Anesthesiology vs IM?

[DrBB]

---

Members do not see this ad.

I'm having trouble deciding which to go into, and with September looming for residency applications...I'm starting to get a nervous.

What I like about anesthesia is that the work is interesting (I like pharm and physio), I like intubating and some of the other procedures, there are lots of options within the field, lifestyle is decent, pay is good (for now), residency has better hours than IM.

What I don't like about anesthesia is the emergencies (I don't know how I'd react when a patient crashes), early hours, working for a corporation (i.e. hospital), the obvious CRNA issue.

I like IM because I find the breadth of disease treated to be interesting, and if I go into it, I would most likely specialize. However, I don't like the amount of paperwork and social work involved. I just can't seem to make a decision one way or the other and I don't really have a "gut instinct" with this choice. Anybody have any advice?

 

[Mman]

The 2 fields are about as dissimilar as you can get within medicine. It's like deciding between neurosurgery and family practice. I suggest you rotate again through them and see which fits you better.

IM people start their workday much later and go home much later. They like to sit around and talk about things and they round and round and round some more. Then they go to clinic and see the same patients month after month.

Anesthesia starts the day much earlier and tends to work at a much faster and more hectic pace. If you aren't comfortable dealing with an emergency situation, you wouldn't like anesthesia. But then again, how to respond in those situations is something you learn as a resident.

 

[okayplayer]

One thought is you could hedge your bet by matching advanced anesthesia and preliminary IM year. If you absolutely love IM at that point you could try to finagle your way in to a spot at that program or elsewhere.

 

[DrBB]

I'm currently on a an anesthesia rotation at a VA hospital without a residency program. They do mostly bread and butter cases there. I've liked the physio and pharm of actual anesthesia so far.

 

[gasblaster]

One thought is you could hedge your bet by matching advanced anesthesia and preliminary IM year. If you absolutely love IM at that point you could try to finagle your way in to a spot at that program or elsewhere.

Haha I think the OP has a thread on exactly this issue/question.

I'm currently on a an anesthesia rotation at a VA hospital without a residency program. They do mostly bread and butter cases there. I've liked the physio and pharm of actual anesthesia so far.

Well the breadth of diseases you find in interesting is actaully seen in the (academic) ORs as well. All those interesting surgical cases are going to be handled by an anesthesiologist. The VA and the cases handled there (at least from my experience) are very different. I would say it's much more similar to an ambulatory center than tertiary care center.

 

[WholeLottaGame7]

Haha I think the OP has a thread on exactly this issue/question.



Well the breadth of diseases you find in interesting is actaully seen in the (academic) ORs as well. All those interesting surgical cases are going to be handled by an anesthesiologist. The VA and the cases handled there (at least from my experience) are very different. I would say it's much more similar to an ambulatory center than tertiary care center.

Depends on your VA. Our VA has some total trainwrecks.

 

[gasblaster]

Depends on your VA. Our VA has some total trainwrecks.

Ah ok. Guess that was just my VA. TIL.

 

[DrBB]

One thought is you could hedge your bet by matching advanced anesthesia and preliminary IM year. If you absolutely love IM at that point you could try to finagle your way in to a spot at that program or elsewhere.

Doesn't everyone hate intern year though?

 

[RMortis]

Do a rotation at a private hospital. IM is different there than at academic places. They don't round for hours, they don't do as much social work. They usually don't have a big clan of people going around for hours. It's usually one doc if it's a hospitalist who examines and makes decisions. There is still paperwork but the hospitalist I've seen have gotten that down pretty easily, I think that's annoying to all students initially. If you specialize you can just be consulted on interesting cases in your specialty or do some procedures if you're in pulm or cardio. Anesthesia is still more interesting to me, but I like the hectic pace

 

[HollywdAnesth]

What I don't like about anesthesia is the emergencies (I don't know how I'd react when a patient crashes), early hours, working for a corporation (i.e. hospital), the obvious CRNA issue.

I bolded a few things because they stood out to me.

If you want to go into Anesthesia but don't want to do difficult cases, then you need to select another field. You should want to go into this field because you want to develop a knowledge base and skill set that will allow you to care for patients in precarious situations. Imagine if a pilot told you that he only flew when there were sunny skies? How good of a pilot would he be if he couldn't deal with adverse conditions?

The early hours thing is something everyone bitches about, but honestly you get used to it.

In regards to working for a hospital, this isn't the case all over the country. In fact, in Texas where I work, it is illegal for physicians to work directly for a hospital, especially for the reasons you have reservations about.

 

[DrBB]

I bolded a few things because they stood out to me.

If you want to go into Anesthesia but don't want to do difficult cases, then you need to select another field. You should want to go into this field because you want to develop a knowledge base and skill set that will allow you to care for patients in precarious situations. Imagine if a pilot told you that he only flew when there were sunny skies? How good of a pilot would he be if he couldn't deal with adverse conditions?

The early hours thing is something everyone bitches about, but honestly you get used to it.

In regards to working for a hospital, this isn't the case all over the country. In fact, in Texas where I work, it is illegal for physicians to work directly for a hospital, especially for the reasons you have reservations about.

It's not really that I don't want to do difficult cases - its more that I'm afraid of them at this point in time. I love the physio and pharm of anesthesia and the ability to see instantaneous results with our actions. Perhaps with training and experience, the big cases will become more manageable and not be as intimidating to me as I see them now.

 

[saratoga733]

hmm, not sure if anesthesia is right for you. anesthesiologists will face some pretty terrifying clinical scenarios in their career: ruptured AAA, emergent difficult intubations, post-partum hemorrhage, the list goes on. and for some reason they all tend to happen in the middle of the night! as an internist, if you are in over your head you can always ship them to the ER.

 

[BLADEMDA]

It's not really that I don't want to do difficult cases - its more that I'm afraid of them at this point in time. I love the physio and pharm of anesthesia and the ability to see instantaneous results with our actions. Perhaps with training and experience, the big cases will become more manageable and not be as intimidating to me as I see them now.

And how many weekend pilots can fly this? It takes time, dedication, knowledge and skill to fly the best. This is why you are going to Medical School then doing a Residency instead of Community College/Online BSN followed by a SRNA mill:

 

[BLADEMDA]

A typical weekend pilot's plane.

 

[BLADEMDA]

Being the Best can save lives.

 

[HollywdAnesth]

I love the physio and pharm of anesthesia and the ability to see instantaneous results with our actions.

What do you mean by this? Are you going to pat yourself on the back every time you give a dose of phenylephrine and the blood pressure goes up?

I don't understand how this translates into a career choice. Intensivists start drips that have immediate physiological impacts, why not do that?

 

[DrBB]

What do you mean by this? Are you going to pat yourself on the back every time you give a dose of phenylephrine and the blood pressure goes up?

I don't understand how this translates into a career choice. Intensivists start drips that have immediate physiological impacts, why not do that?

Not many fields allow us to see an acute change in a person's physiology. Maybe intensivists like you said, but not really any other field. In IM, most of the time you see changes in days, weeks, months, years. I like how every patient that undergoes anesthesia is essentially a study of human physiology, which we test with our drugs. That's what I find to be interesting.

 

[Ballints]

Hey do you think this should affect my decision to pursue IM vs Anesthesia: it would be virtually impossible for me to get anesthesia in california, but in IM it's very possible. I've never lived in california but I visited it and it suits my passions in life perfectly: beach, uphill cycling, muscle beach, sun. I am afraid if I do anesthesia my residency will be in the middle of nowhere (and 4yrs is a lot of time), and then I will probably work in the middle of nowhere because california pays less. If my goal was to be a hospitalist, it seems that geography would be much more flexible. I just want to become an expert at what I do, a specialist, and it seems like anesthesia meets those goals better.

Btw, just out of curiousity: which specialty has more divorces anesthesia or primary care?

 

[XRanger]

Hey do you think this should affect my decision to pursue IM vs Anesthesia: it would be virtually impossible for me to get anesthesia in california, but in IM it's very possible. I've never lived in california but I visited it and it suits my passions in life perfectly: beach, uphill cycling, muscle beach, sun. I am afraid if I do anesthesia my residency will be in the middle of nowhere (and 4yrs is a lot of time), and then I will probably work in the middle of nowhere because california pays less. If my goal was to be a hospitalist, it seems that geography would be much more flexible. I just want to become an expert at what I do, a specialist, and it seems like anesthesia meets those goals better.

Btw, just out of curiousity: which specialty has more divorces anesthesia or primary care?

What made you think it's impossible to get anest in cali but very possible in IM? Anesth and IM have similar competitiveness

 

[Somnus Tuto]

What made you think it's impossible to get anest in cali but very possible in IM? Anesth and IM have similar competitiveness

Not so

 

[XRanger]

Both anesthesia and IM have same step 1 score avg

I guess if you just want to get back to cali and don't care where, it's easier for IM just because there are more IM programs than anesthesia programs, but if you're looking to match at the big name academic hospitals, I would assume both are equally competitive

 

[Ballints]

Both anesthesia and IM have same step 1 score avg

I guess if you just want to get back to cali and don't care where, it's easier for IM just because there are more IM programs than anesthesia programs, but if you're looking to match at the big name academic hospitals, I would assume both are equally competitive

But there are community IM programs in santa barbara, LA, SD. they are much less competitive than ucla, ucsd,etc.

 

[LeverArm]

I find this thread interesting because I am basically having the same issue in choosing. IM sounds very boring with the paperwork and rounding but at the same time IM has some of the coolest subspecialties (cards, gi, pulm, etc) but to reach it and complete it sounds very exhausting. Anes just seems very chill and straight forward - very technical with little higher thought process (similar to surgery). I decided to do my elective in Anesthesia and hope that I fall in love with it otherwise it will be time to buckle down and bust my @SS to shine 3rd year and all throughout IM residency.

 

[Libertas]

I think many would disagree regarding "little higher thought process"

 

[LeverArm]

I think many would disagree regarding "little higher thought process"

I didn't mean it in the sense that it's easy, only meant that it is largely technical and repetitive. Anesthesiologist do not diagnose, treat, nor follow the course of a patient. You wouldn't care if someone is in for an elective nose job or kidney transplant. You don't care about the pathology but instead look at patients much more like a pharmacist (dynamics and kinetics of drugs based on the individual and procedure), which is different than most MD professions.

 

[stargirl50]

Huh. I am in the pre-op clinic now and have diagnosed a new problem in at least one patient, most days more than one patient, every day this week. Not trivial problems, either. In some cases these were issues missed by the patient's PCP or surgeon, in others I feel like a safety net for the underserved caught up in our incredibly fragmented health care system. Guess your comment about not diagnosing, treating, or basically caring about our patients just struck a nerve.

If you do choose anesthesia, don't worry about being a technician or automaton. In a lot of situations (OB, codes in particular) you're it. Plenty of diagnosing and treating and life-saving.

 

[Libertas]

I think it's apparent you know very little about anesthesiology

 

[stargirl50]

Just a little tip for your third year, don't refer to surgery as a field requiring very little thought. The decision whether or not to operate is unbelievably complicated... and I'd say requires a lot of thought.

 

[LeverArm]

Huh. I am in the pre-op clinic now and have diagnosed a new problem in at least one patient, most days more than one patient, every day this week. Not trivial problems, either. In some cases these were issues missed by the patient's PCP or surgeon, in others I feel like a safety net for the underserved caught up in our incredibly fragmented health care system. Guess your comment about not diagnosing, treating, or basically caring about our patients just struck a nerve.

If you do choose anesthesia, don't worry about being a technician or automaton. In a lot of situations (OB, codes in particular) you're it. Plenty of diagnosing and treating and life-saving.

I actually love the sound of that! I am very much looking forward to experiencing anesthesiology in a couple months and this has been the best comment disagreeing with anything I've ever posted 🙂

I am obviously ignorant of the role of anesthesiology and what little I do know I find very interesting. That's why I will do my 3rd year elective in it. Please don't think I am putting down a profession that I hold very important in medicine and one that I am very seriously considering for my future.

 

[stargirl50]

No worries! That is one thing that IS true about anesthesiology... no one understands what we do 🙂 Hope you enjoy your elective!

 

[LeverArm]

Just a little tip for your third year, don't refer to surgery as a field requiring very little thought. The decision whether or not to operate is unbelievably complicated... and I'd say requires a lot of thought.

Neh, here I only partially agree with you. Sure, deciding whether to operate is difficult and involves many doctors and specialists a lot of the time. But from my experience in the OR so far it is mostly just tedious and requires technical skill with a solid sense of anatomy. Don't tell me it's difficult because I already know that and again it is so so so important and bless anyone that will go through the hell to become a skilled surgeon.

 

[1981]

No worries! That is one thing that IS true about anesthesiology... no one understands what we do 🙂 Hope you enjoy your elective!

I agree 100%. Even many CA 2 residents dont understand the length, breadth and depth of this speciality.

What is visible and what most of us see is like 'tip of iceberg'. Rest 90% is only visible when you work in the speciality and be a part of the decision making.

Then one realises that its not only technical but medical also.

 

[1981]

Has anyone ever realised who keeps a patient 'alive' when the surgeon is cutting the intestines, heart and kidneys of the patient.
...
.
.
.

Its the anesthesiologist

 

[HollywdAnesth]

I didn't mean it in the sense that it's easy, only meant that it is largely technical and repetitive. Anesthesiologist do not diagnose, treat, nor follow the course of a patient. You wouldn't care if someone is in for an elective nose job or kidney transplant. You don't care about the pathology but instead look at patients much more like a pharmacist (dynamics and kinetics of drugs based on the individual and procedure), which is different than most MD professions.

When they invent a method to physically bitch slap someone over the internet, I'm going to use it on you first.

I diagnose things every day. Minor things like tourinquet pain to major things like intraoperative myocardial ischemia.

When the airway pressure goes up in the middle of the case suddenly, who do you think comes up with a differential diagnosis? Who is able to distinguish between a pneumothorax and bronchospasm?

You say we don't follow the course of the patient, but from the time I give the Versed to the moment that patient leaves the PACU and/or goes home that patient is MY responsibility. Just because we don't have offices with patients' christmas cards hanging on the wall doesn't mean we don't follow patients.

I've got to stop reading this thread. Its going to give me an ulcer.

Do an anesthesia elective. If you like it, great. If you don't, enjoy IM. Word of advice: speech is silver, silence is golden.

 

[LeverArm]

Oh man... my comment seemed to upset a lot of people. You know what you do better than anyone else so just take pride in it and brush off comments that you know are untrue. My impression of the field is very common amongst medical students and general public that don't know better. I thought anesthesiologist are generally more relaxed than this...

 

[LeverArm]

Just finishing up my IM clerkship in 1 week and going to be starting anesthesia in 2 weeks. The thought of doing 1 more day of rounds for IM makes me want to hurt myself. I cannot wait for gas! I used to be 100% IM for almost 2 years...