confused about anesthesia

[bonedrone14]

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Hey all...I'm currently a third year and am feeling the pressure to figure out what I'm going to he when I grow up...I'm pretty torn and feeling like I don't have enough information to make a decent choice. I've been leaning towards emergency medicine but am trying to make sure that I give everything a look. I've been reading through the old threads around here but still have a couple of questions. My schools hospital only uses md's to start the case and then they go hang out in the break room while the crna's manage the rest. As far as the procedures I've read about y'all doing...at my place its always the surgery residents who do everything. So basically I have no idea what an anesthesiologist really does outside of what I've read here.

If you don't mind...could you maybe ballpark how much of your time is spent in the or vs how much is doing the lines and epidurals and things like that? I wasn't a huge fan of being in the or all day...are you spending a significant portion of the day managing other issues outside or is it pretty much all done in the or?

I really like the idea of having such a commanding knowledge if pharm as well as being one of the main guys counted on in a code situation. Is that a legit reason to pursue anesthesiology?

Sorry for the randomness of this post...I'd appreciate any advice and insight anyone could give though. Thanks!

 

[IkeBoy18]

does your school have an anesthesia rotation?

 

[Psai]

"My schools hospital only uses md's to start the case and then they go hang out in the break room while the crna's manage the rest."

? You spent all day with them and saw this?

 

[bonedrone14]

Yep we have an anesthesia rotation...but you get there at 730...intubate a few patients at the beginning of a case and then go home once that's done and the mds go to the break room.

I know my set up here can't be the way it is everywhere...

 

[bashwell]

I find Richard Novak's articles helpful. For example:

http://theanesthesiaconsultant.com/...ecide-they-want-to-become-an-anesthesilogist/

http://theanesthesiaconsultant.com/2014/12/19/is-anesthesia-a-cushy-specialty/

 

[pgg]

Yep we have an anesthesia rotation...but you get there at 730...intubate a few patients at the beginning of a case and then go home once that's done and the mds go to the break room.

I know my set up here can't be the way it is everywhere...

That's a lousy rotation. You should tell your school and they should stop sending students there. You're wasting your time.

 

[bonedrone14]

Its pretty much only a rotation that 4th years do during interview season or when they're studying for step 2.

Thanks for posting those articles...they were pretty good and helpful.

 

[IanMcGalt]

Don't choose any specialty where there are only groups with exclusive contracts and no option to compete with groups that don't treat younger docs fairly. If you can't walk away and start your own practice, lube up.

 

[bonedrone14]

Don't choose any specialty where there are only groups with exclusive contracts and no option to compete with groups that don't treat younger docs fairly. If you can't walk away and start your own practice, lube up.

So I've definitely been worried about and trying to get a feel for this as well...especially thinking either em or anesthesia. Are there really any fields now days where you could actually open up your own shop?

 

[nimbus]

So I've definitely been worried about and trying to get a feel for this as well...especially thinking either em or anesthesia. Are there really any fields now days where you could actually open up your own shop?

You can open up your own shop as an anesthesiologist

http://nyketamine.com/


But overall the future is meh....arm tans...haha

http://www.gomerblog.com/2014/12/hospital-anesthesiologists/

 

[Sirach38]

So I've definitely been worried about and trying to get a feel for this as well...especially thinking either em or anesthesia. Are there really any fields now days where you could actually open up your own shop?

There are plenty of solo private practice pain docs in my area. It's still possible to open up your own shop. Anesthesia is a very diverse specialty with many options outside of the OR. Whether this will last much longer is anyone's guess but odds are if you're flexible and not geographically limited, you could do whatever you want.

 

[IanMcGalt]

There are plenty of solo private practice pain docs in my area. It's still possible to open up your own shop. Anesthesia is a very diverse specialty with many options outside of the OR. Whether this will last much longer is anyone's guess but odds are if you're flexible and not geographically limited, you could do whatever you want.

Yeah, you could be a surgeon or medicine sub specialist and live in a nice location and do well or you can be an anesthesiologist and either live in some remote s' hole or get rammed your whole career. you decide...

 

[Sirach38]

Yeah, you could be a surgeon or medicine sub specialist and live in a nice location and do well or you can be an anesthesiologist and either live in some remote s' hole or get rammed your whole career. you decide...

I don't think surgeons or IM docs do much better in the "getting rammed" department. Last time I checked, the 5+ years of surgery residency are the ultimate form of "getting rammed" and it doesn't get much better after residency especially in gen surg. Medicine subspecialties have their own ramming to deal with. If not "getting rammed" is your goal, GTFO of medicine.

 

[deleted171991]

I don't think surgeons or IM docs do much better in the "getting rammed" department. Last time I checked, the 5+ years of surgery residency are the ultimate form of "getting rammed" and it doesn't get much better after residency especially in gen surg. Medicine subspecialties have their own ramming to deal with. If not "getting rammed" is your goal, GTFO of medicine.

Not really. Maybe in IM. In surgery, skill is still king, and cannot be replaced by an NP with a smartphone. The good general surgeons might not have the best lifestyle, but they sure as hell are still private and with no shortage of customers. This while big hospitals are eating non-surgical specialties for breakfast.

Everywhere in the world, being a good surgeon with a good personality guarantees a good income level. One cannot say the same about many other specialties, where the impact of a quality physician is not quite as measurable by the patient. (Hence the proliferation of midlevels.) For example, we know who the best anesthesiologists among us are, but not even the surgeons do, and let's not talk about the patients... Why hasn't any physician review site taken off, like Tripadvisor or Yelp? Because the quality of what we do is tough to measure, very subjective. And if it cannot be measured, we can easily be replaced by people who are cheaper or with better PR skills.

If my hands were half as talented as my brain, I would not have done anything else but a surgical residency. Even when the market is saturated, a good surgeon will always survive. There is a reason that residency takes 5 years; it has a high barrier of entry, also called "moat" in investing. It cannot just be taught to nurses in mass education schools. 😉

 

[seinfeld]

When I see an person debating EM vs Anesthesia I see a few items.

1. You want to work in acute medicine
2. You want to work in a hospital setting
3. Long term patient relationships are not your ideal
4. You like procedures

Now EM will be more shift work than anesthesia. If a surgeon is operating we are providing anesthesia. The big downside I felt about anesthesia was that most Anesthesiologists don't diagnose and treat medical illness. i.e. deciding between PCP PNA or Rheumatoid Lung. THis is why i choose critical care to give me a that missing part of general anesthesia.

you must look at what will bother you the most in either speciality, that will inevitably become the largest contributer to job dissatisfaction 10 years post residency.

Honestly I thought I was doing rural family practice until I was challenged by an attending anesthesiologist. AS we did a surgery he asked me to answer all the questions going through his head. Heart rate went up, what was that from , how do I treat it. What is Cardiac Output and if this patient becomes more acidic what could it be from , how would i treat it. How do you keep a patient from moving during a large back surgery when you can't paralyze and you can't you gas. Also they want the patient awake quickly at the end.

Find an attending willing to challenge you.

 

[Sirach38]

Not really. Maybe in IM. In surgery, skill is still king, and cannot be replaced by an NP with a smartphone. The good general surgeons might not have the best lifestyle, but they sure as hell are still private and with no shortage of customers. This while big hospitals are eating non-surgical specialties for breakfast.

Everywhere in the world, being a good surgeon with a good personality guarantees a good income level. One cannot say the same about many other specialties, where the impact of a quality physician is not quite as measurable by the patient. (Hence the proliferation of midlevels.) For example, we know who the best anesthesiologists among us are, but not even the surgeons do, and let's not talk about the patients... Why hasn't any physician review site taken off, like Tripadvisor or Yelp? Because the quality of what we do is tough to measure, very subjective. And if it cannot be measured, we can easily be replaced by people who are cheaper or with better PR skills.

If my hands were half as talented as my brain, I would not have done anything else but a surgical residency. Even when the market is saturated, a good surgeon will always survive. There is a reason that residency takes 5 years; it has a high barrier of entry, also called "moat" in investing. It cannot just be taught to nurses in mass education schools. 😉

These are great points and in no way do I disagree with any of them. I guess my definition of "getting rammed" was a little broader than just lack of job/income security or respect from hospital admins. Yes, surgeons have more respect and income/job security than any other specialty but, in the majority of cases (granted, not all) they have paid a VERY high price for this security and continue to pay it for most of their career. Looking at it from a purely economical point of view without taking into consideration the lifestyle that these men and women endure is not really fair when considering who is "getting rammed" and who isn't. Everything in life (and in medicine) is a trade off. Surgeons have earned job/income security but in a lot cases they have given many other things in exchange (family, children, free time, hobbies, their 20s, large part of their 30s, their health etc.). Taking into account this sacrifice, one could say that yes, every specialty in medicine, in some way or another, "gets rammed". This isn't necessarily a bad thing because sometimes and to some people, the joys of practicing medicine outweigh the pains of "getting rammed".

 

[BLADEMDA]

These are great points and in no way do I disagree with any of them. I guess my definition of "getting rammed" was a little broader than just lack of job/income security or respect from hospital admins. Yes, surgeons have more respect and income/job security than any other specialty but, in the majority of cases (granted, not all) they have paid a VERY high price for this security and continue to pay it for most of their career. Looking at it from a purely economical point of view without taking into consideration the lifestyle that these men and women endure is not really fair when considering who is "getting rammed" and who isn't. Everything in life (and in medicine) is a trade off. Surgeons have earned job/income security but in a lot cases they have given many other things in exchange (family, children, free time, hobbies, their 20s, large part of their 30s, their health etc.). Taking into account this sacrifice, one could say that yes, every specialty in medicine, in some way or another, "gets rammed". This isn't necessarily a bad thing because sometimes and to some people, the joys of practicing medicine outweigh the pains of "getting rammed".

You have no idea what you are talking about here. Many General Surgeons don't do Trauma and have BETTER lifestyles than Anesthesiologists who work in a high acuity setting. As a Surgeon you can pick the type of career you want to have and many choose a lifestyle track post residency which is quite nice. A few Female Surgeons have "specialized" in just Breast surgery and work 8-4 with little to no call. Many of the cases are performed at ASCs.

I submit to you that control of one's destiny is far greater in a field where you can do 1/3 to 1/2 your cases at an ASC; in addition, you need to be the one which controls the patients. EM and Anesthesia along with traditional Radiology are poor choices going forward.

The view from the Ivory Tower is a mirage. The real world is far different than you realize as a Med Student. A 5 year Residency pales in comparison to a 30 year post residency career.

 

[Sirach38]

You have no idea what you are talking about here. Many General Surgeons don't do Trauma and have BETTER lifestyles than Anesthesiologists who work in a high acuity setting. As a Surgeon you can pick the type of career you want to have and many choose a lifestyle track post residency which is quite nice. A few Female Surgeons have "specialized" in just Breast surgery and work 8-4 with little to no call. Many of the cases are performed at ASCs.

I submit to you that control of one's destiny is far greater in a field where you can do 1/3 to 1/2 your cases at an ASC; in addition, you need to be the one which controls the patients. EM and Anesthesia along with traditional Radiology are poor choices going forward.

The view from the Ivory Tower is a mirage. The real world is far different than you realize as a Med Student. A 5 year Residency pales in comparison to a 30 year post residency career.

This is definitely true for certain surgery practices like breast, certain ENT, certain Uro, elective plastics, and vascular vein center. Not so much for all of the rest of surgery. While those 5-9 years (it takes nearly 9 years to become a breast surgeon) may seem like a small deal, they really are not because they are your 20s and 30s. You will spend some of the healthiest and best years of your life living in some hospital working 90-100+ hours per week being all of the attending surgeons' b*#%^.

 

[BLADEMDA]

This is definitely true for certain surgery practices like breast, certain ENT, certain Uro, elective plastics, and vascular vein center. Not so much for all of the rest of surgery. While those 5-9 years (it takes nearly 9 years to become a breast surgeon) may seem like a small deal, they really are not because they are your 20s and 30s. You will spend some of the healthiest and best years of your life living in some hospital working 90-100+ hours per week being all of the attending surgeons' b*#%^.

Or you can do a ****ty 4 year residency and be someone's bitch for the rest of your life.

 

[deleted171991]

This is definitely true for certain surgery practices like breast, certain ENT, certain Uro, elective plastics, and vascular vein center. Not so much for all of the rest of surgery. While those 5-9 years (it takes nearly 9 years to become a breast surgeon) may seem like a small deal, they really are not because they are your 20s and 30s. You will spend some of the healthiest and best years of your life living in some hospital working 90-100+ hours per week being all of the attending surgeons' b*#%^.

Oh, for Pete's sake! As a resident (and even fellow), you are the attending's bitch in most specialties. And you WILL spend the best years of your youth in the hospital. That's why physicians are supposed to be paid so well, because we waste extra 10+ years on medical education, while other people in our generation earn serious money and have a life. That's why medicine is less and less such a good choice; it's like investing in a formerly great stock whose time has passed (think Yahoo or Blackberry).

Listen to Blade. He speaks from experience, our experience as anesthesiology attendings. The people who have a crappy lifestyle in general surgery either enjoy it or have no choice, because they are professionally weak. No truly good surgeon needs to have an employer; please try breaking out solo as an anesthesiologist.

As he said: you can be miserable for 5-8 years, or you can be miserable for 30. Your choice.

 

[koan]

What do you guys (Blade and FFP) think about Pain going forward? Seems like more autonomy and control of flow of patients and schedule than OR anesthesia. I know reimbursements are down and the future is uncertain, but is it still a reasonable track to pursue?

 

[deleted171991]

What do you guys (Blade and FFP) think about Pain going forward? Seems like more autonomy and control of flow of patients and schedule than OR anesthesia. I know reimbursements are down and the future is uncertain, but is it still a reasonable track to pursue?

This: http://forums.studentdoctor.net/thr...ctise-and-i-do-50-anesthesia-and-pai.1112135/

I wouldn't do Anesthesia just for Pain.

 

[Sirach38]

What about critical care? Still hope there?

 

[deleted171991]

What about critical care? Still hope there?

I wouldn't do Anesthesia just for critical care either, although it's probably the best path to it.

Intensivists are just higher paid and respected hospitalists. Otherwise it's the same hospital bitch status.

Go into a tailoring specialty, not a needling specialty.

As usual, all of this doesn't matter if one is literally obsessed with anesthesia, and it's the only path to personal happiness.

 

[Sirach38]

Ahhh!!! I have to stop reading these darn forums. Everytime that I get on here, I have a career crisis and have a big urge to just jump into general surgery. :sad:

 

[deleted171991]

That's why true and long-term mentoring would be so valuable in our profession.

 

[deleted171991]

I thank people like FFP and Blade who have kindly mentored med students. 🙂

I always wonder if I don't do more harm than good. Only time will tell.

Plus you can't put Blade and me in the same sentence. 🙂

 

[Sirach38]

What are your thoughts on IR? Same story as gas because they tend to be hospital employees? Maybe a nice middle ground between gas and gen surg?

 

[IkeBoy18]

I was gungho IR.. hell my mentor is one of the biggest names in IR. Im sure I can go back to IR, but it doesn't satisfy me like anesthesia does.

 

[p30doc]

What are your thoughts on IR? Same story as gas because they tend to be hospital employees? Maybe a nice middle ground between gas and gen surg?

I have a friend who is an IR attending, he says the job market sucks, he is fairly unhappy and has been getting pay cuts over the past couple of years. Radiology is seeing AMC style corporate takeover of PP too.

 

[Sirach38]

I always wonder if I don't do more harm than good. Only time will tell.

Plus you can't put Blade and me in the same sentence. 🙂

If anesthesiology goes down the s*#% hole, you will have done a lot of good. Otherwise, maybe not so much. I'm sure many med students have been discouraged to go into gas by your post. Which may end up being a great thing for them.

 

[IanMcGalt]

I don't think surgeons or IM docs do much better in the "getting rammed" department. Last time I checked, the 5+ years of surgery residency are the ultimate form of "getting rammed" and it doesn't get much better after residency especially in gen surg. Medicine subspecialties have their own ramming to deal with. If not "getting rammed" is your goal, GTFO of medicine.

Go complaint to administration about the surgeons and have the surgeons go complain about anesthesia.
See which they care about.

 

[BLADEMDA]

If anesthesiology goes down the s*#% hole, you will have done a lot of good. Otherwise, maybe not so much. I'm sure many med students have been discouraged to go into gas by your post. Which may end up being a great thing for them.

A dose of reality is important before choosing you career path. You will spend 4-5 years of postgraduate education having a good time (most enjoy the experience) and earning the same salary as your counterparts. But, once Residency/Fellowship ends the real world begins and you need to understand the future is bleak in terms of salary, Group practice, Doing your own cases, autonomy, etc. As long as you can deal with the issues (not to mention CRNA encroachment) then Anesthesiology is the field for you.

I realize options are limited for those with Step scores below 240 so I truly hope my vision of the future is dead wrong for this specialty; the problem is I know I'm right.

 

[BLADEMDA]

Some out there are misreading my posts. I'm not saying to avoid anesthesia if your options are limited. Let's look at an example:

Age 23
Male, White
M.D. School- Average Med School
Mostly Pass with some Honors
Step1 score of 238
total debt: $168,000

Options:

1. EM
2. Gas
3. FP
4. Peds
5. I.M.
6. Radiology

It is certainly reasonable to pick Gas plus Fellowship out of those 6; that said, option 5 with a fellowship (hard to get though) is a good choice as well.

If you didn't have any debt then maybe a 1 year internship followed by a MBA at Harvard or Wharton with a job on WallStreet. No debt allows the person to do I.M. and try for a fellowship in a competitive specialty. If that fails then you can go the MBA route followed by Biotech or Mutual Fund analyst or junior healthcare analyst at a major Wallstreet firm.

 

[Sirach38]

Some out there are misreading my posts. I'm not saying to avoid anesthesia if your options are limited. Let's look at an example:

Age 23
Male, White
M.D. School- Average Med School
Mostly Pass with some Honors
Step1 score of 238
total debt: $168,000

Options:

1. EM
2. Gas
3. FP
4. Peds
5. I.M.
6. Radiology

It is certainly reasonable to pick Gas plus Fellowship out of those 6; that said, option 5 with a fellowship (hard to get though) is a good choice as well.

If you didn't have any debt then maybe a 1 year internship followed by a MBA at Harvard or Wharton with a job on WallStreet. No debt allows the person to do I.M. and try for a fellowship in a competitive specialty. If that fails then you can go the MBA route followed by Biotech or Mutual Fund analyst or junior healthcare analyst at a major Wallstreet firm.

Blade, thanks so much for all the info that you provide us med students. You and FFP have done an amazing job of educating us. I know all the other med students and I are very grateful.

I would add to that list:

7. General Surgery

8. PM&R

9. Ophthalmology

10. Integrated Vascular

11. IR (I know you mentioned rads)

12. Psych

13. Path

Now, this is a very realistic list for those stats. With this list, is gas still a reasonable choice? Seems to me like nothing on the list stands out as FAR superior to gas all around.

P.S. What if we changed Male, White to Male, Black or Male, Hispanic? Would this change the list?

 

[Random Anesthesiologist]

Don't forget OB/Gyn. Yeah it's OB/Gyn but they have some pretty lucrative fellowships in reproductive endocrinology, MFM and Gyn Onc.

 

[Sirach38]

Don't forget OB/Gyn. Yeah it's OB/Gyn but they have some pretty lucrative fellowships in reproductive endocrinology, MFM and Gyn Onc.

Thanks Random Resident...forgot that one because I would rather mop floors than do OB/Gyn but I'm sure it's a great field for the right person.

14. OB/Gyn

 

[pgg]

I know that on SDN everyone is brilliant and handsome (or beautiful) with a keen eye for business ... It sure seems a lot of statements are predicated on the assumption of what a top 10%-er's choices and options are.

"Just do ENT" or "just do derm" isn't realistic advice for most people. The kind of board scores that got most of us into anesthesia wouldn't cut it for some of these destiny-controlling wealth specialties. Likewise, "run a lean efficient profitable practice at an ASC doing just boob cases" isn't where most general surgeons wind up.

Yeah, if your step 1 is 250 and you don't really love any particular specialty you don't have to settle for a field with "issues" and if you're rich and handsome you don't have to settle for a chick with six fingers and a lisp, either. There are vanishingly few specialties left that don't have "issues" with midlevel encroachment or declining reimbursement.

I know more unhappy surgeons than unhappy anesthesiologists. Ours is a great specialty. I love my job, and from reading this forum, it appears I'm living an absolute horror movie of a life: practicing alongside pseudo-independent CRNAs, making government pay somewhere around the 25th %ile MGMA. Maybe less depending on what region I look at. If you're one of the 10%'ers who could make it big in ENT, odds are you won't be scraping around the bottom of the anesthesia world either. If you're not one of them, well, do the options of the elite really have an impact on your decision?

Cue the coulda been an i-banker posts. 🙂

 

[pgg]

I swear to god I wrote my above post before reading this:

Let's look at an example:

[...]
Age 23
[...]
Step1 score of 238
[...]

If you didn't have any debt then maybe a 1 year internship followed by a MBA at Harvard or Wharton with a job on WallStreet. No debt allows the person to do I.M. and try for a fellowship in a competitive specialty. If that fails then you can go the MBA route followed by Biotech or Mutual Fund analyst or junior healthcare analyst at a major Wallstreet firm.

😀

It's the SDN trifecta: a brilliant young prodigy (med school grad at 23! finished university @ 19 in 2 years!) who's a couple std devs above average (step 1 238!) and Wall Street reference.

I love you, Blade. 🙂

Some out there are misreading my posts. I'm not saying to avoid anesthesia if your options are limited.

Fair enough ... and an important caveat to all this "stay away from anesthesia" doom and gloom.

90% of the people out there don't have the option of a highly competitive surgical or medical subspecialty. Anyone can back into IM (somewhere if they're not picky) but after they gut out an IM residency, there's no guarantee they'll be able to land a GI fellowship.

The 10% that do ... I think they can still carve out a good spot for themselves in anesthesia. The sevofluranes, periopdocs, Noyacs, my friend/thorn JPP 🙂, etc ... these guys were always going to kill it no matter what path they took.


The reason these threads are so frustrating to me really hinges on the underlying assumption and prerequisite for the advice to be useful: be brilliant and you can do great things.

 

[BLADEMDA]

I swear to god I wrote my above post before reading this:



😀

It's the SDN trifecta: a brilliant young prodigy (med school grad at 23! finished university @ 19 in 2 years!) who's a couple std devs above average (step 1 238!) and Wall Street reference.

I love you, Blade. 🙂




Fair enough ... and an important caveat to all this "stay away from anesthesia" doom and gloom.

90% of the people out there don't have the option of a highly competitive surgical or medical subspecialty. Anyone can back into IM (somewhere if they're not picky) but after they gut out an IM residency, there's no guarantee they'll be able to land a GI fellowship.

The 10% that do ... I think they can still carve out a good spot for themselves in anesthesia. The sevofluranes, periopdocs, Noyacs, my friend/thorn JPP 🙂, etc ... these guys were always going to kill it no matter what path they took.


The reason these threads are so frustrating to me really hinges on the underlying assumption and prerequisite for the advice to be useful: be brilliant and you can do great things.

PGG,

Your posts are insightful and hopefully add balance to the discussion. It is certainly great you are posting the positive side of things.

 

[BLADEMDA]

Blade, thanks so much for all the info that you provide us med students. You and FFP have done an amazing job of educating us. I know all the other med students and I are very grateful.

I would add to that list:

7. General Surgery

8. PM&R

9. Ophthalmology

10. Integrated Vascular

11. IR (I know you mentioned rads)

12. Psych

13. Path

Now, this is a very realistic list for those stats. With this list, is gas still a reasonable choice? Seems to me like nothing on the list stands out as FAR superior to gas all around.

P.S. What if we changed Male, White to Male, Black or Male, Hispanic? Would this change the list?

I would think recruiting qualified minority candidates into highly qualified specialties would be a valid screening tool other than STEP scores. Some programs will go out of their way to rank a qualified minority with slightly lower stats over a traditional white male applicant. This may suck but it is reality.

 

[BLADEMDA]

Blade, thanks so much for all the info that you provide us med students. You and FFP have done an amazing job of educating us. I know all the other med students and I are very grateful.

I would add to that list:

7. General Surgery

8. PM&R

9. Ophthalmology

10. Integrated Vascular

11. IR (I know you mentioned rads)

12. Psych

13. Path

Now, this is a very realistic list for those stats. With this list, is gas still a reasonable choice? Seems to me like nothing on the list stands out as FAR superior to gas all around.

P.S. What if we changed Male, White to Male, Black or Male, Hispanic? Would this change the list?

You have done your homework so pick a specialty. I can't imagine someone wanting to do Anesthesia would consider Psych or Path. Is Optho really on your personal list? PM & R?

 

[Sirach38]

I would think recruiting qualified minority candidates into highly qualified specialties would be a valid screening tool other than STEP scores. Some programs will go out of their way to rank a qualified minority with slightly lower stats over a traditional white male applicant. This may suck but it is reality.

I'm the exact applicant that you described in your scenario except 24, not 23 and hispanic, not white. That's why I was asking. I guess I may have a shot (although, a long stretch) at ENT or Uro just for being hispanic. But, they definitely don't interest me nearly as much as gas.

 

[Sirach38]

You have done your homework so pick a specialty. I can't imagine someone wanting to do Anesthesia would consider Psych or Path. Is Optho really on your personal list? PM & R?

No, the only things on my menu still are gen surg and gas with gas being far ahead in terms of interest but gen surg obviously being ahead in terms of future. The rest of the list was more for other medical students reading who are considering some of those other fields. So after a (yet another) career crisis today, I'm still going with gas. I know, I need to stop reading and posting in this thread.

 

[Sirach38]

I know that on SDN everyone is brilliant and handsome (or beautiful) with a keen eye for business ... It sure seems a lot of statements are predicated on the assumption of what a top 10%-er's choices and options are.

"Just do ENT" or "just do derm" isn't realistic advice for most people. The kind of board scores that got most of us into anesthesia wouldn't cut it for some of these destiny-controlling wealth specialties. Likewise, "run a lean efficient profitable practice at an ASC doing just boob cases" isn't where most general surgeons wind up.

Yeah, if your step 1 is 250 and you don't really love any particular specialty you don't have to settle for a field with "issues" and if you're rich and handsome you don't have to settle for a chick with six fingers and a lisp, either. There are vanishingly few specialties left that don't have "issues" with midlevel encroachment or declining reimbursement.

I know more unhappy surgeons than unhappy anesthesiologists. Ours is a great specialty. I love my job, and from reading this forum, it appears I'm living an absolute horror movie of a life: practicing alongside pseudo-independent CRNAs, making government pay somewhere around the 25th %ile MGMA. Maybe less depending on what region I look at. If you're one of the 10%'ers who could make it big in ENT, odds are you won't be scraping around the bottom of the anesthesia world either. If you're not one of them, well, do the options of the elite really have an impact on your decision?

Cue the coulda been an i-banker posts. 🙂

Thanks pgg. You have no idea how good it makes me feel to hear this. Sometimes a little bit of hope is nice.

 

[IanMcGalt]

Thanks pgg. You have no idea how good it makes me feel to hear this. Sometimes a little bit of hope is nice.

Nobody said just do ENT or Derm.

I would recommend almost any specialty over anesthesiology.

Do something, anything, where you own the patients. You can be the best anesthesiologist in town and it doesn't matter at all because you have no bargaining power and are legally prevented from competing.

You get mixed reviews right now because so many people got in before this specialty went to ----, so for them it seems great. Even today there are good jobs, but the long term outlook is so poor that it would be foolish to choose this specialty today. Maybe it was foolish to choose it 8-9 years ago when I did (?). Anesthesiology has nowhere to go but down. This isn't a cycle that will reverse. Things won't get better. They will definitely get worse and worse as fewer and fewer corporate owners monopolize this profession and use that widespread control to squeeze you for pay, hours, etc.

I really hope it doesn't get too bad but why give up control of your career to a bunch of suits when you could choose a specialty that allow you to maintain some control?

 

[Sirach38]

I really hope it doesn't get too bad but why give up control of your career to a bunch of suits when you could choose a specialty that allow you to maintain some control?

Because you love the specialty and want to fight for it? Because you can't imagine yourself doing anything else and are fascinated by and passionate about anesthesiology? Why does it have to be an economics based choice? Why can't we just do what we love as med students? Screw it. I'm sick of this fear of the future holding me back from doing something that I love. I'm going to follow my heart and my guy even if I end up making 80K/year in the future. Sometimes it's not all about the money. While salary is important, choosing a medical specialty is more than that. Nobody's future is certain. Might as well do what you love.

 

[Leo Aquarius]

You have done your homework so pick a specialty. I can't imagine someone wanting to do Anesthesia would consider Psych or Path. Is Optho really on your personal list? PM & R?

I can only speak for psychiatry. If you're strong at it, and your patients love you, then they will follow you to the ends of the earth and back. As Salvador Dali said, I am the drug. Of all the specialties, psych enjoys one of the strongest bonds with its patients.

But I agree with the above - do what you love. The only problem is that you don't know what a specialty is really like until, maybe, your third year of residency. It's a highly personal and risky choice - that leap of faith is a big leap.

 

[deleted171991]

Because you love the specialty and want to fight for it? Because you can't imagine yourself doing anything else and are fascinated by and passionate about anesthesiology? Why does it have to be an economics based choice? Why can't we just do what we love as med students? Screw it. I'm sick of this fear of the future holding me back from doing something that I love. I'm going to follow my heart and my guy even if I end up making 80K/year in the future. Sometimes it's not all about the money. While salary is important, choosing a medical specialty is more than that. Nobody's future is certain. Might as well do what you love.

I hope your (future) spouse will feel the same way.

 

[deleted171991]

Nobody said just do ENT or Derm.

I would recommend almost any specialty over anesthesiology.

Do something, anything, where you own the patients. You can be the best anesthesiologist in town and it doesn't matter at all because you have no bargaining power and are legally prevented from competing.

You get mixed reviews right now because so many people got in before this specialty went to ----, so for them it seems great. Even today there are good jobs, but the long term outlook is so poor that it would be foolish to choose this specialty today. Maybe it was foolish to choose it 8-9 years ago when I did (?). Anesthesiology has nowhere to go but down. This isn't a cycle that will reverse. Things won't get better. They will definitely get worse and worse as fewer and fewer corporate owners monopolize this profession and use that widespread control to squeeze you for pay, hours, etc.

I really hope it doesn't get too bad but why give up control of your career to a bunch of suits when you could choose a specialty that allow you to maintain some control?

I couldn't have said it better. Every medical student should read this post before applying to anesthesia.