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[deleted857303]

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[evilbooyaa]

I don't see how GAS is a combination of EM and IM, or a 'compromise'.

Yeah there's airways like in EM.
Yeah there's knowing human physiology like EM and IM, and side effects of medications like both.

Anesthesiologists can do the following things (most may require fellowship training): Run anesthesia in an OR (Adult), Run anesthesia in an OR (Peds/Cards likely = fellowship), Run an ICU (with CCM training), Do pain management/intereventional pain (with fellowship), Do epidurals as an OB anesthesiologist. There are probably more things that they can do in the medical establishment, but that's at least part of it.

 

[pericardium]

EM is quite a bit different because it requires workup of undifferentiated patients. Procedure wise, there's definitely some overlap

 

[LyMed]

I am interested in the medicine of both EM and IM (particularly EM), but dislike rounding and having an erratic schedule among other things. Many have suggested I look into anesthesiology, stating that it is a great middle ground or "compromise" between these two specialties. I have almost no experience in the field myself, and often think of anesthesiologists as being tied down to cases in the OR all day.

I was wondering what your thoughts were on this?

edit-wording

I don't see the relation, however don't let that stop you from exploring the field. Most people have positive feelings about anesthesiology, and you might also.

 

[MSTP18]

The one place where I see them as similar (besides airway management) is that they both have very short term patient relationships (on the scale of hours - this is assuming you're not doing ICU or pain management) and thus very shift oriented where no one is asking for your input on anyone if you're not working.

That being said, from my time on anesthesia, you are correct that if you are working surgeries you will be locked in to one or two ORs for the shift, and depending on the cases, will interact with potentially as few as 1 or 2 patients in a day. Definitely, wouldn't have the constant action and bouncing between patients that EM will have.

 

[bashwell]

I am interested in the medicine of both EM and IM (particularly EM), but dislike rounding and having an erratic schedule among other things. Many have suggested I look into anesthesiology, stating that it is a great middle ground or "compromise" between these two specialties. I have almost no experience in the field myself, and often think of anesthesiologists as being tied down to cases in the OR all day.

I was wondering what your thoughts were on this?

edit-wording

EM is all about "erratic schedule." Not only in terms of working (even as an attending) nights, weekends, and holidays, but also in terms of possible work flow (you don't necessarily know how few or many people will present in the ED at any time), undifferentiated patients (you don't know who will walk through the door), juggling several patients at a time, waiting for lab or imaging results on your patients, calling different specialties to come and see a patient, or to admit them, etc. Not to mention the whole "fish bowl" aspect of EM can be intimidating or stressful for some people. It's like being a waiter or waitress at a busy restaurant. Some people do very well in that kind situation, others not so much.

 

[bashwell]

I am interested in the medicine of both EM and IM (particularly EM), but dislike rounding and having an erratic schedule among other things. Many have suggested I look into anesthesiology, stating that it is a great middle ground or "compromise" between these two specialties. I have almost no experience in the field myself, and often think of anesthesiologists as being tied down to cases in the OR all day.

I was wondering what your thoughts were on this?

edit-wording

Anesthesiologists do pre-op evaluations on some patients, they have to hand off patients in the PACU after their surgery, among several other duties in and around the hospital, such as if you do OB anesthesia, but for the most part they spend their time in the OR. In addition, anesthesiologists are the leaders in terms of making sure all the surgeries in all the ORs of their hospital are running on time, moving efficiently, etc., so they aren't necessarily just stool sitters. The future seems to be increasingly headed towards more of a perioperative role too. For example, it's possible as an attending anesthesiologist you will be supervising CRNAs (at 1:2 or greater), thus covering multiple rooms, rather than sitting your own cases from start to finish. That could be good or bad depending on how you look at it. Anesthesiologists don't always know when the last case of the day will end though, for example if get cases added on, or moved around, so you have to be okay with that -- this could be seen as "erratic". And there can sometimes be respect issues for anesthesiologists, you have to be the type of person who doesn't let that get to you.

 

[JPSmyth]

In the anesth forum on here they make it seem like AMCs are taking over the entire country and there are going to be no good positions left in 10 years. Maybe this is a severe over exaggeration but I really liked shadowing in anesthesia but the outlook is scaring me away a bit

 

[bashwell]

In the anesth forum on here they make it seem like AMCs are taking over the entire country and there are going to be no good positions left in 10 years. Maybe this is a severe over exaggeration but I really liked shadowing in anesthesia but the outlook is scaring me away a bit

Yeah, anesthesia itself is a really cool specialty (with all the cool physiology and pathophysiology, especially cardiovascular and pulmonary, the amazing and immediate pharmacology, the airway management, the procedures, the resus aspects, and much more). However, the politics and business side around it are real and legitimate concerns.

It's true AMCs are taking over, especially on the East coast and it sounds like the South. From what I can tell, a lot of the West coast and a lot but not all of the Midwest are fine for now, but there's no guarantee for the future which is the fear of many anesthesiologists (that's why if you go to the anesthesia forum you'll hear some of them even on the West coast and Midwest say things like "we just want to make hay while the sun is still shining" since no one knows what the future holds). Blade is level-headed and has said much more about all this if anyone wants to know more about all this. Also TempleChariman recently said similar things in his thread which is also on the anesthesia forum and very helpful to read through.

There are also CRNA issues. The AANA (American Association of Nurse Anesthestists) is very militant (they keep saying how they'll provide anesthesia cheaper and better than anesthesiologists), but the ASA (which represents anesthesiologists) doesn't fight back anywhere near as well. The nurse anesthestists are just better organized and more aggressive than anesthesiologists who tend to be more relaxed and chill people which is good for the culture of anesthesia but bad when it comes to dealing with the AANA and CRNAs in general. AAs (anesthesia assistants) would be a better option than CRNAs since they don't have separate governance like CRNAs and nurses in general do from physicians, but there aren't anywhere near enough AAs to staff groups across the nation, CRNAs are far more in number and influence around the nation. There are a lot of states that also allow CRNAs to practice completely independently. And it looks like the future is only going to be more and more ACT (anesthesia care team) models for anesthesia, with an anesthesiologist supervising a team of CRNAs at a ratio of 1:2 or likely higher, because it makes financial sense for most groups and hospitals to operate this way. But that means as an attending you probably won't be able to 100% sit your own cases. You'll be more of a manager of CRNAs.

But don't take my word for it! That's what other attending anesthesiologists are saying too. See articles by Richard Novak (Stanford) "10 Trends for the Future of Anesthesiology" and Karen Sibert (Cedars-Sinai) "Medical students: What no one tells you about anesthesiology".

All that said, anesthesiology could be a good specialty for the right person, but just go into it (like any other specialty) with eyes wide open.