Graduating IM Resident, thinking about Anesthesia

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jcakes said:
. I asked a few of the CC-only docs I was close with during residency which path they would choose if they did it over again and nearly all of them said Anes-CC.
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I'm anesthesia ccm, I can tell you I've never heard any ccm-pulm guys say this EVER, but you'd often hear us (anesthesia-ccm) say we wish were pulm-ccm.

There are so many reasons and I'm beyond surprised you'd do anesthesia-ccm after already a day done IM. There are very, very few of us that have community icu jobs. I can think of maybe only a handful of people outside of myself that do.
 
NITRAS hit the nails on the head. Being a hospitalist can be great. No nights (don't underestimate how awful being on call overnight is - whether it's in the hospital or at home)... flexible appropriate pay (work more - make more). Plus lots of flexibility in work settings.

Also as a hospitalist you're the boss. People listen to you. As an anesthesiologist you're never/rarely the boss. People listen to us sometimes, but often they're just blaming "hey anesthesia" for everything vs asking for Dr. Hospitalist for by-default respected expert input.

BTW I think for equivalent workload hospitalists make more than most anesthesiologists these days.

Note that I like my job as an anesthesiologist. Sure IM has it's downsides too. I'm merely warning the IM pre-exilees against thinking the grass is greener here.
 
jcakes said:
Void88 - This is exactly what I am doing. I graduated IM residency 2019 and am currently a hospitalist who matched and will start Anesthesia training in July with plans to do Anes-CC for a total for four more years post-grad training. The extra years of training never bothered me. First, four more years isn't much different from Cards or GI (both at least 3, usually 4 if you want interventional Cards or some extra GI procedures) and some of the Pulm-CC docs I know did a fourth year of interventional Pulm as well. Secondly, I am not worried about the extra years and losing attending-level pay because I honestly just don't care. I struggled a lot during my PGY2-3 years thinking about which path to take (Pulm-CC v CC v Anes-CC vs Hospitalist with open ICU). I have never been interested in doing pulmonology as a career so the Pulm-CC fellowship was never attractive to me. I asked a few of the CC-only docs I was close with during residency which path they would choose if they did it over again and nearly all of them said Anes-CC. Their reasoning was usually "I can do both, some OR and some ICU". In the hospital where I did my residency (large, Midwest community hospital) this is an option but from talking to the few Anes-CC docs at my hospital, this is a rare find in the community world but less rare in the academic world. I am interested in academics, so finding an OR + ICU job is more realistic for me.

I applied at the beginning of my PGY-III year for R-spots where you start as a CA-1 right away in July as well as advanced CA-1 spots where I would take a gap year. I matched into an advanced spot and am working as hospitalist now. I will admit I have second thoughts now that I am working. I found an amazing hospitalist job with an open ICU and I am very happy. It is true that once you start working it is very difficult to go back to training. But when I am in the ICU seeing patients I know I am happiest there, which keeps me motivated. As a hospitalist, remember your 7am-7pm shift isn't actually 12 hours as you can leave the hospital early on many days but just need to carry your pager . Also the hospitalist v intensivist pay gap (at least where I live) is around $100K which isn't all that large once you factor in the lifestyle benefits of a hospitalist. I work 14 days a month but if I pick up an extra 6 days/month my income will match that of the ICU docs with similar levels of experience (fresh out of training).

The most important thing for you to find out is why would Anesthesia be helpful to your Critical Care career. I was asked this a lot on the interview trail and if I hadn't thought this out I probably would not have matched. A good answer for you is different than a good answer for me, but I can tell you a universally bad answer is "I don't like IM" or "I think Anesthesia-CC is less competitive than Pulm-CC". I emailed a lot of programs and asked about their interest in a candidate such as myself. This helped narrow down where I applied. I didn't go on a ton of interviews (4) but I ranked both R and Advanced so my match list had 8 spots. If you do this, tell the PD so she/he knows to rank you in both lists too. I wasn't spectacular on paper with USMLE in the high 230s, a community IM residency, ZERO research and I am a DO. But after completing a residency you will have a different perspective on what is important to your career than a medical student. I cannot tell you if being IM trained gave me a bump or not in terms of competitiveness with medical students, but don't let the names of programs with R spots intimidate you. An R spot is only as competitive as the number of people who apply. And those that do are either the same as you (completed residency in different specialty) or are military folks who haven't done a fully residency yet. One option I thought of but didn't end up choosing was applying for Pulm-CC and CC fellowship plus Anesthesia since they are on different cycles. Fellowship match day is usually a week or so after thanksgiving and if you matched you could just stop interviewing for Anesthesia. This of course is a lot of time, money and travel and for me it wasn't worth it since I was confident anesthesia-cc was the correct choice for me.

Not sure if my experience will be helpful, but I just wanted to let you know there are people like you out there. The best advice I can give you is talk to as many people as possible before applying. This will force you to explain yourself to each person and thus help you realize for yourself if this path is actually what you want to do. Try your best to find an IM-Anesthesia-CC doc and ask their experience too.

Good luck. And if you decide to apply you can DM me with more specific questions.
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I'm glad you don't care about money because the Time Value of Money you have to give up by foregoing 4 years of hospitalist level pay is tremendous. Especially since the market may dip again this year so now might be a fantastic time to start building your investment nestegg.

Also, to echo the above, as an Anesthesia-CCM trained person I have never heard a Pulm-CCM say they wish they would have gone the anesthesia route.
 
I am Anes CCM trained and boarded. I was shut out of all of the community programs I applied for. Mostly ghosted, no emails or questions not responded. Frustrating. When I did get replies back, it was because they wanted me to run out patient bronchs. Never about ICU.
 
ProwlerturnGas said:
I am Anes CCM trained and boarded. I was shut out of all of the community programs I applied for. Mostly ghosted, no emails or questions not responded. Frustrating. When I did get replies back, it was because they wanted me to run out patient bronchs. Never about ICU.
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It’s ironic that anesthesiologists invented critical care here in the USA and yet now the anesthesia/CC folks are treated like that... while anesthesia/CC is king is basically every other country.

alas
 
We have to applaud @jcakes. Leaving 1.2+ million dollars on the table to go back to do a residency/fellowship is very commendable. If you hated your hospitalist job, which you said you dn't, we would have had a different discussion.

If you work residency hours for the next 3-4 yrs as a hospitalist instead of doing that residency/fellowship, that 1.2 mil will be close 2 mil... To put that bluntly, you could use that $$$ to pay off student loan and a 500k mortgage....
 
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OMS3 here wanting to do IM and eventually critical care, with a tickle of interest in anesthesia...

I didn't even know you could do anesthesia once you went down IM route.
In that case, why decide anesthesia after med school for those interested in critical care medicine?
Might as well do IM then decide between pulm/cc vs anesthesia-cc, right? Which fellowship is harder to get?
 
hungrydoc710 said:
OMS3 here wanting to do IM and eventually critical care, with a tickle of interest in anesthesia...

I didn't even know you could do anesthesia once you went down IM route.
In that case, why decide anesthesia after med school for those interested in critical care medicine?
Might as well do IM then decide between pulm/cc vs anesthesia-cc, right? Which fellowship is harder to get?
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He’s talking about doing a whole 2nd residency in Anesthesia. There is no “Anesthesia fellowship” you can do after IM.
 
CC fellowship after anesthesia residency is only a year and very noncompetitive because you actually earn less in the unit.

But there are a few people who can't stand the work of IM and decide to become anesthesiologists. I know one guy who went to train again after 2 years of getting boned as a night hospitalist. Going back and having people tell you what to do after doing your own thing for a few years must be tough. He didn't need to do the prelim year and went right into the advanced years but doing residency again sounds like a pain.
 
Katheudontas parateroumen said:
Is it because they don’t have opportunity to do ICU job or because anesthesia is just too good?
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There aren’t any opportunities for anesthesia CCM in my large city except at the local university. One of the CCM trained people did move out of state and practices CCM in academics now but the move was multi factorial.
 
SaltyDog said:
There are oddly enough Peds Anes/PICU PP jobs available though.
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Really? That's interesting. When I finished peds a few years ago that wasn't the case. Opportunity costs are very hard- hard to get myself psyched about another four years of fellowship to probably make less than I do now as a generalist. Still, kids are cute and adults are gross. I'll probably at the very least end up doing a peds anes fellowship.
 
shepardsun said:
Really? That's interesting. When I finished peds a few years ago that wasn't the case. Opportunity costs are very hard- hard to get myself psyched about another four years of fellowship to probably make less than I do now as a generalist. Still, kids are cute and adults are gross. I'll probably at the very least end up doing a peds anes fellowship.
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As an adult I take offense
 
hungrydoc710 said:
OMS3 here wanting to do IM and eventually critical care, with a tickle of interest in anesthesia...

I didn't even know you could do anesthesia once you went down IM route.
In that case, why decide anesthesia after med school for those interested in critical care medicine?
Might as well do IM then decide between pulm/cc vs anesthesia-cc, right? Which fellowship is harder to get?
Click to expand...

Like others said, anesthesiology isn't an IM subspecialty or fellowship, but anesthesiology is its own base specialty like IM.

But when it comes to IM/pulm/cc (6 years) vs. anesthesia/cc (5 years), one thing it comes down to is what do you want to be doing when you're not in the ICU? Do you want to be in the OR (anesthesia) or do you want to be seeing patients outpatient or inpatient (pulm)? There are advantages and disadvantages to both. A lot depends on your personal goals in life.

For example, do you want to have your own patients and build your own a practice (pulm), or are you okay with just getting the job done and truly being off when you're off work (anesthesia/cc)? That's just one example.

There are some past threads where people have discussed IM/pulm/cc vs. anesthesia/cc in case you want to know more.
 
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UPDATE:
Now I have done 6 months of Hospitalist job. It definitely has its perks, I mean good pay and a week off every other week. However, I don't enjoy my role at all. A lot of social drama every day, i.e., daily meetings, case manager meet-ups, length of stay huddles, calling family, patients wanting to stay in the hospital when it is clearly not necessary, families wanted updates every day, and nurse paging throughout the day. I feel like we are the dumping ground of the hospital. Every specialist will just write recommendations and we have to follow up on everything. I do understand that it is part of my job as a Hospitalist, but sometimes, their recommendation is to discuss the case with another specialist, I mean for GOD's sake! if you really want another person to have a look at the case, at least have the courtesy of talking to that specialist as the 2nd specialist would want to hear from the first specialist as to why his service is needed. Times I do feel like I made difference in patient's life is when I connect them to the right specialist and the patient getting the right treatment. I struggle with multi-tasking as things keep adding up on that list. No matter how fast I try to do things, I spend most of the day in front of the computer charting notes.

Sometimes, I feel like there is nothing wrong with the specialty but these are all my shortcomings. I knew before finishing residency that I would have to do all these things as a Hospitalist, but I thought with higher pay, working half a year, it would be worth it. But now I feel like it is more than money for me now. To me, work-life does matter. A lot of my fellow internists tell me to take it as a job. Even if it is a bad day, at the end of the day, I go home and get paid. But 3-4 days prior to my week ON, I start getting anxious and constantly think about how my workweek is going to be. I question myself if it is due to not liking the hospitalist role or I have social anxiety issues.

It brings us to the next point. I feel like I need to get out of it. I can go for fellowship, but I cannot do any fellowship just to get out of my role. I think it is important to specialize in what you really like; otherwise, you will be stuck in the same cycle I am. I really like pathophysiology and that is why I always got attracted to Critical Care Medicine. Also, I enjoy the cardio/pulmonary system. As mentioned in the first post of this thread, I really enjoyed the OR and anesthesia when I rotated as a PGY-2/3 IM resident. I feel like I would enjoy anesthesia as a career as I can escape the social drama of IM and still get to CCM as a one-year fellowship OR just apply either CCM only or Pulm/CC this year. I have discussed this with my wife and she is supportive as long as I pick something I can do for the rest of my life.

I am trying to find people who did Anesthesia after IM residency to listen to their perspective for guidance. I really appreciate each and every one of you who took the time to post on this thread. It was really helpful and constructive.
 
void88 said:
UPDATE:
Now I have done 6 months of Hospitalist job. It definitely has its perks, I mean good pay and a week off every other week. However, I don't enjoy my role at all. A lot of social drama every day, i.e., daily meetings, case manager meet-ups, length of stay huddles, calling family, patients wanting to stay in the hospital when it is clearly not necessary, families wanted updates every day, and nurse paging throughout the day. I feel like we are the dumping ground of the hospital. Every specialist will just write recommendations and we have to follow up on everything. I do understand that it is part of my job as a Hospitalist, but sometimes, their recommendation is to discuss the case with another specialist, I mean for GOD's sake! if you really want another person to have a look at the case, at least have the courtesy of talking to that specialist as the 2nd specialist would want to hear from the first specialist as to why his service is needed. Times I do feel like I made difference in patient's life is when I connect them to the right specialist and the patient getting the right treatment. I struggle with multi-tasking as things keep adding up on that list. No matter how fast I try to do things, I spend most of the day in front of the computer charting notes.

Sometimes, I feel like there is nothing wrong with the specialty but these are all my shortcomings. I knew before finishing residency that I would have to do all these things as a Hospitalist, but I thought with higher pay, working half a year, it would be worth it. But now I feel like it is more than money for me now. To me, work-life does matter. A lot of my fellow internists tell me to take it as a job. Even if it is a bad day, at the end of the day, I go home and get paid. But 3-4 days prior to my week ON, I start getting anxious and constantly think about how my workweek is going to be. I question myself if it is due to not liking the hospitalist role or I have social anxiety issues.

It brings us to the next point. I feel like I need to get out of it. I can go for fellowship, but I cannot do any fellowship just to get out of my role. I think it is important to specialize in what you really like; otherwise, you will be stuck in the same cycle I am. I really like pathophysiology and that is why I always got attracted to Critical Care Medicine. Also, I enjoy the cardio/pulmonary system. As mentioned in the first post of this thread, I really enjoyed the OR and anesthesia when I rotated as a PGY-2/3 IM resident. I feel like I would enjoy anesthesia as a career as I can escape the social drama of IM and still get to CCM as a one-year fellowship OR just apply either CCM only or Pulm/CC this year. I have discussed this with my wife and she is supportive as long as I pick something I can do for the rest of my life.

I am trying to find people who did Anesthesia after IM residency to listen to their perspective for guidance. I really appreciate each and every one of you who took the time to post on this thread. It was really helpful and constructive.
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I think @GravelRider is a good source for someone who did anesthesia after IM. But I seem to remember he wished he had done pulm cc instead?
 
void88 said:
UPDATE:
Now I have done 6 months of Hospitalist job. It definitely has its perks, I mean good pay and a week off every other week. However, I don't enjoy my role at all. A lot of social drama every day, i.e., daily meetings, case manager meet-ups, length of stay huddles, calling family, patients wanting to stay in the hospital when it is clearly not necessary, families wanted updates every day, and nurse paging throughout the day. I feel like we are the dumping ground of the hospital. Every specialist will just write recommendations and we have to follow up on everything. I do understand that it is part of my job as a Hospitalist, but sometimes, their recommendation is to discuss the case with another specialist, I mean for GOD's sake! if you really want another person to have a look at the case, at least have the courtesy of talking to that specialist as the 2nd specialist would want to hear from the first specialist as to why his service is needed. Times I do feel like I made difference in patient's life is when I connect them to the right specialist and the patient getting the right treatment. I struggle with multi-tasking as things keep adding up on that list. No matter how fast I try to do things, I spend most of the day in front of the computer charting notes.

Sometimes, I feel like there is nothing wrong with the specialty but these are all my shortcomings. I knew before finishing residency that I would have to do all these things as a Hospitalist, but I thought with higher pay, working half a year, it would be worth it. But now I feel like it is more than money for me now. To me, work-life does matter. A lot of my fellow internists tell me to take it as a job. Even if it is a bad day, at the end of the day, I go home and get paid. But 3-4 days prior to my week ON, I start getting anxious and constantly think about how my workweek is going to be. I question myself if it is due to not liking the hospitalist role or I have social anxiety issues.

It brings us to the next point. I feel like I need to get out of it. I can go for fellowship, but I cannot do any fellowship just to get out of my role. I think it is important to specialize in what you really like; otherwise, you will be stuck in the same cycle I am. I really like pathophysiology and that is why I always got attracted to Critical Care Medicine. Also, I enjoy the cardio/pulmonary system. As mentioned in the first post of this thread, I really enjoyed the OR and anesthesia when I rotated as a PGY-2/3 IM resident. I feel like I would enjoy anesthesia as a career as I can escape the social drama of IM and still get to CCM as a one-year fellowship OR just apply either CCM only or Pulm/CC this year. I have discussed this with my wife and she is supportive as long as I pick something I can do for the rest of my life.

I am trying to find people who did Anesthesia after IM residency to listen to their perspective for guidance. I really appreciate each and every one of you who took the time to post on this thread. It was really helpful and constructive.
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I really think pulm-CC would be a better path. You’d have the ability to weight your practice more towards either clinic/procedure based (pulm) or hospital based (ICU) depending what you prefer.

Good gig.
 
void88 said:
UPDATE:
Now I have done 6 months of Hospitalist job. It definitely has its perks, I mean good pay and a week off every other week. However, I don't enjoy my role at all. A lot of social drama every day, i.e., daily meetings, case manager meet-ups, length of stay huddles, calling family, patients wanting to stay in the hospital when it is clearly not necessary, families wanted updates every day, and nurse paging throughout the day. I feel like we are the dumping ground of the hospital. Every specialist will just write recommendations and we have to follow up on everything. I do understand that it is part of my job as a Hospitalist, but sometimes, their recommendation is to discuss the case with another specialist, I mean for GOD's sake! if you really want another person to have a look at the case, at least have the courtesy of talking to that specialist as the 2nd specialist would want to hear from the first specialist as to why his service is needed. Times I do feel like I made difference in patient's life is when I connect them to the right specialist and the patient getting the right treatment. I struggle with multi-tasking as things keep adding up on that list. No matter how fast I try to do things, I spend most of the day in front of the computer charting notes.

Sometimes, I feel like there is nothing wrong with the specialty but these are all my shortcomings. I knew before finishing residency that I would have to do all these things as a Hospitalist, but I thought with higher pay, working half a year, it would be worth it. But now I feel like it is more than money for me now. To me, work-life does matter. A lot of my fellow internists tell me to take it as a job. Even if it is a bad day, at the end of the day, I go home and get paid. But 3-4 days prior to my week ON, I start getting anxious and constantly think about how my workweek is going to be. I question myself if it is due to not liking the hospitalist role or I have social anxiety issues.

It brings us to the next point. I feel like I need to get out of it. I can go for fellowship, but I cannot do any fellowship just to get out of my role. I think it is important to specialize in what you really like; otherwise, you will be stuck in the same cycle I am. I really like pathophysiology and that is why I always got attracted to Critical Care Medicine. Also, I enjoy the cardio/pulmonary system. As mentioned in the first post of this thread, I really enjoyed the OR and anesthesia when I rotated as a PGY-2/3 IM resident. I feel like I would enjoy anesthesia as a career as I can escape the social drama of IM and still get to CCM as a one-year fellowship OR just apply either CCM only or Pulm/CC this year. I have discussed this with my wife and she is supportive as long as I pick something I can do for the rest of my life.

I am trying to find people who did Anesthesia after IM residency to listen to their perspective for guidance. I really appreciate each and every one of you who took the time to post on this thread. It was really helpful and constructive.
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Just do CCM. Less social issues, but you won’t get away from sitting in front of a computer. Less reliability on specialists and as a locums, less meetings.
Or find a job where you aren’t expected to always be the specialists secretaries.
 
I did anesthesia right after IM. No regrets at all. I think ccm has a lot more social issues and paperwork than anesthesia. I didn’t really like ccm that much when I was a resident.
 
chocomorsel said:
Just do CCM. Less social issues, but you won’t get away from sitting in front of a computer. Less reliability on specialists and as a locums, less meetings.
Or find a job where you aren’t expected to always be the specialists secretaries.
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computer charting is much less in CCM, you are focusing on 2-3 diagnosis and rest are usually chronic or something which can be worked up once the patient stabilizes and transferred out of ICU.
 
dabears505 said:
Please don't go into anesthesia and then do another fellowship and waste 4 years and at least a half million dollars in the process. Just work internal med, enjoy the low stress, start healthy, live a good life.
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A statistically significant impression. I appreciate that. However, it gives me a lot of stress due to all the social work I have to do daily basis. I will be honest, I am a laid-back person, and if something I'm doing helps me afford a comfortable living, it will be hard for me to have the determination or will to do more in my career. My friends are taking any extra shifts they can on a week off, while don't want to do a single shift extra. I feel like it is unhealthy and a sign for me to get out of it. Some nights I stay up at 2-3 am thinking about it and reading up forums for IM --> Anesthesia vs. CCM vs. pulm/CC.
 
void88 said:
A statistically significant impression. I appreciate that. However, it gives me a lot of stress due to all the social work I have to do daily basis. I will be honest, I am a laid-back person, and if something I'm doing helps me afford a comfortable living, it will be hard for me to have the determination or will to do more in my career. My friends are taking any extra shifts they can on a week off, while don't want to do a single shift extra. I feel like it is unhealthy and a sign for me to get out of it. Some nights I stay up at 2-3 am thinking about it and reading up forums for IM --> Anesthesia vs. CCM vs. pulm/CC.
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You sound miserable as a hospitalitist so I say do CCM. But just realize that multidisciplinary rounds, social work, talking to pts families, dealing with consultants etc is unavoidable there as well. However, I am in an academic practice so the burden of those things is much less, though. My fellows and senior residents can handle the vast majority of that tedium and just come to me if they have problems.
 
void88 said:
computer charting is much less in CCM, you are focusing on 2-3 diagnosis and rest are usually chronic or something which can be worked up once the patient stabilizes and transferred out of ICU.
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I don’t know about that. I have seen my friends’ IM notes. So much less work. Ours are a lot more complicated and longer.
 
void88 said:
UPDATE:
Now I have done 6 months of Hospitalist job. It definitely has its perks, I mean good pay and a week off every other week. However, I don't enjoy my role at all. A lot of social drama every day, i.e., daily meetings, case manager meet-ups, length of stay huddles, calling family, patients wanting to stay in the hospital when it is clearly not necessary, families wanted updates every day, and nurse paging throughout the day. I feel like we are the dumping ground of the hospital. Every specialist will just write recommendations and we have to follow up on everything. I do understand that it is part of my job as a Hospitalist, but sometimes, their recommendation is to discuss the case with another specialist, I mean for GOD's sake! if you really want another person to have a look at the case, at least have the courtesy of talking to that specialist as the 2nd specialist would want to hear from the first specialist as to why his service is needed. Times I do feel like I made difference in patient's life is when I connect them to the right specialist and the patient getting the right treatment. I struggle with multi-tasking as things keep adding up on that list. No matter how fast I try to do things, I spend most of the day in front of the computer charting notes.

Sometimes, I feel like there is nothing wrong with the specialty but these are all my shortcomings. I knew before finishing residency that I would have to do all these things as a Hospitalist, but I thought with higher pay, working half a year, it would be worth it. But now I feel like it is more than money for me now. To me, work-life does matter. A lot of my fellow internists tell me to take it as a job. Even if it is a bad day, at the end of the day, I go home and get paid. But 3-4 days prior to my week ON, I start getting anxious and constantly think about how my workweek is going to be. I question myself if it is due to not liking the hospitalist role or I have social anxiety issues.

It brings us to the next point. I feel like I need to get out of it. I can go for fellowship, but I cannot do any fellowship just to get out of my role. I think it is important to specialize in what you really like; otherwise, you will be stuck in the same cycle I am. I really like pathophysiology and that is why I always got attracted to Critical Care Medicine. Also, I enjoy the cardio/pulmonary system. As mentioned in the first post of this thread, I really enjoyed the OR and anesthesia when I rotated as a PGY-2/3 IM resident. I feel like I would enjoy anesthesia as a career as I can escape the social drama of IM and still get to CCM as a one-year fellowship OR just apply either CCM only or Pulm/CC this year. I have discussed this with my wife and she is supportive as long as I pick something I can do for the rest of my life.

I am trying to find people who did Anesthesia after IM residency to listen to their perspective for guidance. I really appreciate each and every one of you who took the time to post on this thread. It was really helpful and constructive.
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Pretty sure, IM to CCM is much more attractive than anesthesia to CCM.
They prefer the IM trained doc's to run an ICU.
 
vector2 said:
You sound miserable as a hospitalitist so I say do CCM. But just realize that multidisciplinary rounds, social work, talking to pts families, dealing with consultants etc is unavoidable there as well. However, I am in an academic practice so the burden of those things is much less, though. My fellows and senior residents can handle the vast majority of that tedium and just come to me if they have problems.
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And sometimes I blame myself for being miserable that maybe I have to work on my personality or just work on being a smarter internist. That maybe there is nothing wrong with the job but maybe it's just me as I can see others having no issue with the above-mentioned things I said.
 
void88 said:
And sometimes I blame myself for being miserable that maybe I have to work on my personality or just work on being a smarter internist. That maybe there is nothing wrong with the job but maybe it's just me as I can see others having no issue with the above-mentioned things I said.
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Or maybe it's just a miserable job that doesn't fit your personality. Tell you what, for me, I immensely enjoy the ICU more than the OR. I went back for a fellowship after being out for seven years. However the paperwork, the nursing calls and the procedures are a time suck. I usually wish I were in the OR instead due to those issues. But the mental stimulation and the respect I get in the ICU I would not trade for the OR. I am a real doctor in the ICU and don't have to deal with egotistical CRNAs or arsehole surgeons who think they are my boss that often. And I get to eat lunch almost every day instead of rushing and/or stuffing my face behind the drapes. Many people think I was crazy for going to do a very unsexy anesthesia fellowship especially after being out for so long, but it makes me more well rounded and ultimately happier.
 
chocomorsel said:
Who’s “they?” And why do they prefer IM docs to run an ICU?
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Sorry, that was vague.
"They" as in the hospitals. I've had interest in both, and often speak to family friends and newly minted friends in those in the fields.

As per why - not 100% sure. I've been told Pulm/CC docs are used as half in pulm clinic and half running thier ICU, so they are very useful in multiple ways. Whereas anesthesia never really get outta the OR and straight CCM (not pulm/cc) aren't as valable bc of not being able to work at pulm clinic.

I def like the idea of pulm clinic half day or one wk, and then ICU in between. Gives great balance.
My main worry is how competitive the field is.

Don't shoot the messenger.
 
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hungrydoc710 said:
Sorry, that was vague.
"They" as in the hospitals. I've had interest in both, and often speak to family friends and newly minted friends in those in the fields.

As per why - not 100% sure. I've been told Pulm/CC docs are used as half in pulm clinic and half running thier ICU, so they are very useful in multiple ways. Whereas anesthesia never really get outta the OR and straight CCM (not pulm/cc) aren't as valable bc of not being able to work at pulm clinic.

I def like the idea of pulm clinic half day or one wk, and then ICU in between. Gives great balance.
My main worry is how competitive the field is.

Don't shoot the messenger.
Click to expand...
True, true, true. They want a two-fer with the Pulm CCM. Otherwise if they just want intensivists, they don't often care the background if not worried about pulmonary consults. However, if it's pulmonary holding the contract, they want their pulmonary fellows for your stated reasons above.
Honestly, some hospitals are so clueless that they will refuse to hire anyone without a Pulm background even for straight ICU. I suspect it's because that's all they know and/or the current Pulm staff already on deck refuse to let anyone else with a different background in.
The tides were changing, but Covid has really accelerated those tides in my opinion as community hospitals are realizing that EM/Anesthesia/Surgery intensivists are fully capable of running the ICUs as well if not better than pulmonary. I guess they were fully expecting us to be total idiots.
 
chocomorsel said:
Many people think I was crazy for going to do a very unsexy anesthesia fellowship especially after being out for so long, but it makes me more well rounded and ultimately happier.
Click to expand...

Hard to underrate happiness. Medicine has a lot that sucks about it in pretty much every field. You gotta do something where you enjoy the fun stuff and can tolerate the bad stuff.
 
You sound burned out, but to echo the others above, I would not recommend anesthesia after IM. You just might find that you traded one thing only now you have to deal with ****ty surgeons or greedy administrators who have no clue or just don’t gaf. Everything becomes a grind after a while, no matter how much you love it. If I were you, I would:

continue what you’re doing, or cut back, find something outside of medicine.

do CC/pulm.

look into doing some academic hospital medicine shifts where you still get the mental masturbation but the residents do the scut lifting.

find a hobby outside of medicine.

spend time with your family, don’t get divorced - choose one or both.
 
Mman said:
Hard to underrate happiness. Medicine has a lot that sucks about it in pretty much every field. You gotta do something where you enjoy the fun stuff and can tolerate the bad stuff.
Click to expand...
Where you been dude? I have missed picking on you. Lol. Glad to see you back.
 
I think what you experience is multi factorial: you, the specialty, the hospital you work for. Consider first if changing setting (each setting goes with a unique culture, academic places more helpful for attendings given the workload is on residents and fellows) would dramatically change your view, then no need to worry; you sound though as if you do not like what you do and if that is deeply instilled within you, very hard to change even in the best setting; I disagree with aforementioned suggestions to do pulm/crit. They forget that it is 2-3 years depending on the program. During that time you can definitely finish anesthesia and that would give you a different perspective to things. Maybe the loneliness and the straightforward of anesthesia suits you better.
I had the opportunity during residency to do one month of CCU with a PGY3 IM resident. I was amazed with how differently we were approaching things and how focused he was to making pts CMO. Hours and hours of conversations with families, sometimes too aggressively, to make them CMO. I was tired seeing that. We do have that in surgical ICUs too but not as often.

Think of what will make you happy. Better wasting 2-3 years than being miserable for life
 
Lidolover said:
I think what you experience is multi factorial: you, the specialty, the hospital you work for. Consider first if changing setting (each setting goes with a unique culture, academic places more helpful for attendings given the workload is on residents and fellows) would dramatically change your view, then no need to worry; you sound though as if you do not like what you do and if that is deeply instilled within you, very hard to change even in the best setting; I disagree with aforementioned suggestions to do pulm/crit. They forget that it is 2-3 years depending on the program. During that time you can definitely finish anesthesia and that would give you a different perspective to things. Maybe the loneliness and the straightforward of anesthesia suits you better.
I had the opportunity during residency to do one month of CCU with a PGY3 IM resident. I was amazed with how differently we were approaching things and how focused he was to making pts CMO. Hours and hours of conversations with families, sometimes too aggressively, to make them CMO. I was tired seeing that. We do have that in surgical ICUs too but not as often.

Think of what will make you happy. Better wasting 2-3 years than being miserable for life
Click to expand...
What is CMO?
 
secretasianman said:
You sound burned out, but to echo the others above, I would not recommend anesthesia after IM. You just might find that you traded one thing only now you have to deal with ****ty surgeons or greedy administrators who have no clue or just don’t gaf. Everything becomes a grind after a while, no matter how much you love it. If I were you, I would:

continue what you’re doing, or cut back, find something outside of medicine.

do CC/pulm.

look into doing some academic hospital medicine shifts where you still get the mental masturbation but the residents do the scut lifting.

find a hobby outside of medicine.

spend time with your family, don’t get divorced - choose one or both.
Click to expand...
I might be burned out. It is very possible. However, I just got out of the residency knowing that I might not like Hospitalist work. When I did an Anesthesia rotation at the end of PGY-2, I already started thinking about it. Least favorite part of my residency was working on the ward's rotation and clinic.
You're right about maybe shifting towards academic hospital medicine or maybe working as a nocturnist. I don't know.
 
Lidolover said:
I think what you experience is multi factorial: you, the specialty, the hospital you work for. Consider first if changing setting (each setting goes with a unique culture, academic places more helpful for attendings given the workload is on residents and fellows) would dramatically change your view, then no need to worry; you sound though as if you do not like what you do and if that is deeply instilled within you, very hard to change even in the best setting; I disagree with aforementioned suggestions to do pulm/crit. They forget that it is 2-3 years depending on the program. During that time you can definitely finish anesthesia and that would give you a different perspective to things. Maybe the loneliness and the straightforward of anesthesia suits you better.
I had the opportunity during residency to do one month of CCU with a PGY3 IM resident. I was amazed with how differently we were approaching things and how focused he was to making pts CMO. Hours and hours of conversations with families, sometimes too aggressively, to make them CMO. I was tired seeing that. We do have that in surgical ICUs too but not as often.

Think of what will make you happy. Better wasting 2-3 years than being miserable for life
Click to expand...
That is true. Being an internist, we are trained to look at the bigger picture and course of hospital stay or anticipate if further workup is worth it or not. Calling Palliative care when we feel like we are just fixing numbers but not the patient. I'm not the best at it and try to avoid calls as much as I can. However, I used to be the most eager resident to intubate or put a line in or do a bedside echo. Not that I'm saying that I don't get stressed out in codes but I don't completely panic, and try to follow the protocol systematically. I've seen some residents who actually look forward to rapid responses and code blue. I'm not that person either.
Like you said, I am contacting our Hospital Director to see if I can find a nocturnist spot, and see if that makes any difference. Generally speaking, the hospitalist group at our place is stable. It is a level I trauma and referral center so lots of pathology.

Right now, my daughter is a toddler and I feel like I have 2-3 years to do something otherwise, I won't do anything or it will get hard to do something about it. Obviously, I question my motives to go for anesthesia every day. Like, what if the grass is greener on the other side? what if I'm just running away from hardship as I'm in the earliest phase of my career? What if I'm just burned out? Why not just CCM as it is an extension of anesthesia? As if they are true in my case, I won't be happy even after doing anesthesia.

You guys have been so wonderful with your replies. Thank you!
 
void88 said:
That is true. Being an internist, we are trained to look at the bigger picture and course of hospital stay or anticipate if further workup is worth it or not. Calling Palliative care when we feel like we are just fixing numbers but not the patient. I'm not the best at it and try to avoid calls as much as I can. However, I used to be the most eager resident to intubate or put a line in or do a bedside echo. Not that I'm saying that I don't get stressed out in codes but I don't completely panic, and try to follow the protocol systematically. I've seen some residents who actually look forward to rapid responses and code blue. I'm not that person either.
Like you said, I am contacting our Hospital Director to see if I can find a nocturnist spot, and see if that makes any difference. Generally speaking, the hospitalist group at our place is stable. It is a level I trauma and referral center so lots of pathology.

Right now, my daughter is a toddler and I feel like I have 2-3 years to do something otherwise, I won't do anything or it will get hard to do something about it. Obviously, I question my motives to go for anesthesia every day. Like, what if the grass is greener on the other side? what if I'm just running away from hardship as I'm in the earliest phase of my career? What if I'm just burned out? Why not just CCM as it is an extension of anesthesia? As if they are true in my case, I won't be happy even after doing anesthesia.

You guys have been so wonderful with your replies. Thank you!
Click to expand...
I just wanna add that CCM is nothing like anesthesiology in terms of everyday work. Most anesthesiologist would hate to work in the ICU everyday.
 
chocomorsel said:
Where you been dude? I have missed picking on you. Lol. Glad to see you back.
Click to expand...
life gets me busy some times and I will take a break from the internet (or at least the time wasting parts of it) for a while.
 
Mman said:
life gets me busy some times and I will take a break from the internet (or at least the time wasting parts of it) for a while.
Click to expand...
I need to be more like that. I waste too much time on here. Need some other hobbies. Come back more often, but don’t be like me. It’s not healthy. Lol.
 
Test Boy said:
I just wanna add that CCM is nothing like anesthesiology in terms of everyday work. Most anesthesiologist would hate to work in the ICU everyday.
Click to expand...
Why is that? I always thought CCM is an extension of Anesthesia outside of OR.
 
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