Doubts in early CA-1 year?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

dmal

Full Member
Verified Member
Physician
15+ Year Member
Joined
Jan 8, 2010
Messages
74
Reaction score
49
I guess this is a spin off to an earlier thread "Not what I thought it would be..."

But I'm almost 1 month into my CA-1 year, and have really not been enjoying the work so far. I find my co-first year's raving about how much they love it, but I have the opposite feeling. I find myself dreading every morning coming to work.

I know I should probably give myself more time, but I'm starting to have a sinking feeling that anesthesiology will turn out to be a poor career choice for me. While I liked physio in med school, I'm finding now that I hate reading about cardiac/pulmonary physio, and more so,pharmacology. I had these doubts earlier during intern year, but ignored them as I was advised to at least start the residency and see how things go. So far, i'm not feeling it.

I'm wondering if these fears/feelings are 'normal' in early CA-1year. At what point do they become a red flag vs just being growing pains of going through anesthesia residency.
Members don't see this ad.
 
dmal said:
I guess this is a spin off to an earlier thread "Not what I thought it would be..."

But I'm almost 1 month into my CA-1 year, and have really not been enjoying the work so far. I find my co-first year's raving about how much they love it, but I have the opposite feeling. I find myself dreading every morning coming to work.

I know I should probably give myself more time, but I'm starting to have a sinking feeling that anesthesiology will turn out to be a poor career choice for me. While I liked physio in med school, I'm finding now that I hate reading about cardiac/pulmonary physio, and more so,pharmacology. I had these doubts earlier during intern year, but ignored them as I was advised to at least start the residency and see how things go. So far, i'm not feeling it.

I'm wondering if these fears/feelings are 'normal' in early CA-1year. At what point do they become a red flag vs just being growing pains of going through anesthesia residency.
Click to expand...

Early CA1 most residents are excited every time they do a new case or learn a new technique. They can't wait until tomorrow for the supraclavicular block. Everyone hates reading the material for the first 6 months. Of course they do, as it builds the foundation for their entire career. If you are dreading the cases and the "job" and it's not related to fears of hurting a patient or malignant staff, you should probably start looking for an exit strategy.
 
I might disagree a little with Il D on this one. I think the transition from intern year to CA1 is very, very stressful. First, you're like an intern all over again, doing something you know nothing about. Second, at many places you go from being treated like a real doctor, to being talked down to by your attendings, the surgeons, and the nurses. Third, every time something new comes up, it's the "first time" it happens, and so everything is stressful and potentially challenging. And all this in an environment where every screw-up is public and affects everyone else's schedule (or at least they perceive that it does). Where you're treated like a child in the sense that you're told when to eat and when to piss. And you're supposed to take some moral high-ground when someone yells at you or talks down to you.

In short, it can be a dramatic shift from what you were used to at the end of your intern year, and that can be very stressful. I and a lot of my classmates experienced pieces of the above and may have felt the way you feel now. Most of us got over it in 4-6 months. You get more confident about what you're doing, so you stress about it a lot less at night while preparing for cases, and that lower stress level allows you to do other stuff to enjoy your life. I'm trying to say that it gets a lot better.

In the meantime, maybe start to think about what it is you don't like about it, and be honest with yourself about what you're into, what kind of life you want to have, and what about your job is important to you. In time, you might either adjust to liking what you do, or come to find that you really don't. Either way, there's not much you can do right now (hiring a resident into another specialty mid-year is highly unusual), but at around the 6 month mark, the timing works out a little better to explore your options for an on-schedule July start someplace.

Good luck; this isn't easy.
 
Members don't see this ad :)
I wholeheartedly agree with chhoukal's post. The first few months of CA-1 year can be a very trying experience. Some people can find it to be more trying than internship itself.

At any rate, it takes time to switch to another residency anyway, so there is built-in time for self- and career-evaluation. To the OP: I wish you the best of luck in sorting this out. Just remember you are not the only one who feels this way right now.



cchoukal said:
I might disagree a little with Il D on this one. I think the transition from intern year to CA1 is very, very stressful. First, you're like an intern all over again, doing something you know nothing about. Second, at many places you go from being treated like a real doctor, to being talked down to by your attendings, the surgeons, and the nurses. Third, every time something new comes up, it's the "first time" it happens, and so everything is stressful and potentially challenging. And all this in an environment where every screw-up is public and affects everyone else's schedule (or at least they perceive that it does). Where you're treated like a child in the sense that you're told when to eat and when to piss. And you're supposed to take some moral high-ground when someone yells at you or talks down to you.

In short, it can be a dramatic shift from what you were used to at the end of your intern year, and that can be very stressful. I and a lot of my classmates experienced pieces of the above and may have felt the way you feel now. Most of us got over it in 4-6 months. You get more confident about what you're doing, so you stress about it a lot less at night while preparing for cases, and that lower stress level allows you to do other stuff to enjoy your life. I'm trying to say that it gets a lot better.

In the meantime, maybe start to think about what it is you don't like about it, and be honest with yourself about what you're into, what kind of life you want to have, and what about your job is important to you. In time, you might either adjust to liking what you do, or come to find that you really don't. Either way, there's not much you can do right now (hiring a resident into another specialty mid-year is highly unusual), but at around the 6 month mark, the timing works out a little better to explore your options for an on-schedule July start someplace.

Good luck; this isn't easy.
Click to expand...
 
Dmal, there is unquestionably a common phenomenon of anesthesiology residents being demoralized for the first 4-6 months, its like starting your morning jog going up a hill. There are multiple reasons for this...I can think of a couple random unorganized thoughts:
1) You might feel as though you have no control over your life, you are stuck in a room often with stand-offish surgeons and nurses who (in OR-subculture) need you to prove your worth to be treated like a human being. You cannot leave the room without a break, and no longer even have control over your bathroom schedule.

2) It is far easier for a new anesthesia resident to cause harm to the patient than an intern, the intern had a resident and an attending watching their every move. No major decision was made without deliberation. Now youre in an environment where things can go bad within seconds and can die within minutes. Your attending knows that and also knows in that situation you do not yet know what to do, how to handle it. Many academic attendings will demoralize you by treating you like a 5 year old. Some will lash out because of their incompetencies. It will all become obvious in about a year and a ahlf.

3) You have looked forward to this for the past couple years. Bad days as an intern youd tell yuorself how it will get better next year, just hang in there. Now you made it and found out its not the bed of roses you expected. Its residency. It sucks. Get over it, accept it, make the best of it, and leave. Keep your mouth shut, work hard, dont screw over your peers....you'll have the last laugh. Trust me.

4) The fact that you dont like coming to work in my mind is pretty reasonable for a resident. But not liking or having an interest in the subject matter is a REALLY bad sign. You have to decide whether youre one of those guys who hate anesthesia or medicine. If the latter, get over yourself, seriously...youre 5 years deep, just get through it. If the former, probably should quit sooner than later cause your just wasting time.
 
dmal..trust me we are in the same boat.
I am a CA-1 and 3 weeks into it I am having the same kinds of doubts. This reminds me alot of med school, where during 1st yr my classmates walked around with silly grins and went on and on about how much "fun" it was and how "happy" they were.
I later found out that 90% of them were FOS, and I think the same can be said for many of my ostensibly enthusiastic classmates.
But something had to initially draw us to anesthesia. We all went through the rigorous interview/match process to try to get into a very competitive specialty. We havent done anything similar to this for all of intern year and I think its natural to need at least several months of being immersed in it before we are reminded of why we chose this field.
At the end of the day, this is still a job. I can't say I dread going to work everyday, and what we're doing is pretty cool, but if I won the lottery and didnt have to make a living would I continue with residency? Not a chance.

Nevertheless, I can't see myself doing anything else in medicine or in life for that matter. At least stick with it through the end of the year, you owe it to yourself and your program that thought enough of you to match you.
 
It's humbling to go from being an intern who know the ins-and-outs of a hospital system to being a CA1 who gets IV fluid all over them because you don't know how to use a 3-way stopcock. It does get better, much better. My advice: be diligent, work hard, don't punch a clock, care about your patients, demonstrate a dedication to providing the best anesthetic you can. It'll get easier (as does waking up..as a fellow I now wake up around 4 am some days and it's pretty easy).
 
i dont know any 2nd year residents who are ecstatic. With that said, the majority of them wish they could be doing what you are doing, with your schedule (which is likely better than theirs), your freedom (quick path to independence in the OR), procedural skills, etc.

I was absolutely EXHAUSTED my first 3 months of CA1 year, even though I wasnt taking call, but once you get in the routine of planning for cases, setting up rooms, figuring out your attending preferences, then a lot of that stuff will become second nature and you will be able to relax a little.

The first 6 months of CA1 year are the most stressful time in your medical career (perhaps a close second to your first week as an attending), dont let things that happen today affect your future.
 
dmal said:
I guess this is a spin off to an earlier thread "Not what I thought it would be..."

But I'm almost 1 month into my CA-1 year, and have really not been enjoying the work so far. I find my co-first year's raving about how much they love it, but I have the opposite feeling. I find myself dreading every morning coming to work.

I know I should probably give myself more time, but I'm starting to have a sinking feeling that anesthesiology will turn out to be a poor career choice for me. While I liked physio in med school, I'm finding now that I hate reading about cardiac/pulmonary physio, and more so,pharmacology. I had these doubts earlier during intern year, but ignored them as I was advised to at least start the residency and see how things go. So far, i'm not feeling it.

I'm wondering if these fears/feelings are 'normal' in early CA-1year. At what point do they become a red flag vs just being growing pains of going through anesthesia residency.
Click to expand...

Everything everyone has said, positive or negative, is true, but the bottom line is it is too early to know how you will feel about this career. Give it some time. If nothing changes after 6 months or so and you still hate it, it's probably a good idea to check out. People spend entire residencies doing something they don't like, only to switch after they finish. Losing one year is nothing, and you'll still learn some worthwhile stuff.
 
dmal said:
I guess this is a spin off to an earlier thread "Not what I thought it would be..."

But I'm almost 1 month into my CA-1 year, and have really not been enjoying the work so far. I find my co-first year's raving about how much they love it, but I have the opposite feeling. I find myself dreading every morning coming to work.

I know I should probably give myself more time, but I'm starting to have a sinking feeling that anesthesiology will turn out to be a poor career choice for me. While I liked physio in med school, I'm finding now that I hate reading about cardiac/pulmonary physio, and more so,pharmacology. I had these doubts earlier during intern year, but ignored them as I was advised to at least start the residency and see how things go. So far, i'm not feeling it.

I'm wondering if these fears/feelings are 'normal' in early CA-1year. At what point do they become a red flag vs just being growing pains of going through anesthesia residency.
Click to expand...

It is way too early to have any red flags - most of what you are experiencing is normal. Reading physiology/pharmacology after a very stressful day is not easy - especially all the basics, which you seem to forget the moment your head hits the pillow.
A lot of the attendings expect you to know everything as if you are a CA-3, not a CA-1. There is a lot of stress of not knowing it, being clumsy at procedural part and forgetting to set up the airway cart with that exact tape the attending you are working with today prefers.
Separate every day what was the most frustrating and annoying. Think about it and look what YOU can do better. Do you know what they expect from you? If it is confusing - talk to your mentor.
And do not panic - it will settle as you gain more confidence in yourself and as you get better.
 
dmal, I was right there with you last year at this time. I would sit in our am lectures and dread each minute going by, knowing that I would have to take another pt to the OR soon. I was stressed out every day, and just miserable in general. Now, a year later, I've become more comfortable with what I'm doing in the OR, and feel like I can handle most things that arise. Now I can look at things with some perspective, and remember why I chose anesthesia in the first place. Just hang in there, it gets better.
 
I would look into jumping ship. You will have to finish this year anyway. Its not a bad idea to explore your options in case your views of the OR grind don't change. I don't think that your co-residents are as stoked on the gas grindy'ness as they let on. More than likely they are faking their enthusiasm to impress nerdy attendings and their upper level joeys. I suggest that even if you don't love the work, at least fake it like the other CA 1 nubez so that your attendings and upper levels don't become wise to your disinterest.
 
Last edited:
Members don't see this ad :)
dmal said:
I guess this is a spin off to an earlier thread "Not what I thought it would be..."

But I'm almost 1 month into my CA-1 year, and have really not been enjoying the work so far. I find my co-first year's raving about how much they love it, but I have the opposite feeling. I find myself dreading every morning coming to work.

I know I should probably give myself more time, but I'm starting to have a sinking feeling that anesthesiology will turn out to be a poor career choice for me. While I liked physio in med school, I'm finding now that I hate reading about cardiac/pulmonary physio, and more so,pharmacology. I had these doubts earlier during intern year, but ignored them as I was advised to at least start the residency and see how things go. So far, i'm not feeling it.

I'm wondering if these fears/feelings are 'normal' in early CA-1year. At what point do they become a red flag vs just being growing pains of going through anesthesia residency.
Click to expand...


Listen, Im in my 5th year as an attending.. and guess what.. i DREAD coming to work.... but it has nothing to do with the patients. its more the environment.. the toxic healthcare environment. you have an OR filled with either post menopausal or pre menstrual women who hate the fact that they have to work and be the bread winner. actually these are women who wish they were born men. add in early mornings, passive aggressive crnas who think they are better than you (we dont have any), aggressive surgeons long hours, threat of lawsuits every single case. loose teeth and you have a recipe for "this job sucks". BUt when i was a first year I didnt hate it as much.. i always hated it but not as much. now I google search "how do i get the F*** out of anesthesia constantly"
 
maceo said:
you have an OR filled with either post menopausal or pre menstrual women who hate the fact that they have to work and be the bread winner. "
Click to expand...

Werent you there for the 60's. Its called empowerment.

How'd that work out for ya all. Prince charming, the ex quarteback, now does nothing but drink beer and on-line gamble.

I know what youre talking about. They talk about their husbands with such embarassment.

Think I'd like to stay home and do dishes and sweep floors, play with the kids, I'm not above that, sign me up.
 
I was exhausted and not especially happy the first 6 months of my CA1 year. It got better, but the next 2.5 years were still residency, and residency sucks, there's just no other way to put it.

But the first 6 months - it was many things
  • a few malignant attendings
  • the first month, a departing program director with get-outta-here-itis who somehow managed to be both uninvolved and malignant
  • two M&Ms (not my fault) and a near miss (my fault) ... realization that the attending safety net had more holes now
  • my general level of anesthesia ignorance (the learning curve is very steep), coupled with a lot of subtle and not-so-subtle pressure to do well on the AKT-1 and AKT-6
  • I'd just spent 3 years working independently as the doctor for a Marine infantry battalion, running a department of ~60 people, outranked by 2-3 people out of 1000 at any given time ... suddenly being the most junior, ignorant, and incompetent guy was an abrupt adjustment
  • mostly though it was two particular attendings upon whom I'd still like to bestow a swift kick to the gonads
  • oddly enough, I grew to like a 3rd attending who was pretty unpleasant early on - he was abrasive but fair

I got through it just by slogging through, working my ass off academically (in part to prove to the malignant ones I wasn't as stupid as they said I was), and enjoying the small victories. A nice anesthetic ... a happy patient awake alert and pain free in the PACU ... the slow realization that not only could I do the job, but that I'd be able to do it very well ...

But yes, the first 6 months were rough. I think anyone who says otherwise is unusually gifted or lying.


There are a lot of things I hated and continue to hate about MEDICINE and some of the PEOPLE that I have to put up with.
 
No matter what your decision it is going to be tough to change to another field in august. You could start looking over your resume, and even put together a personal statement to submit for the match again, since that is probably what takes the most time. That won't be able to be turned in until September, nd probably could wait until later, so you at least have another month to think about it.
Try to stick it out for a few more months and see if it improves as you get more comfortable in this new setting. Also, try to work hard and keep learning for both the skill set you can take forward if you switch, and the letters from your current program you will likely need if you make the change.
 
GREAT post.

I didn't run a battalion but I wasn't a spring chicken when I started residency and this made dealing with everything a little bit harder.

Oddly, I would also like to kick two of my old attendings in the balls as well.


pgg said:
I was exhausted and not especially happy the first 6 months of my CA1 year. It got better, but the next 2.5 years were still residency, and residency sucks, there's just no other way to put it.

But the first 6 months - it was many things
  • a few malignant attendings
  • the first month, a departing program director with get-outta-here-itis who somehow managed to be both uninvolved and malignant
  • two M&Ms (not my fault) and a near miss (my fault) ... realization that the attending safety net had more holes now
  • my general level of anesthesia ignorance (the learning curve is very steep), coupled with a lot of subtle and not-so-subtle pressure to do well on the AKT-1 and AKT-6
  • I'd just spent 3 years working independently as the doctor for a Marine infantry battalion, running a department of ~60 people, outranked by 2-3 people out of 1000 at any given time ... suddenly being the most junior, ignorant, and incompetent guy was an abrupt adjustment
  • mostly though it was two particular attendings upon whom I'd still like to bestow a swift kick to the gonads
  • oddly enough, I grew to like a 3rd attending who was pretty unpleasant early on - he was abrasive but fair

I got through it just by slogging through, working my ass off academically (in part to prove to the malignant ones I wasn't as stupid as they said I was), and enjoying the small victories. A nice anesthetic ... a happy patient awake alert and pain free in the PACU ... the slow realization that not only could I do the job, but that I'd be able to do it very well ...

But yes, the first 6 months were rough. I think anyone who says otherwise is unusually gifted or lying.


There are a lot of things I hated and continue to hate about MEDICINE and some of the PEOPLE that I have to put up with.
Click to expand...
 
Yeah, it is frustrating.

It takes training to provide good clinical care. It takes training to do good research. The problem with academic medicine, is that they will give ANY attending the license to "teach" and to evaluate residents, when most of them have not had any training on how to teach.


I look back on my CA-1 year, and I remember that I never actually taught how to do an anesthetic by anyone during my first month. I tried to come up with some basics (gleaned from senior residents), and I was yelled at for what I did wrong. Over time, I learned how to do things by trial and error, and trying my hardest to avoid being yelled at or criticized.

CA-1 is a tough year.


Arch Guillotti said:
GREAT post.

I didn't run a battalion but I wasn't a spring chicken when I started residency and this made dealing with everything a little bit harder.

Oddly, I would also like to kick two of my old attendings in the balls as well.
Click to expand...
 
all this make anesthesiology training sound a bit malignant.
 
igottaquestion said:
all this make anesthesiology training sound a bit malignant.
Click to expand...

It's all relative. All medical training is malignant to some degree. I think that generally the faster you can hurt somebody, the more stressful, unforgiving, and demanding the residency is going to be. On the whole anesthesia is probably less cruel than most fields, but that (incorrect) lifestyle reputation misleads some into thinking that residency isn't going to be a grind anyway. And all residencies suck.

Also, anesthesia is unique in that no other field has residents working alone with an attending nearly 100% of the time. (Maybe radiology? I don't know.) This makes it harder to have a good perspective of where you fall in comparison to your peers. When you spend so much time alone under the microscope, it's easy to build a distorted image of yourself.
 
igottaquestion said:
all this make anesthesiology training sound a bit malignant.
Click to expand...


You have to work for the good things in life. Anesthesia residency is not outside of this in the least bit.


You will work your arse off doing case after case straight for 24 hours (not being able to remember the first 4 cases of the day).
You will have scary moments (my first intraop death scared the crap out of me, even though he had both feet in the coffin when he came to the OR).
You will be demoralized (some attendings are just douchebags with low self esteem)
You will feel as if there is no more gas in the tank. That is normal when you sell your life away for so many years.

BUT in the end, you will become part of what I think is a facinating field in medicine.

Once done with residency, things get a lot better really fast.

Then you can look back and think to yourself that all that hard work was worth it.

You metamorphosize into someone else... someone better. The skills that you are tought are absolutely incredible and fun to utilize. IMHO. Anesthesia isn't just a job. It is a way of life. And I wouldn't trade it for the world. 😎
 
I'm a month into dating this girl. I'm not really into her. Everyone else raves about how hot she is, but not me. Before each date with her, I'm filled with dread. I guess I should give her more time. Maybe things with her would get better the more time I spend with her, even though I am bored by every new thing that she tells me about herself. If I could just get into a routine with her so everything becomes predictable, I could find a way to spend the rest of my life with her.

Or should I maximize my time with her, meet new people, make new connections, and when time is right, make an amicable separate and move one with my life? What do you think?
 
DrN2O said:
I'm a month into dating this girl. I'm not really into her. Everyone else raves about how hot she is, but not me. Before each date with her, I'm filled with dread. I guess I should give her more time. Maybe things with her would get better the more time I spend with her, even though I am bored by every new thing that she tells me about herself. If I could just get into a routine with her so everything becomes predictable, I could find a way to spend the rest of my life with her.

Or should I maximize my time with her, meet new people, make new connections, and when time is right, make an amicable separate and move one with my life? What do you think?
Click to expand...

Just stay long enough to hit it a couple of times and than start dating her sorority sister. Worked for me!:laugh:
 
IlDestriero said:
Just stay long enough to hit it a couple of times and than start dating her sorority sister. Worked for me!:laugh:
Click to expand...

No matter how much you hate her or anesthesia, one should always capitalize on opportunities to learn new techniques and hone one's skills.
 
igottaquestion said:
all this make anesthesiology training sound a bit malignant.
Click to expand...

Depends what one considers malignant. Not as malignant as surgery, but not as touchy-feely as peds or psych - for sure.

Strangely enough I do not consider my CA-1 year to be tough. Actually it was the easiest year of the residency. For me.
 
Last edited:
Ca-1s who say the love anesthesia the first month of CA-1 year are full of sh#t. It blows in the beginning. Once you know what the hell you're doing and have the confidence to stand up to surgeons, nurses, and your own attendings and people actually respect you, it starts to become fun and interesting. Bottom line. Otherwise it's just "A-line is taking too long, turnover is taking too long, you taped that ETT wrong, you spilled too much blood putting that line in, the patient laryngospasm'd cause you didn't pull the lma deep enough etc. etc. etc." The first six months blow. But I love it now.
 
michigangirl said:
Ca-1s who say the love anesthesia the first month of CA-1 year are full of sh#t. It blows in the beginning. Once you know what the hell you're doing and have the confidence to stand up to surgeons, nurses, and your own attendings and people actually respect you, it starts to become fun and interesting. Bottom line. Otherwise it's just "A-line is taking too long, turnover is taking too long, you taped that ETT wrong, you spilled too much blood putting that line in, the patient laryngospasm'd cause you didn't pull the lma deep enough etc. etc. etc." The first six months blow. But I love it now.
Click to expand...

I loved everything about anesthesia, especially the stark contrast to the intern year. I guess I'm a freak. Having a bunch of bright attendings vs insecure Dbags helps. We also had a week long boot camp with simulations, etc, it helps you prepare for dealing with disasters. One other thing that I did that really helped was read baby miller cover to cover a few months before CA1 started. You don't really understand everything yet, but it puts you in a great starting position.
 
IlDestriero said:
I loved everything about anesthesia....One other thing that I did that really helped was read baby miller cover to cover a few months before CA1 started.
Click to expand...


Absolutely. The new baby miller is an easy read with lots of good pics. I went from baby miller to big blue. Don't waste your time with big barash or big miller. Use these books and others for cross reference. Prepare for the writtens early and it wont' be a difficult test as time will be on your side. IMHO.
 
Then after all these years of school, med school, half a million dollar loans and years of suckass residency, followed by fellowship, and you finally become an attending, you find out these midlevel practitioners are trying to take your jobs away in the near future.

Imagine that.
 
Btw, CA2 year is actually more difficult than CA1 year, with a lot more responsibilities and much much sicker patients
 
reading physio and pharm stuff now sucks whereas in med school it was way better. but you want to know why? its because we had professors teaching us this stuff and giving us notes to learn the material. now as residents, we are given textbooks to read this stuff that is so dry and thick that we don't find that pleasure in studying.

the best thing to do is find alternative methods in learning. what works for you may not be that textbook. it could be another book? note cards? audio lectures? make the subject matter work for you.
 
Daredevil said:
Btw, CA2 year is actually more difficult than CA1 year, with a lot more responsibilities and much much sicker patients
Click to expand...

agree completely. CA-2 year is the most difficult year in anesthesiology residency.
 
You must log in or register to reply here.

Similar threads

D
How early is too early?
2
Replies
81
Views
6K
sevo00
S
O
What happens after 10-year cycle?
Replies
4
Views
1K
Dantrolene FC
D
R
  • Question Question
CA DOs: CME for license renewal?
Replies
1
Views
391
gasman11
G
A
Applying late to CT fellowship vs applying in CA-3 year?
Replies
5
Views
1K
DrN2O
D
coffeebythelake
Tragedy as 2 year old left in hot car dies, husband charged with 1st degree murder, wife is an anesthesiologist.
2
Replies
53
Views
6K
DaTruMD
D
Top