Comparison Anesthesia and IM Residencies

[EmmaNemma]

Just wondering what the difference is in hours and stress between an anesthesia residency and an IM residency. What do anesthesia residents do after the scheduled operations are over or on the weekend? Just curious. Thanks.

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[BobBarker]

Weekends at most programs are covered by in house residents taking 24 hour calls. So they go read, eat, whatever and wait for any other cases.

 

[12th man]

There is no comparison between IM and Anesthesiology.

 

[psychbender]

Just wondering what the difference is in hours and stress between an anesthesia residency and an IM residency. What do anesthesia residents do after the scheduled operations are over or on the weekend? Just curious. Thanks.

At my hospitals, if you are on call and just finished your cases, you go relieve the CRNAs or other residents that still have cases running, and continue that until all cases are complete (which around here can frequently be past 9pm). Also, sometime after 6-ish, we inherit a 20-30 person acute pain service, and deal with their pain all night, preop tomorrow's add-on cases (maybe a half-dozen), and do any emergency cases that show up (relatively rare), start a few IVs, and respond to emergencies in the hospital (codes, urgent/emergent intubations, etc). Weekends are similar; we usually have a few trauma washouts in the morning, followed by pain rounds in the afternoon, and managing the pain service, starting IVs for the ICU/floor, and being available for emergencies for the hospital. Overall, it is not too bad, and I much prefer it to admitting GOMERs and dealing with 3am pages for diet orders and urgent tylenol requests for fevers of 99.8! Also, we take call every single month (ICU call in the SICU, OB call on OB, main OR call for every other rotation), while the Medicine residents here are only on-call on their ward and unit months (maybe five to seven months total for the year, depending on year).

We probably put in similar hours (most of us here average 65-70 hrs/wk, depending on month), but stress is going to be quite variable. I don't find codes or most cases to be all that stressful, but seeing and admitting a dozen people overnight would get me. The reverse would seem to be true to the many Medicine residents (who I see freaking out at most codes). IM and Anesthesiology are incredibly different specialties (though I have heard us referred to as 'the fleas of the OR'), and can hardly be compared effectively.

 

[G-Man82]

... IM and Anesthesiology are incredibly different specialties (though I have heard us referred to as 'the fleas of the OR'), and can hardly be compared effectively.

I'm currently a Medicine prelim intern almost at the start of my anesthesiology years, so I cannot comment based on experience, but just on what I've heard at my current institution from current anesthesia residents. IM is too broad to accurately compare with anesthesiology. While anesthesiologists are sometimes referred to as the "internists of the OR," our scope will be narrower. Most anesthesiology residents that I have spoken with have said that there is an incredible amount of general medicine that they have to deal with or think about each day, but the "general" medicine an anesthesiologist deals with, though still multi-system, is still more focused than the general medicine that an internist will face. A more accurate comparison can probably be made between anesthesiology and critical care medicine, which coincidentally was established by anesthesiologists. The general acuity of a patient once anesthetized I hear is basically like that of an ICU patient. I've been told to expect to run my own mini-ICU in the OR as a CA-2/CA-3 resident.

In terms of overall hours, I think it's variable. One thing I've noticed as a Medicine intern who had to go through the dreaded nightfloat at an inner city hospital with RNs that could be better than they are, is that after 7 or 8 pm, everyone calls you for everything. The pager is non-stop for anything from "emergent" tylenol orders, stupid stuff like diet order requests at midnight or pharmacy med clarification calls for patient x on your list of 100, floor codes that you have to respond to, or urgent stuff on medicine patients such as SOB, chest pain, etc. In places with a nightfloat system, there generally isn't overnight floor call. But those nights can be awful. For the day team, "call" basically means staying until nightfloat arrives and admitting that day's patients (weekday or weekend, it doesn't matter), which can be pretty stressful. Medicine ICU/Floor teams have to come in every single day, with weekends being shortened unless on call or unless that day is your guaranteed 1 in 4 off in the month. That translates to long hours on floor/ICU months for a medicine resident, with a lot of it being paperwork. I'll refer to the post above for anesthesia call, but I've heard overall hours worked to be as little as 55 to as high as 80 depending on the rotation for the anesthesiology resident. Hope that's accurate. Given what I've experienced so far, especially having one more university floor month left in May , I am counting down the days .....

 

[proman]

This:

my own mini-ICU in the OR

Without this:

Everyone calls you for everything,
The pager is non-stop for anything,
That translates to long hours on floor/ICU months for a medicine resident
A lot of it being paperwork.

is a lot of what makes anesthesiology awesome.

 

[jetproppilot]

There is no comparison between IM and Anesthesiology.

I completely, strongly, and wholeheartedly agree with this post.

 

[Dejavu]

In our program, after cases are done or on the weekend, if they are not on call, they go home and have a life, instead of having to come in to round with the "team".

I also concur the "there is no comparison between Anesth and IM residency". I smiled for two weeks straight when I got done with my prelim year and got to doing anesthesia.

Don't even consider IM, IMHO. You get to do plenty medicine in the periop period, if you feel that need, without all the rounding and "clinic days" and getting admits dumped on you by every service looking to cut their workload.

Just my $0.02.

 

[EmmaNemma]

On the spectrum of happiest and most content residents, where do anesthesiology residents fall? Does this change after residency? Thanks.

 

[Dejavu]

On the spectrum of happiest and most content residents, where do anesthesiology residents fall? Does this change after residency? Thanks.

From what I have seen,

Surgery residents work their asses off, but are happy, because all they want to do is cut.

Anesth residents are happy 'cause they don't work as hard, get to do medicine stuff, get to do procedures, don't have to round (except in specific and infrequent rotations like ICU), have very rewarding pt interactions because they help a pt through a difficult day, and it is very common to have the postcall day off. And, most anesth staff docs are nicer to them than surgical staff docs (just compare M&M conference atmosphere). Also, when an IM decides on a med therapy, gives the pt a pill, they have to wait a couple of weeks to see if it was a good idea (ie HTN meds, or other such). In anesthesia, we see our drugs work in 45 seconds. There is much more immediate gratification.

IM residents work as hard as surgical residents, but are an unhappy lot from being dumped on by every other specialty but anesth. How many times have you seen Ortho service have a pt with a fracture, pt has HTN or a raised Creatinine, and they admit the pt to Medicine so all they have to do is deal with the fracture. I'm just saying...

Again, don't take this for anything more than my opinion and observations through the years. There is a reason we very often see people change from IM to anesth (or after completing IM, they do a second residency in anesth because they are sick of the IM life). I have rarely, if ever, seen an anesth resident change to IM, unless forced to because they were not doing well in anesthesia residency. I admit I have seen that twice.

 

[hoyden]

Just wondering what the difference is in hours and stress between an anesthesia residency and an IM residency. What do anesthesia residents do after the scheduled operations are over or on the weekend? Just curious. Thanks.

The difference is enormous - in IM residency as you progress your hours and overall life is getting better which might not be the same in Anesthesiology residency ( depends how it is structured in a particular program). In my program my CA-2 year was the worst ( even worse than internship) and my CA-1 was the best. CA-3 was intermediate.

Weekends are yours if you are not on-call. In any specialty

 

[hoyden]

On the spectrum of happiest and most content residents, where do anesthesiology residents fall? Does this change after residency? Thanks.

Your questions are somewhat strange. Happiness in a specialty generally depends on a satisfaction level you are getting and even if I personally think that being and internist or a surgeon is awful ( because they have clinic) the same thoughts might be in a a head of an internist or a surgeon who are viewing my job as incredibly boring or terrifying


You can not compare the two at all because there are almost no intersection points after you are done with internship

 

[PamIsHorny]

Also, when an IM decides on a med therapy, gives the pt a pill, they have to wait a couple of weeks to see if it was a good idea (ie HTN meds, or other such). In anesthesia, we see our drugs work in 45 seconds. There is much more immediate gratification.

Agreed. As an intern on medicine rotations, I'd write scripts and then hope they'd actually fill the things. Really frustrating for me. Now....no more "I forgot to fill the script," or "I didn't feel like paying for it." If I think the patient needs something, it's flowing through the veins in momments.

I too dig the immediate gratification.

 

[nycitygas]

From what I have seen,

Surgery residents work their asses off, but are happy, because all they want to do is cut.

Anesth residents are happy 'cause they don't work as hard, get to do medicine stuff, get to do procedures, don't have to round (except in specific and infrequent rotations like ICU), have very rewarding pt interactions because they help a pt through a difficult day, and it is very common to have the postcall day off. And, most anesth staff docs are nicer to them than surgical staff docs (just compare M&M conference atmosphere). Also, when an IM decides on a med therapy, gives the pt a pill, they have to wait a couple of weeks to see if it was a good idea (ie HTN meds, or other such). In anesthesia, we see our drugs work in 45 seconds. There is much more immediate gratification.
hours.

IM residents work as hard as surgical residents, but are an unhappy lot from being dumped on by every other specialty but anesth. How many times have you seen Ortho service have a pt with a fracture, pt has HTN or a raised Creatinine, and they admit the pt to Medicine so all they have to do is deal with the fracture. I'm just saying...

Again, don't take this for anything more than my opinion and observations through the years. There is a reason we very often see people change from IM to anesth (or after completing IM, they do a second residency in anesth because they are sick of the IM life). I have rarely, if ever, seen an anesth resident change to IM, unless forced to because they were not doing well in anesthesia residency. I admit I have seen that twice.

Anesthesia weekend call has a big plus in that theres always the potential for a super chill call. Although its rare, it happens and its awesome. I was on call on thanksgiving and didnt do a damn thing.