EM vs Anesthesia, I'm on the edge about both and need a push...

[exacto]

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Going into med school I was 100% stuck on EM. I haven't had either rotation yet, but have worked/ been in the ER for over 3 years and have my anesthesia rotation starting in a few days.

For those of you deciding between the two, what was the tipping factor? Or for those who would never do one over the other, why is that?

I'm more partial to ER, but not 100% set.

 

[vin5cent0]

Call me crazy but wouldn't it be more insightful to ask this question after your rotation if you're still between the two of them...?

 

[exacto]

Call me crazy but wouldn't it be more insightful to ask this question after your rotation if you're still between the two of them...?

Yes, 100%, but I need to start applying on VSAS to programs that I want to audition at and some open up in 3 days.

 

[Chibucks15]

Pro Con lists are always a good way.

Basically, it comes down to do you like being in the OR or not first and foremost. Have you had surgery?

 

[Lexdiamondz]

I'm an EM resident, but I was between EM and Anesthesia for a while - I'd say there are a few questions you have to honestly answer

- Do you prefer a controlled environment or chaotic environment?

- Do you need a predictable schedule or are you okay with having regular interruptions in your sleep-wake cycle?

- Do you want to be a generalist or do you need to fee like a specialist?

- Do you need independence or are you okay with playing second fiddle to some degree?

- Do you find fulfillment in patient interactions or are you happier being more "anonymous" to some degree?

Also consider the worst aspects of both specialties- are you okay with dealing with disrespectful, condescending surgeons? Are you okay with dealing with drunks, drug seekers and agitated/psychotic patients?


Many of these questions will only be answered after doing rotations- truthfully you should do both an anesthesia and EM sub-I as each one is pretty useful for the opposite specialty. I did both but ultimately chose EM, however my experiences in anesthesia were quite valuable.

 

[exacto]

I'm an EM resident, but I was between EM and Anesthesia for a while - I'd say there are a few questions you have to honestly answer

- Do you prefer a controlled environment or chaotic environment?

- Do you need a predictable schedule or are you okay with having regular interruptions in your sleep-wake cycle?

- Do you want to be a generalist or do you need to fee like a specialist?

- Do you need independence or are you okay with playing second fiddle to some degree?

- Do you find fulfillment in patient interactions or are you happier being more "anonymous" to some degree?

Also consider the worst aspects of both specialties- are you okay with dealing with disrespectful, condescending surgeons? Are you okay with dealing with drunks, drug seekers and agitated/psychotic patients?

Thanks, thats really helpfull! glad Im not alone.

 

[Doctor_Strange]

I'm an EM resident, but I was between EM and Anesthesia for a while - I'd say there are a few questions you have to honestly answer

- Do you prefer a controlled environment or chaotic environment?

- Do you need a predictable schedule or are you okay with having regular interruptions in your sleep-wake cycle?

- Do you want to be a generalist or do you need to fee like a specialist?

- Do you need independence or are you okay with playing second fiddle to some degree?

- Do you find fulfillment in patient interactions or are you happier being more "anonymous" to some degree?

Also consider the worst aspects of both specialties- are you okay with dealing with disrespectful, condescending surgeons? Are you okay with dealing with drunks, drug seekers and agitated/psychotic patients?


Many of these questions will only be answered after doing rotations- truthfully you should do both an anesthesia and EM sub-I as each one is pretty useful for the opposite specialty. I did both but ultimately chose EM, however my experiences in anesthesia were quite valuable.

Thanks for giving your insight. I've done 2 weeks in both specialties and see the benefit towards each, but I'm leaning EM as of now. My plan is to start M4 with a quick 2 week anesthesia rotation to see if I like it or not, otherwise I'll move on. As far as I know, getting EM audition rotations appear to be especially challenging compared to other specialties...

 

[Dantrolene FC]

I was in a similar situation as you. I was 95% certain I wanted to do anesthesia, but did EM early on to see if I liked it or not.

What I like about anesthesia is you are going legitimate anesthesia cases all day.

With EM, I see the patient population broken down into 3 categories. 1/3 need to be see by a physician with a true emergency. 1/3 need to be seen by a physician, but not an actual emergency. The other 1/3 don’t need to be seen my a physician at all. Plus you have tons and tons of notes and consults to call. So I basically saw the EM folks only dealing with emergencies for like 10% of the day, which is what I think contributes to their burnout.

In anesthesia, assuming your MD only, you just administer anesthesia all day with very few notes or consults to deal with.

But most importantly… EM is just too similar too much for me.

 

[BorntobeDO?]

Having done rotations I would pick gas all day now. The drug seekers in the ER and lying and drunks steals your soul. Don’t get me wrong, I love the teamwork of the ER but at least in my rural ER rotation the constant confrontation and people lying to me about their substance use grew old. At least in gas you only have to deal with BS from some of the surgeons, and the teamwork aspect is just as strong as ER IMO.

Both specialties have too many mid levels but I do think everyone acknowledges the need for at least one ER physician every shift generally. CRNAs think they don’t need anesthesiologists at all. So from a job security standpoint ER is prob better. It also has higher burnout, so ER is more secure from that perspective also.

 

[Doctor_Strange]

Having done rotations I would pick gas all day now. The drug seekers in the ER and lying and drunks steals your soul. Don’t get me wrong, I love the teamwork of the ER but at least in my rural ER rotation the constant confrontation and people lying to me about their substance use grew old. At least in gas you only have to deal with BS from some of the surgeons, and the teamwork aspect is just as strong as ER IMO.

Both specialties have too many mid levels but I do think everyone acknowledges the need for at least one ER physician every shift generally. CRNAs think they don’t need anesthesiologists at all. So from a job security standpoint ER is prob better. It also has higher burnout, so ER is more secure from that perspective also.

Are you referring to gas here? I have actually not heard much talk about burnout in the specialty -- not saying it does not happen, just the talk of burnout centers around EM/CC most of the time.

 

[BorntobeDO?]

Are you referring to gas here? I have actually not heard much talk about burnout in the specialty -- not saying it does not happen, just the talk of burnout centers around EM/CC most of the time.

Was talking about EM with the burnout. The job market is sort of protected because so many ER docs burn out and quit/part time/urgent within 10 years. The high workload combined with constant conflict and patients lying/manipulating tends to wear people out. I get that there are trauma junkies out there, but it feels to me that the bread and butter of ER is primary care patients with drug abuse and poor compliance.

Gas docs can get burned out, but it seems to be a 'can't get no respect' kind of thing with CRNA's encroaching and surgeons mouthing off, compared to ER burnout because 'most of my patients sucks.' However, I am sure there is a magic ER somewhere were the druggies don't make up a significant portion of your day, I just haven't had that exposure, and can't speak to it. IMO the lows of ER are lower.

 

[Whysoez]

Was talking about EM with the burnout. The job market is sort of protected because so many ER docs burn out and quit/part time/urgent within 10 years. The high workload combined with constant conflict and patients lying/manipulating tends to wear people out. I get that there are trauma junkies out there, but it feels to me that the bread and butter of ER is primary care patients with drug abuse and poor compliance.

Gas docs can get burned out, but it seems to be a 'can't get no respect' kind of thing with CRNA's encroaching and surgeons mouthing off, compared to ER burnout because 'most of my patients sucks.' However, I am sure there is a magic ER somewhere were the druggies don't make up a significant portion of your day, I just haven't had that exposure, and can't speak to it. IMO the lows of ER are lower.

Gas as in gastroenterology?

 

[scoopdaboop]

Gas as in gastroenterology?

Gas is anesthesia, Gi colloquial term for gastroenterology

 

[MightBeACylon439]

Pro Con lists are always a good way.

Basically, it comes down to do you like being in the OR or not first and foremost. Have you had surgery?

Having a surgery rotation and having that determine whether being in the OR as anesthesiologist is a terrible way to do it. The experience is so different between the two is so different it can't even be compared. This may be complicated because your institution doesn't have an anesthesiology rotation, the way that this can be overcome is by doing some days during your weekends or days off (as unfortunate as that sounds).

Also, just a general note- calling it gas is more or less accepted here. However, calling it gas to an anesthesiologist will only serve to either annoy them at best or effectively remove yourself from competition at worst.

 

[Chibucks15]

Having a surgery rotation and having that determine whether being in the OR as anesthesiologist is a terrible way to do it. The experience is so different between the two is so different it can't even be compared. This may be complicated because your institution doesn't have an anesthesiology rotation, the way that this can be overcome is by doing some days during your weekends or days off (as unfortunate as that sounds).

Also, just a general note- calling it gas is more or less accepted here. However, calling it gas to an anesthesiologist will only serve to either annoy them at best or effectively remove yourself from competition at worst.

I just meant to see if you like the overall experience of the OR. Not comparing the jobs or anything. I personally hate the OR

 

[MightBeACylon439]

I just meant to see if you like the overall experience of the OR. Not comparing the jobs or anything. I personally hate the OR

I really don’t think you can compare the experience in the OR between the two. I hate scrubbing in and pretty much every aspect of what a surgeon does. Anesthesiology is wonderful though. If you say “I hate the OR” and haven’t specifically done an anesthesiology rotation then you don’t hate the OR...you hate surgery.

 

[Chibucks15]

I really don’t think you can compare the experience in the OR between the two. I hate scrubbing in and pretty much every aspect of what a surgeon does. Anesthesiology is wonderful though. If you say “I hate the OR” and haven’t specifically done an anesthesiology rotation then you don’t hate the OR...you hate surgery.

Haha very likely. Surgery is not my jam that’s for sure

 

[Dr G Oogle]

IAlso consider the worst aspects of both specialties- are you okay with dealing with disrespectful, surgeons?

I’d say you get to experience this in both specialties

 

[Angus Avagadro]

I’d say you get to experience this in both specialties

You deal with disrespectful attendings by being excellent in you specialty, be it EM or Gas. Surgeons aren't the only physicians who can be disrespectful.

 

[Lexdiamondz]

I’d say you get to experience this in both specialties

100%

Difference is that my livelihood isnt dependent on them - I don't need their group to keep hiring my group to staff the OR the way an anaesthesiologist does, so I don't care.

 

[ace_inhibitor111]

Was talking about EM with the burnout. The job market is sort of protected because so many ER docs burn out and quit/part time/urgent within 10 years. The high workload combined with constant conflict and patients lying/manipulating tends to wear people out. I get that there are trauma junkies out there, but it feels to me that the bread and butter of ER is primary care patients with drug abuse and poor compliance.

Gas docs can get burned out, but it seems to be a 'can't get no respect' kind of thing with CRNA's encroaching and surgeons mouthing off, compared to ER burnout because 'most of my patients sucks.' However, I am sure there is a magic ER somewhere were the druggies don't make up a significant portion of your day, I just haven't had that exposure, and can't speak to it. IMO the lows of ER are lower.

How true is this? The AAMC Specialty data seems to show the number of EM physicians increasing by 17% every 5 years with no signs of slowing so far.

 

[BorntobeDO?]

How true is this? The AAMC Specialty data seems to show the number of EM physicians increasing by 17% every 5 years with no signs of slowing so far.

That’s true, but if the job sucks and has high turnover, even with increasing numbers of new residency’s there will always be some demand outside of recessions.

 

[Splenda88]

Was talking about EM with the burnout. The job market is sort of protected because so many ER docs burn out and quit/part time/urgent within 10 years. The high workload combined with constant conflict and patients lying/manipulating tends to wear people out. I get that there are trauma junkies out there, but it feels to me that the bread and butter of ER is primary care patients with drug abuse and poor compliance.

Gas docs can get burned out, but it seems to be a 'can't get no respect' kind of thing with CRNA's encroaching and surgeons mouthing off, compared to ER burnout because 'most of my patients sucks.' However, I am sure there is a magic ER somewhere were the druggies don't make up a significant portion of your day, I just haven't had that exposure, and can't speak to it. IMO the lows of ER are lower.

EM sucks but the advantage in EM is that you can work only 2 days/wk and still make 200k+/year.

 

[Doctor_Strange]

EM sucks but the advantage in EM is that you can work only 2 days/wk and still make 200k+/year.

I hear this often, but practically it does not seem common at all. At the ED I do shifts at, a reasonably small urban ED, this would not fly. Docs are expected to work a lot -- even the few part-timers there are.

 

[Splenda88]

I hear this often, but practically it does not seem common at all. At the ED I do shifts at, a reasonably small urban ED, this would not fly. Docs are expected to work a lot -- even the few part-timers there are.

When I was doing my ED month there was an ED attending who works 8 night shifts/month (8 hr shift), and she told me she makes just a under 200k/year plus benefits. She even told me "I have the best gig in the world."

 

[BorntobeDO?]

EM sucks but the advantage in EM is that you can work only 2 days/wk and still make 200k+/year.

I wouldn’t pick a specialty purely for income no matter how good a deal it seems. If you can’t stand to work full time then your probably in the wrong specialty. I agree that the job market is good right now tho.

 

[Splenda88]

I wouldn’t pick a specialty purely for income no matter how good a deal it seems. If you can’t stand to work full time then your probably in the wrong specialty. I agree that the job market is good right now tho.

I am not saying that people should choose a specialty based on $$$ alone. But if someone have two specialties that are in the running, they would be foolish to not look at $$$ and lifestyle.

 

[Dantrolene FC]

I'm on a rotation in the ED this month. Oh my god, just kill me now!!!

I see nurses running around, drunks yelling at the staff, people on meth restrained to the bed, cops roaming around 24/7. Strokes, traumas, new HIV diagnosis, ectopics, gun shots, everything. The attendings look so damned stressed 24/7. Plus you have to flip from days, to nights, to evenings, to weekends, to holidays.

This sounds great when your 28, single, no kids, and a resident. Just wait until you're 45 with a spouse and kids.

No thanks!!! I will stick to anesthesia where it is a much more controlled environment.

 

[Sardonix]

I'm on a rotation in the ED this month. Oh my god, just kill me now!!!

I see nurses running around, drunks yelling at the staff, people on meth restrained to the bed, cops roaming around 24/7. Strokes, traumas, new HIV diagnosis, ectopics, gun shots, everything. The attendings look so damned stressed 24/7. Plus you have to flip from days, to nights, to evenings, to weekends, to holidays.

This sounds great when your 28, single, no kids, and a resident. Just wait until you're 45 with a spouse and kids.

No thanks!!! I will stick to anesthesia where it is a much more controlled environment.

Honestly, from a med student perspective that sound amazing.

 

[BorntobeDO?]

Honestly, from a med student perspective that sound amazing.

It will get old when your not. Hence why the specialty has a good job market

 

[Sardonix]

It will get old when your not. Hence why the specialty has a good job market

Absolutely, that's why I said from a med student perspective. Imagine all that you get to see and learn in that setting while not having to crunch out paperwork/notes and take 100% responsibility for all that's going on.

 

[OnePunchBiopsy]

If EM was considered a primary care specialty, would you make the same decision?

EM exposes you to the most marginalized and vulnerable populations. If you set the trauma, critical care, and (minimal) procedures aside, you will be the primary access to medical care for the uninsured.

Unless you open up a low-T clinic.

 

[Doctor_Strange]

I'm on a rotation in the ED this month. Oh my god, just kill me now!!!

I see nurses running around, drunks yelling at the staff, people on meth restrained to the bed, cops roaming around 24/7. Strokes, traumas, new HIV diagnosis, ectopics, gun shots, everything. The attendings look so damned stressed 24/7. Plus you have to flip from days, to nights, to evenings, to weekends, to holidays.

This sounds great when your 28, single, no kids, and a resident. Just wait until you're 45 with a spouse and kids.

No thanks!!! I will stick to anesthesia where it is a much more controlled environment.

Most shops have docs do a gradual shift from day to evenings to nights so it doesn't wreck your circadian rhythm as much. I mean when you consider being on call in literally every other speciality I feel the burden of an ER is still high (maybe highest), but other specialties are too terribly far off in terms of disruption to your CR. Still, it is a valid concern and one I share.

And also, everything you just described sounds awesome. One could argue the life of an anesthesiologist is monotonous which has a it's benefits but you likely aren't as surprised as often in terms of pathology etc. When I was on a 2 week rotation, the most I saw was a difxutl extubation for a patient that had to be transfered to the ICU. Everything else was pretty standard cases with not too many hiccups. Mind you I'm not dissing the field I'm interested in gas too but pros and cons to each speciality for sure!