Anesthesiology to CT Surgery

[CTGasman]

I know this is probably a crazy question to ask, but I'm wondering if I have made the right choice. Don't get me wrong, I love anesthesiology and am usually pretty thrilled about going to work most days. I can say that I truly enjoy my job so far as a New CA-1.

However, I often wonder if I'd be happier on the other side of the drape. I actually went into medicine thinking I wanted to be a CT surgeon since I had enjoyed my premed shadowing months in H.S. and college with a CT surgeon who is a family friend. however, Most people tried talking me out of it due to the long training and +\- poor lifestyle as an attending. I did my anesthesia rotations midway through 3rd year and fell in love with it before I had done my CT surgery rotations in 4th year. I liked the CT surgeon at my home hospital as well as the field, I ended up doing roughly 14 weeks total between 4th year and internship as I was at the same hospital for internship.

I thoroughly enjoy CT surgery, particularly thoracic surgery. My med school/internship attending always gave me honors and comments like " functions as a CT resident, excellent with his hands and surgical skills etc" . Under his supervision he would let me do trachs, bronch/meds, thoracotomies/vats/lobectomies virtually on my own and would often comment to the or staff and other attendings on how I could do the many of the surgeries on my own. He tried talking me out of gas and into ct many times but I figured it was way too late and I was already loving anesthesiology.

My program is starting up a big thoracic program ( we have a very small ct surg program currently) with a focus on robotic thoracic surgery and will be receiving an increased volume of cases as we just hired a new CT robotic guy. He spoke recently to out dept and he had me really excited about the future of thoracic surgery and further made me second guess anesthesiology. I'd love to see if there will be an extra spot that will open up with is expansion.

I know it's usually the other way around and I know the grass isn't always greener on the other side of the drape. Honestly, so far the one of the only things Im not thrilled about with anesthesia is not being in control of my own schedule whatsoever. It's somewhat difficult to make a strong case against anesthesia because I love it, but I don't want to keep wondering for the rest of my career if I made the right choice.

I dont mind working long hours, I work well under stressful conditions, and I really enjoy working with my hands and without trying to be boastful, I think I would be a pretty dang good surgeon as all of my surgery attendings have said so including ortho, gen surg and ct.

I know both fields have their issues and many believe ct surg is a dying field with the advent of pci and cardiologists. However, with the boomer generation and the low dose ct scan screening recommendations for smokers and the incredible increase in mortality for tumors caught and respected in early stages I suspect ct surgeons won't be hurting for business, at least not as much as many anesthesiologists predict they will be withinin the next decade.

Does anyone know of a person who has made this switch? I know most of you will think I'm crazy but I figured this would be the best source of info since I am already in anesthesia and many of you guys are ct trained and are in ct rooms frequently.

Thanks in advance for the replies.

I

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[IlDestriero]

I don't predict I'll be hurting for business,we're constantly growing and there is a 10 year growth plan with major construction and huge expansion underway. We just finished the last multi year growth plan and have outgrown everything early.
If you love CT, go for it. You already sound like a CT surgeon.

 

[shubacabra]

Make the switch. Anesthesia is going to be provided by nurses exclusively in the not to distant future. It may be fun now, but you will soon realize how much of a tech you are and not much of a doctor once you are in private practice competing with Crna's for a few years. At least CT surgery still requires surgeons. Somewhere the ASA went wrong and allowed nurses to do our job, so its just a matter of time.

 

[CTGasman]

I don't predict I'll be hurting for business,we're constantly growing and there is a 10 year growth plan with major construction and huge expansion underway. We just finished the last multi year growth plan and have outgrown everything early.
If you love CT, go for it. You already sound like a CT surgeon.

As a peds attending at a top 10 academic center, I wouldn't imagine you'd be struggling in the future. I was referring to the usual doom and gloom gas thread posters.

Sorry if I came off as arrogant or something, I was just referring to comments that surgeons have made about me.

 

[CTGasman]

Make the switch. Anesthesia is going to be provided by nurses exclusively in the not to distant future. It may be fun now, but you will soon realize how much of a tech you are and not much of a doctor once you are in private practice competing with Crna's for a few years. At least CT surgery still requires surgeons. Somewhere the ASA went wrong and allowed nurses to do our job, so its just a matter of time.

While i do believe there will still be a need for anesthesiologists for sick asa 3 or higher pts, I have no doubts about your concerns especially during routine cases on healthy patients. The uncertain future of gas is a fairly strong motivating factor in my desire to switch.

 

[BobBarker]

One of our CT surgeons was a practicing anesthesiologist for 15 years.

 

[W222]

As an aside, as far as I have seen robotic surgery for anything other urological and gyn (specifically hysterectomies) surgeries is a waste of fc#king healthcare dollars. I have seen poorly skilled surgeons waste tons of times and put patients at risk trying to hone their skills and what do the hospitals do??? Advertise that they have the newest robot and the hospital down the street has one that is two years old. WTF?

 

[urge]

Go for it. What can go wrong? It sucks and you want to come back?

 

[CTGasman]

As an aside, as far as I have seen robotic surgery for anything other urological and gyn (specifically hysterectomies) surgeries is a waste of fc#king healthcare dollars. I have seen poorly skilled surgeons waste tons of times and put patients at risk trying to hone their skills and what do the hospitals do??? Advertise that they have the newest robot and the hospital down the street has one that is two years old. WTF?

This was my impression too until i saw a presentation by a ct robotic pioneer. He admits that there is a steep learning curve and that many surgeons have no business doing it unless they have had extensive training ie at least 40 cases per type of surgery, and that does not mean observing cases, but actually performing them under a well trained surgeon. Also case volume is important, so these cases should only be done at select centers.

He presented some impressive data too regarding shorter stays, faster recovery, better healing, fewer inflammatory mediators, fewer post op pna's etc.

 

[CTGasman]

Go for it. What can go wrong? It sucks and you want to come back?

Thats what i was telling my wife. I guess the question is should i finish out and get ABA boarded first? It would think itt would be far easier to finish out 2.5 yrs of gas before doing CT if i want to leave the door open vs becoming a gas resident after practicing ct for a few yrs.

 

[W222]

He presented some impressive data too regarding shorter stays, faster recovery, better healing, fewer inflammatory mediators, fewer post op pna's etc.

I don't buy this at all. Having seen some glorious F-ups (ie. two robotic arms brushing up against one another and rupturing the PA) there is no way to believe this. Even experienced robotic surgeons will tell you that the actual feel of the tissue is crucial to know how to cut and sew. I would love to see the studies and actually disect them.

 

[imfrankie]

If you love CT, go for it. You already sound like a CT surgeon.

I concur. We do anesthesia around here. And please adjust your own seat.

 

[cchoukal]

I don't buy this at all. Having seen some glorious F-ups (ie. two robotic arms brushing up against one another and rupturing the PA) there is no way to believe this. Even experienced robotic surgeons will tell you that the actual feel of the tissue is crucial to know how to cut and sew. I would love to see the studies and actually disect them.

Agreed. We recruited a guy to do robotic hearts where I did residency. Amazing data from his previous hospital (which it turned out he owned). His results after arriving were spectacularly bad. 15 hr cases, 8 hr partial bypass run for mitral valves, strokes, deaths, the works. Looks to me like it's great for the LIMA harvest and thaw about it.

For the OP, none of us can ever know what truly drives you and makes you happy, but make sure you're in love with the field, the work, and all it would entail atthe attending level. Many people get seduced by the "cool kid factor" of being in surgery, and the abusive/supportive/Stockholm-syndrome nature of the attending-student relationship while on rotations.

 

[W222]

Many people get seduced by the "cool kid factor" of being in surgery, and the abusive/supportive/Stockholm-syndrome nature of the attending-student relationship while on rotations.

I have never heard it stated more eloquently than this. I have met so many med students who fell in love with surgery (esp. neurosurgery, CT) because they think its so "cool" and they were infatuated with their attendings. Fast forward two or three years and those same people are miserable surgical residents and are asking themselves what they did with their lives.

 

[gasblaster]

I have never heard it stated more eloquently than this. I have met so many med students who fell in love with surgery (esp. neurosurgery, CT) because they think its so "cool" and they were infatuated with their attendings. Fast forward two or three years and those same people are miserable surgical residents and are asking themselves what they did with their lives.

Almost happened to me and a surg subspecialty. Idolized the attendings I worked with during 3rd year. Luckily, did another rotation in the same field elsewhere and came to my senses 1 month into 4th year.

 

[Jay K]

I say make the transition now to CT.

 

[urge]

Thats what i was telling my wife. I guess the question is should i finish out and get ABA boarded first? It would think itt would be far easier to finish out 2.5 yrs of gas before doing CT if i want to leave the door open vs becoming a gas resident after practicing ct for a few yrs.

I wouldn't pursue two residencies to find out which one you like the most.

You are either committed in your change or you are not.

Doesn't sound like you are committed to anesthesia.

 

[BIGphysician]

wait so you'd have to do a general surgery residency and then do CT fellowship after that? or is there a CT independent residency? That sounds actually pretty awesome, Id do that myself, but I think the lifestyle would be really bad. I think at some point you just have to commit to your field and make the best of it, and try and excel and make a difference. You know, I'd like to be an astronaut, I could technically change my career trajectory right now and aim exclusively for that, but at some point, id like to actually enjoy my life on Earth and maybe even do some traveling to see some of it.

 

[Nivens]

Reminds me of this article: http://www.artofmanliness.com/2015/05/12/wants-vs-likes/

IMO should be required reading for anyone: a) about to apply to medical school and b) choosing a specialty.

 

[Machinery]

"the only things Im not thrilled about with anesthesia is not being in control of my own schedule whatsoever". When it comes to controlling your schedule CT surgery will be worse. 10x worse to be exact!