Anesthesia vs IM

Discussion in 'Anesthesiology' started by msmith83, Feb 25, 2014.

  1. BLADEMDA

    BLADEMDA ASA Member
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    I hope maybe a point or two from the posts on this thread has you thinking about this field. There are plenty of positives and negatives about Anesthesiology which we have tried to elucidate to you in detail. Of course, the decision is yours to match into the field. All I can do is shake my head and wish you the best in your career path.
    Since you've read the various opinions here on SDN I consider you well informed on the subject. The rest is up to you. Best of Luck.
     
  2. countingdays

    countingdays ASA Member
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  3. pgg

    pgg Laugh at me, will they?
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    Heh, that made me laugh.

    It's a long running joke. On SDN, people who are for whatever reason dissatisfied with medicine (not just anesthesia) often like to post about what they coulda, shoulda, woulda done if they hadn't become doctors. Invariably there's a cohort that thinks that because they were smart and driven enough to get into and through medical school, that they'd have been shoo-in successes in another lucrative field. Investment banking always comes up. Always. Never mind that it's probably THE most cut-throat, high burnout, high failure, 100+ hour/week jobs in America.

    Godwin's law says "As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches 1" ...

    We joke that there's a SDN corrollary to that: "As a SDN discussion about physician pay grows longer, the probability of a woulda coulda shoulda statement involving investment banking approaches 1" ...



    Look, you've got an awful big chip on your shoulder. You're obviously welcome to post here - everyone is, except trolls and really abusive obnoxious people. This subforum in particular is pretty light on the moderating, and an unfortunate side effect of that is there's maybe a bit more rudeness than you might find in other SDN areas. In general, a little deference and politeness to the regulars of any forum is in order. No one's asking for asskissing. You don't have to agree, and reasoned argument is welcome, but settle down, eh?

    I didn't expand on the lists I alluded to earlier because there are SO MANY people here who have lived this specialty and have great cases to talk about and long, hard-earned experiences to share. Not everybody posts every day. Some people go a long time between visits or posts to the forum. Life happens, people lose interest in the internet, some great prolific posters from 5+ years ago aren't around any more. Maybe in 5 years I'll be gone. Look at the cases sevoflurane has posted in the last couple weeks, look at (off the top of my head) idiopathic and urge and plankton and others' responses there. Blade likes copypasta a bit much :) but the guy's been practicing for a long time, reads more than some residents do, has a solid grip on where the job market's been because he's lived it, and when he talks about where he thinks things are going, I personally give his words serious consideration.

    It is the nature of the internet that negatives are overrepresented. You've got to understand that a lot of the angry pessimism from people is borne of love for this specialty and anger over what's happening at the hands of stupid politicians, profit-driven insurance cos, and thirsty militant strip-mall-CRNA-mill prodigies.

    Lots of us love anesthesia and would do it again. Look at periopdoc's signature.
     
  4. Critical Mass REACHED

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    I just found a job working from home making $5,000 a week working for herbalife.com.

    Ask me how.

    J/k

    Thanks for the advice, I'll continue to have a positive outlook, and remain a "glass half full," kinda person.
     
  5. IkeBoy18

    IkeBoy18 ASA Member
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    LMAOOOOOO!!!!! I needed that laugh
     
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  6. Consigliere

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    This just exemplifies what a know-nothing douchetard you are. You thinking prostate cancer is a urologist's "money maker?!" Ha ha ha ha! That is really funny. You know nothing about the real world, med student. Read your naive posts 10 years from now when you've got some hair on your nuts to see how ridiculous you were.
     
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  7. CityLights

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    Just put critical mass on ignore. A premed/med student (whatever he or she is) telling an attending he went into medicine for the wrong reasons, after a well-written post by that attending, is laughable. This user is similarly obnoxious on other subforums.
     
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  8. HollATme

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    Hahahaha!!!!

    Ironic, considering how he called Blade a troll.
     
  9. Critical Mass REACHED

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    http://urologytimes.modernmedicine.com/urology-times/news/payment-slide-regs-aca-urologists-least-favorite-things?page=full

    How do I put someone on ignore. You'd be first on that list.
     
  10. Dwindlin

    Dwindlin ASA Member
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  11. msmith83

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    While I think 200-250k is very good money, the idea that there would be a ceiling on my income bothers me. Not that I intend to make millions or anything, I would just like to know that if I ever need more money.... its there if I work for it. Which of course is why I'm interested in private practice rather than employment by hospital or AMC
     
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  12. Critical Mass REACHED

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    Yup, paints a gloomy picture for urology. The point being, the grass is not greener on any specialty. The big factor being decline in money. Which is why I'll choose to be happy what I'm doing, and not money. I'm sure urology guys are just fine.
     
  13. Dwindlin

    Dwindlin ASA Member
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    Not sure that's quite how I would interpret it, but carry on.
     
  14. kazuma

    kazuma ASA Member
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    I'm curious as to why people think critical care will save anesthesiology with the possible exception being academics. NP's staff ICU's around the country. At my shop, some of the sickest patients in the hospital (the CT-ICU full of bad CAD/CMP/transplants/VADs/ECMO etc) are left to the whims of an NP every night. Not a single in house doc looking after these patients. Sure, the CT surgeons or CCM anesthesiologists/surgeons are a phone call away (if they answer and sometimes they don't), but when SHTF unfortunately it's the NP at bedside calling the shots, placing invasive lines, tubing, and managing ggt's. And this is at an ACADEMIC medical center. This is what happens when nurse managers run hospitals and the current US administration believes APN's are the solution to the "healthcare crisis."

    PulmCC has the monopoly on most private practice ICU's. Finding an ICU job as an anesthesiology CC doc is an elusive endeavor. You hear of these jobs, but they are few and far between. Let's say you do a CCM fellowship and graduate but end up doing straight OR anesthesia. How long can you be out of fellowship and remian credentialed in CCM (assuming you are board certified)? No doubt a CCM fellowship could strengthen your skills and make you a better physician, but how does this translate to more job security or better pay when anesthesia ICU jobs in PP are virtually nonexistent?

    I don't know what the future will bring, but I would imagine our skills will still be needed with the number of sick baby boomers on the horizon. Income is a wild card, but IMO has nowhere to go but down. Blade is correct and he speaks the truth. To call him a troll is absurd. He is easily the most knowledgable person I know of in terms of the business of medicine and anesthesiology. He is an asset to this forum and deserves to be respected as such.
     
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  15. LeverArm

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    Anesthesiology invented the ICU but then did what it does best and sold out to spend more time in the OR. Then sold out again and encouraged crnas. Now as the pay is bottoming, cc sounds more appealing again. In most of the world, all physician anesthesiologists still rule the icu. I really believe as the number of gas cc docs increase we can reclaim the icu. Just look at the growing number of combined cc residencies. Talk to many students who want to do cc deciding to do the anesthesia route, likewise look at how many anesthesia bound students also have an interest in cc.

    20-30 years from now the field will look very different than today and the distinction with midlevels will be clearer.
     
  16. murdoc9

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    Just an anesthesia-bound 4th yr med student chiming in FWIW, but I've been thinking about this a lot recently, given that we soon-to-be matched people are entering a highly uncertain future in this specialty. It seems like if more and more anesthesiologists would get further training in cc, or if somehow the 4 year residency could result in a dual anesthesia/cc board recognition/certification for ALL anesthesiologists, our presence in ICUs would increase very quickly. Not sure if that would be at all feasible for a 4 year residency (perhaps if all residencies were made categorical and intern year became more frontloaded?)

    Understandably, given the current economical forces and sheer numbers in the workforce, critical care anesthesia is not the most attractive or the best bang for the buck. Also understandably, the ICU is a different animal, and definitely not for everyone in the long term. However, IMHO by being dual boarded, or if residency could become this theoretical 4 year "residency in anesthesia and critical care", we would increasingly demonstrate our value/interest in being in the ICU, and there would be a resultant increase in anesth/cc jobs even in smaller centers. Not only that, but this increased "baseline expertise" in critical care would quickly distinguish us even further from midlevel anesthesia providers, who want oh-so-badly to be seen as physician equals... but that's another rant. IDK, maybe that's one way that CC could "save" anesthesiology in the longer term. But what do I know..
     
  17. murdoc9

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    haha you beat me to it.
     
  18. nimbus

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    Just to give a little perspective, this discussion has been going on for a very long time.

    When I was applying to anesthesia residency 23 years ago, many many applicants were expressing an interest in critical care. I was among them and we were all very sincere. But neither I nor 99% of my contemporaries actually went into ICU medicine.

    This time market forces may actually drive trainees to practice ICU medicine. For others, the right OR practice can more than satisfy the desire to do "critical care". I do believe anesthesia residency at a big high acuity program provides an excellent foundation for critical care.
     
    #218 nimbus, Mar 7, 2014
    Last edited: Mar 7, 2014
  19. Yo GabbaPentin

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    Douchtard?! Yes! I like it! Learned a new word!

    For the rest of you... I feel we may have been sucked in by a semi troll.... AGAIN. Calling a well respected poster a troll is one of the first lessons in troll 101. Then displaying severely limited knowledge about everything else with a cocky demeanor... that's lesson number two.
     
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  20. Critical Mass REACHED

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    I worked the ICU as a nurse, it was run by both IM and CC Anesthesiology. Our SICU was run by both Surgery & Anesthesiology departments.

    Some hospitals have SICUs completely run by Anesthesiology.

    NPs I used to work with on the unit were pretty much social workers trying to transition patients out of ICU who no longer needed to be there.

    The number of CC fellowships needs to increase with about 50 slots a year, hopefully with time they will increase in number with greater interest. I agree that Anesthesiology must increase it's hospital presence and the ICU's make sense.

    But what do I know, it's not like I'm one of the old timers who sat around making big money selling out the OR's & ICU's to nurses or other specialties. (Doesn't apply to all in this forum) but if that statement offends you, then it's probably targeted towards you :)
     
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  21. ihearttriangles

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    While I originally admired your spunk I have to say I think you have crossed over into belligerence and just being antagonistic for the sake of being antagonistic. If you really are a med student who will be going into anesthesia I encourage you to keep the fire in your belly alive as like I said before I firmly believe the field needs more people like you, people who are rabble rousers and warriors. However, the first rule to being a leader is that people must either like or respect you. Your approach is breeding neither admiration nor respect so I would respectfully ask you to reconsider your approach so that your passion for the field can be demonstrated in a more diplomatic and productive manner. I like WHAT you are saying but not HOW you are saying it, ok?
     
  22. cincincyreds

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    I've read through these posts. The issue is things are not as good as they used to be, so you have to be proactive. Debt is bad, so minimize and eliminate it first. What is the big deal living like a residet for a few years after finishing residency. Bank the money, read the whitecoatinvestor website, and learn to invest your money. Have a big portfolio of one million dollars before buying the big house and the bmw. Learn to make other sources of income. Keep yourself healthy, eat well and exercise.

    Salaries vary. I see starting salaries of 275-300k at these amc's. The important thing is to be happy at the job and make sure you are working with good people who can help bail you out of bad situations. It is not worth a bad job to make 50k more as the government will take nearly half of it away anyway. When you finish residency you will be in the top 2% o salaries in the country. So people won't accept your crying.
     
  23. LeverArm

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    I agree with what you said and I feel like I'm guilty of the same. But it's very disconcerting when people minimalize something you have a passion for and will devote much of your life to. I respect attendings and those in the field that can give honest perspective on the current situation but some just have this personality that is obvious that they would be miserable at anything. They would absolutely hate their life training and working as neurosurgeons but theyll point to it and talk about how great it is. The types who always believe the grass is greener for others, not only in medicine but in everything in life.
     
  24. msmith83

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    Ok so just to reiterate, if one plans on gong into anesthesia with the hope of going into private practice (or pain) then one might want to peruse another field? In other words, if I go into anesthesia I have to know that it may not be an option
     
  25. Critical Mass REACHED

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    I apologize, sometimes frustration can get the best of someone, especially when you're passionate about the field. But, I'll take your advice. I appreciate your approach as well. I hope to work with people like you in the future.
     
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  26. countingdays

    countingdays ASA Member
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    You are passionate about anesthesia like I'm passionate about Scarlett Johansson. She seems amazing from afar but if I knew her better I might find that she's a bitch.
     
  27. LeverArm

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    Could be said of any specialty but I dont see to many divorcing this bitch even if they see her ugly side.
     
  28. BLADEMDA

    BLADEMDA ASA Member
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    You have hit the proverbial nail on the head here. The field is changing so much that the odds are you will be an EMPLOYEE for the duration of your career. You will be told by your employer the details of your job: Hours, Vacation, Supervision and Pay. Perhaps, your employer will even dictate the practice of your chosen profession.
    Your income will be set by the employer and will adjusted based on market conditions.
     
  29. msmith83

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    When you say the field do you mean medicine or anesthesia? I know as a whole medicine is going that way but certainly certain areas will still last a while without becoming completely dominated by such
     
  30. Consigliere

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    Aha! Now we know why you're such an as_shat.
     
  31. Spikebd

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    Blade, this is THE most worrisome of all issues in medicine today. A huge reason I chose to go to medical school was because of how much autonomy doctors have. With all of these corporate mergers with big hospital systems the autonomy you guys enjoyed during your careers doesn't seem likely to be there bv the time I, a first year med student, will be done training. Unless I get into one of those competitive specialties that you listed. Guess I should study another Friday night, haha... 3rd weekend in a row.
     
    #231 Spikebd, Mar 7, 2014
    Last edited: Mar 7, 2014
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  32. Spikebd

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    Also, Blade, your advice on here has been more valuable than my med school advisor's. Thanks for continuing to post here.
     
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  33. BLADEMDA

    BLADEMDA ASA Member
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    My reference to "field" pertains to Anesthesia. Many other areas may enjoy autonomy for decades longer. Sadly, this will NOT be the case for Anesthesiology by the time you finish Residency training.

    There isn't anything inherently wrong in punching a clock or earning a set salary. But, is this what you want out of your career? Or, are you satisfied out of residency with just a JOB as an employee of a mega anesthesia company.
     
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  34. msmith83

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    Yeah, I guess thats why PM Anesthesia has always been one of my top interests. It has both the benefit of anesthesia along with not being an employee but that trend is dwindling as well?
     
  35. LeverArm

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    Blade, you are coming from a different time my friend. Today's med students view being an employee as expected if not better than being in business. EM and hospitalists jobs are viewed in a positive light today. General surgeons who used to act like sheriff of the town are pushing to have shift work as a hospital employee and surgery cc is becoming popular for partly that reason . Radiologist are increasingly salaried in a hospital or large group. Big salary surgical specialties like ortho, ent, and neurosurg cannot function without being paid by a hospital for the most part.

    I wish medicine was like it used to be but todays system doesnt make it as feasible.
     
  36. msmith83

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    Not this one. I realize the trend is heading that way but it is not what I want. I have little desire to be an employee, whether or not I end up having a choice in the matter may be different however
     
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  37. kazuma

    kazuma ASA Member
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    I've actually seen this quite frequently at my institution. Many of the surgery and surgery subspecialty residents go on to be employees while I personally don't know of any that have joined private groups. Initially it seemed strange because all of my attendings in med school were private practice surgeons. On the other hand, I believe most if not all of our recent anesthesiology residents have joined private groups or stayed on staff as academic faculty.
     
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  38. LeverArm

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  39. gasdoc77

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    I can interject regarding the idea that being a hospital employee somehow makes it more predictable, or "shift work". The hours that need coverage are the same regardless. The only difference is that as a private group you may have the say over how to break it down. With a hospital employee model you hopefully have input, but that is about it. I was with a private group that had structured for lifestyle and it was the embodiment of shift work. You had a 7-3 shift, an 11-7 shift, or a 7p-7a shift. You frequently left earlier than the end of your shift and almost NEVER stayed over. The older docs had structured it that way for their lifestyle. The caveat was that the practice was not equitable and they made all the money and had control. In the end, a private practice group that becomes large enough can function like a union in a way, while as a hospital employee you just trust the machine, which will pay you whatever the going market rate might be. That being said, it's hard to find a truly equitable group.
     
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  40. Psai

    Psai Snitches get zero vicryl
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    No they don't. A lot of us see the reality that is coming and will deal with it. EM and hospitalist jobs are seen in a favorable light by M1s who don't realize that 7 days on and 7 days off doesn't mean you travel and have a good time for the rest of your life. They just look at the hours by the quantity and don't consider the stress and the amount of bs that these people deal with. No one goes into residency wanting to be a resident forever.
     
  41. sleepallday

    sleepallday ASA Member
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    I have a problem with the "shift work" schedule. Sure, it may make your days more predictable but I think this is part of the reason why our field perceived the way it is. (not to mention that this is a CRNA mentality). In my group if you start a case, you almost always finish it.
     
  42. gasdoc77

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    I see both sides of the argument. It was a fast moving practice, but I think one would be hard pressed to prove objectively that outcomes suffered as a result of this shift work structure.
     
  43. BLADEMDA

    BLADEMDA ASA Member
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    It's a gradual move towards marginalization of anesthesia. If you don't see it then you are blind. Regardless, the FUTURE is an AMC or hospital employed position as fewer groups will remain independent. I do expect rural areas to hold out the longest as independent companies.
     
  44. Telekinesis

    Telekinesis Gig 'Em
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    I for one, appreciate Blade's comments. It's not all puppy dogs and rainbows but it's realism. I learn a lot from his posts about the business of medicine which is often neglected.
     
  45. OutRun

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    Replying to this topic from 2014 to not be repetitive and make a new post.

    So, I’m leaning towards IM or Anesthesia. Has anything changed now that we are in 2018? I have a great interest in both fields. If I was to go into IM, I imagine I’d be a hospitalist and possibly go for Allergery/Immuno fellowship if I get the urge to get out of the hospital to forge my own path in outpatient. I love being in the OR, though have no desire to be a surgeon, and anesthesia seems to be calling for me. I see an opportunity to get into gas now that it’s competitiveness has ‘dipped’.
     
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  46. GA8314

    GA8314 Regaining my sanity
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    I know you said "remain", but Prozac?

    SSRIs May Help Us See the Glass Half Full
     
  47. spacegun

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    Anesthesia vs. IM vs. allergy/immuno are each very different.

    If you love the OR, then anesthesia makes sense.

    But if you want to get out of the hospital, then anesthesia doesn't make sense because anesthesia is based in the hospital. You'll be dealing with hospitals your entire career.

    If you want outpatient, then PCP or allergy/immuno make sense, but not anesthesia.

    About competitiveness, why would you pick a specialty based on how easy it is to get in? And IM is still less competitive than anesthesia so if competiveness is important to you then why not IM?

    It sounds like you have a lot of soul-searching to do still. Maybe do rotations in anesthesia and allergy/immuno to help decide what you want?
     
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  48. Psai

    Psai Snitches get zero vicryl
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    Wrong. IM hospital means the wards and the ORs are a totally different beast.
     
    OutRun likes this.
  49. spacegun

    2+ Year Member

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    That's obviously but trivially true in OP's case. OP said, "if I get the urge to get out of the hospital to forge my own path in outpatient." Although there's some overlap, OP needs to decide what they want their primary focus to be between OR (anesthesia) vs. wards (hospitalist) vs. outpatient (allergy/immuno).
     
  50. GravelRider

    GravelRider SDN Lifetime Donor
    Lifetime Donor Gold Donor Classifieds Approved 2+ Year Member

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    Allergy...without a hesitation. Prescribe Zyrtec all day and be home by 3. No calls, no weekends.

    The only downside is it can be competitive, so you have to kiss some cheeks and pretend to do boring research in residency.
     
    sally23, FFP, nimbus and 1 other person like this.

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