EM vs. Anesthesia

[fireorose]

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So I am finshing up my ER rotation and I have enjoyed it alot! I recently have submitted my application to anesthesia residency programs. This rotation has really thrown me for a loop. I love how you never know what can walk through the door in the ER. I am excited about the procedures. The overall atomosphere is fun and all the doctors are awesome. I still know why I want to do anesthesia, but its more cerebral than passionate. But I love being the OR, manipulating drugs, and the procedures. I just feel kind of stuck yet I know if I jump ship is has to have happened yesterday... I just put down all this money on applying to anesthesia. The ER at my school is steady, but not a level 1 trauma center so I wonder if I would feel the same(and I also wonder if it would seal the deal.) This has my stomach in knots! Its hard because I don't feel 100% about either option, but I do feel like I could be happy in a career with both. I just wonder how I'm going to feel 10 or 20 y from now. I just need some advice and encouragement.

 

[EC3]

Take this how you'd like, but I've known several ER residents/attendings who wish they would've done anesthesia. Can't say that I've met an equal number of anesthesiologists who feel the reverse.

I still think anesthesia is the better lifestyle speciality and much less stressful overall. I don't think anesthesia is as "interesting" as ER but everything becomes routine after years of doing it. Anesthesia may be better long term because of the lower level of stress.

What ER doesn't suffer from, though, is the political mess that the anesthesiology speciality is in regarding reimbursement cuts and midlevels.

 

[deleted65604]

One of the downsides of ER, is that we have to frequently interact with surgeons (once every other shift?) The biggest downside with anesthesiology is that you are pretty much stuck in the same room with them 24/7.

I guess you learn to tune them out for the most part, and if they are really adamant in talking to you, just repeat the words, "They're adequately resuscitated, stop the bleeding."

One of the guys I work with started an anesthesiology residency, then switched to ER and hasn't looked back.

Anesthesiology has a good gig. So does ER. You could do your transitional year, and continue to get as much ER and anesthesia time the rest of your 4th year, continue to observe, talk to people and see which you prefer. If you do anesthesia, you still have to do a transitional, right? If you decide on ER, you will have a leg up in your intern year in an ER residency and can really shine compared to the other residents who were just med students weeks before. If you were honest with the PD who you signed up with, they might help you out in the career change, (what PD wants a resident who is going to hate their specialty?)

 

[roja]

I would search this as well. I think there has been a lot of discussion on this, as it pops up every year or so in the forum.

Also, do not jump into one or the other. If you are truly stuck, consider taking time off. Nothing puts you more in a bind than trying to switch residencies. With GME funding and competitiveness, make sure you know what you want to do.

one year is a small price to pay compared to years in a field you end up not loving. And trust me, both of them have downsides that make it so that you want to make sure you love what you are doing.

So, that said, here is my cursory summary:

Similarities: both fields are billed as 'lifestyle' but in many ways really aren't. They both deal with plenty of calm moments intersperced with moments of terror (ie critical care/resusc). In some ways, both are 'shift workers'.
Both have procedural components. Both have to deal with consultants (anesth: surgeons/obs... ed: everyone.

Differences: ED sees everything- peds, primary care, cards, ortho, transplant, trauma, critical care. pretty much anything and everything can and will walk through your door, from the interesting to the mundane. This generally is a plus to those of us who like ED adn a minus to those that dont.

We don't tend to get to excited about drugs and extensive long term physiological management like anesthesia.

Go and talk to the PD at your hospital. In both programs. do NOT let anyone guilt you into anything. This is your LIFE LONG career. Be careful making a decision.

 

[Arch Guillotti]

This topic has been discussed a few times over the years, try a search here or in the anesthesia forum. A number of folks have faced this choice before. Persoanlly I was set on EM before med school, but then I did an anesthesia rotation and came to my senses. I didn't like the feeling of being a jack of all trades and a master of none (no offense meant) nor could I stomach the notion of the volume of nonsense that endlessly rolls through the ED doors.

 

[DocCartman]

I've definitely gotta mirror EC3 on this one: I definitely know EM docs who wish they would've gone the Anesthesia route, while I know very few Gassers who don't love their job.

I too went through the Anesthesia vs EM thing, and ultimately chose EM- I grew up in Baltimore and went to college in LA, and I think my urban upbringing definitely made me want to work in a smoking hot level I trauma center- I'm a glutton for craziness (and I like suturing crackheads who are handcuffed to the bed).

I think if you're only 75% sure about Gas now and end up matching in anesthesia you'll love it by the time you're done residency. If you're only 75% sure about EM and match EM, I think you'll be burned out and dread coming to work everyday- to me that's the difference between the two.

Also, and take my MS4 perspective with a grain of salt, I would suggest AGAINST doing a TY or taking a year off- applying for residency as an MS4 is a pain in the *****- imagine having to apply/interview broadly as a RESIDENT. Plus, statistically your chances go way down.

Good luck!

 

[southerndoc]

Maybe proman is monitoring this thread. If not, PM him and ask. He's a former paramedic who chose anesthesia. So it's very familiar with ER practice environment.

Working in the ER can be stressful, especially during a flu outbreak. Anesthesia's workload is more controlled than chaotic like the ER. Can't speak for the entire field, but I know we pay our anesthesiologists less than ER docs judging from a recent advertisement. (My group has contracts that provide anesthesia, radiology, hospitalist, and emergency physicians.)

 

[deleted65604]

nor could I stomach the notion of the volume of nonsense that endlessly rolls through the ED doors.

Word that. Too true. It really isn't the "Emergency" department. People like to use us as:
1. Convenience-mart. I know I have an appointment with my pediatrician this afternoon, but I want my kid seen sooner. I found this one out at the end of a 2 hour ER work-up (I think I did a UA and a strep) on a well appearing kid with a fever. They wanted me to hurry and discharge them so they could make the pediatric appointment.

My reaction... "S@A^%F^%@#M$%^H&*!"

2. The quick second opinion. The chronic vague fatigue, achiness, chest-pain, abdominal-pain, that has been worked up by four different doctors at 2 different tertiary care centers, and now wants me, jarabacoa, in BFE, at 3 AM, with no access to their labs, imaging, or previous doctor's H and P, to figure it out.

3. The legal get me real high, real fast mart. An endless supply of chronic pain patients, who know that if they say chest pain or abdominal pain, or headache, or SOB, that they will be in the ER FOREVER, and that about 50% of the time, the doctor is going to get sick of their whining and narc them up. If they mix up their visits to different ERs, and mix up the presenting complaint, it is going to take a real long time for everyone to catch on, and for all the doctors to grow the balls (or ovaries) to deny them narcs.

And the list goes on and on...

(Any "healthcare reform" has got to address this behavior and either fine people for inappropriate use of resources, or get people's food-stamps docked, or community service or something, because this is just going to get worse with Obamacare.)

Anesthesia has very defined goals, knock them out, keep them paralyzed, make the numbers look good, and then get them awake and breathing on their own.

 

[fireorose]

Thanks for all the replies! This is definitely a big decision..

 

[Pure Anergy]

Take this how you'd like, but I've known several ER residents/attendings who wish they would've done anesthesia. Can't say that I've met an equal number of anesthesiologists who feel the reverse.

I've heard that too, and there was even a resident I met on my anesthesiology rotation who left EM private practice to do the second residency in anesthesiology. The two of us talked a lot about pros and cons of each specialty, and what I realized as we talked is that most of the cons we discussed didn't really apply to me. I want to stay in an academic center, so I won't experience the private community practice-specific issues, although academia comes with its own share of frustrations. Also, I plan to do a fellowship, so some of the frustrations with general EM won't apply to me either. It was interesting that when I explained my plans, we both came to the conclusion that EM probably was the better choice for me.

This is a little off-topic, but I'm curious about how many people go into EM planning to do a fellowship. I am getting the impression that most people don't do one. Do the more experienced people reading this forum think that's true? Also, for people who do the certified fellowships, what do you think is the most popular one? I'm guessing peds?

 

[roja]

Most people don't do fellowships, however, academics is getting more competitive (although depending on the region, it is still very possible to get academic jobs with a strong cv and no fellowship) and more people wanting to go into academics do fellowships.

In EM there are two major branches of 'fellowships'- those that have a board exam at the end (there are not many) and those that do.

Here is a link:

http://www.saem.org/saemdnn/Home/Communities/Fellows/Fellowship/tabid/78/Default.aspx

 

[quinsy]

Also, for people who do the certified fellowships, what do you think is the most popular one? I'm guessing peds?

I don't think so, though I have no idea of the actual numbers. Peds makes you less money so I think the only people who do it are people who truly love it. I don't really know anyone who's done it or anyone who wants to do it.

I think the most popular fellowships these days are probably ultrasound and tox. (Ultrasound's not 'certified', but after fellowship it can help you not only in an academic post but if you want to be an ultrasound director in the community, which is a nice asset as you look for a job - plus it is only one year!)

 

[EMfosho]

I was also torn between EM and Anesthesia for a LONG time during my 3rd/4th year of med school. For what it's worth, here are my 2 cents and why I chose EM over Anesthesia:

1) I realized that what I loved about Anesthesia was the lifestyle: mostly days/early mornings (although there is certainly call). I loved my anesthesia rotation because everyday was 6-2pm. I did NOT enjoy reading about Anesthesia - one my advisors suggested reading the textbook of your future specialty - if you have no interest in it (i.e. anesthetics and their half lives, solubility, etc.) than you better not go into that field!

2)Also, many people talked about the money of Anesthesia - true, it is very good now. But Nurse Anesthetists are being mass produced and it's already common to see 1 MD for 4 CRNAs...expect that ratio to decrease. Also, remember high swinging salaries (Anesthesia used to pay squat!) is something to stay clear from: this is true of radiology also - supply/demand raises incomes only temporarily until the supply matches up to demand again. This is different from EM, which has always been a "middle of the road" salary - not excessive like rads and not at the lower end like peds.

3) When I did my EM rotation, I looked forward to every shift. My natural energy fit in the ED - no down time, lots of work and being the doctor I always wanted to be - a jack of all trades. This is huge: what made you go into medicine in the first place? Follow that...your heart, not your brain. Brain thinks about money, lifestyle and hours. Your heart drives from passion and interest - which will last you a lot longer. Also, I loved reading about EM - always clinical, very little basic science (total opposite of anesthesia text books).

4) Don't get me wrong, EM is challenging and part of that is why EM docs are proud of what we do. It's not easy and it is way more stressful than Anesthesia but if you love what you do its not that bad. I can honestly say 8 hours in the OR behind the curtain goes by a lot slower than my 8 hours in the ED.

In the end, the point is: do what you love. Not what makes money or seems appealing because of lifestyle. As my old man says: "If you love what you do, you'll be great at it, and the money will follow"

Good luck in your decision.

-EMfosho

 

[J ROD]

I was also torn between EM and Anesthesia for a LONG time during my 3rd/4th year of med school. For what it's worth, here are my 2 cents and why I chose EM over Anesthesia:

1) I realized that what I loved about Anesthesia was the lifestyle: mostly days/early mornings (although there is certainly call). I loved my anesthesia rotation because everyday was 6-2pm. I did NOT enjoy reading about Anesthesia - one my advisors suggested reading the textbook of your future specialty - if you have no interest in it (i.e. anesthetics and their half lives, solubility, etc.) than you better not go into that field!

2)Also, many people talked about the money of Anesthesia - true, it is very good now. But Nurse Anesthetists are being mass produced and it's already common to see 1 MD for 4 CRNAs...expect that ratio to decrease. Also, remember high swinging salaries (Anesthesia used to pay squat!) is something to stay clear from: this is true of radiology also - supply/demand raises incomes only temporarily until the supply matches up to demand again. This is different from EM, which has always been a "middle of the road" salary - not excessive like rads and not at the lower end like peds.

3) When I did my EM rotation, I looked forward to every shift. My natural energy fit in the ED - no down time, lots of work and being the doctor I always wanted to be - a jack of all trades. This is huge: what made you go into medicine in the first place? Follow that...your heart, not your brain. Brain thinks about money, lifestyle and hours. Your heart drives from passion and interest - which will last you a lot longer. Also, I loved reading about EM - always clinical, very little basic science (total opposite of anesthesia text books).

4) Don't get me wrong, EM is challenging and part of that is why EM docs are proud of what we do. It's not easy and it is way more stressful than Anesthesia but if you love what you do its not that bad. I can honestly say 8 hours in the OR behind the curtain goes by a lot slower than my 8 hours in the ED.

In the end, the point is: do what you love. Not what makes money or seems appealing because of lifestyle. As my old man says: "If you love what you do, you'll be great at it, and the money will follow"

Good luck in your decision.

-EMfosho

Great advice!!

 

[Zanegray]

I can honestly say 8 hours in the OR behind the curtain goes by a lot slower than my 8 hours in the ED.



-EMfosho

OMG - can you say molasses? I "loved" the physiology, but just sitting there... argh...

The people who do these specialties are sooo different! Ask your friends which you are!

 

[Arcan57]

Decide if multitasking is something with which you are comfortable and plays to your cognitive strengths. Having seen it a time or two, little sucks more than being a very smart resident that is struggling in EM secondary to inability to multitask. I think a quarter of my posts end up saying this, but carry 4 patients as a student. You may discover that you can't stand splitting your attention, and that CAN be a career decider.

 

[Charlie Hustle]

I'd love to hear if anyone has a fresh take on this topic. I'm a newly minted third year, and up to this point EM and anesthesia have essentially been choices 1a and 1b for me. If you put a gun to my head and made me choose right now, I still think my gut feeling is EM; I just wanted to see if any current residents/attendings had an opinion on the matter.

Thanks everybody.

 

[NERDY]

I would suggest doing rotations in both EM and anesthesia (or at least shadow, if you can't do a formal rotation). I am an EM resident but anesthesia probably would have been my 2nd choice to EM. I enjoy talking to patients but once a patient is asleep, you can't talk to them. Anesthesia has call, especially if you work at a place that does transplants/trauma/ob-gyn while EM does not for the most part (maybe some back up sick call/being available if there is a mass casualty). In addition, for anesthesia, you have to wake up early every day since ORs have early start times.

Also, depending on where you work, as the anesthesiologist, you may be supervising rather than running your own room - do you like that model or do you want to be the one actually "doing"? Both fields have many fellowship and niche opportunities. Anesthesia requires a 1 year prelim/IM year while EM does not. EM can be a 3 year program, while anesthesia will be 4 years. Once your EM shift is done, you are finished for the day. However, in anesthesia, you are only finished when the cases are done (which may go longer than expected). Again, talk to your school advisors, residents, faculty - and make a decision carefully. good luck.

 

[Music MD]

The people who do these specialties are sooo different! Ask your friends which you are!

I think this is great advice. From my experience the personalities are fairly different. Classic anesthesia more analytical, thinker, patience, numbers type person. Classic EM more energetic, feeler, do-er, thick-skinned, with a touch of a ADHD.

 

[TeamZissou]

I think this is great advice. From my experience the personalities are fairly different. Classic anesthesia more analytical, thinker, patience, numbers type person. Classic EM more energetic, feeler, do-er, thick-skinned, with a touch of a ADHD.

And those of us who are analytical, manipulate variables/numbers, ADHD, and energetic do what?

Yeah, that's about where I'm at right now.

 

[deleted547339]

And those of us who are analytical, manipulate variables/numbers, ADHD, and energetic do what?

Yeah, that's about where I'm at right now.

Sounds like me - I did EM, lol.

 

[secants]

You really should do a rotation. I was set on anesthesia for the first three years of med school but then doing a whole dedicated month, I'm having serious doubts about it. I have my EM in sept so I'll see which one I favor more.