anesthesiology vs er

[criticalaction]

Could someone help me please? I want to start off by saying this is not intended in anyway to step on anyone’s toes. I mean this as a sincere question. I am a 4th year medical student. I have done rotations in both emergency medicine and anesthesiology. I find both professions quite similar, i.e. treating critically ill patients, etc. And I am still torn between both. I was wondering if someone could please share your thoughts as to why you choose anesthesiology lets say over a field like emergency medicine and how you feel these 2 professions differ. Thank you so much.

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[lvspro]

Could someone help me please? I want to start off by saying this is not intended in anyway to step on anyone’s toes. I mean this as a sincere question. I am a 4th year medical student. I have done rotations in both emergency medicine and anesthesiology. I find both professions quite similar, i.e. treating critically ill patients, etc. And I am still torn between both. I was wondering if someone could please share your thoughts as to why you choose anesthesiology lets say over a field like emergency medicine and how you feel these 2 professions differ. Thank you so much.

I had the same choice. I chose anesthesia 2/2 my inability to bring myself to enjoy primary care type work. I did so many sore throats, sneezing babies, and cellulitis' on my rotation that I felt like a PCP. Ultimately I found myself looking at anesthesia time as split between real emergencies, procedures, sometimes both, and found this to be more acceptable than PCP work and shiftwork.

 

[fakin' the funk]

I have done rotations in both emergency medicine and anesthesiology. I find both professions quite similar, i.e. treating critically ill patients, etc.

You did an EM rotation and still feel like the patients are "critical" ? I hardly think the sniffles and "I'm out of pain meds" counts.

Anyway - to answer your question - I personally feel other than a foundation in medicine and a fair amount of "procedures" that the fields are very different.

 

[cchoukal]

I agree with the above two posts. As a 4th year, I thought I liked both until I did an EM rotation. Abdominal pain, vag bleeding/itch, and pain seemed to dramatically outweigh any other presenting complaints, and this was at a high-acuity urban level I trauma center. People say they like ER because there's no clinic and no rounding, but I really felt like it was ALL clinic and rounding, just with patients who were, by and large, unfamiliar to you and miserable. I liked the aspect of knowing a little about everything, but became uncomfortable pretty quickly with the idea that no matter which individual thing you knew about, there was someone else in the hospital that knew infinitely more about each area of your knowledge/expertise. Think you know a lot about cardiology and management of these patients? There's a cardiologist who's always second-guessing yoru decisions. Think you know how to manage critical illness? There's always an intensivist who thinks you're a *******. Think you know about infections? Closing wounds? Setting bones? There's always an ID guy, plastic surgeon, and Orthopod who will tell you you did a $hitty job.

In anesthesiology, you have this area in which you are the expert an no one else really comes close (although, in fairness, surgeons often think they know more about anesthesia than we do, and many don't seem to think our knowledge is all that important or "expert", but that's for another post).

 

[Magnus67]

Sorry guys, They are not the same. Redo your rotations and pay attention this time. ED residents wade through piles of S@#$% waiting for that big ER TV show moment to come along, While Anesthesia resident put up with S#$#$ and do absolutely everything they can to prevent ER TV show moments. This is one of dozens fundamental differences in ER vs Gas. The only similarity is some procedures and the possiblity for shift work.

 

[cchoukal]

Sorry guys, They are not the same. Redo your rotations and pay attention this time. ED residents wade through piles of S@#$% waiting for that big ER TV show moment to come along, While Anesthesia resident put up with S#$#$ and do absolutely everything they can to prevent ER TV show moments. This is one of dozens fundamental differences in ER vs Gas. The only similarity is some procedures and the possiblity for shift work.

That's a really cogent summary of the differences.

 

[dannyboy]

And let's not forget... ER docs, like all other docs in the hospital, ultimately write orders for meds, etc. and a nurse carries them out. What makes anesthesia unique to me, as well as very rewarding, is that we are comfortable in pushing our own meds, setting up our own drips, deciding to hang crystalloid vs colloid vs blood products. We bypass the middlemen and do it all ourselves.

 

[coprolalia]

Emergency medicine is probably the most soul-defeating specialty in all of medicine.

-copro

 

[Osteopathology]

In my experience, I have rarely seen any older ER attendings. I believe due to an insanely high burn out rate from the lack of dealing with 'critical' patients.

I would lean towards the anesthesia -- if it were me.

ER = PCP, for 43% of the uninsured population these days.

 

[EC3]

ER resident here...

Pros of ER:
shift work with odd hours and days - gives me free time during the week to go out and enjoy myself without dealing with crowds. especially nice during residency because i can actually have my clothes cleaned and get to the post-office since i'm not working 6 days a week 6a-8p. also, ER residents tend to work some of the fewest hours. be aware, however, that fewest in quantity doesn't correlate to "best" in quality.

great general knowledge (in theory, anyway) - just pick up an ER text and get to reading. There literally 1000's of cool things that you can learn. The unfortunate reality of clinical ER, though, is that most of these cool things either 1) don't present or 2) you don't have time fully work-up/appreciate. Also, although you are not a specialist, you can learn a great deal about things in other specialties and have a good "working-knowledge" in these areas (i.e. EKGs, reading scans, ultrasound, etc.)

procedures - there are plenty of procedures available. be aware, though, that many times you are pressed for time and thus can't always enjoy doing them.

cons of ER:
fast-pace and multi-tasking - initially as a student i really liked the fast pace. as a resident, though, having to always keep up with the patients and keep tabs of what is going on is just a lot of added stress. it's like mixing finals week with a walk-in clinic; half of your shift is just trying to keep things situated in your head about who is who. having to always "move the meat" also means that anything cool is likely not able to be enjoyed for too long.

patients - not patients themselves, per se, but having to deal with the variety of personalties and family members of the patients is very emotionally draining. you can see and dispo 12 easy-going and happy patients in a shift, but all it takes is one difficult patient to really **** up your day. also, it gets depressing listening to people complain all day about how bad their life is. it's also depressing to be yelled at by patients and have them scowl at you (with 3rd grade english) because they weren't seen quickly enough for their sore throat; it's even more depressing when you realize that you pay taxes so that these people can yell at you.

consultants/specialists - no matter what you do you can't please all the consultants... especially when they are other residents.

CYA/legal - no way around this one. every single thing has to be charted and many unnecessary labs/studies are ordered so that some mouthbreather can't hire John Edwards and take your, already meager, earnings.


These are just my thoughts, though, and many of my colleagues could probably offer different perspectives on things. My best advice is really talk to attendings and senior residents and pick their brains, and also see which people seem to be more like you in terms of personalities and interests. For what it's worth IMHO anesthesia people tend to be more laid back than ER folks. ER folks also tend to get a bit more defensive of their speciality and maybe have some insecurities more often. Also, please don't pick ER because you think it will help you answer your families questions better or because it will allow you be a hero in some very rare situation (i.e. 12 armless infants with peanut allergies flying on a plane that just crashed into the ocean after striking the Planter's factory); the reality is that a brief uptodate or emedicine search can answer 99% of these questions and that ABCs covers 99% of being a hero.

Hope this helps, shoot me a PM if you have any questions.

 

[Arch Guillotti]

Also, please don't pick ER because you think it will help you answer your families questions better or because it will allow you be a hero in some very rare situation (i.e. 12 armless infants with peanut allergies flying on a plane that just crashed into the ocean after striking the Planter's factory);

what about the busload of hemophiliacs that crashes into a glass factory?

 

[Kubed]

what about the busload of hemophiliacs that crashes into a glass factory?

... who are all jehovah witness

 

[177983]

... who are all jehovah witness

Hell, doesn't that make the whole situation a lot easier?

 

[Masseter Spasm]

http://forums.studentdoctor.net/showthread.php?t=402195

 

[fakin' the funk]

patients - not patients themselves, per se, but having to deal with the variety of personalties and family members of the patients is very emotionally draining.

This is one of my favorite things about anesthesiology and ICU.

You know that the patient has a medical problem and you spend a good chunk - approaching 90% in the OR - of your time actually dealing with that problem.

 

[Egon]

ED attending responding:

To be happy in ER you have to work in a high acuity setting in a well respected department. Otherwise you will get very burned out on churning through patients who don't need to be in the ER and criticisms from working in a field where your work is always reviewed by someone else...the admitting doctor or oupt doc seeing them next.

I know some community attendings who intubate about once a month... but working in the inner city (but remember at a lower salary) we do our own crics, thoracotomies, TV pacemakers, chest tubes, procedural sedations, thoracentesis, shoulder/hip reductions, perimoterm c-sections (just once), etc. If you're in the community a lot of times various specialties take these cases and you're really just trying to see patients as quickly as possible.

I did anesthesia as one of my last rotations in med school and loved it. Wish there was such a thing as EM/Anesthesia combined because I know a lot of ER residents who would have done it, but not so sure about the reverse.

The pay is higher in anesthesia, but it even outs a bit when you look at salary for hours worked. However, switching days to nights in ER can get very tough, and time gets lost from your week when you adjust your clock.

I find the knowledge base of ER to be the most interesting of any field, everything from snake bites to delivering babies to lysing PEs, but you will only get a couple exicitng cases out of the 30 you'll see on a shift. If I had to do it all over again I would look at anesthesia with critical care fellowship very seriously, or EM/IM/critical care, but these programs are rare...

Good luck with the choice, feel free to PM me.

 

[Bougie]

And let's not forget... ER docs, like all other docs in the hospital, ultimately write orders for meds, etc. and a nurse carries them out. What makes anesthesia unique to me, as well as very rewarding, is that we are comfortable in pushing our own meds, setting up our own drips, deciding to hang crystalloid vs colloid vs blood products. We bypass the middlemen and do it all ourselves.

Absolutely correct. One man army. Case in point....

On call last week. Get called stat to PACU at 3AM. Frantic surgery intern and ICU nurse wheel in 250lb bearded gomer. Gomer dropped SBP to 30s in elevator on the way up from the ER. Combative then obtunded, pulled out his only IV. Car wreck. Attending just wanted to watch his spenic lac in the trauma unit says tern.

Bad idea.

0300: I'm the only anesthesia person around. Junior residents in trauma rooms. Attending downstairs in neuro embo with resident in a blood bath.

0302: Slam 14g in AC, pushed neo stick, "squeeze that saline bag tern", SBP up to 110, STs down, midaz, whiff of etomidate, succ, Mac 4, envision LSU beating Auburn next weekend, Grade III, bougie, tube, "squeeze that Ambu bag tern", PACU nurse: call surgery attending and OR board.

0304: Radial aline in, spiked the Levophed, SBP 90s, splash of the pink stuff, sterile gloves and towels, Cordis in. Pushed stretcher into OR 8. "Go scrub your hands tern and change your boxers while you're at it".

0310: Surgery attending rushes in and makes abdominal incision.

(10 minutes. Same amount of time it takes a fat ER nurse to stuff down his twinkie and tell you he'll take care of your orders after his smoke break.)

0400: RBCs in, spleen in bucket, Levophed off, ETT out, surgeon says "thank God, this guy is the hospital CEO's golfing buddy," gomer asks PACU nurse what's for breakfast.

0410: My attending finally runs in from neuro embo..."where's this spleen guy???"

Gomer's playing with his grandkids the next afternoon and will never know that I exist and so will never tell me he "lost" his prescription for MS Contin. That's the difference med students. I love this job.

 

[coldweatherblue]

awesome post Bougie. just the motivation I need to stop watching WV vs. Boulder and get back to studying histo (exam tomorrow).

 

[treasurefull2]

awesome post Bougie. just the motivation I need to stop watching WV vs. Boulder and get back to studying histo (exam tomorrow).

Damn, THAT gave you motivation to study HISTO? whatever works...

 

[pushthesux]

Absolutely correct. One man army. Case in point....

On call last week. Get called stat to PACU at 3AM. Frantic surgery intern and ICU nurse wheel in 250lb bearded gomer. Gomer dropped SBP to 30s in elevator on the way up from the ER. Combative then obtunded, pulled out his only IV. Car wreck. Attending just wanted to watch his spenic lac in the trauma unit says tern.

Bad idea.

0300: I'm the only anesthesia person around. Junior residents in trauma rooms. Attending downstairs in neuro embo with resident in a blood bath.

0302: Slam 14g in AC, pushed neo stick, "squeeze that saline bag tern", SBP up to 110, STs down, midaz, whiff of etomidate, succ, Mac 4, envision LSU beating Auburn next weekend, Grade III, bougie, tube, "squeeze that Ambu bag tern", PACU nurse: call surgery attending and OR board.

0304: Radial aline in, spiked the Levophed, SBP 90s, splash of the pink stuff, sterile gloves and towels, Cordis in. Pushed stretcher into OR 8. "Go scrub your hands tern and change your boxers while you're at it".

0310: Surgery attending rushes in and makes abdominal incision.

(10 minutes. Same amount of time it takes a fat ER nurse to stuff down his twinkie and tell you he'll take care of your orders after his smoke break.)

0400: RBCs in, spleen in bucket, Levophed off, ETT out, surgeon says "thank God, this guy is the hospital CEO's golfing buddy," gomer asks PACU nurse what's for breakfast.

0410: My attending finally runs in from neuro embo..."where's this spleen guy???"

Gomer's playing with his grandkids the next afternoon and will never know that I exist and so will never tell me he "lost" his prescription for MS Contin. That's the difference med students. I love this job.

The BIG point here is that since you saved this guy's life...Auburn has no chance.