Identity Crisis - Advice regarding future

[thebadger]

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Hey everyone,

I'm a 4th year medical student and I have committed many of my electives to Anesthesia for the upcoming year. I just finished 4 weeks of anesthesia and now I find myself confused about my future.

I became set on anesthesia mostly because the only things in medicine that I really enjoy are codes/resuscitation and procedures (and talking to families, but in smaller doses than internal). I also want to do critical care and so it seemed like a good fit. However, I finished my first anesthesia rotation a bit disenchanted. I'd like a bit of advice from those who are further in their training than me.

I felt like every day was a rehash of the same day. Airway exam, position patient, put in IV, intubate, put on gas, correct slight changes in blood pressure, extubate, repeat x 5 over the day. I felt rather unsatisfied at the end of each day.

Is this what I can expect from a career in anesthesia or are some able to customize it for more 'thrill'? I know that some institutions have anesthesiologists as trauma team leaders.. is this common? Are some mostly involved in critical care and only are in the OR periodically?

Some of advice would be greatly appreciated,

Thanks!

 

[IveGotTwins]

I'm starting my CA-1 year in the morning and I hope to avoid any thrills for a while. I've been looking forward to tomorrow for a couple of years now.

Most jobs become monotonous. As a surgery intern I saw essentially the same 7-8 patients in the ER over the course of the year.

Perhaps you should look into ER if you haven't already.

 

[Bertelman]

I was pretty bored as a med student. I personally need to feel as though I am making a difference to show up to work with any kind of motivation, no matter the occupation. That's just not there as a med student.

Don't give up yet. Anesthesia is a good way to enter CCM.

 

[MD Dreams]

The "rush" becomes old. Most jobs become redundant. But you may want to consider trauma surgery. That way you can do ICU as well.

 

[BobBarker]

You don't want "rush" in anesthesia. Your job is to prevent that.

 

[BLADEMDA]

I'm starting my CA-1 year in the morning and I hope to avoid any thrills for a while. I've been looking forward to tomorrow for a couple of years now.

Most jobs become monotonous. As a surgery intern I saw essentially the same 7-8 patients in the ER over the course of the year.

Perhaps you should look into ER if you haven't already.

Ladies and Gentlemen there is no way I would pick ER over Anesthesiology. No way. The average ER Doc isn't doing trauma or anything exciting at all. You watch the clock all day and work for a hospital or Doc in the box.

Sure, a percentage of Board Certified ER Physicians have exciting jobs but that is the minority. The majority are doing few advanced procedures in a community ER. Boredom and Burnout are far more common in the ER vs Anesthesiology. I think many med students watch way too much TV which glamorizes the ER doc. Caveat Emptor here.

 

[pgg]

More than 90% of patient encounters in every specialty are going to be routine, routine, routine.

1) Your level of daily excitement will depend on the practice environment you wind up in. If you take a surgicenter job, you'll have a different experience than if you take an academic job. There's plenty to keep adrenaline junkies entertained in this specialty, if they pick the right job.

2) At your level of training, the kind of cases you are doing (should be doing) are the simple ones. It won't always be that way - and there will be days when all you WANT are a string of simple cases.

3) I still find a great deal of satisfaction in doing even the simple cases well. There's more to anesthesia than avoiding sentinel events and raising/lowering the table for the surgeon.

 

[BobBarker]

I really enjoy a routine ortho day. Can be refreshing and fun at the same time.

 

[pgg]

The average ER Doc isn't doing trauma or anything exciting at all. You watch the clock all day and work for a hospital or Doc in the box.

Saving the world from the hassle of going to their primary care doctor. 😀

My brother is an EM doctor. He was a paramedic for 10+ years before med school and mostly knew what he was getting into. I couldn't do it.

 

[chessknt]

Hey everyone,

I'm a 4th year medical student and I have committed many of my electives to Anesthesia for the upcoming year. I just finished 4 weeks of anesthesia and now I find myself confused about my future.

I became set on anesthesia mostly because the only things in medicine that I really enjoy are codes/resuscitation and procedures (and talking to families, but in smaller doses than internal). I also want to do critical care and so it seemed like a good fit. However, I finished my first anesthesia rotation a bit disenchanted. I'd like a bit of advice from those who are further in their training than me.

I felt like every day was a rehash of the same day. Airway exam, position patient, put in IV, intubate, put on gas, correct slight changes in blood pressure, extubate, repeat x 5 over the day. I felt rather unsatisfied at the end of each day.

Is this what I can expect from a career in anesthesia or are some able to customize it for more 'thrill'? I know that some institutions have anesthesiologists as trauma team leaders.. is this common? Are some mostly involved in critical care and only are in the OR periodically?

Some of advice would be greatly appreciated,

Thanks!

It might help for you to see the other faces of anesthesia--try to get in on cards, peds, or ob cases. Attendings in academia manage multiple rooms, which is an aspect you are probably not seeing. In PP everything routine moves much faster, so that is another aspect you are not seeing. Like every field, your view is limited by your inability to assume full responsibility and the fact that you only see the academic side.

 

[Impromptu]

Assuming your medical school's hospital is a level 1 trauma center in an alcohol loving, drug using, gun/knife toting, no helmets on motorcycle kind of city, then maybe you should stay overnight on a Friday or Saturday and get a whiff of some of the traumas that come in. It gets even my heart a little elevated when the trauma surgeons come straight up with little or no warning with a cracked chest and someone squeezing the heart.

 

[amyl]

i second what blade said... ER is 80% social issues... or more depending where you are. i don't know, maybe anesthesia isn't for you.... i still find pleasure in the most straightforward case... timing tube out and drapes down perfectly gives me a sense of satisfaction. the surgeon just tried to kill that patient... under different circumstances its a felony 🙂 -- I like getting them through the whole experience be it lap chole or ruptured AAA -- with precision and perfection and a kind word.

 

[BobBarker]

You should probably try to start a band with Skinny Pete. He is really good at piano!

 

[Consigliere]

You should probably try to start a band with Skinny Pete. He is really good at piano!

Excellent, excellent Breaking Bad reference. Thumbs way up! 👍

 

[yappy]

As someone who has spent time working pre-hospital in a large city & rural area I would say that the type of patients a emergency medicine physician sees are largely scum bags.

Lots of drug seekers, losers, or people trying to con the system. There are legit people that I transported and that made for a great feeling being able to help them... but they were rare. The best patients I had was when I worked for a rural ambulance company. The people who dialed 911 actually needed 911. A lot of times the docs had to manage patients that would have normally gone to a level 1 but because there were no level 1's they were it until the flight team came. However, many of the patients were simply old who had emergent episodes of their chronic disease.

Having said all that - I was never a doctor. But I think that sums up the patient population. In the city - it was terrible - I applied many "spit-guards" and had my life threatened regularly.

 

[HollywdAnesth]

What did you honestly expect? Every field of medicine knows that common things present commonly. As an anesthesiologist, you are going to do alot of knee scopes, c sections, gall bladders, etc. not every patient can be a difficult airway, with mh, and critical aortic stenosis.

If you are semi decent at your job, then there shouldn't be a whole lot of "excitement." You end up finding ways to excite yourself. When this surgeon starts closing, what do I need to do to extubate right after the last stitch, etc. The goal of an anesthesia residency is to make sure you're prepared when the accidents and surprises come your way.

There is going to be monotony in every field of medicine, even trauma surgery. If catastrophes happened as much as they do in TV hospitals, we would all burn out in 5 years.

 

[imfrankie]

Go work with Michigangirl and colleagues. You won't be bored.

 

[OB1🤙]

You should probably try to start a band with Skinny Pete. He is really good at piano!

👍👍👍

 

[MichaelPhelps]

Hey everyone,

I'm a 4th year medical student and I have committed many of my electives to Anesthesia for the upcoming year. I just finished 4 weeks of anesthesia and now I find myself confused about my future.

I became set on anesthesia mostly because the only things in medicine that I really enjoy are codes/resuscitation and procedures (and talking to families, but in smaller doses than internal). I also want to do critical care and so it seemed like a good fit. However, I finished my first anesthesia rotation a bit disenchanted. I'd like a bit of advice from those who are further in their training than me.

I felt like every day was a rehash of the same day. Airway exam, position patient, put in IV, intubate, put on gas, correct slight changes in blood pressure, extubate, repeat x 5 over the day. I felt rather unsatisfied at the end of each day.

Is this what I can expect from a career in anesthesia or are some able to customize it for more 'thrill'? I know that some institutions have anesthesiologists as trauma team leaders.. is this common? Are some mostly involved in critical care and only are in the OR periodically?

Some of advice would be greatly appreciated,

Thanks!

What is the alternative? What specific specialty?

Whenever I see these threads complaining about one specialty, it's rare that anyone mentioned what they are considering as an alternative, which is pretty important.

Surgery? EM? IM? what?

 

[gasattack3]

Hey everyone,

I'm a 4th year medical student and I have committed many of my electives to Anesthesia for the upcoming year. I just finished 4 weeks of anesthesia and now I find myself confused about my future.

I became set on anesthesia mostly because the only things in medicine that I really enjoy are codes/resuscitation and procedures (and talking to families, but in smaller doses than internal). I also want to do critical care and so it seemed like a good fit. However, I finished my first anesthesia rotation a bit disenchanted. I'd like a bit of advice from those who are further in their training than me.

I felt like every day was a rehash of the same day. Airway exam, position patient, put in IV, intubate, put on gas, correct slight changes in blood pressure, extubate, repeat x 5 over the day. I felt rather unsatisfied at the end of each day.

Is this what I can expect from a career in anesthesia or are some able to customize it for more 'thrill'? I know that some institutions have anesthesiologists as trauma team leaders.. is this common? Are some mostly involved in critical care and only are in the OR periodically?

Some of advice would be greatly appreciated,

Thanks!

Doing a few things in a room, here and there, as a med student is entirely different than DOING anesthesia as a resident. The responsibility level is not comparible. And, it's just not the same.

Also, as you gain experience and knowledge, there's a LOT to be said about the "finesse" of delivering a smooth anesthetic. This could mean a smooth emergence, and a well controlled post-op pain plan. Towards the middle of CA1 year, you start honing those skills. By the end of CA1 you start looking for challenges. By CA2, the challenges come to you.....

As a med student, I really (in retrospect) had no clue how much knowledge you need to be a good anesthesiologist. I absolutely underappreciated to depth of skills you need to be a true professional.

As to thrills, I think that you'll encounter enought cases gone bad, or simply very sick patients that make it a challenge and break up the monotony, in order to begin to appreciate the days which are less challenging. I've encountered this even as a new CA2.

For your carrer, you can gravitate towards bigger cases, which often comes with sicker patients. There will be enought ASA-4's to go around, for sure. So, no worries there.

Find that person in the group/institution that everyone respects. Notice how they do things different. Notice their habits. Those are the people you can emmulate. I sound like a broken record, but so many of our "challenges" have been self-inflicted, it seems.

Not everyone going into anesthesia is cut out to be the go-to "big case" person, but if that's what you like, you'll probably become good at those cases, and like I said, there will be plenty of those opportunities.

 

[Agast]

I felt like every day was a rehash of the same day. Airway exam, position patient, put in IV, intubate, put on gas, correct slight changes in blood pressure, extubate, repeat x 5 over the day. I felt rather unsatisfied at the end of each day.

Were you doing all of these things by yourself, or were you observing a resident? Because if you were doing all these unassisted, and made it without feeling scared or concerned, then anesthesia is not for you. After going buddy system with the interns starting anesthesiology, nothing was scarier to me than the intern who was NOT concerned and responsive to the simultaneous demands of the patient, procedure and surgical staff. I like to see a good amount of anticipatory anxiety and respect for the fact that we are taking an increasingly unhealthy and aging population, administering potent drugs that quite frankly are poison in the hands of the uninitiated, and guiding them safely to the other side.

 

[yappy]

What if the OP is a smooth operator? You know... like Top Gun material... or Data from Star Trek: The Next Generation.

Were you doing all of these things by yourself, or were you observing a resident? Because if you were doing all these unassisted, and made it without feeling scared or concerned, then anesthesia is not for you. After going buddy system with the interns starting anesthesiology, nothing was scarier to me than the intern who was NOT concerned and responsive to the simultaneous demands of the patient, procedure and surgical staff. I like to see a good amount of anticipatory anxiety and respect for the fact that we are taking an increasingly unhealthy and aging population, administering potent drugs that quite frankly are poison in the hands of the uninitiated, and guiding them safely to the other side.