Easiest fields

[TRAMD]

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This reminds me of a line from a buddy of mine who is an anesthesiologist:

Anesthesia is mostly intense boredom interspersed with moments of shear panic

True 'dat!

 

[timtye78]

Awe come on guys - this will be fun! I'll start.

1. Dermatology - you can see exactly what the problem is. Plus treatment options include: 1) Topical steroids and 2) biopsy.

2. Somewhat surprising: Anesthesia. Its definitely easier to get into, especially compared with Derm. There aren't that many drugs to know but you do need to know when to use them. You have to be good at airways - that is not so much knowledge as it is skill. I think it requires a lot of skill but less knowledge.

After I recognized that you are a medical student, hence not experienced, my irritation with your glib summary of the field of anesthesia declined. I agree it is easier to get into than Derm, yet that gap is narrowing every year. "there aren't that many drugs to know" is a silly statement, since we are expected to know everything about 'our' drugs, plus every conceivable drug interaction, side effect profile, etch Combine that fact with a requisite knowledge of knowing about every drug a patient comes in on; the possible interactions with surgery and anesthesia, and administering every treatment ourselves as opposed to roaming the halls of the hospitals, stirring our Starbucks coffee while writing orders for nurses to do things. Knowledge base: Can you tell me about what every pressure waveform of the Swan-Ganz catheter demonstrates? Can you talk to me about normal and abnormal pressures in the RA, RV, PA, LA, or LV? What is your differential for a decreased mixed venous O2 saturation? Less knowledge required for Anesthesiologists? I doubt it.

At the same time Anesthesia requires a deep deep deep understanding of physiology, the alteration of that physiology under surgery and anesthetic, as I said before Pharm, Surgery, critical care medicine, ventilation, pulmonology, cardiology, etc etc

Someone commented that 'almost anyone can intubate, and anesthesiologists are good for the difficult airways' Sorry, what do you think what the success rate for airway securing in an emergency would be if ER docs and Anesthesiologists did not come to codes? How many med students or IM/FP/OB interns do you think you would give a shot before calling ER/Anes for an emergency airway?

I am not anti-med student at all. Obviously I was one as well. As medical students, you should feel free to come online here an discuss whatever you like, but I recommend caution about making sweeping statements about any field you are not an expert in. Someone might think that you might not know what you are talking about.

 

[deuist]

I'm not running around here saying that a Whipple is a piece of cake cause I saw one as a 3rd year med student (or any kind of surgery, for that matter).

I saw plenty of whipples during my surgery rotation. Apparently, you run your hands through the small bowel for about 8 hours, scream at the resident for a while, make a few cuts, and then the pancreas magically comes out. Next, you sew up the patient and then wait for him to get septic over the course of the next week or two. Seems perfectly simple to me. Maybe the OP should consider a career in general surgery. If you take to doing only whipples, that's what, only one operation a day? Any ***** can handle that kind of easy lifestyle.

 

[jpro]

I would say Family Medicine in an institutional setting, or in a group with other doctors (Not family medicine in a rural setting)
You can probably handle 99% of the patients straight out of med school.
If you want, you can go get more knowledge in procedures and ob-gyn.
If you don't want to deal with it, ship it off.

When I did FM the residents and attendings just looked up www.fpnotebook.com for EVERYTHING. I could do this as a third year. I'm sure they were the exception. BTW, when I told them what field I was going into they thought I had sold out.

 

[DarthNeurology]

That actually would be the opposite of the conventional wisdom. Most people can intubate; there are some more difficult ones, including fiberoptics, which are much more challenging and really require practice. Many of the regional blocks require a fair bit of skill, skills that aren't taught very well in other fields.

However, most anesthesiologists are excellent critical care physicians which requires a huge database of knowledge. I was perfectly comfortable with the SICU rounds run by anesthesia attendings; they knew their stuff, AND could do procedures.

SICU rounds run by an anesthesiologist? I had no idea that anesthesiologists could stand in for a critical care attending or a surgeon who specialized into surgical critical care, . . . i.e. Pulmonary/Critical Care people learn a lot about vents, ID, and I wouldn't expect that to be part of the training of anesthesiologists! (I.e. patients with ARDS on a ventilator usually aren't going to be surgical candidates, . . . and so how would an anesthesiologist obtain experience outside of a SICU rotation in residency?) The pulmonary/Critical Care attendings I have seen manage surgical patients knew a lot about pulmonary processes because they really specialized in that stuff, did bronchs etc, . . . and likewise the Surgery attendings in the SICU had great knowledge about how to manage surgical residents, especially their ability to detect subtle signs that a patient needed adjustments in management or when to go back to OR decisions made in conjunction with reading their own CTs. I guess I also like the other poster i am ignorant about the training that anesthesiology residents receive as I thought mostly it involved intraoperative monitoring during surgery? . . . upon googling it , it appears that there is a critical care fellowship for anesthesiologists after residency, maybe that is what is required for an anesthesiologist to work as a sicu attending?

 

[OldPsychDoc]

Some of the specialties where are MUCH less likely to have a patient die under your care than anesthesiology:
...
Psychiatry
...
Sure all of these specialties will have people die but not usually while they are in your physical presence and you are not usually the one that is expected to acutely prevent their death.
...

Sorry to be coming late to this thread, and I'm really not trying to make this into a micturition contest, but lets think about what the phrase "under your care" means.

This whole conversation brings back to mind the morning when I returned a page and heard "OPD, the Medical Examiner would like to talk to you about one of your patients." 😱

There is something about a patient suicide that just seems to intensify this idea that one is expected to be able to prevent a patient's death, even if not (hopefully) "in your physical presence". 🙁

 

[Winged Scapula]

SICU rounds run by an anesthesiologist? I had no idea that anesthesiologists could stand in for a critical care attending or a surgeon who specialized into surgical critical care, . . . i.e. Pulmonary/Critical Care people learn a lot about vents, ID, and I wouldn't expect that to be part of the training of anesthesiologists! (I.e. patients with ARDS on a ventilator usually aren't going to be surgical candidates, . . . and so how would an anesthesiologist obtain experience outside of a SICU rotation in residency?) The pulmonary/Critical Care attendings I have seen manage surgical patients knew a lot about pulmonary processes because they really specialized in that stuff, did bronchs etc, . . . and likewise the Surgery attendings in the SICU had great knowledge about how to manage surgical residents, especially their ability to detect subtle signs that a patient needed adjustments in management or when to go back to OR decisions made in conjunction with reading their own CTs. I guess I also like the other poster i am ignorant about the training that anesthesiology residents receive as I thought mostly it involved intraoperative monitoring during surgery?

Anesthesia residents spend a lot of time outside the OR as well...managing patients in the ICUs, learning pain management (both acute and chronic) and are generally excellent critical care/intensivists. Most of the anesthesiologists who were SICU attendings, IMHO, had also done Critical Care fellowships, furthering their base knowledge.

 

[fuzzyerin]

I can't believe no one suggested this path yet:

Do one year of internship. Get licensed. (This is even optional)

Quit medicine and hock pharmaceuticals. Tons of money, not bad hours, and you don't actually have to know anything - you just say what your company pays you to say.

 

[GasEmDee]

I guess I also like the other poster i am ignorant about the training that anesthesiology residents receive as I thought mostly it involved intraoperative monitoring during surgery? . . .

Intraoperative monitoring? Yes. A monkey can sit there and "monitor." My grandmother can sit there and "monitor." In fact, anyone can sit there and look at numbers. But an anesthesiologist can actually do something when things go wrong. Anesthesia, like critical care medicine, involves active resuscitation of the patient to maintain vital organ function in the face of physiologic insult.

Operating room anesthesia can be viewed as critical care on a single-patient basis. Of course the SICU is much broader in scope than the OR -- and the Medical ICU even broader than that. In an ICU setting, a patient is cared for over a longer time period, and that necessitates more attention to and understanding of the natural course of the disease. It also necessitates more attention to longer-term issues like nutrition, treatment of infection, and weaning of support. There are consult services to help with that. No intensivist goes it alone.

I personally think that an anesthesiologist whom has not received fellowship training in critical care should not be running an ICU of any sort. But for most of us who have done work in both the ICU and the OR, it is easy to see that the former is a natural extension of the latter.

 

[GasEmDee]

(I.e. patients with ARDS on a ventilator usually aren't going to be surgical candidates, . . .

First of all, ventilators and pulmonary mechanics are the bread and butter of anesthesiologists, and not that of surgeons. Wouldn't you think so?

Second, these patients aren't going to be candidates for elective procedures...but these patients -- and far sicker ones -- can be taken to the OR for urgent or emergent procedures. Patients in heart failure go to the OR, e.g., for CABG, ventricular assist devices, intra-aortic balloon pumps, or even non-cardiac cases. Patients in fulminant liver failure go to the OR -- e.g., for liver transplant. In fact, patients having multi-organ failure go to the OR for a multitude of reasons. Not every case is elective.

I remember vividly my first sick patient, one week into residency. She had a purulent, infected diabetic foot and was floridly septic, but she NEEDED that foot taken off. No antibiotic was going to save her when that big nidus of infection was still attached to her body. She crashed on induction of general anesthesia. She ultimately did fine, and in retrospect, this was actually a very simple case from an anesthetic standpoint. But, it was my first taste of how much critical care anesthesiologists actually do.

 

[arsenalgunner]

I agree it is easier to get into than Derm, yet that gap is narrowing every year.

Of course it is! 🙄

 

[TRAMD]

Sorry to be coming late to this thread, and I'm really not trying to make this into a micturition contest, but lets think about what the phrase "under your care" means.

This whole conversation brings back to mind the morning when I returned a page and heard "OPD, the Medical Examiner would like to talk to you about one of your patients." 😱

There is something about a patient suicide that just seems to intensify this idea that one is expected to be able to prevent a patient's death, even if not (hopefully) "in your physical presence". 🙁

The saddest and most frustrating of all deaths.

 

[deuist]

I don't know why anesthesiology keeps getting touted as a competitive specialty. I was just looking over the numbers for this year's Match and noticed that 1,104 U.S. seniors applied for 1,364 spots in anesthesiology nationwide. Of the seniors, 1,070 matched (97%), and 36 residency spots were left unfilled---enough places for all American applicants to wind up somewhere.

Further, I looked at the applicants' data from last year. The average STEP I score was 220, the vast majority of seniors were not AOA, and almost half had no publications. Therefore, anesthesiology is only mildly competitive like emergency medicine.

 

[DrRobert]

Therefore, anesthesiology is only mildly competitive like emergency medicine.

I agree. Anesthesiology is definitely moderately competitive, similar to EM.

 

[deuist]

I agree. Anesthesiology is definitely moderately competitive, similar to EM.

I'm not ragging on it as a specialty. I'm just tired of seeing it lumped with radiology, ophthalmology, and derm in terms of competitiveness. Meanwhile, people generally roll their eyes on this board at emergency medicine as if anyone can just sign up for it.

 

[PMPMD]

Let me rephrase my badly phrased original thread....

Of the fields the fields that are the easiest to get into....Psychiatry, Family Medicine, Neurology, PMR, OB-Gyn and IM....which would require me to memorize the least and achieve a 100k per yr salary working 40 hrs a wk. I'm thinking it would be Psychiatry. I think their job is an important one but requires less memorization than some of the other fields and a cusher lifestyle.

going back to the OP...

if all you want is $100k and 40 hours/week...

WHY GO INTO MEDICINE AT ALL?

there are MANY better options for satisfying those requirements. and they don't require accumulating 6 figure loan debt, sleep deprivation, etc.

now back to the anesthesia-related hijack of this post (which as an anesthesia resident, I've been thoroughly enjoying)

 

[GasEmDee]

I'm not ragging on it as a specialty. I'm just tired of seeing it lumped with radiology, ophthalmology, and derm in terms of competitiveness. Meanwhile, people generally roll their eyes on this board at emergency medicine as if anyone can just sign up for it.

I agree too. Top programs are competitive, but the field as a whole is not that competitive. There are tons of spots available.

 

[pmichaelmd]

I agree too. Top programs are competitive, but the field as a whole is not that competitive. There are tons of spots available.

Anybody read The House of God? We anesthesiologists didn't even have to apply for positions in residency. During med school, we received letters reading, "Do you want to be an anesthesiolgist? [Y/N]" I circled "Y." Several years later, I got another reading, "Would you like a job with an anesthesiology group for big money? [Y/N]" Again, I circled "Y" and here I find myself. No application, no tests, no requirements for "real" knowledge. Amazing, isn't it? 😀

-PMMD

 

[Kubed]

Anybody read The House of God? We anesthesiologists didn't even have to apply for positions in residency. During med school, we received letters reading, "Do you want to be an anesthesiolgist? [Y/N]" I circled "Y." Several years later, I got another reading, "Would you like a job with an anesthesiology group for big money? [Y/N]" Again, I circled "Y" and here I find myself. No application, no tests, no requirements for "real" knowledge. Amazing, isn't it? 😀

-PMMD

God that would be sweet! I'll happily accept any postcards anyone wants to send me! 😀

 

[dara678]

SICU rounds run by an anesthesiologist? I had no idea that anesthesiologists could stand in for a critical care attending or a surgeon who specialized into surgical critical care, . . . i.e. Pulmonary/Critical Care people learn a lot about vents, ID, and I wouldn't expect that to be part of the training of anesthesiologists! (I.e. patients with ARDS on a ventilator usually aren't going to be surgical candidates, . . . and so how would an anesthesiologist obtain experience outside of a SICU rotation in residency?) The pulmonary/Critical Care attendings I have seen manage surgical patients knew a lot about pulmonary processes because they really specialized in that stuff, did bronchs etc, . . . and likewise the Surgery attendings in the SICU had great knowledge about how to manage surgical residents, especially their ability to detect subtle signs that a patient needed adjustments in management or when to go back to OR decisions made in conjunction with reading their own CTs. I guess I also like the other poster i am ignorant about the training that anesthesiology residents receive as I thought mostly it involved intraoperative monitoring during surgery? . . . upon googling it , it appears that there is a critical care fellowship for anesthesiologists after residency, maybe that is what is required for an anesthesiologist to work as a sicu attending?

Believe it or not, I bet a lot of ppl are of the same mind as DarthNeurology. Because anesthesiologists work behind the scenes, so to speak, a lot of what they do is really unknown and thus, ignored. Yes, anesthesiologists can ran ICUs. Anesthesia is, basically, the intraoperative management of the critically ill patient (which any patient is when they undergo induction), and that can extend to the extraoperative theatre as well. Anesthesiologists have a unique and thorough knowledge of ventilator management, physiology, and pharmacology and thus are uniquely supplied to manage an ICU. Of course, any anesthesiologist wanting to do should (and probably must) complete a critical care fellowship, just like any general surgeon or pulmonologist. In fact, on the east coast, many ICUs are co-run by anesthesiologists.

It's totally appropriate to ask questions about a specialty that you may not know much about. However, I would suggest to ask the question in a respectful, rather than derogatory manner. I think studentdoctor.net is a great place to talk about all things medicine, but it's also an opportunity to learn about what we all do too. 🙂

 

[GasEmDee]

Anybody read The House of God? We anesthesiologists didn't even have to apply for positions in residency. During med school, we received letters reading, "Do you want to be an anesthesiolgist? [Y/N]" I circled "Y." Several years later, I got another reading, "Would you like a job with an anesthesiology group for big money? [Y/N]" Again, I circled "Y" and here I find myself. No application, no tests, no requirements for "real" knowledge. Amazing, isn't it? 😀

-PMMD

I circled "N" and somehow got a spot anyway 😎