GI fellowship vs. anesthesia

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Choice?

  • GI

    Votes: 44 62.0%

  • Switch to anesthesia after residency

    Votes: 2 2.8%

  • Switch to anesthesia after pgy-2

    Votes: 25 35.2%
  • Total voters
    71
S

SandP

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Intern here in IM debating whether to pursue GI fellowship or jump ship to anesthesia after residency. Any thoughts? Don't now if I'm suffering from gas is greener syndrome.


Note: I do not want to jump ship mid way. Doesn't make sense to do 2/3 years of a residency before jumping ship. Maybe a little bit of sunk cost in there but overall I think it would be way less risky to complete a full residency first (plus I would have the support of my program)
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SandP said:
Intern here in IM debating whether to pursue GI fellowship or jump ship to anesthesia after residency. Any thoughts? Don't now if I'm suffering from gas is greener syndrome.
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If you were planning to jump ship to anesthesiology you don't need to wait until you finish your IM residency to do that. Apply now and get in for PGY2-3. Time is money and you are wasting it
 
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SandP said:
Intern here in IM debating whether to pursue GI fellowship or jump ship to anesthesia after residency. Any thoughts? Don't now if I'm suffering from gas is greener syndrome.
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If you really want to do anesthesia, might as well jump ship now. No benefit to waiting after completing IM residency to do it
 
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Most folks that want to switch to anesthesia don’t really have a good understanding what the specialty entails, don’t appreciate the scope of practice concerns, don’t understand supervising CRNAs, think anesthesia residency will be a breeze, don’t understand the hours and call requirements, etc. At the moment GA salaries are up, but if you ask the anesthesia forum most people will say GI is the way to go. But I would say most anesthesiologists have a grass is greener mentality when thinking about GI as well.
 
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Are you competitive for GI? GI is significantly more competitive than anything in anesthesia. Are you willing to do the hoop-jumping and boot-licking required to get a GI fellowship? Be honest with yourself there. If so, then GI is a no-brainer.

If you are hell bent on anesthesia then switch now. Don’t wait. There is absolutely no benefit to having both trainings. It’s a waste of time and money.

Another data point to consider: GI requires 3 years IM and 3 years fellowship. Add another year if you try to get a chief year to pad your CV or have to take a gap year as a hospitalist in order to kiss some more buttocks to get your fellowship spot. With anesthesia, you are looking at your intern year plus 3 years of residency +/- 1 year fellowship. Anesthesia gets you out and earning a living a little bit faster. I still think GI wins overall, though.

Don’t sleep on the other IM specialties. Everyone thinks about Cards or GI, but the other IM specialties can get you a decent lifestyle with OK pay in less time. Some even pay pretty well because you can still find private practices to join or start your own. Not the case in anesthesia.

So…
-Do GI if you can. Few specialties match the lifestyle:income ratio of GI. Derm and ortho come to mind.
-If you really must switch, don’t wait. Waiting would be an enormous mistake.
-Don’t disregard the other doors that IM opens for you.
 
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This would be such a bad decision. GI is such a great field. No in house calls. Salary much much better than anesthesia. Hours are generally better in GI. There is not a single reason why you would want to do anesthesia over gi.

Do you want to be giving propofol for the gi doctor doing his colonoscopy egd for a lot less money instead of doing the colonoscopy?
 
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I don’t think anyone can really give you advice on deciding between specialties unless they’ve practiced them both. Best you could do is ask specific questions, like what is the call/hours, what do you like/hate about the specialty, what location do Yoj want to practice and what are the salaries like, etc.
 
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dabears505 said:
This would be such a bad decision. GI is such a great field. No in house calls. Salary much much better than anesthesia. Hours are generally better in GI. There is not a single reason why you would want to do anesthesia over gi.

Do you want to be giving propofol for the gi doctor doing his colonoscopy egd for a lot less money instead of doing the colonoscopy?
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This is what I mean. Anesthesiologists only interact with GI doctors in the colonoscopy suite. We don’t really know what the clinic schedule is like, what the salary is like (except for maybe those high earners that do a ridiculous amount of screening colonoscopies), we certainly don’t interact with GI docs that do mostly clinic. Maybe the home call is worse than we imagine. Maybe that hours aren’t as good as we imagine.
 
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SandP said:
why is it a no brainer?
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Our GI docs get a lot of leeway with regards to life and the hospital. They also make a LOT more than anesthesia (ours are ~2x my 99% anesthesiologist pay)
They have hired PAs for almost all of their clinic and just scope all day. If they want to get out early, they just close their schedule. Call for them is 1 in 7 and the true emergent scopes at night are minimal. The rest are seen in the day.

Meanwhile I have to justify all sorts of stuff about my existence, and stay to finish whatever cases the GI doc wants to do into the evening, even if my kids have a game.

I would hate GI, and like anesthesia so I am happy here. From a lifestyle standpoint, theirs is way better. Choose based on the job you want, but if you like both equally then do GI.
 
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SandP said:
why is it a no brainer?
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The above posts sum it up pretty well. I will add that we live in a world where there is an explosion of midlevels, predatory hospital administrators and staffing companies. These realities make it a significant disadvantage to being in a hospital based specialty: EM, anesthesia, hospital medicine, CCM etc. GI is in a significantly better position to deal with these problems than any hospital based specialty.
 
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If you are willing to move out of the highly saturated urban areas then you can find GI practices where their part-time MDs make as much as FT anesthesiologists. And to boot, they are one the specialties where mid-level encroachment is still in its infancy. If you are competitive for GI then do GI.
 
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SandP said:
Intern here in IM debating whether to pursue GI fellowship or jump ship to anesthesia after residency. Any thoughts? Don't now if I'm suffering from gas is greener syndrome.


Note: I do not want to jump ship mid way. Doesn't make sense to do 2/3 years of a residency before jumping ship. Maybe a little bit of sunk cost in there but overall I think it would be way less risky to complete a full residency first (plus I would have the support of my program)
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Wow! you are so confused which hole you wanna make a living off. You need help.
 
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CCM-MD said:
This is a no brainer. Do GI, if you can get in.
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My mother’s GI doc does 40 scopes a day 3 days a week and drives a Maserati. Just saying.

Then again I almost never have to deal with feces.
 
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Gi makes a lot more than anesthesiology. Better lifestyle and more control.

Just this Monday we had gi book 2 ercp but the gi guy can only come in during the evening so we had to stay to do the case. Went from 6pm to midnight. Gi had way more control on their life than anesthesiologists do
 
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anbuitachi said:
Gi makes a lot more than anesthesiology. Better lifestyle and more control.

Just this Monday we had gi book 2 ercp but the gi guy can only come in during the evening so we had to stay to do the case. Went from 6pm to midnight. Gi had way more control on their life than anesthesiologists do
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Why were you there so long for a one hour case?
 
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Do you want to:

1) Have a 90% chance of working for a large anesthesia “corporation”, or else, a govt-run medical facility??

2) Have your life subjected to the whims of a jackass hospital CEO, who is looking to polish up his resume by “cutting anesthesia costs”, every 3 years, during the RFP process, when he requests bids from every low-rent AMC in the country to staff the OR with “anesthesia providers”?

3) Have your hours/calls revolve around someone else’s dinner/social/meeting/vacation plans, or their inability to find their azz with both hands (lookin’ at you, slow/incompetent/inconsiderate surgeons...)?

There are a FEW anesthesiology positions out there, in selected markets, that have seen their pay go up substantially in the last 10-15 years.

The rest???

They have seen their pay stuck at $375-$450k for the last 15 years, due effectively to the “price controls” of AMC’s.

Not to mention, the Govt (Medicare/Medicaid) pays anesthesia 1/4-1/3 of “private rates” for their services, vs. paying 70-80% for other medical/surgical specialties.

Nobody is “starving”, as an anesthesiologist, but the salary/pay is not keeping up with inflation, and the “lifestyle” is only as good or bad as what is dictated by a large corporation/hospital/a-hole surgeons/specialists you cover.

In case you’re not getting the hint, go do GI, if you have that option. Smelling schidt beats kissing azz....
 
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I guess GI but I’d pick neither if I had the choice to make again. Honestly anesthesia has been pretty good for me. More money is always nice but I don’t care for GI mentality (scope everything in sight with a self righteous attitude about it). Plus they play w more slobber than we do and mess with dirty buttholes all day. Softball there for ya Salty.
 
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PainDrain said:
My mother’s GI doc does 40 scopes a day 3 days a week and drives a Maserati. Just saying.

Then again I almost never have to deal with feces.
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Maserati are ok but not as impressive as you think.
 
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dipriMAN said:
This is what I mean. Anesthesiologists only interact with GI doctors in the colonoscopy suite. We don’t really know what the clinic schedule is like, what the salary is like (except for maybe those high earners that do a ridiculous amount of screening colonoscopies), we certainly don’t interact with GI docs that do mostly clinic. Maybe the home call is worse than we imagine. Maybe that hours aren’t as good as we imagine.
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Have a good buddy who is GI. In a three MD PP group. He’s not enjoying it too much either.

He’s worried that their referral based will dry up, since there’s a lot of IM docs who are consolidating around him, forming IM mega groups and hiring their own new cardiologists and GI. Starting their own “medical group”. Think about that.... ultimately GI don’t really own their patients either, they’re being relegated to just proceduralists.

Grass is greener on the other side or is it?
 
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Have you considered that once the camera-in-a-pill becomes ready for primetime better than 90% of the endoscoptist's procedures go away? I imagine you will probably get paid something to review the images, but way less than driving the scope...and even then, you'll only get paid until AI takes over.

On the other hand, the GI doc will continue to have ownership of the patients s/he brings to the hospital (though being "on call" for GI bleeds for others' inpatients is not really better--in my mind--to being responsible for other specialists' patients only while they are in the operating room. I expect YMMV, especially since you embarked on career in internal medicine in the first place). Being the one that brings patients to the hospital/GI center by itself is huge now, and will likely only get more important as corporate medicine evolves and metastasizes.

If you are really ambivalent about IM/GI (and not one of those "I can't see myself doing anything else" types), I'd cut your losses on IM and transfer into anesthesia July 1.
 
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I like anesthesia. Some of our GI docs tell med students to do anesthesia. When I’m not at work, I’m off. I don’t have to worry about whether or not my clip was insufficient and is going to rebleed or whether or not a GI bleed coming in through the ED can wait a couple hours until the morning.

likewise with ortho, i don’t have to worry about a non compliant patient getting infected and haunting me for years to come.

Or with ED, about what happens after you send someone with a questionable history home. Or when you’re reviewing a chart your mid level undersold in a patients that’s now gone and see a red flag that was overlooked.

I live where i want. Make good money. Sleep well at night. Just do what you like. Im young but I legitimately like doing anesthesia and think some procedures are actually fun. Doing a block, having a badass fracture fixed and the patient wakes up like nothing happened. Labor epidurals? Legitimately satisfying. I can’t imagine finding endoscopes fun.
 
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If you like the work, GI is a great specialty and is one that's tough to beat imo. Have to also consider that not everyone who wants it, gets it. Only around 450 GI spots in the country. From what I've seen, they are often stand outs in their IM programs. And have a lot of other impressive things in their CV's in general. Quite a bit of self selection going on as well. Fact that OP is an IM intern and even thinking about anesthesia makes me wonder a few things.
 
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SnapperRocks said:
I like anesthesia. Some of our GI docs tell med students to do anesthesia. When I’m not at work, I’m off. I don’t have to worry about whether or not my clip was insufficient and is going to rebleed or whether or not a GI bleed coming in through the ED can wait a couple hours until the morning.

likewise with ortho, i don’t have to worry about a non compliant patient getting infected and haunting me for years to come.

Or with ED, about what happens after you send someone with a questionable history home. Or when you’re reviewing a chart your mid level undersold in a patients that’s now gone and see a red flag that was overlooked.

I live where i want. Make good money. Sleep well at night. Just do what you like. Im young but I legitimately like doing anesthesia and think some procedures are actually fun. Doing a block, having a badass fracture fixed and the patient wakes up like nothing happened. Labor epidurals? Legitimately satisfying. I can’t imagine finding endoscopes fun.
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Considering your name, are you down under?
 
PainDrain said:
My mother’s GI doc does 40 scopes a day 3 days a week and drives a Maserati. Just saying.

Then again I almost never have to deal with feces.
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40 scopes per day is a LOT. That is not typical. Most GIs I know can do 10-15/day assuming a 730-5 schedule. That’s a lot of work and doesn’t necessarily point to better lifestyle. But it’s certainly more money
 
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SaltyDog said:
No, but we charge by the minute.
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If it’s a second room (at night, and I as “primary call” can’t cover it), I’m actually LOSING money every minute (if it’s Medicaid/Medicare). They pay $1.50 a minute (or less), and a CRNA “costs” $2 a minute, when brought in on call....
 
DirtDocMD said:
If it’s a second room (at night, and I as “primary call” can’t cover it), I’m actually LOSING money every minute (if it’s Medicaid/Medicare). They pay $1.50 a minute (or less), and a CRNA “costs” $2 a minute, when brought in on call....
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MD only. I may not make as much, but I’m never losing money.
 
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That’s good.

Our payer mix is so horrible (only 20-30% private), that we’d either have to work for peanuts (sub-$250k), or demand the hospital hike the subsidy to the moon, in order to do MD only. Still get to do our own cases 80% of the time, luckily, but Medicare/Medicaid at sub-$90 an hour makes it impossible to pay MD’s, or even CRNA’s, at market rates.
 
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Yeah...I think i'll stay in Anesthesia. I like all the Drs and staff in the GI dept, but hard pass on the 10+ rectal exams on procedure days. Not to mention aerosolized $h!t being launched at your face for 8 hours. No thanks.
 
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dabears505 said:
This would be such a bad decision. GI is such a great field. No in house calls. Salary much much better than anesthesia. Hours are generally better in GI. There is not a single reason why you would want to do anesthesia over gi.

Do you want to be giving propofol for the gi doctor doing his colonoscopy egd for a lot less money instead of doing the colonoscopy?
Click to expand...
Do you want to be the guy writing notes all day, assuming liability for the patient, or the guy that puts them to sleep with not having to see them in the clinic? Do you want to be the guy that smells like sh1t all day that has to deal with insurance pre-auths and admins?
SaltyDog said:
No, but we charge by the minute.
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this. Take as long as you want, as long as you pay.
 
GandalfTheWhite said:
Do you want to be the guy writing notes all day, assuming liability for the patient, or the guy that puts them to sleep with not having to see them in the clinic? Do you want to be the guy that smells like sh1t all day that has to deal with insurance pre-auths and admins?
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They have NP's and fellows for that. Some of our GI's meet the patient for the very first time in the procedure room. "Hi I'm Dr.GI, you're here for an (upper/lower/EUS, blah blah blah) today?" They can't even be bothered to say hello to the patient in the preprocedure area 30 feet away while they're getting their IV/consent/vitals.
 
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GI has other perks.

C856296E-9677-494E-A486-E0DE07C59F85.jpeg
 
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Yeah, but what what may not be immediately apparent to the outside observer is that the GI docs took 4 hours to get the chocolate bars, the vending machine got 14 Gy of radiation in the process, and a surgeon is eventually going to come along and smash the vending machine with a hammer anyway
 
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Well it could be like for us epidurals for labor you only get a max 7 hrs time. I wonder if that is the case for colonososcopy in ny
 
dabears505 said:
Well it could be like for us epidurals for labor you only get a max 7 hrs time. I wonder if that is the case for colonososcopy in ny
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so if you have to take out an epidural and resite it at hour 6, does the clock go back to zero?
 
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I was in a similar shoe as you. Was categorical medicine and struggled between pulm/crit or anesthesia after training. Initially planned to finish IM because it seemed obvious to me that there is a lot of benefit to be dual boarded but like you are seeing here, MANY people that are already in practice advised me to not wait and to jump ship ASAP if that is what I want to do. I listened and transferred after PGY-2 year and am very glad I did. The extra board certification means jack **** once you're in the real world, especially in PP. It might give you slight brownie points if you decide to stay academics but even then, the slight bump in respect you get from some colleagues is not worth losing a year of getting paid 500k.
 
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