Help Give me some Perspective

[Ellie321]

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Struggling between interventional cards and anesthesia. Going through IM is going to be a struggle for me: I dislike clinics, not excited about rounds, no interest in any other IM field except for cards. I think it might be difficult for me to excel in IM residency enough to secure a spot in cards.

I've done a formal month-long rotation through anesthesia. I liked it, but not enough to "love" it. I think the procedures are cool and somewhat exciting, but I don't find them to be the end-all-be-all of my happiness like others in my class going into the field seem to feel. I do like hands-on aspect of anesthsia and find physiology intellectually stimulating. However, I don't enjoy sitting through long cases on stable patients. I also don't have much interest in chronic pain (big at our school). One other thing that bothers me some is the passiveness of most anesthesiologists I've encountered, which doesn't make me feel very secure or comfortable about the future of the field. I don't sense much proactiveness or drive in many I've worked with. I enjoy their wit, humor, and laid-back attitude, but of the ones I've worked with, don't really have any that I look up to (really hope that doesn't come across as egotistical). My personal statement and recs are lined up for anesthesia, but I am starting to have 2nd thoughts. (I've also written a personal statement for Cards/IM, and could secure LORs without much difficulty.)

If I went with my passion, i would go cardiology. But lifestyle (perceived or real), lack of rounds, no clinics, no long notes for me favors anesthesia. Not so sure that these should be relevant points for choosing one specialty over another. Also, not exactly certain lifestyle will be much different in practice.

One thing is for certain, I love CV physiology and CV pharmacology. Anyone with words of wisdom? Advice? Opinion? Suggestions? I welcome any and all input!

 

[urge]

Struggling between interventional cards and anesthesia. Going through IM is going to be a struggle for me: I dislike clinics, not excited about rounds, no interest in any other IM field except for cards. I think it might be difficult for me to excel in IM residency enough to secure a spot in cards.

I've done a formal month-long rotation through anesthesia. I liked it, but not enough to "love" it. I think the procedures are cool and somewhat exciting, but I don't find them to be the end-all-be-all of my happiness like others in my class going into the field seem to feel. I do like hands-on aspect of anesthsia and find physiology intellectually stimulating. However, I don't enjoy sitting through long cases on stable patients. I also don't have much interest in chronic pain (big at our school). One other thing that bothers me some is the passiveness of most anesthesiologists I've encountered, which doesn't make me feel very secure or comfortable about the future of the field. I don't sense much proactiveness or drive in many I've worked with. I enjoy their wit, humor, and laid-back attitude, but of the ones I've worked with, don't really have any that I look up to (really hope that doesn't come across as egotistical). My personal statement and recs are lined up for both anesthesia, but I am starting to have 2nd thoughts. (I've also written a personal statement for Cards/IM, and could secure LORs without much difficulty.)

If I went with my passion, i would go cardiology (no pun intended). But lifestyle (perceived or real), lack of rounds, no clinics, no long notes for me favors anesthesia. Not so sure that these should be relevant points for choosing one specialty over another. Also, not exactly certain lifestyle will be much different in practice.

One thing is for certain, I love CV physiology and CV pharmacology. Anyone with words of wisdom? Advice? Opinion? Suggestions? I welcome any and all input!

Stay in IM. 3 years go by fast.

 

[Josh1]

If I went with my passion, i would go cardiology.

Go with your passion, it's much harder to regret, every field will have difficulties, few will be a passion

 

[Stank811]

Agree with above post....you will not be unhappy in the future if cardiology is your passion

 

[Ellie321]

Thanks for the thoughts so far. I'm thinking of forging ahead with IM, with goal being cards.

Someone I respect once told me to be careful "following one's passion" in medicine. He cautioned that a field one finds intellectually stimulating may not be so stimulating in actual practice. Makes me hesitate...

 

[Ellie321]

Another thought...

If I don't go for cards, I will probably always wonder what if. If I absolutely hate IM, I could switch into anesthesia and likely have a much better appreciation of it than I do now.

I can't believe I'm at this point in my 4th year and still haven't figured these things out! I started medical school 100% surgery (through year 3.5). My fellow classmates are shocked that I'm even considering IM.

 

[muhali3]

I shadowed a cardiologist in PP for a summer. For him, he seemed more satisfied with the social aspect of it rather than the medical aspect. He told me he sees the same type of patients day in and day out. Prescribing and changing the dose of coumadin to almost every patient he had. It did not seem very intellectually stimulating. But he seemed to have a very good relationship with all his patients.

 

[Ellie321]

I shadowed a cardiologist in PP for a summer. For him, he seemed more satisfied with the social aspect of it rather than the medical aspect. He told me he sees the same type of patients day in and day out. Prescribing and changing the dose of coumadin to almost every patient he had. It did not seem very intellectually stimulating. But he seemed to have a very good relationship with all his patients.

Good point. I don't mind patient interactions, but long-term/chronic folloups seem like such a chore. I'd rather spend my socializing time with friends and family rather than with patients. 🙁 Chit-chat and small-talk with patients wears me down.

 

[OB1🤙]

Obvious answer is to do anesthesia then a cardiac fellowship. Best of all worlds.

 

[muhali3]

Obvious answer is to do anesthesia then a cardiac fellowship. Best of all worlds.

Even though I'm pre-med, I agree with this. Since you said you love CV physiology & pharmacology, cardiothoracic anesthesia would be a very good fit.

 

[B-Bone]

If I went with my passion, i would go cardiology. But lifestyle (perceived or real), lack of rounds, no clinics, no long notes for me favors anesthesia. Not so sure that these should be relevant points for choosing one specialty over another. Also, not exactly certain lifestyle will be much different in practice.

I think it's a bad idea to pick a specialty based on what you DON'T do in it. If anesthesiology doesn't interest you, don't do anesthesia. If you truly don't give a s*&% what you do all day as long as you aren't rounding/in clinic/writing notes, then do whatever floats your boat i.e. Anesthesia, Home Depot, ski bum, etc.

 

[SinghDoc]

Agree with anesthesia then CV fellowship if you hate rounds/notes/clinic. I did 3 years of IM and hated my ****ty monday clinic, still get flashbacks of doing nasty PAP smears and screening rectal exams and counseling people on diet/excercise/tobacco cessation. I felt bad for the intern taking over my panel as he had a nice stack of scooter applications to fill out.

Unless you are dead-set on interventional (I thought I was set on EP) it's a pretty tough lifestyle with 2 AM MIs and such with a VERY heavy workload during general cardiology fellowship. Its also very competitive, it took 2 of my roommates in med school 3 years of research and heart failure fellowships after completing a medicine residency to get into another 3 years of cards fellowship plus another 1 year of interventional. 3 years is a long time doing something you know you don't enjoy (IM).

doing CV anesthesia and/or CCM fellowship after anesthesia allow you to do TEE, bronchs, be an intensivist, do general and regional anesthesia (crazy fun BTW) which I think allows for a pretty good lifestyle and high degree of job satisfaction. Even if you do anesthesia/CV/CCM, that would be 4+1+1=6 years vs IM/Cards/Inteventional that would be 3+3+1=7 years (assuming you match outright for cards).

That's my take FWIW

 

[Ellie321]

I think it's a bad idea to pick a specialty based on what you DON'T do in it. If anesthesiology doesn't interest you, don't do anesthesia. If you truly don't give a s*&% what you do all day as long as you aren't rounding/in clinic/writing notes, then do whatever floats your boat i.e. Anesthesia, Home Depot, ski bum, etc.

You're likely right. But my aversion towards much of what makes up IM (aka rounds, notes, rounds, clinics, dispo issues, noncompliant pts) makes me worried that I may not enjoy the practice of cardiology (unless I'm a busy interventionalist, but that comes with a lot of "ifs"). Just the thought of having to deal with the above makes me a little nauseous. I absolutely love learning about most all cards topics...love EKGs, interpreting Echos, various imaging modalities, new up-and-coming technologies and procedures in interventional cards...not sure if it's enough to carry me through the other aspects of practice I don't enjoy.

Also, I didn't mean to imply I don't have any interest in anesthesiology, just don't have the same degree of excitement as learning about cards topics. I believe I can be a decent anesthesiologist, but it would be more of a "job" to me than my (maybe somewhat romanticized) view of interventional cards. Sometimes I wonder if I wouldn't be more excited about anesthesia than I am if I had exposure to a different program.

What do people think about applying to both IM and anesthesia? Would it be the "kiss of death"? Applying to both might give me a little more time to stew over this.


Aside: I have given a lot of thought to cardiac anesthesia...would be my ultimate goal if I went the anesthesia route.

 

[Ellie321]

Agree with anesthesia then CV fellowship if you hate rounds/notes/clinic. I did 3 years of IM and hated my ****ty monday clinic, still get flashbacks of doing nasty PAP smears and screening rectal exams and counseling people on diet/excercise/tobacco cessation. I felt bad for the intern taking over my panel as he had a nice stack of scooter applications to fill out.

Unless you are dead-set on interventional (I thought I was set on EP) it's a pretty tough lifestyle with 2 AM MIs and such with a VERY heavy workload during general cardiology fellowship. Its also very competitive, it took 2 of my roommates in med school 3 years of research and heart failure fellowships after completing a medicine residency to get into another 3 years of cards fellowship plus another 1 year of interventional. 3 years is a long time doing something you know you don't enjoy (IM).

doing CV anesthesia and/or CCM fellowship after anesthesia allow you to do TEE, bronchs, be an intensivist, do general and regional anesthesia (crazy fun BTW) which I think allows for a pretty good lifestyle and high degree of job satisfaction. Even if you do anesthesia/CV/CCM, that would be 4+1+1=6 years vs IM/Cards/Inteventional that would be 3+3+1=7 years (assuming you match outright for cards).

That's my take FWIW

How difficult was it to switch into anesthesia from IM?

 

[imfrankie]

You're likely right. But my aversion towards much of what makes up IM (aka rounds, notes, rounds, clinics, dispo issues, noncompliant pts) makes me worried that I may not enjoy the practice of cardiology (unless I'm a busy interventionalist, but that comes with a lot of "ifs"). Just the thought of having to deal with the above makes me a little nauseous. I absolutely love learning about most all cards topics...love EKGs, interpreting Echos, various imaging modalities, new up-and-coming technologies and procedures in interventional cards...not sure if it's enough to carry me through the other aspects of practice I don't enjoy.

Also, I didn't mean to imply I don't have any interest in anesthesiology, just don't have the same degree of excitement as learning about cards topics. I believe I can be a decent anesthesiologist, but it would be more of a "job" to me than my (maybe somewhat romanticized) view of interventional cards. Sometimes I wonder if I wouldn't be more excited about anesthesia than I am if I had exposure to a different program.

What do people think about applying to both IM and anesthesia? Would it be the "kiss of death"? Applying to both might give me a little more time to stew over this.


Aside: I have given a lot of thought to cardiac anesthesia...would be my ultimate goal if I went the anesthesia route.

You are a pediatric cardiac anesthesiologist. You won't be bored, will always be in demand and the sky is the limit for doing good things. You will love it.

 

[SinghDoc]

Funding issues will be the stumbling block for those already done with residency..I advise switching while still a resident but others may have differing opinions on SDN.

 

[Ellie321]

Funding issues will be the stumbling block for those already done with residency..I advise switching while still a resident but others may have differing opinions on SDN.

I'm afraid I don't know much about the funding situation. Could you (or someone) educate me on this? Or any sites with info? I would have thought anesthesia residencies might value someone who's completed IM.

 

[imfrankie]

I'm afraid I don't know much about the funding situation. Could you (or someone) educate me on this? Or any sites with info? I would have thought anesthesia residencies might value someone who's completed IM.

I think they would. They want warm, capable bodies to bill through.

 

[cfdavid]

At some point you just need to make a decision.

I think that the future generations of anesthesiologists will likely be taking a more proactive role in protecting the future of the profession and are aware of the challenges. I would probably agree that this field has a deficit of the role models which you seem to seek and respect. They do indeed exist, however.

Good luck in your decision.

I'd like to add that anesthesiology is a field where you really do have the ability to practice very differently from your peers, even in the same group (from what I've seen at various institutions). The field, perhaps to a fault, has traditionally accomodated a wide range of personality types. You can be a more hands on, engaging, constantly striving to add value type of a guy/lady if you wish. In fact, these are the ones most respected by a wide range of professionals in the hospital.

 

[RemyMcswain]

That was the same exact position I was in last year.

I decided on anesthesia because I realized that I enjoyed the physiology/pathophysiology of cardiology rather than the prospect of being a cardiologist.

 

[pushthesux]

The hardest thing I have found in Anesthesia is that no one respects you or what you do. It's multifactorial. First of all, anesthesia is pretty safe so problems arise very rarely....this breeds the idea that nothing should EVER go wrong and if it does it's YOUR fault. Second of all, when problems do arise I think the personality of most anesthesiologists shine through....calm, cool, never phased by an actively dying patient....so no one really knows/respects your skills. Third of all, the surgeon is the "doctor"...both to the patient and the OR staff. Fourth, you interact with nurses and OR staff more than other physicians...I just haven't figured out how to converse with them intelligently about such things as improving the perioperative morbidity/mortality of patients.

I did a CCM fellowship to separate myself a little bit....I really have very little ego, but I do feel like I am considered as much of an asset to the OR as a CRNA in the eyes of most OR staff. That's a tough pill to swallow.

 

[muhali3]

I did a CCM fellowship to separate myself a little bit....I really have very little ego, but I do feel like I am considered as much of an asset to the OR as a CRNA in the eyes of most OR staff. That's a tough pill to swallow.

well...that kind of sucks.

 

[SinghDoc]

I wasn't sure how to add quotes/questions/remarks from earlier posts in this thread, but I'll do it like this:
"Could you (or someone) educate me on this?" (in regard to funding second residency)
AProgDirector is a great resource, an active residency program director, I would start with a search on SDN from previous threads. I kinda zoned out on the details once they let me sign my residency contract.

"I do feel like I am considered as much of an asset to the OR as a CRNA in the eyes of most OR staff"
To the thread starter, this unfortunately is part of the job, it sucks more in the university setting over private practice where everyone in general is a lot more chill and cooler with one another and your skills are appreciated (especially regional blocks/catheters). We all have at least a little ego, if you can manage it and work in the right environment with a balanced family life you will have a pretty kick ass life/career as an anesthesiologist, it could be worse...you could have it in your head that you want to do general surgery and be a glutton for punishment (low reimbursement, frequent call, clinic, 90 day post op care, long hours, divorce, etc.) Type B personality and passive/aggressive sense of humor tend to help me through the day in the OR.

"I decided on anesthesia because I realized that I enjoyed the physiology/pathophysiology of cardiology rather than the prospect of being a cardiologist."
-I wish I had this kind of maturity in med school to know myself rather than an idealized version of myself, i.e. for Indians being a cardiologist is like doing ortho for the ex-atheletes/jocks in med school. Patients tend to suck, but anesthesia is the only field I know where there is 100% patient compliance

 

[Gern Blansten]

CMS, the people who pay for medicare services, fund a good portion of residency positions. The number of years they will pay for is determined by what specialty you initially match into. For example, if you match into Family medicine, you are set to be paid for 3 years. If, after 2 years, you decide to switch into Anesthesiology, you will get academic credit for your pgy-1 year (almost always), but will still need 3 more years of training, yet CMS only recognizes one more year. Therefore, if a hospital is at their cap for CMS spots, you will be a financial burden for the last 2 years.

In the late 90's CMS put a cap on how many spots they would fund for each residency program. So, for instance, if a program was at 10 residents per year, that is where they have been ever since then. However, programs can expand, but the cost is paid by the hospital. So, if you get picked up by a hospital who is CMS capped at 6 spots but has since expanded to 10 spots per year, it is probably not a big deal to them because the hospital is already self-funding four spots per year anyway.

At our hospital, it is rarely an issue because we are so far over the cap in most departments. Hope this helps.

 

[pgg]

The hardest thing I have found in Anesthesia is that no one respects you or what you do.

That may be overstating things a bit, but it is a problem when CRNAs do most of the same things we do, and generally manage to avoid sentinel events.

I feel valued enough, by the people whose opinions I care about in return. If some clueless obnoxious circ nurse has her own unrealistic CRNA dream$ and can't tell the difference, whatever. It's not like I value her opinion on anything else.


I've found that of all the people in the perioperative arena, it's the PACU nurses who are consistently most clued in to our value. They are the ones who live and breathe the subtle differences in the effects of anesthesia. Awake, pain free, nausea free, short PACU stays ... compared to patients arriving obtunded with OP airways, only to wake up and yak, then need to stay an hour and 20 minutes while they treat hypotension or hypertension.

That's not to say that anesthesiologists never drop these turds in the PACU, but we all know which way that balance swings. And PACU nurses stuck with these patients all day know the score too.