I don't know what to do anymore! So stressed

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SierraMist14

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Hi all,

I'm currently a USMD med student; 212 Step I, 2 honored clerkships and am 5 weeks out of my third year. I need to make a decision on a specialty.

I've gotten down to 2 choices; OB/GYN and Anesthesiology. Of course there are pros and cons to both, but I simply can't make a decision. I like the material and population of OB/GYN but lots of people have been scaring me about the stress/malpractice/lifestyle. I also find anesthesiology appealing, but have been told the usual (job security, competition, etc.). Does anyone have any input or advice for me? It's really starting to stress me out, and I only have a short time left to make a decision. Thanks.
 
My sister went to a top 5-7 med school in USA.

Also did her residency and was administrative chief resident at one of top ob/gyn programs.

Let's just say she burned out after 4 years and left ob/gyn. It's a lot of work and not great pay unless u go into fertility. Yes a lot of stress as well.

She's been a medical officer at government agency for the past 10 years.

So the answer is DO NOT go into any speciality! Get into a government non clinical job. It's a chill job.
 
If those 2 are the only options, gas all the way for me. The "issues" gas faces is not unique to the specialty.
 
@SierraMist14, a few questions just to scratch the surface:

Do most people like you when they meet you? Do you enjoy long-term patient-doctor relationships? Do you love physiology and pharmacology? Could you see yourself doing "nursing-level" stuff, e.g. emptying urine? Can you handle regular disrespect easily, even from the lowest staff member? Do you like living dangerously? Can you see yourself enjoy working for others, while they take 30-40% of what you bill, for the rest of your life? What makes you happy, as a doctor, and separately as a person?

If I were you, I would also try to look for a third option, unless I loved gyn (not OB). I am also wondering what kind of person would love both gas and obgyn, and nothing else. They seem so different. Make us understand what makes you tick. What's the one word people would use to describe you?

The book "The ultimate guide to choosing a medical specialty" used to help a lot with pros and cons. There are also some personality tests online; one of them says I should have been a GI or a surgeon. 🙂
 
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1. I'd also keep in mind you're posting on the anesthesiology forum. You might get different responses if you also ask in OB/GYN.

2. I might be wrong, but I think @EtherBunny may have done OB/GYN first, then switched to anesthesiology. However, EtherBunny subsequently switched to pain! So I guess that's your answer? 🙂

3. This thread might help?
 
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bashwell said:
I'd also keep in mind you're posting on the anesthesiology forum. You might get different responses if you also ask in OB/GYN.

I might be wrong, but I think @EtherBunny may have done OB/GYN first, then switched to anesthesiology. However, EtherBunny subsequently switched to pain! So I guess that's your answer? 🙂

This thread might help?
Click to expand...
Interestingly, pain came to my mind, too, when I first saw the combination of specialties. Except that pain is tough to get, and completely different from anesthesiology (which might make one very unhappy if one goes into it just for pain).

One more thing: I strongly doubt that OP is a good candidate for gas with that Step 1 score. Not to mention pain.
 
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if you do OB, you do OB only. if you do anesthesia, you do anesthesia and OB
 
FFP said:
@SierraMist14, a few questions just to scratch the surface:

Do most people like you when they meet you? Do you enjoy long-term patient-doctor relationships? Do you love physiology and pharmacology? Could you see yourself doing "nursing-level" stuff, e.g. emptying urine? Can you handle regular disrespect easily, even from the lowest staff member? Do you like living dangerously? Can you see yourself enjoy working for others, while they take 30-40% of what you bill, for the rest of your life? What makes you happy, as a doctor, and separately as a person?

If I were you, I would also try to look for a third option, unless I loved gyn (not OB). I am also wondering what kind of person would love both gas and obgyn, and nothing else. They seem so different. Make us understand what makes you tick. What's the one word people would use to describe you?

The book "The ultimate guide to choosing a medical specialty" used to help a lot with pros and cons. There are also some personality tests online; one of them says I should have been a GI or a surgeon. 🙂
Click to expand...

i have to say some of these questions are a little misleading. I do very little, if any, "nursing-level" type stuff. (can't remember last time I emptied urine) I haven't been disrespected by the "lowest staff member". And I keep 100% of what I bill; our OB's on the other hand are employed and do not. That's not to say these things don't happen but just don't happen across the board.

One of the biggest difference between to two specialties is that with anesthesia, you generally do not get to develop those long lasting doctor-patient relationships that you would with OB/GYN.
 
sleepallday said:
One of the biggest difference between to two specialties is that with anesthesia, you generally do not get to develop those long lasting doctor-patient relationships that you would with OB/GYN.
Click to expand...

This right here. Like you said, there are pros and cons to both and also, don't let the horror stories on the forums scare you away. As a matter fact, take everything you read on the internet with a grain of salt. And unless deadlines have changed, you have plenty of time to decide. I was all about surgery until Dec of my 4th year (I double applied surgery and anesthesiology just so I'd have options). If you're really undecided, the apply for both. Either the decision will be made for you (ie no interviews) or you'll figure it out along the way. Expensive? Yes. But this is your career you're investing in.
 
FFP said:
Interestingly, pain came to my mind, too, when I first saw the combination of specialties. Except that pain is tough to get, and completely different from anesthesiology (which might make one very unhappy if one goes into it just for pain).

One more thing: I strongly doubt that OP is a good candidate for gas with that Step 1 score. Not to mention pain.
Click to expand...
According to matching outcomes 2014, 174 people applied to gas with a score between 211 and 220. 167 matched.
 
sleepallday said:
i have to say some of these questions are a little misleading. I do very little, if any, "nursing-level" type stuff. (can't remember last time I emptied urine) I haven't been disrespected by the "lowest staff member". And I keep 100% of what I bill; our OB's on the other hand are employed and do not. That's not to say these things don't happen but just don't happen across the board.

One of the biggest difference between to two specialties is that with anesthesia, you generally do not get to develop those long lasting doctor-patient relationships that you would with OB/GYN.
Click to expand...
I don't have to empty urine either, but I lift patients and do enough jobs that many physicians never have to, and would never consider to, and have no idea that we do.

By the time s/he graduates, non-employed positions will be rare. I don't know who's more misleading, honestly. Being employed in a corporate environment is not far from being a resident for life.

Same goes for "lowest staff member". While it's much rarer since I became an attending, there is no week a surgical A-hole does not interrupt a preop exam or does something else disrespectful, and let's not speak of my residency experience. And color me unimpressed if people respect (and, gasp!, even like) me once they get to know me. When you wear scrubs all day long, you won't get the respect reserved for suits. They should respect my degree, not my clothes.
 
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JLarry8900 said:
According to matching outcomes 2014, 174 people applied to gas with a score between 211 and 220. 167 matched.
Click to expand...
That doesn't mean they matched into good programs, with chances for a good fellowship.
 
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FFP said:
Sad. That explains why most of the current crop at my program sucked at the ITEs (when compared to previous generations). The 90's are making a comeback, I guess.
Click to expand...
If the 90's are making a comeback, then 10 years later the 00's will make a comeback too, right? 🙂

Perhaps not. It's tough to make predictions, especially about the future.
 
pgg said:
If the 90's are making a comeback, then 10 years later the 00's will make a comeback too, right? 🙂
Click to expand...
I used to hope that, but then I remembered that there weren't so many fresh grads, including CRNA mills, before. 😉
 
FFP said:
That doesn't mean they matched into good programs, with chances for a good fellowship.
Click to expand...
Maybe, maybe not, but OP could have many considerations, including geography, which would make a "good" program mean something totally different to him or her. Plus, getting a fellowship has many variables, and we're not even sure if OP wants one.
 
FFP said:
I used to hope that, but then I remembered that there weren't so many fresh grads, including CRNA mills, before. 😉
Click to expand...
Yes. Also, let's not forget the increase in the number of US physician graduates (MD & DO) since then, while residency spots have remained level. Anesthesiology programs didn't fill in the 90s - that will never happen again in an era of doctors going completely unmatched.
 
SierraMist14 said:
Hi all,

I'm currently a USMD med student; 212 Step I, 2 honored clerkships and am 5 weeks out of my third year. I need to make a decision on a specialty.

I've gotten down to 2 choices; OB/GYN and Anesthesiology. Of course there are pros and cons to both, but I simply can't make a decision. I like the material and population of OB/GYN but lots of people have been scaring me about the stress/malpractice/lifestyle. I also find anesthesiology appealing, but have been told the usual (job security, competition, etc.). Does anyone have any input or advice for me? It's really starting to stress me out, and I only have a short time left to make a decision. Thanks.
Click to expand...

Ob Gyn issues:
-Reimbursement has been slashed for basic procedures and really can't go any lower
-Develop long term relationships with patients. If you sub specialize or make a good name for yourself, patient's will come to see you specifically . This will not happen in anesthesia. I'm in fellowship and have seen many patients come from thousands of miles and pay competely out of pocket to see one of my attendings because of his stellar reputation. (This can be a pro or con depending on your personality type as most of the anesthesiologists I know prefer to have shorter patient relationships).
-Can operate as much or as little as you would like
-Fair amount of variety on a day to day basis in the office (infertility, bleeding, etc)
-Job security since the burn out rate is relatively high and there are more and more high risk obstetric patients that midlevels just can't manage
-The calls are physically brutal. If you are in a busy practice, you will be up all night doing deliveries, consults, etc
-Regardless of specialty, most physicians will be sued, but count on being sued at least once and paying a ridiculous malpractice rate in a lot of states/regions for the "privilege" of being an underpaid obstetrician.

If you plan on doing an OB GYN residency, you need to love obstetrics because this will be a majority of your residency and profession for a large amount of time. You can't dread it or you will make yourself miserable.

Honestly, anesthesia seems like a good gig with a higher earning potential that seems very mentally stimulating. My only reservation would be the climate of the job situation currently and the current attendings on this forum would be able to answer that more effectively.
 
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SierraMist14 said:
Hi all,

I'm currently a USMD med student; 212 Step I, 2 honored clerkships and am 5 weeks out of my third year. I need to make a decision on a specialty.

I've gotten down to 2 choices; OB/GYN and Anesthesiology. Of course there are pros and cons to both, but I simply can't make a decision. I like the material and population of OB/GYN but lots of people have been scaring me about the stress/malpractice/lifestyle. I also find anesthesiology appealing, but have been told the usual (job security, competition, etc.). Does anyone have any input or advice for me? It's really starting to stress me out, and I only have a short time left to make a decision. Thanks.
Click to expand...

It's always tough when you're at a major crossroads like this in life. The one piece of advice I can give you is that even if you make the "wrong" choice out of the gate, you still have flexibility once you're in residency (or even after you're done with training) to get back on the right track. Don't stress out too much over this decision. For the next 5-10 years of your life, you'll still have a fair amount of latitude in terms of redirecting your career trajectory.

My best piece of advice to you is this:

1. Shadow as many people as possible in anesthesiology and OB-Gyn before you make your decision. Make sure that you venture outside of academia to spend some time with private practice folks. They will have a different perspective on things. If you need to take a leave of absence from med school to do this shadowing, by all means go for it. Nobody will fault you for taking extra time to make this decision. If anything, it's a sign of maturity and will only help you in interviewing for residency positions.
2. Choose your poison wisely. The truth of the matter is that there really isn't a "perfect" field in medicine. Every specialty has its own set of drawbacks and frustrations, even the highly coveted specialties like derm, plastics, etc. The key is finding a field that has drawbacks compatible with your happiness personally and professionally. If a lawsuit would push you to the brink of self destruction, then you should think long and hard about a career as an OB. Delivery of children is a high stakes endeavor. It's a tremendous privilege bringing a life into this world. People will respect you for it, but this comes at a price. Lawsuits will always be possible, even for things out of your control. In a similar vein, if you would have a problem with patients asking for the "doctor" when you meet them before their surgery to discuss the anesthetic plan, think twice before you become an anesthesiologist. I have tremendous respect for OR anesthesiologists. It's a great specialty and requires a tremendous amount of skill and knowledge, but patients have a much stronger bond with their surgeons. The bottom line: pay attention to the cons of every field and be honest with yourself. If the drawback really bothers you on some fundamental level, pay attention. Chances are it will bother you in the long run.

Good luck with your decision!
 
Re: malpractice

People don't realize that economic (and/or total) damages are not capped in most states (except for CO, IN, LA, NE, NM, SC, VA - AFAIK). While your malpractice insurance payouts are.

Meaning that the younger the patient, the more millions out of your pocket (and they get easily into that stratosphere). All that care and loss of income for many decades of prospective life adds up. This applies to both OB and OB anesthesia; also somewhat to pediatric anesthesia.

Food for thought.
 
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Even if @Consigliere has a "interesting" way of making his point, his point is very true. Anesthesiolgy and OB/Gyn are two VERY different specialties with VERY different sets of headaches. Personally, I couldn't do it, but that's just me. Are there other fields of medicine I could do? Maybe? Rads. Rads. Oh, and Rads. (Personality type)

The thing that scares me about this medicine gig in general is what I've read a few posts back and on other threads. Lawsuits. It's crazy. What is is, something like 90% I think I read will be sued at some point? Please correct me if I'm wrong. That's like EVERYONE on this forum pretty much. That's the one thing that had I known, I would've got that business degree instead or working in a lab or something. Even if the plaintiff doesn't win, the stress is unimaginable. I believe (and I could be totally wrong so take everything after with a grain of salt), I believe to win a lawsuit you have to prove negligence. I ask the forum, how many times have you found yourself being overtly negligent? I may have done hiccups here or there or had trouble with something, but negligent? Again, I'm young in my career and somewhat naive. I know this. But if there were any forum advice I'd want to know on her, it would be to how to have a career and avoid and lawsuit. These people don't realize it, but the lawyers are out here trying to destroy lives, not just careers. (sorry. ranted)
 
I know several Anesthesiologists that switched from OB training into anesthesia vs the opposite

I know 2 retired OBs who were so burned out that at ages 32 and 36 they had had enough. All of my anesthesia friends are still working into their late 30s...lol.

Malpractice is a concern, as above.

OB is not a career decision but rather a life decision. You're gonna work...no doubt about it! I work hard but when its over, its over. My OBs that I work with go to clinic when I go to bed after being up all night.

A lot of doom and gloom projected with the future of Anesthesia...but I like my chances with Anesthesia for many reasons. All of healthcare is changing rapidly...pick something you love and can see doing for the next 25-30 yrs. When I considered OB (and surgery) not too long ago no way I was giving up my life, seeing my spouse, missing my kids. Just couldn't do it.

You have all summer to figure it out and double appylying is an option as Twig mentioned above. Expensive to do but it can be done. So many people do an rotation in Oct-Feb of 4th yr and change their mind!!
 
I know good people who switched into anesthesia as a second specialty, worked 5 years post-residency, then got a heart attack and died at 45. There is a reason anesthesiologists are in the top in suicide statistics. Both residency and postgraduate practice can be stressful, especially for people who care more about the patients than politics.

If it makes you happy, go for it. If it just sounds good, but you have never spent weeks in the OR with residents, it might be too good to be true. It definitely will require more and more medical knowledge, experience and IQ, since the simple cases will be for midlevels more and more. Anesthesia won't be for average people in the future, for the simple reason that CRNAs are cheaper. If you hate all that basic and clinical science behind internal medicine and critical care, and didn't score above 220-230 on either Step, go do something else, cut and sew like a tailor, and you'll be safer. As an anesthesiologist, you will be an intraop (and possibly periop) internist, because that's where CRNAs can't keep up. Anything CRNAs can do... you won't.
 
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FFP said:
Re: malpractice

People don't realize that economic (and/or total) damages are not capped in most states (except for CO, IN, LA, NE, NM, SC, VA - AFAIK). While your malpractice insurance payouts are.

Meaning that the younger the patient, the more millions out of your pocket (and they get easily into that stratosphere). All that care and loss of income for many decades of prospective life adds up. This applies to both OB and OB anesthesia; also somewhat to pediatric anesthesia.

Food for thought.
Click to expand...
Quoted for future reference.
 
To be blunt...

If you're stressed over polar opposite choices - ob/gyn vs. anesthesia - how are you gonna feel in either field when you're alone and two lives are on the line. At 2am. And then again at 4am. And then again at 6am.

Go into something else.
 
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bashwell said:
Just wondering, if you don't mind saying, where you would consider going, Twiggidy?
Click to expand...

I'd go to the UK. Mainly because I'd enjoy living there. I understand the money is less there, but they work a little less and I believe lawsuits aren't out of control there like they are here. Again, there are more deeper issues of why I'd leave the US but I can't really discuss it on this forum.

This is all a pipe dream. Getting the ability to practice there I hear is insanely hard, even for people who trained in the US system

Devil's advocate: Maybe I just haven't found the right job in the right city here in the US. Maybe if I did that I'd be a little happier. I take too much call where I work and I think it affects (effects?) my outlook.
 
FFP said:
Can you see yourself enjoy working for others, while they take 30-40% of what you bill, for the rest of your life?
Click to expand...

The issue here is that FFP, with his lack of real world business experience, was unable to negotiate a better contract. Don't let his bitterness dissuade you if you're leaning toward gas.
 
nimbus said:
Neither. Get an MBA at Wharton. Become an investment banker and buy anesthesia practices. Heard they are cash cows.
Click to expand...
Investment bankers get burned out WAY quicker than doctors. Grass isn't always greener...
 
cognitus said:
The issue here is that FFP, with his lack of real world business experience, was unable to negotiate a better contract. Don't let his bitterness dissuade you if you're leaning toward gas.
Click to expand...
Let's see your contract when the time comes. Given your business experience and skills, which resulted in having to change careers despite having an MBA, I am not at all optimistic.

My negotiating skills have little to do with the scarcity of good jobs in the very competitive market my wife likes to live in. It's an employer's, not employee's, market.
 
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cognitus said:
Investment bankers get burned out WAY quicker than doctors. Grass isn't always greener...
Click to expand...
Good investment bankers then go on and invest on their own, even establish their own firms, something one cannot do in anesthesia.
 
FFP said:
Let's see your contract when the time comes. Given your business "experience", which resulted in having to change careers despite having an MBA, I am not at all optimistic.
Click to expand...
LOL. We'll see. Regardless of whatever contract terms I agree to, I know that I'm good enough to do something else if I'm not happy with them rather than spend time on the internet being unhappy and bitter with what I agreed to.
 
cognitus said:
LOL. We'll see. Regardless of whatever contract terms I agree to, I know that I'm good enough to do something else if I'm not happy with them rather than spend time on the internet being unhappy and bitter with what I agreed to.
Click to expand...
Suuuuure. My best regards to Santa!

What determines your salary and contract nowadays is more likely the market, not your negotiating skills. Most groups will make you an offer, take it or leave it. Unless you are in BFE.
 
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FFP said:
Good investment bankers then go on and invest on their own, even establish their own firms, something one cannot do in anesthesia.
Click to expand...
Smart people can leave and do something else if they are unhappy, which you have not shown the ability to do...
 
FFP said:
But your wife has? Regardless, she has all my respect.
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Good lord. I angered you so much you had to dig deep into the archives to see that I'm married. LOL. The jerk store called,...
 
cognitus said:
Good lord. I angered you so much you had to dig deep into the archives to see that I'm married. LOL. The jerk store called,...
Click to expand...
Nope. I didn't have to. Most people are married or divorced, at your senior age.

Seriously, it's OK not to like me. It's really not worth developing an obsession over it. Let's just agree to ignore each other, like people on civilized forums do. I'll start first...
 
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