contemplating switching residency fields

[switch2010]

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hi y'all,

I am about to start my pgy-3 year in rads, and now thinking I'm not really getting what I want out of it, i.e. turns out I do need that instant gratification of helping out a patient, even with IR being an option I think anesthesia may be more my thing, lots of variety from CC to pain mgmt, to genA. And I know IR can do a pain management fellowship, but I can't imagine an anesthesia department hiring a radiology trained pain doc over an anesthesia trained one just like an IR dept hiring an anesthesia trained interventionalist, due to lack of coverage for the other components of the department. I was between the 2 fields during my 3rd year, but did not do much as far as my 4th year b/c I was heavily involved in rads. And did only a 2 week elective. However, I did do SICU, and did MICU and CCU during my intern year and love critical care, though I hate medicine so it's clearly out. Going into rads, I obviously like procedures, and after reading the highlights of Baby Miller, I really enjoyed learning about anesthesia. Here's the question I pose to you guys. Most people that switch (correct me if I'm wrong) are from surgery or medicine and thus have either done an anesthesia rotation and have at least some exposure to it. Whereas formally I have exactly 2 weeks plus my ICU rotations, so how fishy does it look if rads, switches into anesthesia? My reasons are sincere, I have examined all other specialty choices that I could switch to, and I know about the negatives of anesthesia as much as the positives, at least from the perspective of an interested party and not an insider.
I'm at a "top 10" university rads program, step 1, 2, 3 are >240, >250, >250, not AOA, mostly honors.
Also if you could give me some advice regarding how to proceed about this would be helpful if you guys don't mind. I can get LOR from my IM prelim attendings, rads PD, but not sure where I would get an anesthesia letter. SICU was in med school 2 years ago, so doubtful the attending will remember me well enough to write me a letter. thanks in advance.

 

[IN2B8R]

hi y'all,

I am about to start my pgy-3 year in rads, and now thinking I'm not really getting what I want out of it, i.e. turns out I do need that instant gratification of helping out a patient, even with IR being an option I think anesthesia may be more my thing, lots of variety from CC to pain mgmt, to genA. And I know IR can do a pain management fellowship, but I can't imagine an anesthesia department hiring a radiology trained pain doc over an anesthesia trained one just like an IR dept hiring an anesthesia trained interventionalist, due to lack of coverage for the other components of the department. I was between the 2 fields during my 3rd year, but did not do much as far as my 4th year b/c I was heavily involved in rads. And did only a 2 week elective. However, I did do SICU, and did MICU and CCU during my intern year and love critical care, though I hate medicine so it's clearly out. Going into rads, I obviously like procedures, and after reading the highlights of Baby Miller, I really enjoyed learning about anesthesia. Here's the question I pose to you guys. Most people that switch (correct me if I'm wrong) are from surgery or medicine and thus have either done an anesthesia rotation and have at least some exposure to it. Whereas formally I have exactly 2 weeks plus my ICU rotations, so how fishy does it look if rads, switches into anesthesia? My reasons are sincere, I have examined all other specialty choices that I could switch to, and I know about the negatives of anesthesia as much as the positives, at least from the perspective of an interested party and not an insider.
I'm at a "top 10" university rads program, step 1, 2, 3 are >240, >250, >250, not AOA, mostly honors.
Also if you could give me some advice regarding how to proceed about this would be helpful if you guys don't mind. I can get LOR from my IM prelim attendings, rads PD, but not sure where I would get an anesthesia letter. SICU was in med school 2 years ago, so doubtful the attending will remember me well enough to write me a letter. thanks in advance.

I'm still unclear why you would not pursue IR if you like procedures so much.... Why on earth wait for your pgy3 year to make that decision--you are well on your way, man: get through it and become a radiologist rock$tar, you can always go back and do 3 yrs of anesthesia if you find out that you don't like being a radiologist anymore....

 

[WholeLottaGame7]

I'm still unclear why you would not pursue IR if you like procedures so much.... Why on earth wait for your pgy3 year to make that decision--you are well on your way, man: get through it and become a radiologist rock$tar, you can always go back and do 3 yrs of anesthesia if you find out that you don't like being a radiologist anymore....

Either way, it's going to be 3 more years (2 more R years +1-2 fellowship for IR or 3 CA years), so if you switch now, you won't lose any time. The bigger issue is, have you really had enough exposure to anesthesia to make that switch?

 

[MrBurns10]

Why not just do a neurorads fellowship? You can do lots of spine injections and essentially run a pain practice without an additional pain fellowship.

 

[Sergio99]

Hello, Switch,

The only way to know is applying. You may get lots of advice and probability analyses, but the truth of the matter is, you will never know for sure unless you apply.

There are always people that change their minds at the last minute, die in accidents, get sick, get married, etc., and a position opens up. Of course, the chances are not great, we already know that, but if you land one of those positions, you don't care whether the chances were one in a hundred, one in a million or one in a billion. The only thing that counts is that you got the job, and if you had not applied because you thought the chances were low, you would have never gotten it.

So, there you got a realistic analysis of the situation: start applying.

Greetings

 

[pgg]

Something else to consider - you have rockstar stats, and are currently at a top 10 university program in rads.

You're not likely to slide into a comparably superb anesthesia program as a CA1 in the next 22 days. Would you be happier as a PGY2 anesthesia resident at a weak program or a PGY4 radiology resident at a great program?

What's your plan for the 2010-2011 academic year if you don't find an acceptable CA1 position? Be a PGY4 rads resident? Camp out in Baja for 12 months exercising your liver?

 

[switch2010]

Hey thanks for the replies so far,
actually was planning on applying through ERAS again mostly to advanced programs, and would be totally ok repeating an intern year since I am 2 years out from clinical medicine , my first one was pretty benign so no bad memories. also I didn't go to a "top 10" program because of the ranking, I just happened to find the residents and attendings to be very congenial, the atmosphere was relaxed and it's a nice part of the country, I'd be looking for the same in an anesthetia program, it doesn't have to be stellar, just a place where I can get a solid education, plus I'm very self motivated, so I feel if I'm lacking in something I can self-correct. Although I very much like IR, and is pretty much the only reason I did radiology, there are a few things I dislike about it which have been driving me nuts, not the least of which is the persistent (often losing) turf battles between surgeons and cards and rads (even anesthetia with regards to pain medicine, though to be honest to me that's is theoretical b/c I have not heard much about it), and frankly I don't want to spend my carreer fighting them off, that's not why I went into medicine, and the thought of it really bums me out. I know anesthetia has it's own share of problems, namely, CRNAs and d%$^ surgeons, but in reality, is a nurse really ever going to take over a doctor's job, sure they can do the lap choles, appy, but what about the big whack surge onc, neuro, cards cases, not to mention SICU. And surgeons can be *****%$%$ all they want, ultimately, no anesthetia = no surgery. And though IR is becoming more clinical with regards to admitting patients, outpatient clinics, etc., unless the training paradigm changes I'm not sure if they will ever be clinicians. And lately I've been realizing that I miss patients, like I said I went into rads hoping to do IR, and felt that 4 years w/o much patient interaction is ok, it does not seem to be, I didn't go to med school to sit in a dark room dictating cases. And anesthetia always appealed to me, like I mentioned in my OP, pain management and critical care especially, and being handy with ETT is always nice. I have talked some anesthesia friends, and I have a few friends who have been attendings for a couple of years who really enjoy it. So I'm pretty set on it, I feel like I've given it a lot of thought and feel l am making the right decision. To answer some of the questions you posed, I will be doing the PGY-3 in rads, where I do get some good IR exposure, perhaps I may have an epipheny and change my mind and fall in love with IR all over again, but if not, I am planning on applying for advanced positions both through ERAS and outside the match for CA1 positions, ??maybe look at resident swap, but not sure if I want to waste the money. All I know is that diagnostic rads is not an option for me, and I guess part of the appeal of applying to rads, was that switching out of it into a different field would be "easier", compared to switching into it, say from surgery, because it would be (erroneously, from personal experience way less down time in rads then IM) viewed as me switching from a low intensity specialty to a high intensity one.

 

[Taurus]

there are a few things I dislike about it which have been driving me nuts, not the least of which is the persistent (often losing) turf battles between surgeons and cards and rads (even anesthetia with regards to pain medicine, though to be honest to me that's is theoretical b/c I have not heard much about it), and frankly I don't want to spend my carreer fighting them off, that's not why I went into medicine, and the thought of it really bums me out. I know anesthetia has it's own share of problems, namely, CRNAs and d%$^ surgeons, but in reality, is a nurse really ever going to take over a doctor's job, sure they can do the lap choles, appy, but what about the big whack surge onc, neuro, cards cases, not to mention SICU.

If you dislike turf battles, you're heading into the biggest one in medicine with anesthesiology. At least in radiology, you're dealing with fellow physicians who had similar level of training as you. In anesthesiology, you're dealing with a nurses who have 2 years of training and now think they that they are as good or better than you. Did I mention that there are 40k of them? Under Obamacare and a bankrupt economy, you can expect things to get worse not better for everyone involved in anesthesia.

I would suggest that you delve deeper into this issue before switching out of a top 10 rad program.

 

[pgg]

there are a few things I dislike about it which have been driving me nuts, not the least of which is the persistent (often losing) turf battles

Not touching that one ... 🙂

 

[Sergio99]

Did I mention that there are 40k of them?

Hello,

The very reason they even exist is that there weren't enough of us in the first place.

The more you discourage doctors from becoming anesthesiologists, more CRNAs you are inviting into the game.

Greetings

 

[switch2010]

please...I am not looking to start ANOTHER CRNA vs. MD war, nor who has it worse, rads or anasthetia, b/c both have it pretty good. I am well aware of the issue, but like I said before, an RN, regardless of which letters are in front or behind those two, will never replace an MD.
Please correct me if I'm wrong, but I do not think CRNAs are allowed anywhere near an open heart, an open cranium, a flouro suite or SICU and if crap hits the fan during a "routine procedure", they will most certainly call the MD in. Furthermore, MD have a better graps of the pathophys, phys and general management. RNs are taught an algorithm and not principles. In my IM year I had an NP start a pt with a SBP of 160 on hydralazine 25 mg tid, too bad her diastolic was around 40 on a good day. Therefore, as much as CRNAs want to, they will never reach our level, at some point they will reach critical mass, and their sheningans will be made public. On the other hand, what Taurus said about IR vs. other PHYSICIANS, that is a much more serious turf war. Those other physicians can claim better understanding of pathophys/clinical mgmt of a pt then IR. I don't think CRNAs pose a threat to anasthetia like vasc surge, cards poses to IR. Given a choice I think most people would choose MD over RN, especially if DNPs/CRNAs are thinking of equalizing compensation, why would you pay the same amount of money for a lesser product. And the ones that choose DNP will go back to MD after having an MI from too much hydralazine.

Could someone comment on the fact that I have no access to an anesthetia letter, other then the longshot of my attending in the SICU from 2 years ago.

Thanks.

 

[hoyden]

You seem pretty well burned out, but to be honest, it does not look like you really want to switch to anesthesia, you just want this c*** ( which residency in any field is) to be done. You have just ONE year to go and you will be out - and you can pursue fellowship in IR and be almost a surgeon 😉)))

The tough battles you are experiencing now may start to seem heaven once you get to be a CA-1 ( I do not suppose you have to repeat intern year).

And remember - it is just residency - and it is s***y for every specialty. Real life is different, however being attending anesthesiologist does not mean you won't have any turf battles. And you may hate them even more.


As for Taurus remarks - keep in mind that what he has said is not only pertinent to CRNA vs MD battle. You will have nurses on your anesthesia back all the time - always, for the rest of your carrier if you switch and turf battles are the everyday reality ( OK, I am a bit exaggerating))) in anesthesiology. Being an IR is a totally different place on a ladder from the nurses point of view.
And hospital's as well.

Consider this, since your the main reason you are tired by your own specialty( I would still say - residency) is not the specialty itself.

Hey thanks for the replies so far,
actually was planning on applying through ERAS again mostly to advanced programs, and would be totally ok repeating an intern year since I am 2 years out from clinical medicine , my first one was pretty benign so no bad memories. also I didn't go to a "top 10" program because of the ranking, I just happened to find the residents and attendings to be very congenial, the atmosphere was relaxed and it's a nice part of the country, I'd be looking for the same in an anesthetia program, it doesn't have to be stellar, just a place where I can get a solid education, plus I'm very self motivated, so I feel if I'm lacking in something I can self-correct. Although I very much like IR, and is pretty much the only reason I did radiology, there are a few things I dislike about it which have been driving me nuts, not the least of which is the persistent (often losing) turf battles between surgeons and cards and rads (even anesthetia with regards to pain medicine, though to be honest to me that's is theoretical b/c I have not heard much about it), and frankly I don't want to spend my carreer fighting them off, that's not why I went into medicine, and the thought of it really bums me out. I know anesthetia has it's own share of problems, namely, CRNAs and d%$^ surgeons, but in reality, is a nurse really ever going to take over a doctor's job, sure they can do the lap choles, appy, but what about the big whack surge onc, neuro, cards cases, not to mention SICU. And surgeons can be *****%$%$ all they want, ultimately, no anesthetia = no surgery. And though IR is becoming more clinical with regards to admitting patients, outpatient clinics, etc., unless the training paradigm changes I'm not sure if they will ever be clinicians. And lately I've been realizing that I miss patients, like I said I went into rads hoping to do IR, and felt that 4 years w/o much patient interaction is ok, it does not seem to be, I didn't go to med school to sit in a dark room dictating cases. And anesthetia always appealed to me, like I mentioned in my OP, pain management and critical care especially, and being handy with ETT is always nice. I have talked some anesthesia friends, and I have a few friends who have been attendings for a couple of years who really enjoy it. So I'm pretty set on it, I feel like I've given it a lot of thought and feel l am making the right decision. To answer some of the questions you posed, I will be doing the PGY-3 in rads, where I do get some good IR exposure, perhaps I may have an epipheny and change my mind and fall in love with IR all over again, but if not, I am planning on applying for advanced positions both through ERAS and outside the match for CA1 positions, ??maybe look at resident swap, but not sure if I want to waste the money. All I know is that diagnostic rads is not an option for me, and I guess part of the appeal of applying to rads, was that switching out of it into a different field would be "easier", compared to switching into it, say from surgery, because it would be (erroneously, from personal experience way less down time in rads then IM) viewed as me switching from a low intensity specialty to a high intensity one.

 

[G-Man82]

Could someone comment on the fact that I have no access to an anesthetia letter, other then the longshot of my attending in the SICU from 2 years ago.

Thanks.

Not sure if I'm the best to answer this, but do you really need a letter from an Anesthesiologist if you're switching from the middle of a different residency? I'm not even sure how you would do that because it would be difficult for you to do an elective rotation with Anesthesiology as a Radiology resident. Have you tried getting advice from the Anesthesia faculty at your hospital? Anesthesiology programs are usually getting inquiries from other Attendings or Residents who want to switch, so he/she might know better. Perhaps, since you already know the system, the PD there might consider you for their own program.

 

[Jeff05]

stay and finish rads. instant gratification of helping a patient? how did you discover that during a radiology residency?
finish rads. do interventional if you want.

 

[chocomorsel]

You seem pretty well burned out, but to be honest, it does not look like you really want to switch to anesthesia, you just want this c*** ( which residency in any field is) to be done. You have just ONE year to go and you will be out - and you can pursue fellowship in IR and be almost a surgeon 😉)))

The tough battles you are experiencing now may start to seem heaven once you get to be a CA-1 ( I do not suppose you have to repeat intern year).

And remember - it is just residency - and it is s***y for every specialty. Real life is different, however being attending anesthesiologist does not mean you won't have any turf battles. And you may hate them even more.


As for Taurus remarks - keep in mind that what he has said is not only pertinent to CRNA vs MD battle. You will have nurses on your anesthesia back all the time - always, for the rest of your carrier if you switch and turf battles are the everyday reality ( OK, I am a bit exaggerating))) in anesthesiology. Being an IR is a totally different place on a ladder from the nurses point of view.
And hospital's as well.

Consider this, since your the main reason you are tired by your own specialty( I would still say - residency) is not the specialty itself.

Ok, re-read the post. The OP has THREE years to go as he's getting ready to start his PGY3 in July. Last I checked, rads was a 5 year program. He still has plenty of time to switch if he wants.
OP, if you are ready to switch, switch. Don't waste any more time in a place you don't want to be in. And just an FYI, Oklahoma had some recent openings due to program expansion and don't know whether they are filled yet, but you could always try. And there are always posts here from different programs with openings. Good luck, I bet you will do just fine with your stats although you might have to sit out a year or do another year of rads while waiting.

 

[maceo]

are you insane.. finish radiology and do work from home.. anesthesia is really not that cush and its hard ass work

 

[sebsvenmdc]

I switched from general surgery. My entire residency application was geared to general surgery. However, I got to know the anesthesiology attendings and residents at the university I was at. Bottom line: they ended up signing me out of the match with no letters, personal statement, etc.

MDs will never be replaced by CRNAs. The acuity in hospitals is too high nowadays and the complication rate would skyrocket if that happened. This is my opinion.

However, anesthesiology is one of the most stressful specialties in medicine. I hope you realize this before you switch, because most medical students don't.

Dream: I've been in the OR for a few months. Not much, I know. I haven't seen any codes yet, but I've seen things get pretty stressful for anesthesiologists...struggling to intubate w/ sats in the 70s, pts w/ "crap hemodynamics" req. intraop. TEE, etc. For the most part, you would agree that it's not that stressful minus the emergencies? I'm just curious as to whether your statement about the misinformed med student is directed towards:
1) anesthesiology having a more stressful baseline (all the time)
or
2) lack of knowledge of the crises that arise

I have to admit, when things have gotten nerve-wracking, my fight-or-flight has gone mostly flight and I've wanted to run out of the OR! I know that's a terrible thing to say, but I chastise myself for it and realize I need to stay the freak calm and realize it's a part of the job description!

 

[switch2010]

I'm not considering switching into anesthesia b/c I think it is "easy", and after several years in residency I have no delusions about the stress of any medical field, nor do most radiologist "work from home", mostly teleradiologists that are almost universally frowned upon by hospital based rads and PP groups and are almost single handedly destroying the field. Radiology residency while fascinating is no less grueling, call is not q1month like most people believe, most residents work >70 hrs a week, with minimal downtime, especially on call where you are the only radiologist in the whole hospital, (not the reason I'm switching, just wanted to correct some misconceptions).

The reasons I'm switching are simple 1)I have a particular accumen toward things anesthetia does, i.e. managing the airway, acute respiratory issues, pharmacology and physiology and enjoy doing those things 2)I enjoy the personalities that tend to go into anesthetia 3)anesthetia is critical to patient management without the hang-up of having to follow people's diabetes and htn for 20+ years
4)I like the sphincter tightening emergencies that can come up during any case/procedure/SICU call night; something I did not know about myself until I did an internship in a county hospital where there are only 2 interns on call overnight with minimal supervision and lots of codes/acute MIs.

part of the reason I went into rads, was that I had an outstanding mentor, and while in school, pretty much was blinded to the major negative of radiology: minimal interaction with patients. I miss it. I believe the attrition rate for radiology is quite low, and most people who leave, do so for the same reason I am. There just isn't enough time for soul searching in med school, trying to get the best grades to get into the best residency in the most competitive fields, doesn't leave much time for self-reflection.

I believe anesthesia will provide a lot of what I want out of being a doctor.

If anyone has further opinions I welcome them, this has been quite informative. thanks again for the replies.

 

[Surfer]

stay in rads. work sucks. rads will give you the best bang for your work buck. i love my job. i really do. but its just that... a JOB. there are a lot of things i'd rather spend my fridays, saturdays, and sundays doing. as a radiologist, you will work 40 hours per week. and you will make bank. residency sucks no matter what your specialty is. just hang in there, it will get better. the grass is always greener...

 

[InductionAgent]

Stay in radiology. I agree with the above posters that you can get your patient interaction by doing IR. Anesthesiology has minimal patient interaction, and few of them seem to fully appreciate what we do. It's fine for me, because I will admit that I do not especially enjoy patient interaction.

 

[switch2010]

thanks for the replies, they were helpful, I think I am proceeding with the switch, it feels right.

 

[aubergine]

Hey switch,

Just another 0.02. I'm currently a PGY-1 who switched into Anesthesia this year. I switched from a field that people generally think is "easier" than Anesthesia, and so I got a lot of discouragement from friends and residents. However, at the end of the day, you really have to do what you feel is right. Whatever you pick you'll do for years, and you are right that med school does not really give you enough time to make these difficult decisions.

Also, I was really fortunate and was able to switch without a formal letter from an Anesthesiologist. I ended up focusing on letters from ICU docs I had worked with. Of course, this is anectodal, but I just wanted you to know that it is possible.

Of course, take all of this with a grain of salt - I haven't started Anesthesia yet, so I can't speak to whether I made the right decision. I do know that I'm more excited about Anesthesia than I ever was with my current residency program. I'm definitely happy that I took the risk and submitted my applications. FYI, I went through ERAS and looked for spots outside the match. Find a Resident can be helpful to at least keep an eye on what's open for spots outside the match.

Best of luck to you.

 

[Licoricestick]

Dream: I've been in the OR for a few months. Not much, I know. I haven't seen any codes yet, but I've seen things get pretty stressful for anesthesiologists...struggling to intubate w/ sats in the 70s, pts w/ "crap hemodynamics" req. intraop. TEE, etc. For the most part, you would agree that it's not that stressful minus the emergencies? I'm just curious as to whether your statement about the misinformed med student is directed towards:
1) anesthesiology having a more stressful baseline (all the time)
or
2) lack of knowledge of the crises that arise

I have to admit, when things have gotten nerve-wracking, my fight-or-flight has gone mostly flight and I've wanted to run out of the OR! I know that's a terrible thing to say, but I chastise myself for it and realize I need to stay the freak calm and realize it's a part of the job description!

The stress isn't about the crises themselves - it's the potential for them, preventing them and just the nature of what we do.
In what other job is it normal to take a fit and healthy 25yo and render them unconscious, apnoeic and hypotensive within 30min (or less) of meeting them?

Sure I had the potential to do harm to patients as an intern and RMO, and a really remote possibility that I could kill someone due to that, but as an anaesthetist almost every interaction I have with a patient in theatre (and quite a number in remote anaesthetising locations) has the potential to kill them or have serious morbidity.

That's the stress - the unknown. No matter how good we are, no matter how careful, there are always things that can go wrong, both in and out of our control. There is no such thing as a "routine anaesthetic".