Advice on how to reapply to anesthesiology as an IM intern

[Doctor_Strange]

Hey All,

USDO at university of IM program. So far during intern year I have had a "meh" experience. Some days I am just really deflated with all the note-writing and all the non-medicine that goes in in the day-to-day work of inpatient medicine. My clinical rotations as a medical students were terrible and I did not get a great insight into all this, but I had decided to pursue IM over say anesthesiology because at that time I told myself it would be worth it to match into Cardiology, an elective that I did actually enjoy as a fourth year med students. I did, however, do two weeks with anesthesiology at a community site as a med student, and while I enjoyed it I worried it would be monotonous or that it was not the right fit for me, but compared to inpatient medicine I think I would enjoy the immediacy that anesthesiology has to offer (I was always told to look into it considering how much I excelled at pharmacology in my pre-clinical years lol). As it stands, I worry that by the end of intern year if I have not actually come to enjoy internal medicine that it would be time to reconsider applying again, which itself is a daunting task. I know my best bet is to match or connect with the in-house anesthesiology program that is actually very DO-friendly.

I wanted to ask if anyone here has done it and what was your experience or challenges. I can get a LOR from an anesthesiology I precepted with two years ago (he was former faculty at my anesthesiology program). Otherwise, I am unsure about the politics or challenges of alerting my PD about my thoughts. I worry the moment I relay my concerns it is gonna cause a whole lotta trouble.

Maybe this in intern blues, maybe it's not. I just feel like I may have not realized I knew what I got myself into...

Thank you

Edit: 243/237 Step scores, no red flags

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[kidthor]

Stick to IM, match into cardiology, GI, Pulm, or really whatever IM field. You’re welcome.

 

[coffeebythelake]

Stick to IM, match into cardiology, GI, Pulm, or really whatever IM field. You’re welcome.

Why? I am glad I did anesthesiology and would never think about doing GI or pulmonary or cardiology. Scope creep is happening jn every aspect of Medicine including these IM subspecialty fields. Arguably it is worse with IM FNPs and PAs. I think the OP needs to reflect deeply and make sure they actually go into something they will want to so for decades to come.

 

[BLADEMDA]

Hey All,

USDO at university of IM program. So far during intern year I have had a "meh" experience. Some days I am just really deflated with all the note-writing and all the non-medicine that goes in in the day-to-day work of inpatient medicine. My clinical rotations as a medical students were terrible and I did not get a great insight into all this, but I had decided to pursue IM over say anesthesiology because at that time I told myself it would be worth it to match into Cardiology, an elective that I did actually enjoy as a fourth year med students. I did, however, do two weeks with anesthesiology at a community site as a med student, and while I enjoyed it I worried it would be monotonous or that it was not the right fit for me, but compared to inpatient medicine I think I would enjoy the immediacy that anesthesiology has to offer (I was always told to look into it considering how much I excelled at pharmacology in my pre-clinical years lol). As it stands, I worry that by the end of intern year if I have not actually come to enjoy internal medicine that it would be time to reconsider applying again, which itself is a daunting task. I know my best bet is to match or connect with the in-house anesthesiology program that is actually very DO-friendly.

I wanted to ask if anyone here has done it and what was your experience or challenges. I can get a LOR from an anesthesiology I precepted with two years ago (he was former faculty at my anesthesiology program). Otherwise, I am unsure about the politics or challenges of alerting my PD about my thoughts. I worry the moment I relay my concerns it is gonna cause a whole lotta trouble.

Maybe this in intern blues, maybe it's not. I just feel like I may have not realized I knew what I got myself into...

Thank you

Edit: 243/237 Step scores, no red flags

Sometimes you have to go through a difficult process and do things you don't enjoy to get to your goal. IM is that process for you. In order to specialize in Cards or Gi you must complete 3 years of IM. The question you need to answer is do you want to be a Cardiologist which is NOTHING like general IM. If the answer is yes then suck it up and put on your big boy/girl pants.

 

[jsammi245]

Hey All,

USDO at university of IM program. So far during intern year I have had a "meh" experience. Some days I am just really deflated with all the note-writing and all the non-medicine that goes in in the day-to-day work of inpatient medicine. My clinical rotations as a medical students were terrible and I did not get a great insight into all this, but I had decided to pursue IM over say anesthesiology because at that time I told myself it would be worth it to match into Cardiology, an elective that I did actually enjoy as a fourth year med students. I did, however, do two weeks with anesthesiology at a community site as a med student, and while I enjoyed it I worried it would be monotonous or that it was not the right fit for me, but compared to inpatient medicine I think I would enjoy the immediacy that anesthesiology has to offer (I was always told to look into it considering how much I excelled at pharmacology in my pre-clinical years lol). As it stands, I worry that by the end of intern year if I have not actually come to enjoy internal medicine that it would be time to reconsider applying again, which itself is a daunting task. I know my best bet is to match or connect with the in-house anesthesiology program that is actually very DO-friendly.

I wanted to ask if anyone here has done it and what was your experience or challenges. I can get a LOR from an anesthesiology I precepted with two years ago (he was former faculty at my anesthesiology program). Otherwise, I am unsure about the politics or challenges of alerting my PD about my thoughts. I worry the moment I relay my concerns it is gonna cause a whole lotta trouble.

Maybe this in intern blues, maybe it's not. I just feel like I may have not realized I knew what I got myself into...

Thank you

Edit: 243/237 Step scores, no red flags

I agree with the other post and I would stay in IM and go into cardiology or whatever specialty you want. You are an intern and just started and it is going to be tough in the beginning. Eventually you will get use to it and be more efficient in your notes. It will be much better as you progress up in residency when you can start doing more specialty rotations. I really wished I stayed in IM during my preliminary year but was so scared to switch out of anesthesiology at the time. Your two weeks in anesthesiology as a medical student may not have shown you the other side of anesthesia. It's not always green on the other side. Please stay put and tough it out. Residency will go by fast.

 

[GassYous]

Intern year definitely sucks at the beginning. I went from wanting to quit to wanting to switch to im by the end of the year. Once you get the hang of juggling multiple things and getting your work done on time, you'll be good. BTW I am glad I decided to stick with anesthesiology.

 

[kidthor]

Agreed with GassYous. Intern year, especially early on, is filled with dispo nonsensical work. I suspect it's not at all representative of life as an IM generalist or subspecialist, and rather represents the use of cheap labor to do half medical scutwork and half clerical scutwork. It's the ultimate downhill position in the poop-goes-downhill academic medicine ant hill.

OP - you are having a grass is greener question without a clear drive toward anesthesiology and with at pre-stated strong interest in cardiology. I bet when you get later in intern year or 2nd year you'll be happy with IM. If you really end up unhappy then you'd be (based on general stats impression) able to switch into anesthesiology just fine.

 

[GravelRider]

Hey All,

USDO at university of IM program. So far during intern year I have had a "meh" experience

Really? You’ve had a “meh” experience? What were you expecting? It sounds like you need to reevaluate your expectations. Intern year generally sucks, so “meh” sounds like you’ve had an awesome and cushy intern year to me.

 

[JiPo]

The OP also needs to weigh in the realistic odds of matching into cardiology. Not all university IM program are equal, and my understanding is that it is harder to match into IM subspecialty as a DO. See how recent graduates at your program did to gauge your chance of matching. If the odds are not in your favor, switching to Anesthesiology isn’t the worst idea, especially if you do not see yourself working as a hospitalist.

 

[Doctor_Strange]

The OP also needs to weigh in the realistic odds of matching into cardiology. Not all university IM program are equal, and my understanding is that it is harder to match into IM subspecialty as a DO. See how recent graduates at your program did to gauge your chance of matching. If the odds are not in your favor, switching to Anesthesiology isn’t the worst idea, especially if you do not see yourself working as a hospitalist.

Thankfully, my program has a good record of matches, including DOs. And per 2018 NRMP, out of 76 DOs that had applied for Cards, 47 matched (61%). Not terrible odds. Where one does residency clearly has an outsized impact on those odds. But yes, hospital medicine is 100% not for me.

 

[vector2]

Why? I am glad I did anesthesiology and would never think about doing GI or pulmonary or cardiology. Scope creep is happening jn every aspect of Medicine including these IM subspecialty fields. Arguably it is worse with IM FNPs and PAs. I think the OP needs to reflect deeply and make sure they actually go into something they will want to so for decades to come.

There's probably some scope creep in non-invasive / preventive cards, but almost none as of now for the interventional and imaging folks. That being said, hopefully I'll be long retired from medicine before I see a Jenny McJennerson FNP deploying a TAVR or determining the severity of someone's mitral stenosis.

 

[nimbus]

There's probably some scope creep in non-invasive / preventive cards, but almost none as of now for the interventional and imaging folks. That being said, hopefully I'll be long retired from medicine before I see a Jenny McJennerson FNP deploying a TAVR or determining the severity of someone's mitral stenosis.

Also from what I’ve seen, the nurse practitioners who work with proceduralists usually function as residents would, collecting data on new consults and presenting them to the proceduralists, rounding on inpatients, seeing uncomplicated follow ups in clinic, etc. They greatly increase the productivity of a single proceduralist.

 

[secretasianman]

Hey All,

USDO at university of IM program. So far during intern year I have had a "meh" experience. Some days I am just really deflated with all the note-writing and all the non-medicine that goes in in the day-to-day work of inpatient medicine. My clinical rotations as a medical students were terrible and I did not get a great insight into all this, but I had decided to pursue IM over say anesthesiology because at that time I told myself it would be worth it to match into Cardiology, an elective that I did actually enjoy as a fourth year med students. I did, however, do two weeks with anesthesiology at a community site as a med student, and while I enjoyed it I worried it would be monotonous or that it was not the right fit for me, but compared to inpatient medicine I think I would enjoy the immediacy that anesthesiology has to offer (I was always told to look into it considering how much I excelled at pharmacology in my pre-clinical years lol). As it stands, I worry that by the end of intern year if I have not actually come to enjoy internal medicine that it would be time to reconsider applying again, which itself is a daunting task. I know my best bet is to match or connect with the in-house anesthesiology program that is actually very DO-friendly.

I wanted to ask if anyone here has done it and what was your experience or challenges. I can get a LOR from an anesthesiology I precepted with two years ago (he was former faculty at my anesthesiology program). Otherwise, I am unsure about the politics or challenges of alerting my PD about my thoughts. I worry the moment I relay my concerns it is gonna cause a whole lotta trouble.

Maybe this in intern blues, maybe it's not. I just feel like I may have not realized I knew what I got myself into...

Thank you

Edit: 243/237 Step scores, no red flags

Wasn’t Dr Strange a board certified neurosurgeon but decided to take a sabbatical in Tibet and then left medicine when he was able to make his side hustle his main gig ?

 

[JiPo]

Wasn’t Dr Strange a board certified neurosurgeon but decided to take a sabbatical in Tibet and then left medicine when he was able to make his side hustle his main gig ?

Two things I walked away from that movie:
1. Don't ever text and drive
2. Get own occupation disability insurance

 

[<(^_^)>]

Also from what I’ve seen, the nurse practitioners who work with proceduralists usually function as residents would, collecting data on new consults and presenting them to the proceduralists, rounding on inpatients, seeing uncomplicated follow ups in clinic, etc. They greatly increase the productivity of a single proceduralist.

This is true, but things are changing quickly. 10 years ago 10,000 NP and about 5,000 PA graduated annually. 5 years ago 20,000 NPs and 7,000 physician assistants graduated annually. Now it’s 36,000 NP and 10,000 physician assistant. Combined you have 15k -> 27k -> 46k in just 10 years. Total numbers from ~150k to ~500k in 10 years (physicians by contrast pretty stable at ~900k-1M). In 10 more they will outnumber physicians, potentially by a significant margin (as NP/PA are mostly young). If history is any guide they will aggressively expand their scope of practice in response to the job market softening and continue to blur the lines with 6-12 month “fellowships” and “residencies”.

If you look at the scope of NPs over the past 10 years or so they went from 11 states with independent practice to most recently 30 (with both Florida and California changing recently). In many states (Texas) supervision is really just a checkbox unfortunately. Quality of NP graduate has nosedived and yet scope creep has accelerated. I would be very reluctant to commit 8 years to interventional cardiology for example, given the past 8 years.

PS:

 

[Doctor_Strange]

Update: I am enjoying IM a lot more, but still feel the occasional FOMO about not pursuing anesthesiology. I look at the current skillset I have as a PGY-2 and honestly...it feels like nothing. I look at my friends as a CA-1 and am envious that they are learning some valuable set of skills. For me, maybe that validation or reward will come from matching into Cardiology, but If I do not match or even have the energy to do Cardiology since residency is exhausting, the thought of becoming hospitalist is not all that enthralling to me.

I don't think doing an anesthesia residency is worthwhile though -- the time to do three years of training I could go into fellowship (I likely will need to take one year off in between residency and fellowship to beef up my resume but even so I will still be making an attending salary).

 

[nimbus]

This is true, but things are changing quickly. 10 years ago 10,000 NP and about 5,000 PA graduated annually. 5 years ago 20,000 NPs and 7,000 physician assistants graduated annually. Now it’s 36,000 NP and 10,000 physician assistant. Combined you have 15k -> 27k -> 46k in just 10 years. Total numbers from ~150k to ~500k in 10 years (physicians by contrast pretty stable at ~900k-1M). In 10 more they will outnumber physicians, potentially by a significant margin (as NP/PA are mostly young). If history is any guide they will aggressively expand their scope of practice in response to the job market softening and continue to blur the lines with 6-12 month “fellowships” and “residencies”.

If you look at the scope of NPs over the past 10 years or so they went from 11 states with independent practice to most recently 30 (with both Florida and California changing recently). In many states (Texas) supervision is really just a checkbox unfortunately. Quality of NP graduate has nosedived and yet scope creep has accelerated. I would be very reluctant to commit 8 years to interventional cardiology for example, given the past 8 years.

PS: View attachment 343075

Donor hearts and lungs are very scarce. I’m sure he would not last long at that job if he was not very good at it.

 

[nimbus]

Update: I am enjoying IM a lot more, but still feel the occasional FOMO about not pursuing anesthesiology. I look at the current skillset I have as a PGY-2 and honestly...it feels like nothing. I look at my friends as a CA-1 and am envious that they are learning some valuable set of skills. For me, maybe that validation or reward will come from matching into Cardiology, but If I do not match or even have the energy to do Cardiology since residency is exhausting, the thought of becoming hospitalist is not all that enthralling to me.

I don't think doing an anesthesia residency is worthwhile though -- the time to do three years of training I could go into fellowship (I likely will need to take one year off in between residency and fellowship to beef up my resume but even so I will still be making an attending salary).

Just remember an anesthesia residency is about as long as a pulm/cc or a cardiology fellowship. I know someone who worked as a hospitalist for a year, then did anesthesia residency, and does not regret it. Do what you like.

 

[GravelRider]

Update: I am enjoying IM a lot more, but still feel the occasional FOMO about not pursuing anesthesiology. I look at the current skillset I have as a PGY-2 and honestly...it feels like nothing. I look at my friends as a CA-1 and am envious that they are learning some valuable set of skills. For me, maybe that validation or reward will come from matching into Cardiology, but If I do not match or even have the energy to do Cardiology since residency is exhausting, the thought of becoming hospitalist is not all that enthralling to me.

I don't think doing an anesthesia residency is worthwhile though -- the time to do three years of training I could go into fellowship (I likely will need to take one year off in between residency and fellowship to beef up my resume but even so I will still be making an attending salary).

What sort of skill sets are you looking for? Just focus on being a good internist. Procedural skills are easy. Medicine is hard. If procedural skills are what you want, I’m sure you can seek them out.

In terms of beyond IM residency, Anesthesia is shorter than if you do interventional cards or EP (4 years). General cardiologists don’t do a ton of hands-on procedures. If you are already committed to do a hospitalist year then really focus on IM residency. I actually had fun as an IM resident when I was a second and third year. Once the stress of the scut work was gone, medicine was actually interesting.

Once again, my recommendation for all IM residents is to pursue a fellowship. Even think about some of the less sought after ones. I know some nephrologists and hematologists that have pretty nice setups. They certainly aren’t sitting in an OR at 3am on Thanksgiving while the surgeon is running the bowel on a septic old lady who will be dead in 24 hours with or without the surgery.

 

[Test Boy]

What sort of skill sets are you looking for? Just focus on being a good internist. Procedural skills are easy. Medicine is hard. If procedural skills are what you want, I’m sure you can seek them out.

In terms of beyond IM residency, Anesthesia is shorter than if you do interventional cards or EP (4 years). General cardiologists don’t do a ton of hands-on procedures. If you are already committed to do a hospitalist year then really focus on IM residency. I actually had fun as an IM resident when I was a second and third year. Once the stress of the scut work was gone, medicine was actually interesting.

Once again, my recommendation for all IM residents is to pursue a fellowship. Even think about some of the less sought after ones. I know some nephrologists and hematologists that have pretty nice setups. They certainly aren’t sitting in an OR at 3am on Thanksgiving while the surgeon is running the bowel on a septic old lady who will be dead in 24 hours with or without the surgery.

I don’t think anyone would recommend a nephrology fellowship nowadays. It’s probably the least desirable IM fellowship now.

 

[GravelRider]

I don’t think anyone would recommend a nephrology fellowship nowadays. It’s probably the least desirable IM fellowship now.

Probably. The point is to look beyond cards and gi.

 

[IMGASMD]

I don’t think anyone would recommend a nephrology fellowship nowadays. It’s probably the least desirable IM fellowship now.

All these things are still subject to market forces. In a few years, there will be a shortage of X specialists, because no one wanted it.

Isn’t ID sort of coming back? I also met an ID and an nephro a few years ago doing a “shortened” critical care fellowship. And that particular hospital let them do many hands on stuff. Both of their prior fellowships made them invaluable to the team.

 

[nimbus]

All these things are still subject to market forces. In a few years, there will be a shortage of X specialists, because no one wanted it.

Isn’t ID sort of coming back? I also met an ID and an nephro a few years ago doing a “shortened” critical care fellowship. And that particular hospital let them do many hands on stuff. Both of their prior fellowships made them invaluable to the team.

That’s great. So many nephrologists can’t/won’t insert dialysis catheters. It’s shameful.

 

[IMGASMD]

That’s great. So many nephrologists can’t/won’t insert dialysis catheters. It’s shameful.

This hospital made sure they can. They all have “line service” month. They were inserting all the lines for the whole hospital. And switching lines every X days.

Half of the unit were either on dialysis or CRRT…. Which made nephro much more rounded.

 

[kidthor]

This hospital made sure they can. They all have “line service” month. They were inserting all the lines for the whole hospital. And switching lines every X days.

Half of the unit were either on dialysis or CRRT…. Which made nephro much more rounded.

I worked at a hospital with a “line service” that was staffed only by NPs (supervised by an absent IR guy) who worked weekdays M-F from 8a-3p at best. The rest of the time the whole hospital would call the anesthesia phone for line issues then get nasty when we couldn’t/wouldn’t drop everything to put in an IV at 3am on Saturday for free.

 

[invitro]

I actually did what OP wanted to do, albeit 15 years ago. Anesthesia was average in competitiveness back then and usually there were several spots outside the match to choose from; if you were a US md with above average stats it wasn’t too hard to match. I’m not sure if that is the case today. I really didn’t like IM so it was the right choice for me.

However if you can hack IM, the ops are probably better long term. Cards, GI are great but look at heme/onc, allergy and even rheum.

One of my friends was pretty average in med school (bottom 25th percentile) but had great business sense and went into rheum…he built up several infusion centers in the south. Sold to PE for 15 mil and STILL owns the buildings which he rents out. Worked for a few more years then retired and lives in south Florida. He teases me about all the cool cars he leases and women he dates lol.

Another friend, also middle of the pack in med school (he went to a DO school) did heme/onc in the Midwest. Joined the right practice and makes >1million/year with a 50hr week. He’s a family man so no teasing.

Both of those guys do much better than most (not all of course) anesthesiologists, even those in pain. I do okay (>550k) but both of those guys do much better with a way easier schedule. There are a lot of options out there if you can stick it out in IM.

If you decide to do cardiology or GI the sky’s the limit if you are location independent. 1million/year is not hard in the south/Midwest.

Sometimes I wonder if I made the right choice! I’m happy though. Once you have your needs met and several years living expenses saved up it’s all good.