Drop rads for anesthesiology?

[JJArms22]

I'm a 4th year and have been set on radiology for a while now, but recently I've become unsure about it. I'm on an elective right now, and while some aspects are interesting, I sometimes get these moments where I tell myself "I can't do this for the rest of my life." On paper, rads has so many positives, but when I'm actually there shadowing and trying to be engaged, I find it lackluster and dull. I want to do more procedures, not just sit all day reading CT after CT. I feel like I'd get burned out doing that really fast. Now I'm curious about anesthesiology since procedures seem to be the bread and butter of the field. I'm not sure if I should really look into it or not.

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[AdmiralChz]

Now I'm curious about anesthesiology since procedures seem to be the bread and butter of the field.

So, you have an interest in Anesthesiology because... we do a lot of procedures?

That's true, but there's a LOT more to our job than that. You should schedule a quick rotation if you want some exposure, as what we do goes beyond blocks, lines and intubations. A thorough understanding of physiology, pathology, pharmacology and surgical procedures is essential for your daily practice.

IR is procedural-based to a higher degree without as much of an interpretation component (on the surface), have you investigated that?

But on the other hand if you really don't enjoy your daily work and can't get excited about a field exploring other things may be in order.

 

[JJArms22]

So, you have an interest in Anesthesiology because... we do a lot of procedures?

That's true, but there's a LOT more to our job than that. You should schedule a quick rotation if you want some exposure, as what we do goes beyond blocks, lines and intubations. A thorough understanding of physiology, pathology, pharmacology and surgical procedures is essential for your daily practice.

IR is procedural-based to a higher degree without as much of an interpretation component (on the surface), have you investigated that?

But on the other hand if you really don't enjoy your daily work and can't get excited about a field exploring other things may be in order.

It's not just the procedures. I do like physiology and pharmacology. I also like that most anesthesiologists are laid-back, and I feel like I'm pretty laid-back myself. There's a lot of upside to anesthesiology: good pay, no BS paperwork/charting/rounding, brief patient interaction, smooth sailing 90% of time (I think), and of course, cool procedures. I'll admit, Idk a lot about the field other than what I superficially mentioned. Also, 4 years of residency beats 6. I have considered IR, but I don't know enough about it to say I'm wiling to stick through 5 years to possibly not even get into a fellowship.

 

[sevoflurane]

It's not just the procedures. I do like physiology and pharmacology. I also like that most anesthesiologists are laid-back, and I feel like I'm pretty laid-back myself. There's a lot of upside to anesthesiology: good pay, no BS paperwork/charting/rounding, brief patient interaction, smooth sailing 90% of time (I think), and of course, cool procedures. I'll admit, Idk a lot about the field other than what I superficially mentioned. Also, 4 years of residency beats 6. I have considered IR, but I don't know enough about it to say I'm wiling to stick through 5 years to possibly not even get into a fellowship.

I was in the same position as yourself about 15 years ago. Did 2 Rads rotations (one was IR), had the letters, etc. Ultimately I choose anesthesia during the heyday of IR. Glad I went with gas... but IR can and is still very lucrative and fun in some ways... but the guys i work with are busy.... super busy at all times of the night and they always work with the same people (same staff and deal with a lot of neurosurgeons- for better or worse).

Anesthesia is def. chill with the day in and out of it. You work with lots of diff. teams- peds, transplant, cardiac, regional, ob, trauma, etc. Heck did a 41 y/o Liver, lung, kidney harvest on call a couple days ago form 1:30-3 am and then vent off after cross clamp. Had the UCSF superstars there and the interaction and feeling of what we were doing (for the donor and recipients) was very real: Meaningful experience for all involved.

You know what is funny?

The older I get in this career choice, the more I appreciate the specialty and what we do in it.

Anesthesia is a place where you do a "days" work... but sometimes a "days" work will get you home saying damn...

It feels good- yet - you only you really appreciates the depth of that feeling.

What has been hurting the specialty is the same cancer that has been hurting many of the other specialties and when you get down to it:

Anesthesia is pretty awesome place to be and it will give back to you throughout your career if you take it one patient at a time and really have a passion for it. Unfortunately it's easy to get sidelined by other aspects of anesthesia as a career choice (greedy partners, military CRNAs, bad personalities, location, income and lifestyle). The key is to keep those issues in check and to rise above them.

A huge plus is that as you approach retirement, you can customize your job to meet your needs. Very few specialties will allow you to do this.

Was talking to a superpod recently. His thoughts is that he was jealous of us and our ability to clock out. He goes on a 2 week vacation and still gets called about serious issues almost daily. He's on to something there.

Good luck... it's not an easy decision.

 

[Aurum]

I'm in the exact opposite position as the OP. Was all geared up to apply for gas since the start of MS3, but didn't enjoy my month long elective as much as I thought I would. Now I'm halfway into my rads elective and enjoying it a ton. I find the variety of procedures that the diagnostic radiologists at my institution do fascinating and arguably more interesting than the intubations/line placements that are the bread and butter of gas (with the exception of TEE/blocks/pain procedures which are dope). I'd say a lot of the upsides you mention for gas seem to apply to rads as well in my admittedly limited understanding of both.

While most anesthesiologists may appear chill, they lean somewhat more intense than the average diagnostic radiologist as the field demands a high degree of vigilance and quick action. Most of my classmates going into gas also strongly considered surgery to give you an idea of the spectrum of personalities. Many rads (and gas!) residents describe shadowing in the field as watching someone else play a video game (i.e. boring and difficult to engage with), so keep that in mind as you progress in either rotation. Regardless, try to get a quick rotation in and see whether or not your mental picture of gas fits what anesthesiologists actually do.

 

[deleted171991]

Most of my classmates going into gas also strongly considered surgery to give you an idea of the spectrum of personalities.

I cannot emphasize this enough. If one would never consider going into surgery (just because of the people and operating itself, not because of the lifestyle, clinic etc.), one should never consider anesthesiology either. Many of the people who are unhappy in anesthesiology would have been much better suited for a non-surgical specialty, and the opposite.

For radiology, I cannot imagine anybody who doesn't adore anatomy doing it well. Same for anesthesiology and physiology.

 

[dmk5n]

Have a look at Interventional Pain too. Some aspects of anesthesia, a lot of rads, PMR, and some psyche too.

 

[nimbus]

From what my med school buddy tells me, PP radiology sounds a lot more demanding than MD only anesthesia. He reads a HIGH volume of films literally nonstop with no time to chill. He says it's literally like drinking from a firehose. I never feel that way.

 

[deleted171991]

From what my med school buddy tells me, PP radiology sounds a lot more demanding than MD only anesthesia. He reads a HIGH volume of films literally nonstop with no time to chill. He says it's literally like drinking from a firehose. I never feel that way.

Because you don't work in a high-volume ACT practice, which is the future of anesthesia in this country, and feels exactly like drinking from a firehose.

 

[dhb]

You know what is funny?

The older I get in this career choice, the more I appreciate the specialty and what we do in it.

Funny, i find it the other way around.

 

[anbuitachi]

you should do IR. there are a lot of integrated IR programs now. They do so many procedures, it makes my life miserable being in the basement getting irradiated w them all the time

 

[sevoflurane]

Funny, i find it the other way around.

Maybe you should have done something different.

 

[dhb]

Maybe you should have done something different.

I don't know, you tell me do you think you are making a valuable contribution to people's health when you are doing arthroplasties for BMIs >35, back fusions, CABG in patients with little functional capacities, weight loss surgeries...?

 

[deleted171991]

I don't know, you tell me do you think you are making a valuable contribution to people's health when you are doing arthroplasties for BMIs >35, back fusions, CABG in patients with little functional capacities, weight loss surgeries...?

Now you're not thinking like a surgeon, as any good anesthesiologist should.

If surgeons went to prison for every borderline fraudulent unethical thing they do (as in useless surgeries), there would be so many of them there that they would lobby for protected minority status. I find it funny when we are trying to push the fiduciary standard on financial advisors, but nobody holds surgeons responsible for not having the patients' best interests in mind.

 

[sevoflurane]

I don't know, you tell me do you think you are making a valuable contribution to people's health when you are doing arthroplasties for BMIs >35, back fusions, CABG in patients with little functional capacities, weight loss surgeries...?

Yeah... I am definitely making a valuable contribution.

Florid MR previously undiagnosed picked up by TEE, Left main occlusion after tavr picked up by anesthesia, ruptured AAA needing some serious help by anesthesia... 5 year old with a nasty distal radius fracture that gets some awesome regional (goes from crying to laughing)- yes done awake.

These are all very recent... and the list goes on and on.

As I said, anesthesia and what we do is and always will be an awesome specialty that NO ONE else can do.

Yes. We make a HUGE difference (and very often life and death- don't be fooled by thinking otherwise).

 

[sevoflurane]

The older I get, the more profound that statement becomes.

 

[nimbus]

Yeah... I am definitely making a valuable contribution.

Florid MR previously undiagnosed picked up by TEE, Left main occlusion after tavr picked up by anesthesia, ruptured AAA needing some serious help by anesthesia... 5 year old with a nasty distal radius fracture that gets some awesome regional (goes from crying to laughing)- yes done awake.

These are all very recent... and the list goes on and on.

As I said, anesthesia and what we do is and always will be an awesome specialty that NO ONE else can do.

Yes. We make a HUGE difference (and very often life and death- don't be fooled by thinking otherwise).

And if you work in a busy trauma center you literally get to save lives and go home a hero. Not just gangsters but upstanding citizens who've had random disaster strike them. Some days I'm not even doing it for the cash. You can make a profound difference working as part of a great team. Your moment to shine🙂

 

[sevoflurane]

And if you work in a busy trauma center you literally get to save lives and go home a hero. Not just gangsters but upstanding citizens who've had random disaster strike them. Some days I'm not even doing it for the cash. You can make a profound difference working as part of a great team. Your moment to shine🙂

Someone who gets it.
Feel you @nimbus ...

 

[GA8314]

Because you don't work in a high-volume ACT practice, which is the future of anesthesia in this country, and feels exactly like drinking from a firehose.

I miss sitting my own cases. I so them solo from time to time but mostly ACT. I put myself in our fastest Gen Surgeons room on Tuesday. To me, that is more chill than running 3 or 4 rooms, but I do plenty of that as well. It is more stressful and less professionally rewarding while more physically taxing, but also more lucrative I am sure. That said, I try very hard not to abuse the ACT model and add value to many encounters daily. We also do a lot of regional which helps that.

There is NO perfect anesthesia practice setting. And what may be very good for one, may not appeal to another. The absolute beauty of anesthesia is the diversity of practice settings. If you keep your skills, save early and often while times are good, then it will be a nice career given that you maintain a professional attitude, enthusiasm, and work ethic. If you do this is the practice setting of your choice, then you will do very well and be happier than most people in corporate America.

Just my 2 cents.

 

[deleted171991]

And if you work in a busy trauma center you literally get to save lives and go home a hero. Not just gangsters but upstanding citizens who've had random disaster strike them. Some days I'm not even doing it for the cash. You can make a profound difference working as part of a great team. Your moment to shine🙂

Funny. That's how I feel in a good ICU (not every day, but enough of them).

 

[dhb]

Yeah... I am definitely making a valuable contribution.

Florid MR previously undiagnosed picked up by TEE, Left main occlusion after tavr picked up by anesthesia, ruptured AAA needing some serious help by anesthesia... 5 year old with a nasty distal radius fracture that gets some awesome regional (goes from crying to laughing)- yes done awake.

These are all very recent... and the list goes on and on.

As I said, anesthesia and what we do is and always will be an awesome specialty that NO ONE else can do.

Yes. We make a HUGE difference (and very often life and death- don't be fooled by thinking otherwise).

Well you have an impact where there's room for it, i didn't say the whole job was meaningless but there is a large part of our practices that is not aimed at patients well being but at pumping money into the system whatever the outcome.

 

[Moose A Moose]

I miss sitting my own cases. I so them solo from time to time but mostly ACT. I put myself in our fastest Gen Surgeons room on Tuesday. To me, that is more chill than running 3 or 4 rooms, but I do plenty of that as well. It is more stressful and less professionally rewarding while more physically taxing, but also more lucrative I am sure. That said, I try very hard not to abuse the ACT model and add value to many encounters daily. We also do a lot of regional which helps that.

There is NO perfect anesthesia practice setting. And what may be very good for one, may not appeal to another. The absolute beauty of anesthesia is the diversity of practice settings. If you keep your skills, save early and often while times are good, then it will be a nice career given that you maintain a professional attitude, enthusiasm, and work ethic. If you do this is the practice setting of your choice, then you will do very well and be happier than most people in corporate America.

Just my 2 cents.

I won't have an opportunity to work with gas for a few months. What goes into the 3:1, 4:1, etc model? Things I read on here are pretty vague.

What are you doing as the anesthesiologist? Do you start/finish the case? Pop in room-to-room to say hi? Monitor vitals from another room akin to tele?

Would you mind giving me the break down versus sitting your own case start to finish? Appreciate it.

@FFP or anyone else feel free to chime in.

 

[Groove]

I'm a 4th year and have been set on radiology for a while now, but recently I've become unsure about it. I'm on an elective right now, and while some aspects are interesting, I sometimes get these moments where I tell myself "I can't do this for the rest of my life." On paper, rads has so many positives, but when I'm actually there shadowing and trying to be engaged, I find it lackluster and dull. I want to do more procedures, not just sit all day reading CT after CT. I feel like I'd get burned out doing that really fast. Now I'm curious about anesthesiology since procedures seem to be the bread and butter of the field. I'm not sure if I should really look into it or not.

Easy, do rads and then complete an interventional fellowship. Split your time between diagnostic/interventional once you get done. I know a lot of radiologists who do this and are very happy. Lots of short procedures with almost instant gratification. I think the grass is greener no matter what specialty you pick but I'll be honest... I'm a bit jealous of our radiologists and especially the IR guys (I'm EM). Great money, great schedule, low stress, excellent longevity.

 

[GA8314]

I won't have an opportunity to work with gas for a few months. What goes into the 3:1, 4:1, etc model? Things I read on here are pretty vague.

What are you doing as the anesthesiologist? Do you start/finish the case? Pop in room-to-room to say hi? Monitor vitals from another room akin to tele?

Would you mind giving me the break down versus sitting your own case start to finish? Appreciate it.

@FFP or anyone else feel free to chime in.

There are 7 components to qualify for Medical Direction:

• Performs a pre-anesthetic examination and evaluation;
• Prescribes the anesthesia plan;
• Personally participates in the most demanding procedures in the anesthesia plan, including induction and emergence;
• Ensures that any procedures in the anesthesia plan that he or she does not perform are performed by a qualified anesthetist;
• Monitors the course of anesthesia administration at frequent intervals;
• Remains physically present and available for immediate diagnosis and treatment of emergencies; and
• Provides indicated-post-anesthesia care.

So, if I am running 3-4 rooms with CRNA's, I'm seeing a lot of patients that day. I see them all. Do the history and brief, focused PE. I'm there, in the room to start/induce all GA cases except for MAC's (like in eye rooms) where we do not claim Medical Direction, even though we fulfill most of the 7 steps of direction anyway (see all patient, and care for them in recovery etc)....

Notice that "induction and emergence" is stated. I'm often not there during "extubation" but will be for difficult patients. Patients often emerge from anesthesia at different points (may be in PACU if pulled deep, or if LMA is pulled while patient still has some level of MAC on board). This is different from extubation of an endotracheal tube. Otherwise, to start a case, I'm either pushing induction drugs while CRNA tubes, OR I will have them push drugs while I tube.

I make "rounds" (and this is where we can ALL improve, and is also where ACT models are "abused"). "Monitors the course of anesthesia administration at frequent intervals" is vague. But, the best docs in an ACT model will "round" on their rooms. This can always be improved upon.

I am in the process of putting a list together for all of our CRNA's (our employees) of when we expect a call/text for things going on in the room. Typically, this is implied (major hemodynamic issues requiring frequent pressor support etc. and is likely mostly doc/CRNA dependent). We will have a universal list for our practice that I will be making, however.

I could give a lecture on missed opportunities in anesthesia. But, doing an ACT model is imperfect, but arguably a very safe way to go as there is always back up.

There are also benefits to an ACT model from a clinical perspective (I do way more blocks than if I sat my own room. I do way more advanced airway stuff (prepping a patient for awake FOI while rare, requires time and focus), as well as drawbacks. I always look for ways to add value, which is critical. This can be done via multiple initiatives.

I am lucky in that we do sit our own rooms from time to time, and as I've said it is more personally rewarding for me hands down. Nothing is black and white however, and as stated, there is some non-financial upside to ACT-medical direction.

I hope this helps.

 

[Twiggidy]

I'm a 4th year and have been set on radiology for a while now, but recently I've become unsure about it. I'm on an elective right now, and while some aspects are interesting, I sometimes get these moments where I tell myself "I can't do this for the rest of my life." On paper, rads has so many positives, but when I'm actually there shadowing and trying to be engaged, I find it lackluster and dull. I want to do more procedures, not just sit all day reading CT after CT. I feel like I'd get burned out doing that really fast. Now I'm curious about anesthesiology since procedures seem to be the bread and butter of the field. I'm not sure if I should really look into it or not.

Do IR? It's true that people will push you around in both anesthesia and radiology but less so in Rads and in IR you can be more of a boss. Read most threads on this forum, if it were up to me and I had read this forum I would've done Rads in a heartbeat. Anesthesia is cool but compared to Rads I think there's more negatives than positives.

 

[JJArms22]

Easy, do rads and then complete an interventional fellowship. Split your time between diagnostic/interventional once you get done. I know a lot of radiologists who do this and are very happy. Lots of short procedures with almost instant gratification. I think the grass is greener no matter what specialty you pick but I'll be honest... I'm a bit jealous of our radiologists and especially the IR guys (I'm EM). Great money, great schedule, low stress, excellent longevity.

Easy, do rads and then complete an interventional fellowship. Split your time between diagnostic/interventional once you get done. I know a lot of radiologists who do this and are very happy. Lots of short procedures with almost instant gratification. I think the grass is greener no matter what specialty you pick but I'll be honest... I'm a bit jealous of our radiologists and especially the IR guys (I'm EM). Great money, great schedule, low stress, excellent longevity.

Thanks, I'm leaning towards doing DR at places with ESIR. IR might be a good fit. Although I definitely wouldn't say it's low stress with a great schedule. From what I've seen and heard, it's supposedly the opposite.

 

[deleted171991]

Low stress, great schedule, good money... choose one.