Anesthesia or Internal medicine?

[rayoo-14]

Hello everyone
what i like about IM: the knowledge part is probably the most intriguing part for me in IM. the wide variety of cases and the patient care as well. and of course the wide spectrum of specialties in it ( like cardio,nephrology,gastro )
what i dislike about IM: probably what i most fear is the communication between medical teams and the conflict that can occur. and the maybe that IM is not that demanding

what i like about anesthesia : its a unique specialty which combines surgery and medicine,its also a demanding specialty . the lifestyle as well is really good.
what i dislike about anesthesia : my fear is that being in the OR maybe it would boring ? like what is said about anesthesia being 99% boring and 1% Adrenalin ? will i get bored in anesthesia ?

also personality wise i tend to be laid back and also really value lifestyle and having time to spend with my future family
hope you help me

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[step213]

Hello everyone
what i like about IM: the knowledge part is probably the most intriguing part for me in IM. the wide variety of cases and the patient care as well. and of course the wide spectrum of specialties in it ( like cardio,nephrology,gastro )
what i dislike about IM: probably what i most fear is the communication between medical teams and the conflict that can occur. and the maybe that IM is not that demanding

what i like about anesthesia : its a unique specialty which combines surgery and medicine,its also a demanding specialty . the lifestyle as well is really good.
what i dislike about anesthesia : my fear is that being in the OR maybe it would boring ? like what is said about anesthesia being 99% boring and 1% Adrenalin ? will i get bored in anesthesia ?

also personality wise i tend to be laid back and also really value lifestyle and having time to spend with my future family
hope you help me

In my personal opinion -

- anesthesia is more fun then IM in the daily practice (it may appear boring from the outside as a med student but actually practicing is more fun when you have the autonomy to choose how you deliver your anesthetic. Although i do like inpatient medicine quite a bit.. anesthesia still trumps it).
- IM knowledge is one of those things taken for granted by anesthesiologist who are also IM trained because it probably doesn't change day to day practice in the OR all that much. What I can say though is that being an internist you'll understand your patient in the OR on a different level (again mostly will not change what you actually do in the OR tho) - you'll understand their chronic disease, why they may be on certain therapies vs not on them and how that relates to the patient.. for instance just by looking at someone's cardiac meds and therapies you can probably stage most heart failure patients without knowing anything else about them.
- Life style is where IM has it at though, hospitalist lifestyle is sweet yet pays less then general anesthesia practice. And being able to eat and use the restroom whenever you want as an internist is a benefit that shouldn't be overlooked... PCP/concierge medicine is amazing too if you can get into the whole patient as a customer thing- as a concierge doc you have ownership over the patient which makes you not as expendable as perhaps an anesthesiologist in a group that is vying to keep their contract with a hospital.
- Does critical care turn you on or make you want to run out the door... its a nice blend of both specialties, high acuity and being able to really think through your patients while also not necessarily feeling like you're on the hampster wheel of the OR. Despite being thought of as a high intensity speciality i feel a ICU day is quite relaxing compared to a full day of quick turn overs in the OR.

If you really like both AND have a future career goal that could benefit from training in both - you can consider a combined program - there are only 7ish or so spots in the country so make sure its really right for you if you want to consider it.

 

[deleted171991]

Solution: IM + Critical Care. Next!

 

[anbuitachi]

In my personal opinion -

- anesthesia is more fun then IM in the daily practice (it may appear boring from the outside as a med student but actually practicing is more fun when you have the autonomy to choose how you deliver your anesthetic. Although i do like inpatient medicine quite a bit.. anesthesia still trumps it).
- IM knowledge is one of those things taken for granted by anesthesiologist who are also IM trained because it probably doesn't change day to day practice in the OR all that much. What I can say though is that being an internist you'll understand your patient in the OR on a different level (again mostly will not change what you actually do in the OR tho) - you'll understand their chronic disease, why they may be on certain therapies vs not on them and how that relates to the patient.. for instance just by looking at someone's cardiac meds and therapies you can probably stage most heart failure patients without knowing anything else about them.
- Life style is where IM has it at though, hospitalist lifestyle is sweet yet pays less then general anesthesia practice. And being able to eat and use the restroom whenever you want as an internist is a benefit that shouldn't be overlooked... PCP/concierge medicine is amazing too if you can get into the whole patient as a customer thing- as a concierge doc you have ownership over the patient which makes you not as expendable as perhaps an anesthesiologist in a group that is vying to keep their contract with a hospital.
- Does critical care turn you on or make you want to run out the door... its a nice blend of both specialties, high acuity and being able to really think through your patients while also not necessarily feeling like you're on the hampster wheel of the OR. Despite being thought of as a high intensity speciality i feel a ICU day is quite relaxing compared to a full day of quick turn overs in the OR.

If you really like both AND have a future career goal that could benefit from training in both - you can consider a combined program - there are only 7ish or so spots in the country so make sure its really right for you if you want to consider it.

Do hospitalists actually make less per hour wise?

 

[deleted547631]

Hospitalists: 23-26 weeks per year on 7 on/7 off, 'round and go', make $250K base salary in major metros, lots of time off to work extra shifts or do some other side hustle, a plethora fellowship opportunities, strong job market.

Anesthesiologists: Income is strong (starting around $320K+ base), good lifestyle (8-10 weeks vacation per year), procedural-type work, no clinic (unless in Pain).

I think a lot if it comes down to whether you're okay with not doing procedures (typically IM) versus doing procedures in an OR setting. I'm torn between both, too.

 

[psychbender]

Hospitalists: 23-26 weeks per year on 7 on/7 off, 'round and go', make $250K base salary in major metros, lots of time off to work extra shifts or do some other side hustle, a plethora fellowship opportunities, strong job market.

Anesthesiologists: Income is strong (starting around $320K+ base), good lifestyle (8-10 weeks vacation per year), procedural-type work, no clinic (unless in Pain).

I think a lot if it comes down to whether you're okay with not doing procedures (typically IM) versus doing procedures in an OR setting. I'm torn between both, too.

Hey, you can always do CCM for two years after IM or 1 year after anesthesiology, work the same 7 on/7 off as the hospitalists, with more sick patients and procedures...while making the same as an anesthesiologist.

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[neutro]

There are no notes in anesthesia nor any rounding

 

[deleted171991]

There are no notes in anesthesia nor any rounding

Nor independence.

 

[VA Hopeful Dr]

also personality wise i tend to be laid back and also really value lifestyle and having time to spend with my future family
hope you help me

Outpatient IM

 

[neutro]

Nor independence.

No one is truly independent imo. Not even the godly neurosurgeon or cardiologists who have to abide by the suits, medical board, insurance companies and their needy patients.
True independence is linked to financial security and the ability to walk away from any job, environment or situation at anytime.

 

[deleted171991]

No one is truly independent imo. Not even the godly neurosurgeon or cardiologists who have to abide by the suits, medical board, insurance companies and their needy patients.
True independence is linked to financial security and the ability to walk away from any job, environment or situation at anytime.

I can walk away from the ICU and go scratch my butt for 2 hours elsewhere. I can start my rounds at 9 if I want to. I can stop them whenever I want and take a break. I can write my notes at home. I can do tons of things one only dreams about while being the valet in the OR.

The main thing CCM does not beat anesthesia at (YET!) is reimbursement for the same amount of work. CCM is much harder work for the same money. It's also a much broader and deeper specialty, which requires a bigger time investment in continuous self-education.

 

[neutro]

I can walk away from the ICU and go scratch my butt for 2 hours elsewhere. I can start my rounds at 9 if I want to. I can stop them whenever I want and take a break. I can write my notes at home. I can do tons of things one only dreams about while being the valet in the OR.

The main thing CCM does not beat anesthesia at (YET!) is reimbursement for volume of work. CCM is harder work for the same money.

Well that has little to do with independence and more with your temperament and what you value more, ie scratching your butt for two hours. Must be a large butt! I never bring work home so I never do notes at home.

That’s why I did pain mgt to have independence and truly have control over my practice, business, time off. But at this time, the environment isn’t so hot so I went back to Anesthesia which is less complicated. I get 10 weeks off for 1.5X more money and no pager to hold unless I’m on call. I can plan and take vacations when I want and even during day to day, it’s not that terrible.

 

[deleted171991]

Yeah, I occasionally value being able to "scratch my butt" and have a coffee with my co-workers in the middle of the day. I would even take a nap if I could. There are tons of books that show how these increase productivity, among many other things one can do in intensive care/pain, and not in anesthesia.

As you said, it's a matter of temperament. The more independent I feel, the happier I am. And, as I said, anesthesia is the better gig (money-wise) for now (hence I am not giving it up yet). But, if I had to choose now, I would choose an academic IM residency, no-brainer.

 

[neutro]

Yeah, I occasionally value being able to "scratch my butt" and have a coffee with my co-workers in the middle of the day. I would even take a nap if I could. There are tons of books that show how these increase productivity, among many other things one can do in intensive care/pain, and not in anesthesia.

As you said, it's a matter of temperament. The more independent I feel, the happier I am. And, as I said, anesthesia is the better gig (money-wise) for now (hence I am not giving it up yet).

I’m not disagreeing with you, and that’s why I believe a mix practice is best.

 

[Southpaw]

Most med students don’t know what they want. So default to what everyone else wants in a job - money, vacation, intellectual stimulation, and freedom. Anesthesia is great but requires a certain mindset. You can do a lot with IM so without knowing anything about you other than your post on this anonymous forum, that’s what I’d recommend.

 

[rayoo-14]

Most med students don’t know what they want. So default to what everyone else wants in a job - money, vacation, intellectual stimulation, and freedom. Anesthesia is great but requires a certain mindset. You can do a lot with IM so without knowing anything about you other than your post on this anonymous forum, that’s what I’d recommend.

What’s the mindset that is usually needed for anesthesia ?

 

[dannyboy1]

Due to my spending a lot of time supervising combined with slow turnover and late surgeons I have plenty of time to drink all the coffee in the world and can scratch the entire departments butt.....

 

[dannyboy1]

I can walk away from the ICU and go scratch my butt for 2 hours elsewhere. I can start my rounds at 9 if I want to. I can stop them whenever I want and take a break. I can write my notes at home.

Rounds .... notes ?
What are these things you speak of??

 

[Southpaw]

What’s the mindset that is usually needed for anesthesia ?

We are the offensive linemen of the medical field. Our true happiness is found outside of the hospital.

 

[deleted171991]

What’s the mindset that is usually needed for anesthesia ?

To paraphrase the John Travolta ad:

Profession: your true passion in life
Career: anesthesiologist

Or, as one of my wiser older colleagues used to say, whenever I got pissed off by another surgical dumb-ass: it's just a job, man.

Don't be too passionate about anesthesia. It's an adulterous spouse.

 

[Twiggidy]

What’s the mindset that is usually needed for anesthesia ?

The one thing that everyone going into anesthesia needs to understand is that this is a SERVICE industry. As an anesthesia dept, you bring zero revenue to this game we call medicine. As said above, anesthesiologists are the offensive lineman. You're needed for the offense, but people come to see the QB and WR. (We can argue later about who are the left tackles). We're random midfielder. We might score one for the team every once in a while, but people are here for the strikers.

You want to know how important you are and where your mindset as an anesthesiologist should be? Well, look at this list in "every specialty"...

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