EM vs. Anesthesia

[jonwilli]

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I have always wanted to do EM and through my first few rotations nothing changed my mind until Anesthesia. I am not having difficulty. Some of the attendings are trying to convince me that Anesthesia and EM are similar and that I will be much happier later in life with Anesth. Can anyone who had similar thoughts or mind debates please chime in!!!

Thanks!

 

[greatdane]

I think about the only similarity would be they are both ?shift work? for the most part (although I do believe there is some call in anesthesia)?other than that I think they are about as far apart as you can get. I guess it comes down to do you want patient contact. I would also venture to say most EM docs would tell ya you would be happier doing EM in the long run. As my trauma attending says ?the definition of an ET tube is this; a plastic tube with someone asleep at both ends?.

 

[FoughtFyr]

Originally posted by jonwilli
I have always wanted to do EM and through my first few rotations nothing changed my mind until Anesthesia. I am not having difficulty. Some of the attendings are trying to convince me that Anesthesia and EM are similar and that I will be much happier later in life with Anesth. Can anyone who had similar thoughts or mind debates please chime in!!!

Thanks!

I had the same problem. Especially as i did my anes. rotation with a former EM doc who switched!

As he put it, anes. is "the only docs in the hospital that deal with life and death emergencies on EVERY case. Granted, we cause the problem, but if we don't breathe for them, keep their hearts going etc. They die..."

I still chose EM.

- H

 

[Apollyon]

Originally posted by greatdane
I think about the only similarity would be they are both ?shift work? for the most part (although I do believe there is some call in anesthesia)?other than that I think they are about as far apart as you can get.

A good friend was fixed on EM until he did gas. EM and gas have shift work, and all sorts of procedures, all the time. Also, in both, there can be complex management decisions.

I think they're closer than you think.

 

[SuperflyMD]

Of the 8 anesthesiologist I worked with, only 2 said they would choose it again. One of the other 6 pointed out that if you take the best, smartest, most prepared and dedicated anesthesiologist, and put him in a room with the worst surgeon since the civil war, the butcher is still the top dog.

Of course, if you are thinking about EM, then you are already prepared for being undervalued and unappreciated no matter how well you do your job, so you'll probably be ok either way--just like the rest of us on this forum. (always wanted to use one of those)

 

[bryanboling5]

I have the same problem. Now, granted, I'm still a pre-Med so I've got some time to decide, but I love both anes. and em. What I'm really hooked on is Trauma/critical care and, at least around here, that's mostly surgery. But, I don't want to be a surgeon. I've seen fellowships for both EM and Anes in Trauma/Critical CAre, but around here, there's not much in the way of "role-model". Anyone have insights on this?

 

[Sessamoid]

I can't imagine anybody describing EM and gas as similar, except in lifestyle. To those physicians who chose their field largely because of the lifestyle it offered, I suppose the two fields are a lot a like. The practice of these specialties could hardly be more different however.

Gas was described to me by my medical school's anesthesiology chairman as hours and hours of inactivity marked by sudden, short periods of absolute terror.

EM OTOH is fast-paced, constantly on the go, with an emphasis of accuracy and speed of your history and physical exam to guide the workup (if needed). Those periods of "terror" happen a lot more often for EM so that we're not terrified when it happens. The only people that run a similar number of codes are the pulmonology/critical care subspecialists.

As to your dilemma. All trauma/critical care specialists will be surgeons (out of necessity), but I know of at least one such surgeon who doesn't operate much anymore. He actually prefers the ICU setting, and his partners are more than happy to be able to offload the critical care aspects of their practice so that they can concentrate on operating. If you're willing to go through with the residency and fellowship, that may be a viable possibility. The other obvious path is to go internal medicine then pulmonology/critical care. You can probably work out a deal with a group of trauma surgeons to help take care of most of their critical care patients (though obviously the surgical issues they will still have to deal with, which to me were the most interesting parts of it).

EM is the other obvious choice. Which you decide on depends on what aspects of medicine and/or surgery you like.

edit: I just realized I grouped responses to two people in the same message. Take the parts that apply to you, as you would.

 

[PiPhiDoc]

I don't know if it was your thread in the Anesthesiology forum or not, which I already addressed, but I'll put my 2 cents in here as well in case it wasn't you...

I did 3years of my four year em residency before changing to anesthesiology. I must preface this by saying that these were MY opinions about EM and why it didn't work for me, but I have to stress that I think that ER docs have one of the hardest jobs in the hospital and I have NOTHING but admiration and respect for my former collegues.
That being said....
REASONS WHY I LEFT EM:
1. Sick of social disease -- IE drug abuse, homelessness, narcotics seeking, inappropriate use of the ed for trivial things (possible insomnia and 4 in the morning????) or primary care
2. I hated the pressure of "moving the meat" and feeling like my big job was to get people out the door
3. TRANSFERS. A huge issue now that many of the private docs won't come in to consult on patients that they won't get paid for, or there isn't any room in the hospital, or there aren't any nurses. Spent regularly 1-2 hrs/12hr shift dealing with this crap. And the way medicine is going, it isn't going to get better
4. Death and dying issues unique to the ED. In the ICU's, the OR, and heck, even the floor -- death does not often come suddenly and, it often seems, arbitrarily to snatch healthy young people who don't deserve to die. Most of the time these paeople have been sick. Their family knows it. You know it. Only in the ED will you face the often unexpected and completely unfair death of the healthy until moments ago patient. And have to face their family with this information. Telling the family of a child that their child is dead is one of the most excruciating things I have ever done, second to the thoracotomy of that same child.

I think there are a lot of pressures unique to EM that you have to be able to/learn to leave in the ED and not take home with you. I could not do this.
5. Even though it is shift work -- I felt like I was on an endless stream of nights/weekends/holidays. Who cares if you are off on Tuesday afternoon if everyone you would want to hang out with (including your spouse) is at work?

REASONS WHY I LOVE ANESTHESIOLOGY:
1. I make people feel better every day.
2. I get to do really cool procedures.
3. I love being in the OR -- and then getting to leave to go to the bathroom.
4. I love pharmacology and physiology, and I really feel like I'm becoming an "expert" in one area rather than having a breadth of understanding but little depth
5. I have a regular schedule, and when I'm done with call, I get to turn the pager/patient over at 7am and walk out of the hospital.
6. I NEVER, EVER, EVER have to do another rectal exam/disimpaction/perianal abcess I&D/psych eval/foreign body removal again

AGAIN - I must stress that these are MY OPINIONS. Do what you feel is right to you -- no matter how much people try to sway your opinion. YOU are the only one who has to get up and do your job every day. Thank god we all like different specialties -- or we would really be in trouble! So think about what you like/don't like and what you can and can't live with. NO specialty is fabulous every hour of every day -- but you should be able to come home most days and feel really, really good about what you do.

Enough.🙂