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Anyone do anesthesia residency after finishing IM?

Discussion in 'Anesthesiology' started by IManesthesiaSwitch, Sep 9, 2017.

  1. IManesthesiaSwitch


    Sep 9, 2017
    I'm midway through a residency in Internal Medicine. I'm getting really fed of managing chronic diseases, I can't stand clinic and hate rounding/mental masturbation. I can't see myself doing this for the rest of my life. The more I think about it the more I miss the OR and doing procedures. I did anesthesia late in my 4th year of med school and am really contemplating finishing up this residency and applying to anesthesia. I've thought about Pulm/cc but don't like fighting losing battles and hate the poor outcomes, the burnout and the lifestyle. I've thought about trying to swap into a program to save a year but feel like it's too risky now and a little too late. Plus I'm guessing having already completed an IM residency I would be somewhat more competitive when applying to anesthesia. Looking for some insight or feedback from anyone who did two residencies. How does it work and what are the potential obstacles? Am I just thinking the grass is greener on the other side?
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  3. Psai

    Psai Account on Hold Physician 2+ Year Member

    Jan 2, 2014
    A lot of people tend to see the negatives of what they're doing and the positives of other fields. Being a resident is pretty different from being an attending due to pay, control over hours, control over location, etc. That being said, I have several attendings who finished an im residency and are now anesthesiology attendings. They seem to be pretty happy with their choice.
    nimbus and AdmiralChz like this.
  4. AdmiralChz

    AdmiralChz ASA Member 7+ Year Member

    Sep 8, 2008
    We averaged one resident who finished IM training every two years or so at my program.
  5. urge

    urge 10+ Year Member

    Jun 23, 2007
    There are a lot of IM trained anesthesiologists.

    Not sure it makes you more or less competitive than the rest.
  6. nimbus

    nimbus Member 10+ Year Member

    Jan 13, 2006
    Do GI. Be rich. Have a better lifestyle.
  7. anbuitachi

    anbuitachi ASA Member 7+ Year Member

    Oct 26, 2008
    we have a lot of attendings here who first did IM, practiced, then anesthesiology residency. None of them are recent grads though. Things have changed a lot so maybe fewer people are doing it nowadays.
  8. Ezekiel2517

    Ezekiel2517 Anesthesiologist Physician 10+ Year Member

    Jan 21, 2005
    gotta agree with this. I actually don't think there are many specialties better than anesthesia, but GI is one of them.
    jthedestroyr likes this.
  9. FFP

    FFP Grunt, cog, body, pompous ass Gold Donor Classifieds Approved 10+ Year Member

    Oct 17, 2007
    the opposite pole
    Disclaimer: I am not an internist.

    You're also thinking the grass is greener. I assume you are a PGY-2, meaning you still have stuff to learn. When I was a medicine intern, I remember the PGY-3s being much cooler cats than the second years. Most of them enjoyed what they were doing. I personally loved acute care stuff the most (still do), which kind of rhymed with my then future anesthesia residency. Except that anesthesia is not (just) acute care medicine, it's something different. Doing cross-coverage at night in the ICU or in the hospital, that's acute care. Meaning that you may enjoy a nocturnist type of job (no clinic, few admissions, minimal chronic disease and social crap, still internal medicine).

    Anesthesiology is built on internal medicine, but it's more surgical than one thinks, also more technical (monkey see, monkey do). A good internist has a good chances of becoming a good anesthesiologist, based on his/her knowledge about co-existing diseases, and a good chance to royally suck at it, based on his/her personality. The two specialties attract different kinds of people. You should really think twice before applying for anesthesiology.

    You are right: your value will be much higher if you're also board-certified in IM. Perioperative medicine (at least preop clinic) is here to stay, and IM-boarded people may get out of the OR and do some easier things, in a bigger department. Also your current residency PD will be much more inclined to help if s/he knows you are not going to jump ship before graduating IM.

    If you want to start your anesthesiology residency in 2019, now is the moment to apply. Your best chance is with advanced programs, because they don't include an internship, which makes them less popular and also the best fit for your situation. Whatever you decide, move fast, before programs start downloading applications on the 15th. Don't wait for the recommendation letters. Good luck.
    Last edited: Sep 9, 2017
  10. GravelRider

    GravelRider SDN Lifetime Donor Lifetime Donor Gold Donor Classifieds Approved 2+ Year Member

    Sep 30, 2014

    I was IM. I like anesthesia, but doing a second residency was a mistake. Do an IM fellowship instead.
    painlove and FFP like this.
  11. Twiggidy

    Twiggidy ASA Member 2+ Year Member

    Jan 13, 2015
    and this....don't sleep on cardiology (especially interventional) as another consideration to GI. Or even critical care if you want less clinic. Sure you'll still have some clinic but the money is good and you'll deal with less nonsense than anesthesiologist. FFP is correct, this is a "grass seems greener" post.

    I think most people switch into anesthesiology because it's "easier" and that probably equates to, "no clinic = easy lifestyle". There may be truth in that, but I'd debate anyone that practicing in this field is "easier", especially including hospital politics, etc.

    Personally, I think you time is better spent figuring out the proper IM fellowship that will limit you clinic and give you that procedure itch you desire and also pay you well.
  12. scutdoc

    scutdoc ASA Member 2+ Year Member

    Mar 23, 2014
    I believe anesthesiology is still a good choice if you like the job. Depending on location, I've seen brand new attendings getting job offers starting at $350k-$450k for 50 hours per week on average. Some weeks you might have to work 60+ hours, other weeks you might only work 30-40 hours. Just depends.

    I know of IM, FM, and peds switching into anesthesiology so it's definitely possible. You'll probably get more interviews from anesthesiology programs and from top tier anesthesiology programs if you complete your IM residency.

    However, let me play devil's advocate for a minute. You might be looking at IM vs. anesthesia during residency, but you have to look beyond residency. You might hate rounding now, but rounding in private practice looks much better than rounding in a teaching hospital. You might hate clinics now, but outpatient clinics sometimes look good to me as you have a family and get older. As for fighting losing battles and poor outcomes, I'd love to introduce you to the Cadre of Registered Nurse Assassins (CRNAs). In my opinion, burnout can happen in any specialty (even derm), and lifestyle is what you make of it in any specialty (even neurosurgery). In anesthesiology, you will be in a codependent relationship with surgeons, for better or for worse. Instead of pulm/cc, you could do pulm/sleep, if you want procedures, a good lifestyle, and good money.

    Can you do an anesthesiology elective at your program? That way you can ask the anesthesiologists at your program all these questions and see what they think too.
  13. jthedestroyr

    jthedestroyr ASA Member 5+ Year Member

    Jan 23, 2013
    his alternative advice is spot on. i have a friend that was going to do anesth from IM, he instead did pulm/cc. the job offers he got were amazing. his inbox literally was spammed with job offers everywhere!!

    I can only imagine if he did GI what it would have been like. I can tell you crna turn an awesome job into a dredge. even the ones that are "nice" can turn in you the min they "dont agree." the fact you have options to not have to deal with this toxic work environment, id run at a chance not to have to deal with crna. Im doing a fellowship purely to avoid having to work with them should tell you all you need to know.
    scutdoc likes this.
  14. Twiggidy

    Twiggidy ASA Member 2+ Year Member

    Jan 13, 2015
    i want to add to this. he's correct, attending life is much different in all specialties. and yes, you may hate clinic now, but when you're an attending, you will develop relationships with people also working in clinic and if all goes well, they'll be akin to a second family. also, unless you do pain from anesthesia, the codependent relationship is 100% correct and I don't think there's a for better part of that. all of your income depends on working with another physician which is why anesthesiology is a service field. you can never be truly independent in anesthesia unless you open a pain practice.
    scutdoc, FFP and nimbus like this.
  15. jh2006

    jh2006 7+ Year Member

    Sep 17, 2010
    I remember a GI who practiced for only a few years, and then went back to do an anesthesia residency. At the time I thought that was crazy, but I guess some people love anesthesia enough to leave what others would consider a more lucrative field with a better lifestyle.
  16. FFP

    FFP Grunt, cog, body, pompous ass Gold Donor Classifieds Approved 10+ Year Member

    Oct 17, 2007
    the opposite pole
    That must have been another example of a person choosing a specialty (GI) based on hearsay.

    As a GI, s/he probably got to know and befriend enough anesthesiologists to get a very good idea what s/he was getting into the second time.
  17. jh2006

    jh2006 7+ Year Member

    Sep 17, 2010
    Seems like the only logical explanation. I just found, and still find it, quite remarkable. After 3 years of IM, 3 years of GI fellowship, and 6 years of practice, I think most would just grin and bear it, especially in a field like GI. Even if you're not crazy about the field, the lifestyle and money would be disincentive enough to not go back to being a resident.

    I haven't seen or heard of anything similar where another IM subspecialist did the same. Most people transitioning, mainly from surgery it seems, do so while in residency, or directly after finishing their IM residency. I suppose they're may be others like this guy, but they must be incredibly rare.
  18. CopaceticOne

    CopaceticOne Stayin' outta trouble 5+ Year Member

    Jun 11, 2011
    I happen to know two people who did IM then Pulm-CCM and then decided to go into anesthesiology. And I don't know a whole lot of people in the field... yet.
    nimbus likes this.
  19. Psai

    Psai Account on Hold Physician 2+ Year Member

    Jan 2, 2014
    Glad they decided to finish their training
    CopaceticOne likes this.
  20. parrotpink


    Dec 20, 2017
    Can you expand on this? Why was it a mistake for you...genuinely interested please
  21. SnapperRocks

    SnapperRocks ASA Member 2+ Year Member

    Jun 9, 2015
    I don’t get the draw to GI. Clinic. Talking to people about bowel movements and rectal exams all day long. No thanks.
  22. DeadSpace

    DeadSpace I don't need no stinkin perfusion.

    Jan 14, 2018
    Dirty South
    I have picked up on how co-dependent our relationship is with the surgeons. Is there another specialty where one physician has to cater to the other in order to do their job? Sure, I'll stand around and wait for you to eat in the lounge and arrive whenever you want. Sure, I don't mind the Christmas music playlist for hours. Sure, I can move the bed another 2 degrees to the left for you for the 5th time...
  23. San Marzano

    San Marzano ASA Member 7+ Year Member

    Jun 23, 2008
    You could always anesthetize a patient without a surgeon but that would be a bit pointless and I don’t think insurance would cover it.

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