Contemplating a Switch from IM to Anesthesia

[bellatrix]

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I am a PGY2 in IM and am living a life of quiet desperation. I had a difficult time deciding between general surgery vs (procedural) IM when applying for residencies (strange, I know). I had a 4 week anesthesia elective during my last month of med school & loved it.

I am bored to tears at writing long notes, going through exhaustive differentials for what is essentially a social admission, being expected to accept our f---ed up medical system with a smile, and rounding for hours on end. I spend much of my day in front of a computer instead of with patients. My program is very "top down" in culture & I'm expected to passively learn about esoterica such as Wegener's Granulomatosis & Still's disease from the chief residents & attendings in morning report. My favorite rotations thus far have been my ICU rotations, where I can make quick decisions & see the results in minutes to hours, and where I can do procedures. In the MICU, however, our intensivists do not intubate or do all procedures & more emphasis is placed on the intellectual exercise of epic 4-5 hr long rounds.

I love interacting with patients & even do not mind clinic. I just find most of the work of IM to be tedious. Has anyone made the switch of IM to anesthesia? Do you have any advice? I can't tell if I am just unhappy with my program, dysthymic with sleep deprivation, or if I truly do not fit into IM.

 

[Buckeye Anes]

I am a PGY2 in IM and am living a life of quiet desperation. I had a difficult time deciding between general surgery vs (procedural) IM when applying for residencies (strange, I know). I had a 4 week anesthesia elective during my last month of med school & loved it.

I am bored to tears at writing long notes, going through exhaustive differentials for what is essentially a social admission, being expected to accept our f---ed up medical system with a smile, and rounding for hours on end. I spend much of my day in front of a computer instead of with patients. My program is very "top down" in culture & I'm expected to passively learn about esoterica such as Wegener's Granulomatosis & Still's disease from the chief residents & attendings in morning report. My favorite rotations thus far have been my ICU rotations, where I can make quick decisions & see the results in minutes to hours, and where I can do procedures. In the MICU, however, our intensivists do not intubate or do all procedures & more emphasis is placed on the intellectual exercise of epic 4-5 hr long rounds.

I love interacting with patients & even do not mind clinic. I just find most of the work of IM to be tedious. Has anyone made the switch of IM to anesthesia? Do you have any advice? I can't tell if I am just unhappy with my program, dysthymic with sleep deprivation, or if I truly do not fit into IM.

A lot of IM programs allow you to do an "airway/anesthesia" elective which would be a good way to compare the specialties and see which you really like.

 

[9french]

I am a PGY2 in IM and am living a life of quiet desperation. I had a difficult time deciding between general surgery vs (procedural) IM when applying for residencies (strange, I know). I had a 4 week anesthesia elective during my last month of med school & loved it.

I am bored to tears at writing long notes, going through exhaustive differentials for what is essentially a social admission, being expected to accept our f---ed up medical system with a smile, and rounding for hours on end. I spend much of my day in front of a computer instead of with patients. My program is very "top down" in culture & I'm expected to passively learn about esoterica such as Wegener's Granulomatosis & Still's disease from the chief residents & attendings in morning report. My favorite rotations thus far have been my ICU rotations, where I can make quick decisions & see the results in minutes to hours, and where I can do procedures. In the MICU, however, our intensivists do not intubate or do all procedures & more emphasis is placed on the intellectual exercise of epic 4-5 hr long rounds.

I love interacting with patients & even do not mind clinic. I just find most of the work of IM to be tedious. Has anyone made the switch of IM to anesthesia? Do you have any advice? I can't tell if I am just unhappy with my program, dysthymic with sleep deprivation, or if I truly do not fit into IM.

Most anesthesiologists will agree with you that the endless rounds and mindnumbing paperwork of IM is frustrating. For me, that, plus being the dumping ground of the hospital, and the inability to definitively treat most of what I saw, made IM far less than appealing.

However, Anesthesiology may have its share of downsides for you, too. The first is that the interaction with patients is minimal. If you do your job right, most will not remember you. You will always be second tier in the patient's eyes to the surgeons. We rarely diagnose more than a small subset of pathologies (PDPH, arrythmias, airway issues, ARDS, etc.), and although we may institute treatment, we rarely follow the treatment to the end. Procedures quickly lose their excitement. Routine intubations, epidurals, and central lines are just that- routine. Plus, if you are in a ACT type practice, the CRNAs will do most of these so you can stay legal with billing.

Since you are already two years into your residency, a good option may be subspecialty medicine. The cardiologists do not endlessly round, they do tons of procedures, and they have the ability to definitively treat most problems which come their way. They also have clinic which you seem to enjoy, and a continuous relationship with their patients. The same can be said for pulm, GI, and Heme/Onc. If you love interacting with patients, these may be a better fit than anesthesiology.

 

[psychbender]

Has anyone made the switch of IM to anesthesia? Do you have any advice? I can't tell if I am just unhappy with my program, dysthymic with sleep deprivation, or if I truly do not fit into IM.

One of my attendings was initially an internist. He had some of the same experiences you have, with hating long rounds, academic osmosis, lack of procedures, minimal meaningful interactions with patients due to being a slave to the chart, the medical system as a whole, etc. He is now a Cardiac trained Anesthesiologist, and absolutely loves his job.

Agree with above, see if you can get an elective in Anesthesiology to see if this is really what you want to do with your life.

 

[guitarguy]

I can't even count the number of people I've known both within and outside my program who have switched from IM to anesthesia. My advice would be to finish up your IM residency, and consider an anesthesia residency as like a medicine fellowship. Many, many, many dual board-certified IM and anesthesia trainees choose to do 1 year fellowship training after anesthesia in Critical Care. This may make it easier for you to attend, later in your career, in both surgical and medical ICU's. Many anesthesia programs will view your medicine residency as a valuable asset.

 

[DET0897]

However, Anesthesiology may have its share of downsides for you, too. The first is that the interaction with patients is minimal. If you do your job right, most will not remember you. You will always be second tier in the patient's eyes to the surgeons. We rarely diagnose more than a small subset of pathologies (PDPH, arrythmias, airway issues, ARDS, etc.), and although we may institute treatment, we rarely follow the treatment to the end. Procedures quickly lose their excitement. Routine intubations, epidurals, and central lines are just that- routine. .

Go ahead, list some downsides too

 

[dhb]

The problem with IM is that as a resident your work (rounding on patients) has little to do with what you will be doing when you subspecialize, which is much more procedures since that is where the $ are.

 

[Nasty Gas]

Your situation is not unique and I encounter several of my former medicine colleagues (from internship) who frequently ask me if there are openings in our department. IM and anesthesia are very different and after reading your post I have to agree with others that 1) you should finish your IM residency (most feels that it gets much better as a third year) 2) consider sub-specializing in a more procedure-based specialty such as GI or interventional cards and 3) explore anesthesia more through an elective, if available (one word of caution about this: watching anesthesia is very, very boring. Doing anesthesia is very, very exciting -- at least for me).

As an anesthesia resident / attending you have to be OK with being secondary to the surgeon in the patient's eyes. You don't have you own patients like you do in IM and no one knows you as "their doctor." For most of us, this is an acceptable trade-off because we don't want to be bothered with all the minutia and details that go into maintaining a long-term patient relationship. If you really like patient contact, you may be unsatisfied with this aspect of anesthesia. Another aspect to consider is how much you like practicing internal medicine, because you'll loose a lot of your IM skills in a three-year anesthesia residency. We are really good with physiology, but a lot less good with managing chronic disease -- we simply don't do it on a regular basis (hallelujah!)

The idea about surgical critical care is a good one, and may be your best option. It sounds like the acuity of the SICU would suit you better than the management of end-stage chronic disease you find in the MICU. It is only one more year than a medicine fellowship and the SICU is a LOT more fun than the MICU.

With that being said, if you're still serious about leaving your IM residency I'd start contacting PDs in earnest now to secure a spot for either this July or next. Based upon what's available you can make your decision.

 

[InductionAgent]

I agree with those who advice finishing your medicine residency. At this point, you'd most likely only be able to miss out on your PGY 3 Medicine year, which should be the best with the most opportunity for electives in areas of interest.

Another big reason to finish your medicine residency is that if you don't like anesthesiology, you have a solid backup. I've seen this happen, where people come into anesthesiology from other specialties and find that it's not what they'd hoped it would be. Doing a one-month elective is a good idea, but it still won't give you the same feel for the specialty you'll have after six months of residency.

 

[bellatrix]

Wow. Thank you all for your advice. I am impressed by the quick responses in this forum.

I will definitely finish my IM residency and am looking forward to an anesthesia elective. I've entertained anesthesia since my first general medicine month as an intern. I chalked that up to 'intern blues', but PGY2 year has not been better. And I knew something was wrong last week when, during a morning report case on pheochromocytoma, I was much more interested in intraoperative management than diagnosis & follow-up.

 

[geauxg8rs]

You can also think about Pain Management. I did an anesthesia residency and wanted to have more interaction with patients (longer term). I like the mix of clinic and procedures. I also like my hours better than my gas colleagues. The money (from what I can tell is roughly the same).

A cautionary(yet hopeful) note though is that your future practice is not going to be like your work as a resident (no matter what residency program or type you graduate from). You can tailor any job to what you want it to be.

 

[HighAltitude]

I started out in internal medicine thinking cards or CCM would be cool and and that the IM residency would be quick and painless. I quickly learned to really hate terminal rounds and clinic. Hospitalist work looked better - you see results in days rather than months. I moved on to a pulm/critical care program at a much faster paced institution and found waiting days to see results still drove me nuts and I loved being in the our mixed med-surg unit where you can see the results in hours, not days. But wait - then came the anesthesia rotations and hanging out mith my new anesthesia buddies who could see results in minutes?? As one friend (IM->anes->crit care) put it "When I'm in a heart room I do an art line, push lethal drugs, intubate, throw in a RIJ, float a swan then go get my 8am coffee?". Bye bye pulmonary, hello anesthesia. I'm hooked and wish I had done anes then CCM and I'd be an attending now rather than a PGY-7 with a year to go.

You're already in IM. If anesthesia is what you want to do then look at it as a 3 year fellowship. Its competitive and and being IM BE/BC will only help you. Being boarded in something else makes the financial part of residency much easier and I make more moonlighting than I do in the residency gig.

Hope this message comes through and doesn't suck too badly - just joined SDN a few minutes ago and this is my first message........

 

[dbiddy808]

I also did an internal medicine residency followed by an anesthesiology residency. While it sucked having to do a second residency and being the low-man on the totem pole again, I think it was worth it. Three years goes by fast. I also thought about doing critical care when I started my anesthesia residency because I missed managing more complex issues than we see in the OR, but reality set in. You take a 50% pay cut to work as an intensivist (in most settings). I am an attending now and life is pretty sweet. 90% of the time everything is very routine and very easy. Low stress. Most of the surgeons are nice. No pager going off every 5 minutes.... No dietary reccs..... No pharmacy calls about your abbreviations.... And I make BIG bucks. I'd say go for it!

 

[jetproppilot]

I also did an internal medicine residency followed by an anesthesiology residency. While it sucked having to do a second residency and being the low-man on the totem pole again, I think it was worth it. Three years goes by fast. I also thought about doing critical care when I started my anesthesia residency because I missed managing more complex issues than we see in the OR, but reality set in. You take a 50% pay cut to work as an intensivist (in most settings). I am an attending now and life is pretty sweet. 90% of the time everything is very routine and very easy. Low stress. Most of the surgeons are nice. No pager going off every 5 minutes.... No dietary reccs..... No pharmacy calls about your abbreviations.... And I make BIG bucks. I'd say go for it!

Nice REAL WORLD post, bro.👍

 

[HighAltitude]

Nice REAL WORLD post, bro.👍

I hear you man - I moonlight as an intensivist in an somewhat odd arena (eICU) and can be just like what you know ICU to be - endless fires to put out and endless calls. One place I work covers upwards of 120-170 pts and another place covers around 30. Go figure which is quieter. At least for those places I'm an attending and get paid like a real doc and can get s hit done.

Anesthesia nights are what we all know and "love" (sarcasm intended) - either doing cool cases, rotting away in the 18hr crani where you want to overhead chime "anesthesia stat to OR3" so you can go out and take a whiz, or watching the history channel and doing an occasional intubation in the unit (tonight)

The last decision you have to make if you do some combo of residencies is what kind of career you want, which is something I'm looking at right now - pure OR time or mixed OR and unit. As Jet points out thats a real world topic all by itself.....

 

[amyl]

op - medicine sucks. your original post could have come right from my mouth.... congratulations on seeing the light.

 

[CambieMD]

I also completed another residency prior to completing a gas residency. Finishing your im residency and becoming boarded would be the way to go.
Make strong connections with a few of your attendings.You will need them for strong letters when you apply to anesthesia.

I have never regretted leaving fp. I do not regret starting out in fp. I actually think that the time that I spent as an fp has helped me as an anesthesiologist.

The three years of residency went by quickly.

Cambie

 

[bellatrix]

I am status post an anesthesia elective and loved it. Decisions are made quickly, procedures done, minimal paperwork and the OR is a big physiology lab. The female anesthesia attendings look well-rested & (mostly) content.

I'm currently in an "Urgent Clinic" IM rotation and I would rather be waterboarded for 15 minutes than face another day of narcotic seeking patients with back pain. Going to slog it out in medicine for another year & join the fold. Thanks again to all who replied. I look forward to lurking on this board!

 

[DO4lifer]

you should ask other IM residents in your position. maybe its more common than you think...hence why many do fellowships? after residency you can choose never to round again via private practice.

 

[error404]

I'm currently in an "Urgent Clinic" IM rotation and I would rather be waterboarded for 15 minutes than face another day of narcotic seeking patients with back pain.

I'm guessing you're not going for a pain fellowship. 🙂

 

[gothamdoc]

Deleted by user.

 

[radslooking]

I also completed another residency prior to completing a gas residency. Finishing your im residency and becoming boarded would be the way to go.
Make strong connections with a few of your attendings.You will need them for strong letters when you apply to anesthesia.

I have never regretted leaving fp. I do not regret starting out in fp. I actually think that the time that I spent as an fp has helped me as an anesthesiologist.

The three years of residency went by quickly.

Cambie

as someone in a similar position, boarded in IM, I would agree to finish your residency. I can go back and do anesthesia if I finally get a big enough itch to. I basically hang around this forum because the peeps are cool and there is some pimp information to be had. I say finish it and then decide. Then you always have the option of a procedural specialty or going back to anesthesia. The second residency should be less grueling as the first as you've worked out most of medicine in your head by then.