A toss up..EM vs Anesthesia

[donkeykong1]

If you enjoyed both and had to choose which would you go into in 2014 based on lifestyle, future, job prospects etc..

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[PatsyStone]

Have you rotated through both? If so, sometimes it helps to think out-loud, so what do you like and dislike about EM and anesthesia

 

[Robotman]

None of our opinions would be valid because of our perception in life. We could give you our opinion and even sway your opinion because you can think, "Hey, I feel the same way about X" but it is not valid way to make a decision based on this because we are not anesthesiologist or EM docs.

The best way to get the information you seek for lifestyle, job prospects and nurse hot-ability is to look through each of these forums for threads about these topics. This way you can get biased information from actual people in these fields and then decide how these pertain to your life and hopes.

 

[chajjohnson]

Just listen to your heart. That's what I do.

 

[Robotman]

Just listen to your heart. That's what I do.

 

[sylvanthus]

Spend 10 minutes reading through the anesthesia forums sometime as well as take a look at the match statistics.

 

[donkeykong1]

I have experienced both. Have formal rotations in each coming up soon. But I would like to get more opinions on here to see if I'm missing pros/cons for each side

I like the pharm and phys of anesthesia, im still a rookie with IV's, lines, intubation, but I'm afraid about what the CRNA blow out will do to future job prospects and have been cautioned by quite a few private practice attendings about this not just sdn stuff.

I enjoy working the fast paced ER, acute illness, im the type of guy with not a lot of patience and like to get things done fast. The night schedule thing and the lack of continuity in shift times are the drawbacks...and although I've only practiced suturing on foam twice..haven't been good at it at this so far..tried taking out sutures off some kids head and got a ton of hair out the first time. whatever that means?

 

[DermViser]

If the choices are Anesthesiology vs. Emergency Medicine --- Anesthesiology for sure.

 

[Frazier]

If you enjoyed both and had to choose which would you go into in 2014 based on lifestyle, future, job prospects etc..

I'll bite.

If I enjoyed both EM and anesthesia -- and had to choose in 2014 -- based on the lifestyle, future, job prospects, etc...

I'd choose psych. HTH.

 

[DermViser]

I'll bite.

If I enjoyed both EM and anesthesia -- and had to choose in 2014 -- based on the lifestyle, future, job prospects, etc...

I'd choose psych. HTH.

While I agree with you Psychiatry has a great lifestyle and is a great outpatient specialty that can help people. It truly requires a very patient and empathetic person and can be emotionally and mentally draining. It's not for the people who like doing procedures or like seeing immediate results, or want to feel like they're treating a disease entity. These are conditions that are many times life long and which you'll be managing and unfortunately due to insurance reimbursement schemes - psychotherapy is not always given it's due when it comes to being taught in residency programs.

 

[Frazier]

While I agree with you Psychiatry has a great lifestyle and is a great outpatient specialty that can help people. It truly requires a very patient and empathetic person and can be emotionally and mentally draining. It's not for the people who like doing procedures or like seeing immediate results, or want to feel like they're treating a disease entity. These are conditions that are many times life long and which you'll be managing and unfortunately due to insurance reimbursement schemes - psychotherapy is not always given it's due when it comes to being taught in residency programs.

This is true.

 

[donkeykong1]

If the choices are Anesthesiology vs. Emergency Medicine --- Anesthesiology for sure.

what about the independent midlevels and private practices being bought out at alarming rates. just playing devils advocate. i very much like anesthesia

 

[DermViser]

what about the independent midlevels and private practices being bought out at alarming rates

Emergency medicine has the same thing - NPs and PAs.

 

[PatsyStone]

If the choices are Anesthesiology vs. Emergency Medicine --- Anesthesiology for sure.

+1

 

[donkeykong1]

Emergency medicine has the same thing - NPs and PAs.

Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients

1. Sharon R Lewis1,*,
2. Amanda Nicholson2,
3. Andrew F Smith3,
4. Phil Alderson4

Editorial Group: Cochrane Anaesthesia Group

Published Online: 11 JUL 2014

Assessed as up-to-date: 13 FEB 2014

DOI: 10.1002/14651858.CD010357.pub2

read here:
http://onlinelibrary.wiley.com/doi/...ionid=B8D9CAC782B9EC65DAD59C8BDA956CB1.f01t02

 

[DermViser]

Physician anaesthetists versus non-physician providers of anaesthesia for surgical patients

1. Sharon R Lewis1,*,
2. Amanda Nicholson2,
3. Andrew F Smith3,
4. Phil Alderson4

Editorial Group: Cochrane Anaesthesia Group

Published Online: 11 JUL 2014

Assessed as up-to-date: 13 FEB 2014

DOI: 10.1002/14651858.CD010357.pub2

read here:
http://onlinelibrary.wiley.com/doi/...ionid=B8D9CAC782B9EC65DAD59C8BDA956CB1.f01t02

What's your point? Did you read the summary?

"No definitive statement can be made about the possible superiority of one type of anaesthesia care over another. The complexity of perioperative care, the low intrinsic rate of complications relating directly to anaesthesia, and the potential confounding effects within the studies reviewed, all of which were non-randomized, make it impossible to provide a definitive answer to the review question."

 

[donkeykong1]

What's your point? Did you read the summary?

"No definitive statement can be made about the possible superiority of one type of anaesthesia care over another. The complexity of perioperative care, the low intrinsic rate of complications relating directly to anaesthesia, and the potential confounding effects within the studies reviewed, all of which were non-randomized, make it impossible to provide a definitive answer to the review question."

my point is that its just the beginning.

 

[DermViser]

my point is that its just the beginning.

Beginning of what?

 

[donkeykong1]

of crna running the OR independently in all states. first its inconclusive evidence.. eventually they'll put some meta analysis together to sway the gov

 

[DermViser]

of crna running the OR independently in all states. first its inconclusive evidence.. eventually they'll put some meta analysis together to sway the gov

You don't think the same will be for ERs when care in the ER is very expensive?

 

[donkeykong1]

touche. hope you're right

 

[Spikebd]

You don't think the same will be for ERs when care in the ER is very expensive?

Actually, I'm doubtful of that. I think nurses respect ED doctors more than they do anesthesiologist for whatever reason. There will always be a need for an ED doc on hand, not sure it's the same with anesthesia.

 

[KinasePro]

Just go pass gas. They have to put up with less sheer bullsh*t per dollar earned. Also, you can go into pain or SICU for better job prospects with less midlevel encroachment. Plus gas is inherently cooler than EM, which is basically glorified triage in 2014 and beyond.... *dodges tomatoes from EM posters*

 

[link2swim06]

and although I've only practiced suturing on foam twice..haven't been good at it at this so far..tried taking out sutures off some kids head and got a ton of hair out the first time. whatever that means?

Don't let this stop you from choosing EM. I looked like a parkinson's patient the first time I sutured as a M3. After doing it about 20 times (2-3 months of EM residency) it's no longer a big deal and it's actually a pretty mundane task.

 

[Spikebd]

You don't think the same will be for ERs when care in the ER is very expensive?

But I think the nurse thing is just a piece of the puzzle. EM wins against anesthesia in regards to turf battles (my opinion only). Still, even with the CRNA thing I think anesthesiologists should be in adequate demand.

 

[KinasePro]

Actually, I'm doubtful of that. I think nurses respect ED doctors more than they do anesthesiologist for whatever reason. There will always be a need for an ED doc on hand, not sure it's the same with anesthesia.

There are plenty of EDs staffed by mostly mid-levels. My own academic center just reduced the MD to midlevel ratio from 2:1 to 1:1. The future of EM is more mid-level utilization, sadly.

 

[Carbocation1]

How are gas job prospects looking in big city areas in the Northeast? Will you able to find a job in your desired location with a min. starting salary of 200k?

 

[DermViser]

Actually, I'm doubtful of that. I think nurses respect ED doctors more than they do anesthesiologist for whatever reason. There will always be a need for an ED doc on hand, not sure it's the same with anesthesia.

No one's talking about nurses. We're talking about NPs who have done the same for primary care saying they are just as good if not better than physicians.

 

[DermViser]

There are plenty of EDs staffed by mostly mid-levels. My own academic center just reduced the MD to midlevel ratio from 2:1 to 1:1. The future of EM is more mid-level utilization, sadly.

Yup, esp. since increased insured has led to MORE people showing up in ERs.

 

[Carbocation1]

I was considering IM+subspecialty but the chair of Medicine at a prominent institution clearly stated at a Q+A session that the reimbursement between Primary Care and specialists will be next to nil in the future due to greedy specialists bankrupting the system... Gas is my 1B in terms of interest.

 

[DermViser]

I was considering IM+subspecialty but the chair of Medicine at a prominent institution clearly stated at a Q+A session that the reimbursement between Primary Care and specialists will be next to nil in the future due to greedy specialists bankrupting the system... Gas is my 1B in terms of interest.

Your chair of Medicine is a fool. Not at all shocked that a chair of Internal Medicine (usually a general internist) believes specialists are greedy, meanwhile his salary is probably 600K.

 

[Carbocation1]

Your chair of Medicine is a fool. Not at all shocked that a chair of Internal Medicine (usually a general internist) believes specialists are greedy, meanwhile his salary is probably 600K.

Nope, he's a specialist, but not at all a field that is high-paying (or I should say was because he doesn't see pts anymore)

 

[Spikebd]

No one's talking about nurses. We're talking about NPs who have done the same for primary care saying they are just as good if not better than physicians.

Yea, PA or NP they still fear trauma more than an outpatient clinic. The NP's and PA's going into emergency medicine are staffing fast tracks and aren't anywhere near as militant as the CRNA AANA agenda. They want backup in the ED. My opinion is that midlevels are a cause for concern in emergency medicine but nowhere near as bad as the CRNA problem

 

[DermViser]

Yea, PA or NP they still fear trauma more than an outpatient clinic. The NP's and PA's going into emergency medicine are staffing fast tracks and aren't anywhere near as militant as the CRNA AANA agenda. They want backup in the ED.

Yes, at least for now, they're doing fast track. Key word being NOW.

 

[Spikebd]

There are plenty of EDs staffed by mostly mid-levels. My own academic center just reduced the MD to midlevel ratio from 2:1 to 1:1. The future of EM is more mid-level utilization, sadly.

Yes, at least for now, they're doing fast track. Key word being NOW.

Where do you see anesthesia going with more CRNA schools going to the DNAP? I ask because I'm not as far along in my med training as you and like reading your posts.

 

[DermViser]

Where do you see anesthesia going with more CRNA schools going to the DNAP? I ask because I'm not as far along in my med training as you and like reading your posts.

I see Anesthesia picking up more Anesthesiology Assistants actually (who fall under the Board of Medicine). The DNP degree will make the CRNA track longer (obvi). Let the CRNAs get complete independence. When people start dying left and right, people will come scrambling back and demand a physician if they aren't doing it already.

 

[KinasePro]

Where do you see anesthesia going with more CRNA schools going to the DNAP? I ask because I'm not as far along in my med training as you and like reading your posts.

Not sure what to say about the future of CRNA's, but I imagine they're here to stay along with AAs.

The limiting factor for mid-level encroachment in gas is the minute-to-minute liability. It's way too easy to kill someone in the OR. As america gets older, sicker, and fatter the experience of MD anesthetists will be more highly valued, IMO. As someone going into a surgical field, I spend a lot of time in the OR, and even as a lowly M4 I've already seen MD's save the CRNA's ass more than 50 times at least.

Also like I mentioned earlier, gas docs have outs into other professions. They don't need to staff ORs if they don't want to. This leaves them with some leverage IMO, unlike CRNAs who are literally cogs in the machine and 100% expendable and replaceable.

 

[Spikebd]

I see Anesthesia picking up more Anesthesiology Assistants actually (who fall under the Board of Medicine). The DNP degree will make the CRNA track longer (obvi). Let the CRNAs get complete independence. When people start dying left and right, people will come scrambling back and demand a physician if they aren't doing it already.

I think the fellowships anesthesiologists have make it a field to strongly consider, but I'd want to be sure general anesthesiology is a viable career before making the leap into a residency.

 

[DermViser]

I think the fellowships anesthesiologists have make it a field to strongly consider, but I'd want to be sure general anesthesiology is a viable career before making the leap into a residency.

The fellowships I think also help --- Pain Medicine, which is mainly outpatient, etc. I think if you like kids, Pediatric Anesthesiology is very helpful also.

 

[circulus vitios]

EM. Better job market, higher hourly rate, shorter work week on average. Swing shift isn't that bad.

 

[DermViser]

EM. Better job market, higher hourly rate, shorter work week on average. Swing shift isn't that bad.

All of which can easily change. Also, those 12 hour shifts are exhausting bc there is no filter - you can the best and the worst (drunk, drug high, etc.). That's why you can only a do a certain number of shifts a month.

 

[ACSurgeon]

Depends on what attracts you to each field, what draws backs you preceive.

For me: I'd pick anesthesia over EM because anesthesia has a true mastery of a body of knowledge and skills. That appeals to me.

EM tries to have a solid level of knowledge of most things, which ends up meaning the basics. There is a lot of triage in EM, calling consults, dealing with things that primary care should be handling, and other nonsense. Granted, EM docs do take care of a significant portion of patients that walk through the door without calling consults, but many of those patients should have been seen by primary care (i.e. non-urgent). The shift work and overall low number of hours per month appeal to those applying to EM, but it still has a high level of burnout; either because it's not really that great of a lifestyle, or because those going EM have low tolerance for handwork (I suspect it's mostly the former and not the latter). Other things appealing to folks applying to EM include doing procedures. From what I've observed in our ER, procedures end up coming in the way of EM providers getting their work done, so it's more of a burden than a pleasure (e.g. calling trauma surgery to suture a simple lac).

 

[TooMuchResearch]

I have experienced both. Have formal rotations in each coming up soon. But I would like to get more opinions on here to see if I'm missing pros/cons for each side

I like the pharm and phys of anesthesia, im still a rookie with IV's, lines, intubation, but I'm afraid about what the CRNA blow out will do to future job prospects and have been cautioned by quite a few private practice attendings about this not just sdn stuff.

I enjoy working the fast paced ER, acute illness, im the type of guy with not a lot of patience and like to get things done fast. The night schedule thing and the lack of continuity in shift times are the drawbacks...and although I've only practiced suturing on foam twice..haven't been good at it at this so far..tried taking out sutures off some kids head and got a ton of hair out the first time. whatever that means?

We have pharm, phys, IVs, lines, and intubations in the ED. I promise.

You get better at suturing with practice. In the meantime, check out lacerationrepair.com.

 

[Silent Cool]

All of which can easily change. Also, those 12 hour shifts are exhausting bc there is no filter - you can the best and the worst (drunk, drug high, etc.). That's why you can only a do a certain number of shifts a month.

DV,

Do you think the EM market will massively saturate? Also, do you think that the hype over EM will fade as well? It seems that--all of a sudden--EM has become insanely popular for the reasons mentioned above.

 

[Doctor Bob]

For me: I'd pick anesthesia over EM because anesthesia has a true mastery of a body of knowledge and skills. That appeals to me.

EM doesn't have a true mastery of a body of knowledge and skills?

Other things appealing to folks applying to EM include doing procedures. From what I've observed in our ER, procedures end up coming in the way of EM providers getting their work done, so it's more of a burden than a pleasure (e.g. calling trauma surgery to suture a simple lac).

At non-academic hospitals, the ED docs do all of their procedures... and lots of stuff up on the floor as well because the inhouse docs aren't credentialled.

 

[DermViser]

DV,

Do you think the EM market will massively saturate? Also, do you think that the hype over EM will fade as well? It seems that--all of a sudden--EM has become insanely popular for the reasons mentioned above.

I think it depends. Right now, we're seeing with more people getting insured ER use has actually gone UP, not down. I think people who realize EM was a mistake don't realize it until years down the line, of how exhausting it can be. They either go into an administrative position, or go into Urgent Care.

 

[Rendar5]

Academic and Community ED are very different, so whoever thinks we call consults all the time should work in a community hospital. The only consults I call are to tell someone to take a patient to the OR/endo suite today, or arrange for a procedure tomorrow, or just to assign a neurologist to the stroke patient. I see a consultant with patients in my ED maybe once every couple weeks. Honestly, as an ED doc, I'm tempted to pick the other field plenty of days because the personality disorder patients can't talk to you (get to deal with those a lot in the ED) and intubation's my favorite procedure, but I'd be bored to death after the first week of work. Pick the field that can keep your interest and won't burn you out with the mundane aspects.

 

[Silent Cool]

If you enjoyed both and had to choose which would you go into in 2014 based on lifestyle, future, job prospects etc..

Dentistry.

Wait, was that one of the options?

 

[DermViser]

Nope, he's a specialist, but not at all a field that is high-paying (or I should say was because he doesn't see pts anymore)

I should probably be a little more clear - I'm talking about a specialty with a lot of procedures or what is pejoratively called -- a proceduralist.

 

[Silent Cool]

I should probably be a little more clear - I'm talking about a specialty with a lot of procedures or what is pejoratively called -- a proceduralist.

Yeah, a friend of mine going into PMR always says, "Procedures pay."

Why is this true? Is it because of lobbying on the part of physician groups that tend to perform more procedures?

How will the health care 'pie' (as it were) be disseminated in the future? More of an even distribution to large hospitals (which is probably why small practices are vanishing) and then an approximate distribution to the various providers in the hospitals that is correlated to their approximate time in training?