Anyone leave anesthesia for IM

[mmtst18]

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Have you ever heard of going from anesthesia to Int Medicine. You always hears other specialties switching into anesthesia. I am seriously not satisfied with anesthesia. I love working with my hands. I love doing procedures and comforting patients at a difficult time in their lives. However, I wish I had more continuity. I did my prelim in Medicine--it was hell working more than the 60 hours a week I currently have (more like 80-90hrs) Although I was satisfied professionally in medicine--I haven't felt that same way for the past year and a half.
I keep trying to convince myself--I can always do medicine later, and that when I have a family I will want the lifestyle anesthesia will afford me. It makes practical sense to finsh the next year and a half and then do IM, however at times I am so disheartened with the profession that I want to leave now--and I am sure that brings up many questions and to LORS, PD, and which programs would even take me.

Please help me

 

[shala]

if it fullfills you in medicine, sure. why not?
I have heard some internal medicine doctor who trained as anesthesia before, but most of them from other countries. prelim is the intern year and definately working as hell, but years later on come with lighter schedule.


QUOTE=mmtst18]Have you ever heard of going from anesthesia to Int Medicine. You always hears other specialties switching into anesthesia. I am seriously not satisfied with anesthesia. I love working with my hands. I love doing procedures and comforting patients at a difficult time in their lives. However, I wish I had more continuity. I did my prelim in Medicine--it was hell working more than the 60 hours a week I currently have (more like 80-90hrs) Although I was satisfied professionally in medicine--I haven't felt that same way for the past year and a half.
I keep trying to convince myself--I can always do medicine later, and that when I have a family I will want the lifestyle anesthesia will afford me. It makes practical sense to finsh the next year and a half and then do IM, however at times I am so disheartened with the profession that I want to leave now--and I am sure that brings up many questions and to LORS, PD, and which programs would even take me.

Please help me[/QUOTE]

 

[APACHE3]

Won't that be a $300-400K decision?? I'm sure things will get better when you're an attending. GL

 

[rs2006]

Hi all,
I hope all is good for everyone in the forum.
Very interesting thread. I am a fourth yr med student in the same predicament-- I find myself torn between medicine and anesthesia. I liked anesthesia because of my love of pharm and instant gratification, and procedures, but I have decided to apply for internal medicine because of a number of factors--

Stability: IM offers you a degree of stability which anesthesia does not-- If you look back 10 years, you will find that NO ONE was going into anesthesia because jobs were scarce, salaries were low, the field had high malpractice. Fast forward 10 years to the present and salaries have skyrocketed and jobs are plentiful, and malpractice is similar to where it was 10 years ago, and EVERYONE wants to go into Anesthesia now (After all, who wouldn't when offered $400k /yr vs an internists salary (for which you MUST WORK HARD of $150k). However, the reality is that sure internists do not make much $, but the market is not going to fluctuate that much and there is not much of a threat from any midlevel practitioner. The other issue with anesthesia is the CRNAs. Yes (sorry MD Anesthesiologists), I know this is a dead horse that has been beaten several times on the anesthesia forum, but the REALITY of it is that they are able to practice WITHOUT physician supervision in 14 states and that there is no law from preventing them from lobbying other states for removal of the physician supervision requirement. In addition, the fact is that there are approx 35k MD anesthesiologists and approx 30k CRNAs so regardless, the CRNAs are not going anywhere and the reality is that there are enough of them that if they want to create a stink about something they have the numbers to do so. In addition, given the reality that the baby boomers are going to start to reach 65 in approximately 5-10 years and that the already cash strapped medicare system is going to have to find a way to provide care to these people-- how is that going to happen in light of our health care system's current economic situation-- are we going to cut the salaries of the internists, general surgeons, and other not so highly compensated physicians to pay anesthesiologists 400k when there are CRNAs who can do the same job at 1/3rd the cost. In addition, there are no real conclusive studies (that everyone agrees on) that show that outcomes ( in terms of morbidity and mortality) are better when MDs provide anesthesia care. Just my 2 cents-- take it with a pinch of salt as I am just a lowly fourth year medical student-- just nobody. Any counter thoughts would be much appreciated from someone more knowledgeable about these issues than me. Thank you very much and sorry for my rambling.

 

[2ndyear]

That was a good take on the recent history of anesthesiology, let me just counter a few misconceptions as you may be considering both fields still.

CRNA's are allowed to bill Medicare independently in 14 states. Whether or not this translates into 'no supervision' is a different issue. 95% of anesthetics in the US are delivered by the care team model, signed off or collaberated with an MD. You'll see their literature stating that 65% of anesthetics are done by CRNA's, but you'll never see them saying that only 5% are independent of anesthesiologist supervision. You are correct though that there are large numbers of CRNA's who are very politically motivated. They aren't going to go away any time soon. But neither are NP's who, it could be argued, are making inroads into primary care IM. If your eyes are set on a subspecialty this isn't much of an issue right now, but for primary care I would argue that the threat is just as big as the CRNA issue.

Physician salaries have little to do with escalating costs of healthcare, it's all about procedure (or time for anesthesia) reimbursement. Cardiology is hot right now, putting stents in = big bucks. If/when reimbursement drops, the field will cool down a bit.

10 years ago there was a big scare in anesthesia, primary care was billed as the wave of the future, groups put a hold on hiring, residencies went unfilled and here we are today. A shortage of anesthesia providers that is forcasted to last well into the future. The jobs were scarce because of the fear though, not from the workload which had steadily been increasing to where it is today. The work is there and will continue to be for quite some time.

Just a final thought on IM and anesthesia. My intern year I watched a graduating class of IM residents choose their fields. A few did fellowships, GI, cards, etc., but the ones who chose not to all joined hospitalist groups. I really don't see the continuity of care as a hospitalist much different from an anesthesiologist. Both show up, go to work on patients that they have little to no relationship with, and go home. Now I'm not saying that hospital based medicine is a bad choice, I would do it if I chose IM, but it does shed some light on the current attitude of many physicians, myself included. Don't get me wrong, IM is a great field and if it fits you then go for it. We need more good internists around.

 

[rs2006]

Thanks for such a good post!! With all due respect to you and everyone in this forum I just wanted to clarify that CRNAs are able to provide anesthesia care in 14 states without physician supervision (info from CRNA website press release) and that they are also the main provider of anesthesia in the military-- (I have heard that 90+% of the anesthesia providers currently deployed in the wars oversease are CRNAs. But, back to the medicine thing. Yes, I agree that nurse practitioners and PAs are a potential threat to medicine docs, but I have heard from most of them that even if they are given all the rights to practice independently that the reality is that they will still end up referring their patients to the MD/DOs if the patient's problem is truly complex.

That was a good take on the recent history of anesthesiology, let me just counter a few misconceptions as you may be considering both fields still.

CRNA's are allowed to bill Medicare independently in 14 states. Whether or not this translates into 'no supervision' is a different issue. 95% of anesthetics in the US are delivered by the care team model, signed off or collaberated with an MD. You'll see their literature stating that 65% of anesthetics are done by CRNA's, but you'll never see them saying that only 5% are independent of anesthesiologist supervision. You are correct though that there are large numbers of CRNA's who are very politically motivated. They aren't going to go away any time soon. But neither are NP's who, it could be argued, are making inroads into primary care IM. If your eyes are set on a subspecialty this isn't much of an issue right now, but for primary care I would argue that the threat is just as big as the CRNA issue.

Physician salaries have little to do with escalating costs of healthcare, it's all about procedure (or time for anesthesia) reimbursement. Cardiology is hot right now, putting stents in = big bucks. If/when reimbursement drops, the field will cool down a bit.

10 years ago there was a big scare in anesthesia, primary care was billed as the wave of the future, groups put a hold on hiring, residencies went unfilled and here we are today. A shortage of anesthesia providers that is forcasted to last well into the future. The jobs were scarce because of the fear though, not from the workload which had steadily been increasing to where it is today. The work is there and will continue to be for quite some time.

Just a final thought on IM and anesthesia. My intern year I watched a graduating class of IM residents choose their fields. A few did fellowships, GI, cards, etc., but the ones who chose not to all joined hospitalist groups. I really don't see the continuity of care as a hospitalist much different from an anesthesiologist. Both show up, go to work on patients that they have little to no relationship with, and go home. Now I'm not saying that hospital based medicine is a bad choice, I would do it if I chose IM, but it does shed some light on the current attitude of many physicians, myself included. Don't get me wrong, IM is a great field and if it fits you then go for it. We need more good internists around.

 

[powermd]

Choosing between IM and anesthesia ought to be a much simpler decision. Anesthesia and IM are extraordinarily different fields. If you are procedure-oriented, okay with short-but-intense patient relationships, love the OR, enjoy the adrenaline rush of having to think on your feet, and can handle the pressure of life-threatening situations on a daily basis- anesthesia may be right for you. I don't see much in anesthesia that a true medicine personality type would find appealing, besides the salary.

 

[ucla2usc]

1

 

[ucla2usc]

Choosing between IM and anesthesia ought to be a much simpler decision. Anesthesia and IM are extraordinarily different fields. If you are procedure-oriented, okay with short-but-intense patient relationships, love the OR, enjoy the adrenaline rush of having to think on your feet, and can handle the pressure of life-threatening situations on a daily basis- anesthesia may be right for you. I don't see much in anesthesia that a true medicine personality type would find appealing, besides the salary.

If you love physiology and altering it with drugs, IM and anestetia go hand in hand, especially critical care.

BTW, have you considered critical care fellowships with anestetia? What about pain management? Both of these may give you more of the relationship aspects of medicine that the OR lacks. Could be the perfect mix without the loss of years and potential income.

But, as a person who couldn't find anything I liked about any lifestyle speciality, and chose IM because of sheer passion, I'd say go with you heart.

 

[powermd]

If you love physiology and altering it with drugs, IM and anestetia go hand in hand, especially critical care.

BTW, have you considered critical care fellowships with anestetia? What about pain management? Both of these may give you more of the relationship aspects of medicine that the OR lacks. Could be the perfect mix without the loss of years and potential income.

But, as a person who couldn't find anything I liked about any lifestyle speciality, and chose IM because of sheer passion, I'd say go with you heart.

After doing anesthesia for the past 3 months after a medicine internship, I think the fields are more different than they are alike. Of course, they have in common the fact that you are practicing medicine- "altering physiology with pharmacology". Lots of fields require this. In anesthesia I find people focusing much more closely on the basic principles of physiology than in IM. That's not where I see the real differences though. Anesthesia is so much more psychomotor-oriented than IM- less theory, and much more emphasis on practical application "at the bedside" (or OR table). You also have much less time to recognize changes in your patient's condition before treating it. Critical care and anesthesiology are certainly related, but taking care of rapidly changing conditions in the OR over the course of a few hour surgical case is quite different than the long term care in the ICU. Personally, I find the ICU to be depressing as hell, but that's just me!