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Am I glorifying anesthesiology too much?

Discussion in 'Anesthesiology' started by Bean Counter, Sep 11, 2017.

  1. Bean Counter

    Bean Counter 7+ Year Member

    Aug 25, 2010
    Current MS4 here who should be working on ERAS right now but instead I'm procrastinating on the forums and I feel I need to at least get this off my chest and see what happens.

    I've been stuck deciding between radiology and anesthesiology for a very long time and time is pretty much up now. I really like both specialties and identified my interest in both pretty early on but I geared myself towards radiology for of a few reasons:
    1) IR
    2) I spoke to the specialty advisor at my school who is a Pain doc from anesthesiology and he advised me to explore other options. Told me he liked being in the OR and hated clinic... but yet went into pain and hated his clinic patients although I'm sure he did very well in his career. Also told me it can get boring after a while. Said b/c I have a good Step 1 score (~<250) I could match into something "better"
    3) Lots of doom and gloom here and other forums scared me away.. being honest

    Taking those things into consideration, I ditched anesthesia and set up a few IR and DR electives for fourth year and now that I've done them I've realized a couple of things.

    IR can be pretty great but depending on the setting it may or may not be so amazing. While I was rotating through academic centers there were lots of really innovative procedures that we were doing that I really enjoyed but now that I'm in a community hospital, not so much. I'm seeing a lot of biopsies, drains, and port placements and not much else. Even the trauma cases we saw in IR were a little anticlimactic. There's also something a lot less "tactile" about it than I originally imagined. I'll use a case we did as an example of that... trying to thread the wire past some large renal calculi into the ureter to place a stent under fluoro and the only thing you can do is pull the wire back, rotate it a little, and push forward and hope it moves forward this time... for 3 hours just looking at the screen and fiddling with the wire. I know most cases aren't like that but when you're scrubbed in as a med student looking over the attending's shoulder for a few hours you have some time to contemplate how much you really want to be in their place.

    On the other hand I found DR more interesting than I anticipated and I think it's something that you get to enjoy more with more knowledge you have. All of the residents/attendings I encountered seemed to like what they were doing and that was very encouraging. With that being said, I don't have a natural interest in reading images and dictating tons of incidental pulmonary nodules on a chest CT while the PACS list continues to grow is anxiety inducing. I know things can change and the more I learn about what to look for in imaging the more interested I become but it's still hard for me to envision dictating reads for my entire career at this point.

    Also, many radiology residents I spoke with originally went into radiology for IR but decided against it after seeing how much they work. To me, DR seemed mentally exhausting even though the hours are good. The volume and speed those guys have to work at is amazing. Now I'm having a hard time seeing myself doing either. To top it off, IR has its own pathway now and is insanely competitive to get into directly. ESIR programs are probably my best bet but there isn't any guarantee because the entire fellowship structure is changing. Radiology pretty much requires a fellowship regardless so that means 6 years of post-grad training no matter what, possibly 7 for IR worst case scenario.

    Anesthesiology, in my eyes, seems like a lot of what I came into medicine for. Insulated away from a lot of the social stuff that IM/EM gets and dealing only with sick patients or patients that need to have something done. Short but rewarding interactions with patients before undergoing a life-changing events. It's not always intense when things are running smoothly but when things do go wrong you are the last line of defense and have to act under pressure. You are an expert at keeping people alive and life support. I enjoy the physiology of anesthesiology more than I enjoy the anatomy in radiology. I also like the neurological component of it referring to regional blocks and pain. Lots of variety of patients and procedures and there also seem to be good fellowship options after residency to expand your practice setting outside of the OR into the ICU or clinic. I like the OR environment and there seems to be great personalities in anesthesia that I match well with. Anesthesiology honestly looks like a lot of fun to me and could lead to a good job with a lot of options and flexibility.

    A little more about me if it helps paint the picture. I have always considered myself more of a do-er vs a talker. Grew up building things with my dad, playing team sports, and working on car engines and stereos. I like acute care and seeing immediate results. Treating patients long term never really interested me. Consider myself to be very laid back but also think I work well under pressure. Changed careers so I'm non-traditional and go to a non-top tier med school. Good Step 1 score and even mix of H/HP 3rd year grades. Some research but not much and not in either anesthesiology or radiology. From the west coast and would like to move back for family/friends.

    I'll end it here before this gets any longer but any guidance is much appreciated.
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  3. teeva

    teeva 2+ Year Member

    May 21, 2015
    Unfortunately, you can't separate the purity of anesthesiology practice from the realities of the modern day American medical system and everything it encompasses that's repeated ad naseum on these forums - corporate takeover, mid level conquests, predatory partnerships if they aren't extinct, hostile hospital admins, etc.

    Go into radiology or IR and don't look back.
    Consigliere and acidbase1 like this.
  4. bashwell

    bashwell Classifieds Approved 2+ Year Member

    Mar 20, 2013
    Since IR is a competitive specialty now, but you're competitive for IR, why not pick IR? If you don't like IR, then you can switch to anesthesiology. It's probably easier to switch from IR to anesthesia than from anesthesia to IR. I've been told anesthesia is generally open to residents who change their minds and want to switch into anesthesia.
    spacegun and nimbus like this.
  5. anbuitachi

    anbuitachi ASA Member 7+ Year Member

    Oct 26, 2008
    anesthesiology is one of the largest specialties so it's easy to switch into, plus the fact that many med schools dont even require an anesthesiology rotation. i think there'll ALWAYS be room for competitive applicants from other specialties
    AdmiralChz and bashwell like this.
  6. Man o War

    Man o War 2+ Year Member

    Apr 13, 2015
    You sound a lot like me.
    I did a cardiac fellowship, and found a private practice all doc group. I'm very happy with my choice.
  7. Stank811

    Stank811 Junior Member 10+ Year Member

    Aug 26, 2004
    I had very similar thoughts when I had to make a decision. I did anesthesia followed by CC. Couldn't be happier with my choice. Found a great PP group to work with.
    BLADEMDA likes this.
  8. jthedestroyr

    jthedestroyr ASA Member 5+ Year Member

    Jan 23, 2013
    this. there are a few that state it over and over, and you should heed our warning.

    i recognized all the negatives in anesthesia, but you dont realize how bad midlvl stuff is until you see it first hand and be on recieving end of attendings backing the nurse (play nice) while the nurses are advocating behind your back for independent practice.

    if you didnt have that, its an awesome job.
    bashwell and FFP like this.
  9. Bean Counter

    Bean Counter 7+ Year Member

    Aug 25, 2010
    I appreciate the honesty here. I'm trying to make the most well-informed decision as possible and it's important to hear all sides, especially being aware of the fact that you don't get taught any of this during med school. While I don't think these problems are isolated to anesthesiology, it does seem that this specialty is getting it the worst and its unfortunate that it's having a significant negative impact on the experience of a lot of physicians after dedicating so much time into this career.

    While I hope it doesn't come to this, it is actually really comforting to know and I hadn't thought about how anesthesiology is so open to accepting applicants from other specialties switching over. I hadn't really thought about this as an option but it does seem true that switching over from radiology is a potential option down the line.

    I'm glad to hear that there are still those who are happy with their choice to enter the field. CC and cardiac fellowships are the two routes that I could see myself in if I do pursue anesthesiology and I gather that the more complex the cases you are prepared to take on, the less concern there is about midlevels. I pretty much know that no matter what I do, I plan on doing a fellowship because it's all but required in radiology and in anesthesiology it adds to your skillset and it helps market yourself for jobs whether or not it is actually required to do the cases. I also gather that most anesthesiologists really like the actual practice of anesthesiology but despise the business/political aspects of it which is why I'm glad I asked this question because it confirms my belief that anesthesiology is enjoyable and I probably would enjoy the work more than I would enjoy the work in radiology but there are some major caveats. It really makes this a tough decision
    bashwell and IAmRonBurgandy? like this.
  10. pjl

    pjl ASA Member 10+ Year Member

    Oct 29, 2006
    I currently love my job, almost every day.

    However, I expect within 15 years it will have become so bastardized into supervising increasingly cocky but less well trained midlevels that I am only going for the paycheck.
    At that point I will either find a practice where I am valued or retire.

    I also expect this trend to come in virtually all specialties, with procedural specialties being the last holdouts. Other specialties may have a few more years, we do seem to have a head start, but EM and others are rapidly catching up.

    Sent from my iPhone using SDN mobile app
  11. rakotomazoto

    rakotomazoto ASA Member 7+ Year Member

    Aug 25, 2009
    Los Angeles, CA
    Agree with going for IR since you seem to have the stats to pull it off. You can always switch into anesthesiology later if you totally hate it. No specialty is perfect and plenty of people have a tough time deciding. In the end, you just have to go for something and reassess as you move along through residency.

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