anesthesiology compared to emergency medicine

Discussion in 'Anesthesiology' started by Frank Miller, Jan 2, 2009.

  1. Frank Miller

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    I am presently scheduled to begin my residency in anesthesiology but I;m having reservations about it. I'm considering terminating it and entering an emergency medicine residency. Please share your thoughts.
     
  2. proman

    proman Member
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    Please share your reservations. Sounds like you haven't even started the residency. Personally, I loathe the ER.
     
  3. filter07

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    Nobody likes the ER, even the ER physicians (they only can tolerate working there part time)
     
  4. BubbleHead

    BubbleHead Senior Member
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    Until I went to medical school and found out about Anesthesia. ED medicine is as much primary care as a Family Medicine clinic, oh wait it is a Family Medicine Clinic most of the time.

    Primary Care = I'll tell you how to take better care of yourself, then you'll come back and tell me you didn't do any of the things I told you to do. Then, we'll play the game again... and again... and again, until I can't stand it and go back to do an Anesthesia Residency.
     
  5. BubbleHead

    BubbleHead Senior Member
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    Ever wonder about first time postings, in Jan, claiming to be a Resident, claiming to be ready to start residency, with some vague question (a vague fodder type question) that I high school student would ask...

    I never do. Good Luck Frank!
     
  6. EternalMD

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    I suppose the OP could be in their prelim year "scheduled" to start in July. i would wonder what these reservations are if not one day has been spent doing anesthesiology.
     
  7. desflurane

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    Even if the post is bogus this EM vs Anes question is a common one. I'll give my two cents because I went through the same thing.

    Keep in mind all advice is biased. Ask this question to on the EM boards and you'll get the other side I'm sure.

    I initially matched EM coming from a med school with a state of the art ED in a setting with no other Level 1 trauma centers in the area. I was intent on being a gung-ho EM cowboy. I had some misgivings about the jack-of-all trades moniker and the lifestyle but charged forward anyway.

    I started my intern year in IM in a large academic center in a major city. There I saw how EM is in the real world. Yes it's true everyone hates the EM physician. The jack-of-all trades master of none title is pretty accurate. The lifestyle isn't bad and the compensation way better than primary care. There is also an expiration date to your career in EM. It's rare to see old timers in an ED. Burnout is common.

    It is nice for those who like immediate gratification in that you get first crack at a diagnosis. Trauma gets old and algorithmic. Does it really matter what other departments think of you? Everyone hates everyone no matter what....except the nephrologists, everyone loves the nephrologists.

    Anesthesia to me was more of a career. You spend your residency learning the field and your career perfecting it. There is no way you could learn all there is to know in EM over a career....master of nothing. The lifestyle is whatever you want it to be depending on how much you want to earn.

    There are downsides, mostly surgeon respect issues but you either get over it early on or you leave. There are also life/death issues that are similar I presume in the ED. Intentionally taking away a persons protective mechanisms can get hairy at times.

    This wasn't as coherent as I'd hoped but I hope it helps some.
     
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  8. fastosprintini

    fastosprintini Junior Member
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    nice comparison des!
    i however disagree with the popularity of nephrologists , after all, they are sending their patients down to the or with a #24 iv in the antecubital fossa, preferably with levophed going through....:mad:
    fasto
     
  9. mstudent12345

    mstudent12345 medical student
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    I have been doing EMS for 6 years and had some exposure to the ed as a student, now I am applying in anesthesia; the fields are totally different.

    About 80% of ER work is primary care or at best 1st crack at hospitalist work. Lots of differential diagnosis, following up labs/radiology, dealing with the family etc. All of this in a (usually) overcrowded environment where everyone is p/o'd.

    The similarity comes for the at most 20% that are ICU type patients or trauma patients, where you put in the lines, do the intubations, etc.

    In gas you have short but meaningful pt interactions followed by a busy 15 min or so setting up the pt, placing the tube, lines etc and then an extended period of vigilance. You are the expert in airway and sedation and know as much as pretty much anyone about the really sick patients.

    so your answer is what you want, the only similarity between the two really is the "shift work" which is probably more true in the ED.
     
  10. Desert MD PsyD

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    Working as the head of a ED/Trauma Dept, I must say, Im in love.
    I think its going to be a personal decision, what does your heart tell you? I tell my students and residents to follow their heart and their passion. I think many times, students and residents forget the main reason they choose medicine as a career in the first place.

    If your doing it for the money, they everyone knows theres more money in anesthesia.. haha

    Good Luck

    Dr. Desert, MD, PsyD
     
  11. pseudoknot

    Physician PhD Faculty Lifetime Donor Verified Account 10+ Year Member

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  12. CambieMD

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    Nephrologists are neat people. They know a lot and are generally laid back.
    Renal patients tend to be difficult sticks.

    Cambie
     
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  13. Masseter Spasm

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    Here is what I said in an earlier discussion of this topic:

    I considered going into both anesthesia and emergency medicine but chose to do an emergency medicine residency. During my residency I identified a number of issues with the specialty which I could not resolve. Thus, late in my residency as my fellow residents sought employment I searched for residency positions in anesthesia. What amazed me is that none of my established attendings tried to change my mind. When I discussed with them why I was choosing this path they agreed that this was a wise decision for me.

    I have friends who continue to practice Emergency Medicine and seem to enjoy it. If you have the right personality, EM could be your field. In many ways Anesthesia and EM are similar. Both specialties require that you be able to quickly interact with a patient and identify pertinant historical and clinical features that apply to your management plan.

    Things I dislike about emergency medicine:
    The shift-work mentality does not build professional respect
    Most of your working hours are during afternoons, evenings, weekends
    holidays, etc. (I used to be away from home 16-18 nights/month)
    Spent alot of time talking to people on the phone
    Spent alot of time waiting for other people to do things (consults,
    returns pages, admit pt, etc.)
    Most of time is spent seeing stuff that could/should be seen in clinic
    Rarely see a critically ill patient (the type of case that draws people to
    the specialty)
    Production pressure ("move the meat")
    As an EP you are not a "specialist" in any discipline of medicine,
    despite what you may think
    The nature of the work is stressfull. The multi-tasking is comparable
    to being an air-traffic controller or bonds trader
    I rarely did procedures, despite being at one of the busiest ER's in the
    country (>110,000 visits a year)

    Things I like about Anesthesis:
    You get to be an expert in a specialty
    You get to see an effect from your actions (pharmacology,
    physiology, critical care in action)
    Better hours (Quality not Quantity)
    More procedures
    Better interactions with patients and physicians

    I do not regret my training in Emergency Medicine. I achieved board certification but chose not to practice. My training was excellent preparation for anesthesia (much better than 1 year of transitional/medicine rotations). I can not recommend that those considering both fields follow my path. That would require 6-7 years of residency training.

    The best thing you can do to assist your decision is to talk to as many practicing physicians in both fields as possible. This means trying to talk to those in the community as well. (Don't limit your discussions to the academic practioners alone.) Go shadow a community hospital EP or Anesthesiologist for a few days if you can. Do an elective in either specialty in a non-academic environement. Think deeply about what type of personality you have, what brings you professional fulfillment, and how you want to spend your professional time. Hope this helps.
     

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