4th year needing career advice: Stuck on the fence between Anesthesia or Path

[CAthunder]

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Hi all,
as you probably already know, the rising 4th years are getting ready to apply for the next ERAS cycle. I'm really on the fence between Anesthesia or Pathology. I ruled everything out throughout my 3rd year and have really enjoyed these two fields. I was told that I will need to choose between the two soon and I completed both path and gas already.

If I did go to path, I am shooting for the Dermpath fellowship. I know, however, that it's not safe to go into a field because of a fellowship (since you may never get it). therefore, I'm very confused right now. Any helpful advice would be great.

appreciate it, everyone,
-ct

 

[Doctor4Life1769]

Hi all,
as you probably already know, the rising 4th years are getting ready to apply for the next ERAS cycle. I'm really on the fence between Anesthesia or Pathology. I ruled everything out throughout my 3rd year and have really enjoyed these two fields. I was told that I will need to choose between the two soon and I completed both path and gas already.

If I did go to path, I am shooting for the Dermpath fellowship. I know, however, that it's not safe to go into a field because of a fellowship (since you may never get it). therefore, I'm very confused right now. Any helpful advice would be great.

appreciate it, everyone,
-ct

WTF.

You want like a rare/competitive multi-track anesthesia residency... then you want path and dermpath?? I fail to see how this is even remotely close to each other.

Do you like dealing with acute issues (and human interaction)... or looking at slides/autopsies/specimens (and no human interaction)? Do you like pharm/physio/pathophys or just path?

 

[CAthunder]

Do you like dealing with acute issues (and human interaction)... or looking at slides/autopsies/specimens (and no human interaction)? Do you like pharm/physio/pathophys or just path?

Ha, as you can tell, I'm a very confused 4th year. I am trying to line up my aways but I also have been changing them around and can't seem to stick to one because of my interest in both fields. What should I do?

I think i'm liking more of the specimens and reading slides now. Autopsies really interest me. I initially came in wanting to do anesthesiology, but pathology pulled me in after doing some rotations in it.

In terms of lifestyle, pay, job market, competitiveness how do path and anesthesia differ?
Thanks--any help is appreciated for this confused rising 4th year

 

[Entgegen]

WTF.

You want like a rare/competitive multi-track anesthesia residency... then you want path and dermpath?? I fail to see how this is even remotely close to each other.

Do you like dealing with acute issues (and human interaction)... or looking at slides/autopsies/specimens (and no human interaction)? Do you like pharm/physio/pathophys or just path?

I don't have much advice for the OP, but for what it's worth, as someone who matched into path this year I really enjoyed my emergency medicine rotation...so much so that if I hadn't had it in December, I would've been really torn between which of the two fields to apply to. In fact, I'm going to be doing an additional EM rotation in a couple weeks (while all my med school friends are done with rotations and off on vacation) to see if I might ultimately switch to EM. People can have interests in different fields for different reasons, and just because the two fields are very dissimilar doesn't mean that they can't see themselves doing both.

 

[CAthunder]

I don't have much advice for the OP, but for what it's worth, as someone who matched into path this year I really enjoyed my emergency medicine rotation...so much so that if I hadn't had it in December, I would've been really torn between which of the two fields to apply to. In fact, I'm going to be doing an additional EM rotation in a couple weeks (while all my med school friends are done with rotations and off on vacation) to see if I might ultimately switch to EM. People can have interests in different fields for different reasons, and just because the two fields are very dissimilar doesn't mean that they can't see themselves doing both.

Word, Thanks entgegen, for the advice! Can't disagree with you there.

 

[TrojanGopher]

In terms of lifestyle, pay, job market, competitiveness how do path and anesthesia differ?
Thanks--any help is appreciated for this confused rising 4th year

I think these reasons are all the wrong reasons for choosing a specialty, but I'll answer anyway. Both have relatively good lifestyles, job market for anesthesia is "threatened" by CRNAs, both have average Step 1's in the mid 220s, and pay will probably drastically change for both specialties (though how much is anyone's guess).

But seriously, I think it should come down to whether you like histology/pathology or physiology more. Also, pathology tends to me introverted compared to anesthesia.

 

[urge]

Do you want boring stress free work the rest of your life?- Path

Do you want boring stressful work with a lot of in house calls the rest of yor life?- Anesth.

 

[bravotwozero]

'In house' calls? So Anesthesiologists don't do shiftwork?

 

[PMPMD]

'In house' calls? So Anesthesiologists don't do shiftwork?

I can't tell if youre being sarcastic

 

[Neon Goat]

I'm really on the fence between Anesthesia or Pathology. I ruled everything out throughout my 3rd year and have really enjoyed these two fields.

Since I've been reading this forum for a couple years, I've noticed that you will get more in-depth advice and replies if you explain more about who you are and what you like and dislike. You're "on the fence" b/w anesthesia and path, but we don't know why, we don't know how you ruled out all the other specialties, and we don't really know what you love about these two. If you want strangers to help you make one of the biggest decisions about the rest of your life, I think you're going to have to give them more than a few sentences.

 

[bravotwozero]

I can't tell if youre being sarcastic

No, I'm being quite serious actually. I was under the impression that Anesthesia doctors didn't do 'calls' but worked in shifts...Is that incorrect?

 

[imfrankie]

No, I'm being quite serious actually. I was under the impression that Anesthesia doctors didn't do 'calls' but worked in shifts...Is that incorrect?

Lots of practice models--lots.

 

[kazuma]

Interesting thread as I also enjoyed path quite a bit. I actually know a pathologist that switched out of anesthesia residency into path about 25-30 years ago. As far as job lookout goes, for both specialties it looks pretty grim but probably worse for path. Just go over to the path forum to read about how the glut of path graduates has killed the market and how grads are doing 1 or more fellowships to buy time and make themselves look more appealing. (lol kind of sounds like anesthesiology grads) There are path jobs available, but you have to be willing to go anywhere. Also, there are mega path corporations like ameripath that are annihilating small groups and buying out practices and basically running a path mill. From the dozen or so pathologists I have talked to this is a major problem for the field and that it is kind of a career killer if you work for one of these businesses because you will have a hard time finding another job after you have only looked at one type of specimen for years.




I think the above post is pretty spot on.

"Do you want boring stress free work the rest of your life?- Path

Do you want boring stressful work with a lot of in house calls the rest of yor life?- Anesth."

While they are two totally different fields, they can both be rewarding. They both have their own issues, and future salary is a complete crap shoot. I'd make a list with the pro's and con's of each and do whichever feels best. I definitely believe that anesthesiology is a stressful specialty at times, so just be certain you can handle those types of situations before you take the plunge.

 

[CAthunder]

Since I've been reading this forum for a couple years, I've noticed that you will get more in-depth advice and replies if you explain more about who you are and what you like and dislike. You're "on the fence" b/w anesthesia and path, but we don't know why, we don't know how you ruled out all the other specialties, and we don't really know what you love about these two. If you want strangers to help you make one of the biggest decisions about the rest of your life, I think you're going to have to give them more than a few sentences.

Apologies for not being clear. The one thing that is holding me back from anesthesia is the first intern year in internal med (plus, path interests me). I don't want to be an internal med doc, that's why I ruled int med out. I didn't have a good experience with my int med rotation and I don't want to experience that again for another year. I did well, but I never want to go through something like that ever again. So my mindset is, "any specialty that requires a prelim internal med year is scratched out." Unfortunately, the field that I had a passion for requires an int med year. Is there someone out there who can give me advice about this/ persuade me that this shouldn't be a hurdle if there is a field that I want to pursue as a lifetime career?

 

[IveGotTwins]

Apologies for not being clear. The one thing that is holding me back from anesthesia is the first intern year in internal med (plus, path interests me). I don't want to be an internal med doc, that's why I ruled int med out. I didn't have a good experience with my int med rotation and I don't want to experience that again for another year. I did well, but I never want to go through something like that ever again. So my mindset is, "any specialty that requires a prelim internal med year is scratched out." Unfortunately, the field that I had a passion for requires an int med year. Is there someone out there who can give me advice about this/ persuade me that this shouldn't be a hurdle if there is a field that I want to pursue as a lifetime career?

There's no rule that you have to do an internal medicine internship. You can do a year of general surgery or a transitional year as well.

Also, the categorical programs have their own intern year that can have a mixture of internal medicine and surgery rotations with things like ICU, ER and ENT clinic mixed in.

I agree with you, a year of internal medicine would be extremely painful. So do what I did, apply to nothing but surgery prelims and transitional years. And if the categorical program has nothing but medicine for the PGY-1( i.e. Kansas), rank it low.

Of course, a year of gen surg is another animal all it's own that others wouldn't want to tackle.

 

[Doctor4Life1769]

Hey man, where'd you end up? You can PM me if you wish. Hope you're happy wherever it may be!

 

[El Dooderino]

Interesting thread as I also enjoyed path quite a bit. I actually know a pathologist that switched out of anesthesia residency into path about 25-30 years ago. As far as job lookout goes, for both specialties it looks pretty grim but probably worse for path. Just go over to the path forum to read about how the glut of path graduates has killed the market and how grads are doing 1 or more fellowships to buy time and make themselves look more appealing. (lol kind of sounds like anesthesiology grads) There are path jobs available, but you have to be willing to go anywhere. Also, there are mega path corporations like ameripath that are annihilating small groups and buying out practices and basically running a path mill. From the dozen or so pathologists I have talked to this is a major problem for the field and that it is kind of a career killer if you work for one of these businesses because you will have a hard time finding another job after you have only looked at one type of specimen for years.




I think the above post is pretty spot on.

"Do you want boring stress free work the rest of your life?- Path

Do you want boring stressful work with a lot of in house calls the rest of yor life?- Anesth."

While they are two totally different fields, they can both be rewarding. They both have their own issues, and future salary is a complete crap shoot. I'd make a list with the pro's and con's of each and do whichever feels best. I definitely believe that anesthesiology is a stressful specialty at times, so just be certain you can handle those types of situations before you take the plunge.

In regards to anesthesia this is complete hyperbole unless tier of program matters way more than I thought

 

[xbulletin]

The best way to get an answer is to do rotations in both specialities. You'll quickly figure out if you like one or the other more.

Pathology has an easier lifestyle (way less hours), but significantly lower pay. It can be very research oriented if you desire. If you don't like human interaction, its a good place to be. I wouldn't go into it specifically for dermpath as its extremely competitive.

Anesthesiology has long hours, high pay, high stress. Its absolutely not shift work, except in very rare jobs at outpatient centers.

One of the above posters described the future of both as "grim". Thats ******ed. Its impossible to really predict the future of either specialty. Its probably most likely that things don't drastically change ( see the last hundred posts on the threat of CRNAs). Between these two specialties, choose the one you're most comfortable and happier doing.

 

[Doctor4Life1769]

The best way to get an answer is to do rotations in both specialities. You'll quickly figure out if you like one or the other more.

Pathology has an easier lifestyle (way less hours), but significantly lower pay. It can be very research oriented if you desire. If you don't like human interaction, its a good place to be. I wouldn't go into it specifically for dermpath as its extremely competitive.

Anesthesiology has long hours, high pay, high stress. Its absolutely not shift work, except in very rare jobs at outpatient centers.

One of the above posters described the future of both as "grim". Thats ******ed. Its impossible to really predict the future of either specialty. Its probably most likely that things don't drastically change ( see the last hundred posts on the threat of CRNAs). Between these two specialties, choose the one you're most comfortable and happier doing.

It appears the OP has done rotations in both fields.

Maybe do another rotation, say in dermpath and SICU?

 

[hivoltage]

I will echo what urge said

DO you want boring stress free work in path

or

Do you want boring highly stressful work with anesthesia with lots of inhouse calls and you being marginalized on a daily basis and you have to get in the hospital at the crack of dawn every single day?

 

[Narcotized]

I'm really on the fence between Anesthesia or Pathology. -ct

"Sleeping" patients, or dead patients; not as dissimilar as some think.

 

[Harrison486]

Do you want boring highly stressful work with anesthesia with lots of inhouse calls and you being marginalized on a daily basis and you have to get in the hospital at the crack of dawn every single day?

What's with all the negativity towards anesthesiology in this thread?

 

[Doctor4Life1769]

I will echo what urge said

DO you want boring stress free work in path

or

Do you want boring highly stressful work with anesthesia with lots of inhouse calls and you being marginalized on a daily basis and you have to get in the hospital at the crack of dawn every single day?

🙄

Surgeons will disparage pathologists too if the frozen results aren't given on time. Then again, surgeons disparage everyone. If you're referring to hospital administrations though... well, I'm sure an active anesthesiologist can change that.

 

[ssmallz]

In regards to anesthesia this is complete hyperbole unless tier of program matters way more than I thought

I gotta agree. The job market this year wasn't THAT bad. Sure it's tight in some areas but even without a fellowship there are some pretty good jobs to be had. FWIW, I've had multiple convos w/EM, ENT, and ortho residents and their experiences seem to be pretty similar to ours. The market is tight for all specialties near major cities. Fellowships can help you crack the market but it's more about who you know than what you know.

 

[kazuma]

Indeed, that was definitely an overstatement saying the job outlook for anesthesiologists is grim, but it might be even more "tight" by the time the current MSIV's are looking for jobs. Isn't that part of the reason why there is a surge in residents interested in going on to fellowships? I was told by PD's this last year that in the past it was difficult to attract a resident to stay for a fellowship when there were very lucrative job offers in great locations to be had. Now that the market is cooling off there appears to be a increased interest in fellowships.

With that said, most of the residents that I talked to this year ended up getting jobs in their location of choice. Off hand the only guys I remember having trouble getting their top choices were residents looking for jobs in highly desirable places or saturated metro areas. Locations specifically mentioned were Utah, Colorado, Phoenix, and Kansas City. Granted these were just comments I got from a few residents that were not going on to fellowships.

However, the job outlook for pathologists is pretty bad. Unless something dramatic has occurred since the last time I read the path forum two years ago. There are path jobs to be had, but you have to be willing to move to just about anywhere.

 

[pgg]

Indeed, that was definitely an overstatement saying the job outlook for anesthesiologists is grim, but it might be even more "tight" by the time the current MSIV's are looking for jobs. Isn't that part of the reason why there is a surge in residents interested in going on to fellowships?

I suspect that a significant factor in the uptick in fellowship competitiveness isn't the actual current & near-future job market, but uncertain fear of what the future job market might be.

Nothing wrong with wanting to hedge your future employment prospects with a nice line on the resume, but that feared market may or may not come to pass.

Unless you love the subspecialty or you've GOT to live someplace where you know it'll take a fellowship to get a foot in the door, a CA4 year seems a steep price to pay for the sake of job security alone.

There's something to be said for making hay while the sun is shining, too.

 

[ScotchBonnet]

Pathology resident here and wanted to clear up a couple misconceptions in this thread.
1) There is actually quite a bit of human interaction in pathology...it just isn't with patients (typically). Instead, you spend time interacting with clinical colleagues (discussing difficult cases, informing them of unexpected cancer diagnoses, reviewing frozen sections, etc.) as well as all of the staff in the various labs. Sometimes, we even work directly with patients (e.g. apheresis or FNA).
2) I think it is an oversimplification to say there is no stress in pathology and that the residency hours are unequivocally easier than those in anesthesiology. When people use the word stress, they seem to usually mean acute, immediate life-threatening situations. True, those types of situations are common in anesthesiology and nonexistant in pathology. Pathology can be stressful, for example, when trying to make a diagnosis that has major treatment or prognostic implications on a small or otherwise suboptimal biopsy. Certainly this is not "acute" stress and one generally has time to think but it is stress nonetheless In regards to hours, surgical pathology rotations at institutions with high volumes of specimens can be very time consuming and even cause one to come close to breaking work hour rules (less commonly 80 hours in a week and more often 10 hours between work days in my experience). What does make pathology easier in terms of work hours is the fairly frequent rotations with super easy hours (e.g. chemistry), lack of an intern year, and lack of in-house call. Bottom line: many well respected pathology programs have rotations that are quite demanding.

 

[adoniah]

This topic is perfectly timed because I've had this exact debate recently and was discussing it with a friend today.

I'm relatively younger in my training (MS2), but I've quickly realized I don't enjoy clinic or rounding...so that immediately narrows things down to a surgical specialty, or anesthesiology, radiology or pathology. I spent a good amount of involved time with anesthesia this summer and absolutely loved it, but I've now started to think maybe I don't have the "quick reflexes" needed to be an anesthesiologist. Maybe I've become unsure of myself because I'm so sick of 2nd year, but I can't deny that often times I like having time to think things over. Does anesthesiology eventually become more reactionary as you progress through residency?

FWIW, I agree with what others have said regarding benefits of each, but I just don't know how I would react 10 years from now. Would I be happy interpreting slides all day and never really meaningfully interacting with patients? Or would I find that I lack the instinctive prowess to acutely manage a coding patient as an anesthesiologist? That's where my debate is...I enjoyed many aspects of path (save cardiac/pulm. as I hated that crap) and legitimately found it interesting. But at the same time, I love doing procedures and am a very hands-on person. Not sure where I would be a good fit? Not decisive enough for anesthesia, but maybe too extroverted for pathology. Anyone else have suggestions for a personality like that given my dislike of clinic and rounds?

 

[BeddingfieldMD]

There's also ED and family practice. True, you may have minimal rounding with both of these during residency, such as during sign-outs and dealing with your OB and inpatients with FP. But an increasing number of FP folks these days choose to work in jobs that are all clinic-based with no inpatients. Sure, both of these have their own negatives, obviously, but just giving you some other options.

I'm relatively younger in my training (MS2), but I've quickly realized I don't enjoy clinic or rounding...so that immediately narrows things down to a surgical specialty, or anesthesiology, radiology or pathology.

 

[IveGotTwins]

This topic is perfectly timed because I've had this exact debate recently and was discussing it with a friend today.

I'm relatively younger in my training (MS2), but I've quickly realized I don't enjoy clinic or rounding...so that immediately narrows things down to a surgical specialty, or anesthesiology, radiology or pathology. I spent a good amount of involved time with anesthesia this summer and absolutely loved it, but I've now started to think maybe I don't have the "quick reflexes" needed to be an anesthesiologist. Maybe I've become unsure of myself because I'm so sick of 2nd year, but I can't deny that often times I like having time to think things over. Does anesthesiology eventually become more reactionary as you progress through residency?

FWIW, I agree with what others have said regarding benefits of each, but I just don't know how I would react 10 years from now. Would I be happy interpreting slides all day and never really meaningfully interacting with patients? Or would I find that I lack the instinctive prowess to acutely manage a coding patient as an anesthesiologist? That's where my debate is...I enjoyed many aspects of path (save cardiac/pulm. as I hated that crap) and legitimately found it interesting. But at the same time, I love doing procedures and am a very hands-on person. Not sure where I would be a good fit? Not decisive enough for anesthesia, but maybe too extroverted for pathology. Anyone else have suggestions for a personality like that given my dislike of clinic and rounds?

ALL surgical subspecialties will have clinic. No way around it. You have to see the patient before and/or after the operation after all. I had the same misconception and then did 3+ ortho rotations and was shocked at how much clinic there actually was.....

Now I'm matched into anesthesiology and couldn't be happier.

 

[hivoltage]

ALL surgical subspecialties will have clinic. No way around it. You have to see the patient before and/or after the operation after all. I had the same misconception and then did 3+ ortho rotations and was shocked at how much clinic there actually was.....

Now I'm matched into anesthesiology and couldn't be happier.

If radiology was 2 years right now.. i would leave anesthesia in a minute to pursue that field.. Just too many problems with anesthesia right now.

 

[Doctor4Life1769]

If radiology was 2 years right now.. i would leave anesthesia in a minute to pursue that field.. Just too many problems with anesthesia right now.

Rads isn't all that perfect either.... pretty much HAVE to do a fellowship.
One of the biggest reimbursement cuts too.... 👍

 

[adoniah]

ALL surgical subspecialties will have clinic. No way around it. You have to see the patient before and/or after the operation after all. I had the same misconception and then did 3+ ortho rotations and was shocked at how much clinic there actually was.....

Now I'm matched into anesthesiology and couldn't be happier.

I guess my question is...does a lot of it become second nature. I know I like to be able to think things through, but do you quickly reach the point where things are knee jerk reactions during a procedure?

 

[IveGotTwins]

I guess my question is...does a lot of it become second nature. I know I like to be able to think things through, but do you quickly reach the point where things are knee jerk reactions during a procedure?

I can't say for certain since I haven't even begun a residency and had the opportunity for a procedure to become knee jerk, however I believe that in one way or another EVERYTHING becomes routine. If you get confident in performing something eventually you will have some sort of autopilot.

A non-perfect analogy might be driving a car on the highway. It's dangerous and many people could be injured or die if you screw up. But even so I find myself turning the key off and not remembering the trip but I know I had to have made the necessary maneuvers to get myself from the hospital to my house. Also, look at all the people out there on the road doing other things besides driving while behind the wheel. There must be a small amount of autopilot at play. Additionally you may not always need to think through every patient in which you are going to perform an anesthetic on but you will be ready to recognize the brake lights and swerving ******s ahead and early on this may take much thought and anal clenching but eventually you will probably react accordingly without much more than the appropriate response.

 

[hivoltage]

Rads isn't all that perfect either.... pretty much HAVE to do a fellowship.
One of the biggest reimbursement cuts too.... 👍

but the day to day life of a radiologist is a whole lot better than ours

 

[psychbender]

Not decisive enough for anesthesia, but maybe too extroverted for pathology. Anyone else have suggestions for a personality like that given my dislike of clinic and rounds?

Actually, the Blood Bank director at my hospital is quite an interesting Pathologist, as she interacts with other physicians quite regularly, and helps guide blood product resuscitations throughout the hospital. Whenever we have a big case coming up, she'll talk to us, and ensure that we have enough appropriate product set aside, pop her head into the OR regularly to see how things are going, help expedite the process if more product are needed, give suggestions, and check on the patient post-op, to see how the resuscitation went, and if further products are needed. So, there's one exception to the rule.

As for suggestions, have you looked into Prev Med?

 

[adoniah]

Preventative medicine...I think I'd pass on that 🙂

Here's the thing...I absolutely love anesthesiology! Seriously, it's the only time in my life where I've felt "at home" and thought that I had found something I could truly do everyday. That's why I asked the question wondering if things become automatic? About the only thing that makes me hesitant is the worry that at the moment I'd have no clue what to do when someone codes (though, what M2 does?). Maybe I'm overthinking this whole thing, but that's what my worry stems from.