder if I'll grow to hate all the paperwork in IM. I like keeping on my toes, but those "nightmare" scenarios in anesthesia frankly scare me somewhat. For some reason I imagine myself in charge of a big fat guy, impossible to intubate and being completely incompetent as I sit there and watch the guy desat himself to death...Although I guess its less so if I remember that obviously that's what residency is for...to prepare docs to deal with those things.

Man. What a give and take. I'll cut my ramble off here (a result of being tired and stressed, and contemplative today), but those are the things that flood my head when I try to debate between the two. Keep the discussion going guys, I enjoy hearing others' viewpoints.

Hurricane95 said:

Wow...how funny. I'm in the same exact boat as you. I'm a third year finishing up my first rotation (surgery, no chance in hell ill do that one) and have my tentative eye on either IM with a fellowship or anesthesia.

On the one hand, I find IM really interesting (especially cardio and GI) and love the fact that you really learn about a little of everything out there, but anesthesia also seems really interesting and I like the fact that they do all those little procedures that seem lots of fun. Of course if I were to go into interventional cards or GI there are procedures involved there too. I like the OR, but would never want to be the surgeon in charge of steering the ship and standing there for hours on end, working 80 hour weeks. Internal medicine has its mix of characters from what I've seen, from the very nice to a-holes that could very easily fit into surgery just as well. EVERY anesthesiologist i've met is super chill, funny and overall seems like a great person to have as a coworker. Everyone in that specialty seems to be happy with what they do. In medicine this varies. Pay is more or less equal if I were to do anesthesia or one of those two IM fellowships so this is not a big factor to consider. Hours in medicine seem to be worse, and work can haunt you long after you drive home, whereas in anesthesia you are DONE once you leave the hospital for the day. I think I really like that. In medicine you sit and have time to think about what comes next...in anesthesia as mentioned above things can change in mere seconds and it requires quick action on your behalf to keep an easy case from crashing terribly. I kind of like both, although sometimes I wonder if I'll grow to hate all the paperwork in IM. I like keeping on my toes, but those "nightmare" scenarios in anesthesia frankly scare me somewhat. For some reason I imagine myself in charge of a big fat guy, impossible to intubate and being completely incompetent as I sit there and watch the guy desat himself to death...Although I guess its less so if I remember that obviously that's what residency is for...to prepare docs to deal with those things.

Man. What a give and take. I'll cut my ramble off here (a result of being tired and stressed, and contemplative today), but those are the things that flood my head when I try to debate between the two. Keep the discussion going guys, I enjoy hearing others' viewpoints.

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also consider anesthesia would be two less years than im and specializing (at least). Im with cards + interventional would be 7 yrs.

and who is that girl? man she's hot.

I'm a fourth year now so time is ticking. And I wonder if 1 month rotations will give me enough experience to make the right choice.

For the IM guys, how much do you guys really work a week? 50 hours or more because you have to take home calls and more. How much of it is medicine versus tracking down paperwork and calling people to check their labs, etc.? I enjoy the medicine part but I don't know how appealing the social aspects can be.

For any anesthesia guys, what is something IM has that you don't? Do you feel that you are pressured to keep things going even if it is somewhat unsafe? What are the BIG negatives of anesthesia? How are the surgeons in private practice? I know a lot are douche in big academic institutions, but what is the time pressure in private practice.

I know the following about both: a bunch of ******o nurses claiming to help patients (ex: nurses write prescriptions in WI apparently).

Thanks everyone.

mm78 said:

How are the surgeons in private practice? I know a lot are douche in big academic institutions.

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