Anesthesia vs. Psych

[lacrossegirl420]

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Having a very difficult time deciding between these two. If I could I’d love to do both. For those who were making a similar decision, what ultimately drew you to one over the other? Did you regret your decision at all?

 

[JBM16BYU]

I am neither, but purely from observation, those are very different specialities. Anesthesiology tends to work on a shift schedule, you are in the OR, you are treating hyper acute cases, lots of hands on procedures, lots of physiology, and most of the time you spend with the patients they are asleep. Psychiatry, on the other hand, can be either outpatient, inpatient, or mixed, typically does not have lots of procedures, still lots of pharmacology, and involves a lot of conversation with your patients. The one connecting factor I see is both can do fellowships in Pain Medicine. It would be helpful to know what draws you to both?

 

[Wamuu]

Having a very difficult time deciding between these two. If I could I’d love to do both. For those who were making a similar decision, what ultimately drew you to one over the other? Did you regret your decision at all?

How did you arrive at these two specialties? I would get it if you're between something like ortho and PM&R, but these are very different.

 

[guytakingboards]

As everyone has said, your two options are very different. It's okay to like multiple, even different things in medical school but bottom line it really comes down to what you see yourself doing in 10-15 years. There's no right/wrong answer here.

Regarding regret: after that same 10-15 years your priorities will not be even remotely the same as now and it's unlikely that regret for a possible wrong career choice will supersede stuff like buying a house, raising a family, paying back student loans, etc... in terms of things to worry about. Once you're that far gone it's just make the best of a less than perfect situation.

My overall point: think deeply about the two choices, make the choice, accept that you are passing up something you would have potentially enjoyed, and don't look back.

Caveat: if you get into whatever specialty residency training and are just so unhappy, you can transfer then.

 

[DOswag]

Psychiatrist here. Obviously I'm going to be a little bit biased because I love what I do. But as has been said the practice of each of these is vastly different even going beyond just the subject matter. Anesthesia will be in the OR and have different schedule. It's difficult to look far into the future from where you are now but you will get there someday. Think about what you can see yourself doing for a career because it gets harder the further away you get from training to switch careers in medicine. It's difficult anyway no matter where you are in your practice but if you find yourself unhappy in one and are considering switching specialties later on, it will require residency training which will be several years of drastically decreased pay and terrible hours. You will likely be in a completely different place in your life with priorities, family etc.

My practice currently is straight outpatient, no therapy, mostly med management and our practice does TMS and IV ketamine, I see 15-20 patients most days, no call, no nights, no weekends, 40 hours working Mon-Thur 10 hour days with 3 day weekends every weekend. This is my first year post military working in the civilian world and I'm on pace to make 350-400K. Anesthesia you will likely make more money and I'm sure there are some pretty cush gigs out there though.

 

[solitarius]

In a "grass is greener" moment recently, I had a strange fascination with Anesthesiology because it is so different from Psychiatry. Some cool things: Limited patient interaction. Seems pretty chill until there is some crisis. Tons of PTO. Flexible work arrangements. Unusually good compensation.

Then I thought about what I didn't like. Player B in the OR. You could kill the patient. Moving patients between table and gurney. Pushing gurneys all day. Grueling full-time schedules. Sticking patients who are hard to place lines into.

Pretty simple: Psychiatry has lots of patient interaction. Anesthesiology has minimal.

Overall, I'm pleased with my choice, but anesthesiology would be my backup.

 

[djo208]

I'm a psychiatrist. I'm not going to discuss the relative benefits of anesthesiology as a career versus psychiatry, but I will share the career track of one of my former residents just as a point about what can be done in terms of carving out your own niche.

The two are very different specialities and the training experience will be very different, but one of my former residents did take a career track that broached a gap between anesthesia and psychiatry in an interesting way. As someone noted already, one point of overlap is pain management. Both psychiatrists and anethesiologists do sometimes specialize in pain management. The skillsets that the one has versus the other with respect to pain management are going to differ to some degree. Both can, of course, use pharmacotherapy to address pain. Psychiatrists have in their toolkits, however, evidence-based psychotherapeutic approaches to pain management, e.g., CBT or mindfulness-based interventions. There is a lot of comorbidity between pain and psychiatric and social stressors, so your average psychiatrist might be better equipped to assist with these in a more holistic/person-centered sort of way. However, in general, the anesthesiologist is going to be better equipped to take procedural approaches to pain management. I train psychiatry residents in my role as faculty at a medical school. One of our former residents completed an interventional pain management fellowship after completion of his fellowship. Since completing his fellowship, he performs minor spinal procedures as part of his practice. Needless to say, this is highly unique, but I guess it can be done!

One of the very cool things about medical fields is that there is often a way to carve out your own unique niche or specialty if you want to and are creative. For example, I know many non-psychiatrists who have worked their way into psychiatric or psychiatry-adjacent fields, from Dr. Robert Laitman, who is a nephrologist by training but became a clozapine expert, to many non-psychiatrists who work in addiction medicine. I don't think it's the easiest or most straightforward route to take and it would take some commitment and energy to do something like that with psychiatry, but it can be done. The borders between fields are to some degree artificial. Really, there is one human body and one person and the organ systems all interact.

You still have to choose a residency, though! But I thought I'd share, in case it's helpful.

 

[Styrene]

In order to do psych, you will have to come face to face with many highly agitated, aggressive, psychotic/manic, and frightening patients. If that doesn't bother you, the training is not too difficult.

 

[DOswag]

In order to do psych, you will have to come face to face with many highly agitated, aggressive, psychotic/manic, and frightening patients. If that doesn't bother you, the training is not too difficult.

Those weren’t too bad. Inpatient psych is pretty cool. Just get your B52’s ready and you’re good to go 😉

 

[DOswag]

I’m also a good size dude, former college football LB so there is that lol

 

[djo208]

In order to do psych, you will have to come face to face with many highly agitated, aggressive, psychotic/manic, and frightening patients. If that doesn't bother you, the training is not too difficult.

It is true that the frequency with which you deal with agitation varies between fields, but whether you go into psychiatry or another field, if you train in a hospital setting working with patients, you will eventually meet agitated people, be they patients or otherwise. In some fields other than psychiatry, this will even be a frequent occurence (e.g., emergency medicine or critical care). Difficult things happen in hospitals and so people have strong emotions about them. Medical illness itself frequently causes cerebral dysfunction and resultant behavioral dysregulation. However, if you train in psychiatry you are likely to be very well-prepared to respond to these situations when they arise. Not to say that there aren't situations where these interactions can be fraught or where pharmacotherapy is required to treat some acute pathology, but words, a sandwich, analgesia, or something very reasonable is often the solution, once you look into it. I've been called to bedside many times for what was presented to me as a dangerous and emergent situation, yet an extra blanket or getting a family member on the phone has many times adequately de-escalated the situation.

Anything you don't know how to approach can be scary. It becomes less scary the more you learn about it. This is true of human behavior, too, inclusive of agitation.

 

[voxveritatisetlucis]

Anesthesia is less likely to be replaced by AI if that’s an important thing to you

 

[djo208]

I can't tell the future and only time will tell, but I am sure that, as a psychiatrist, many of my patients work with me at least in part because of the human relationship they have with me. I know that a machine can make statements that sound empathic, but I'm not sure that patients will believe that the machine IS empathic. Effective psychiatric care tends to integrate a psychotherapeutic approach, even if you're "just prescribing." Although I know that there are overfilled clinics with harried providers where things aren't done the way they should be done, proper psychiatric sessions don't tend to consist of just a survey of symptoms followed by medication instructions. I actually think that psychiatry might be one of the fields that is somewhat safe from AI. I could be wrong. On top of that, psychiatrists also have the option of providing psychotherapy, which I also think is somewhat AI-resistant, as it also has a basis in human relationship.

 

[voxveritatisetlucis]

I can't tell the future and only time will tell, but I am sure that, as a psychiatrist, many of my patients work with me at least in part because of the human relationship they have with me. I know that a machine can make statements that sound empathic, but I'm not sure that patients will believe that the machine IS empathic. Effective psychiatric care tends to integrate a psychotherapeutic approach, even if you're "just prescribing." Although I know that there are overfilled clinics with harried providers where things aren't done the way they should be done, proper psychiatric sessions don't tend to consist of just a survey of symptoms followed by medication instructions. I actually think that psychiatry might be one of the fields that is somewhat safe from AI. I could be wrong. On top of that, psychiatrists also have the option of providing psychotherapy, which I also think is somewhat AI-resistant, as it also has a basis in human relationship.

I’m not doubting that a human psychiatrist would provide superior care but when there’s a profit incentive to eliminate jobs, then usually it will happen. Why pay 10 psychiatrists 380k each per year if a machine could do it for Pennies on the dollar

 

[djo208]

Maybe in some contexts, but many patients have a lot of choice. And if they're not getting better or are looking for something they're not getting, they often just switch providers. I think many of my patients would just stop coming if I replaced myself with a robot.