As a lowly medical student here are my perceived pros and cons of anesthesia vs IM/subspecialty (two specialties I'm interested in pursuing).
Pros:
-Less documentation than IM
-Interesting physiology and evolving field
-Procedural based/hands on
-less required scut work than other specialties
-shorter/less intense training to achieve relatively good income
-variety of cases and ability to have variety if desired
Cons:
-lack of ownership of patients
-hospital based (call, answering to the man, etc.)
-surgeons controlling schedule
-CRNA/midlevel issue
-Highly stressful and high boredom depending on the case type
Anything I missed/misrepresented?
Just throwing some initial thoughts down.
Pros:
-Less documentation than IM
Definitely less writing than IM, but consider a job where you are supervising 4 rooms at a GI procedural center. Just to make the math easy, let's say they do 10 scopes in each room per day. That's a lot of pre-ops/H&Ps/consents. There is more of this in anesthesia than you think.
-Interesting physiology and evolving field
Everyone talks about "the physiology and pharmacology" in anesthesia, but none of us are in the back drawing out neurohormonal pathways on a whiteboard, trying to figure out what drug to give. Yes, we need to know physiology and pharm, but so do a lot of other specialties. We do get faster feedback from out interventions than IM, and know how to handle the medications and delivery routes ourselves (vs relying on pharmacists and nurses), which is definitely something I like. As for the "evolving field" bit... no. Relative to many other fields in medicine, ours is a relatively static field. Compare it to onc, or interventional/structural cardiology, which are evolving at much more rapid pace.
-Procedural based/hands on
More than IM? Sure, I'll give you that one... unless we're talking Icards or GI or interventional pulm.
-less required scut work than other specialties
Depends on what you mean by scut, but at my shop I push the bed, transfer the monitors in the PACU, and sometimes do my own machine turnover. The surgeon has a dedicated person in the OR to tie his or her shoes (not quite, but close)...
Look, our skillset is part internist, part respiratory therapist, part pharmacist, part ICU nurse. We don't need a lot of help to do our jobs, so in many cases the system has pruned our assistants.
-shorter/less intense training to achieve relatively good income
My days on IM as an intern were the opposite of intense. There was a lot of work to do, yes, but there was very little of the sort of time pressure I'm under in the OR, both to improve turnover efficiency and in the care of patients.
My clinical training is 6 years, most fellowship-trained people do 5. 6 years to be an IM subspecialist. More or less a wash here in terms of years.
-variety of cases and ability to have variety if desired
Generalist anesthesiologist vs general internist... there's a lot of variety in both of these fields.
Cons:
-lack of ownership of patients
Can be both a pro and a con. None of the annoying phone calls/patient portal/email crap, no insurance BS, etc. But also no recognition, little clout with the hospital since you are easily "replaceable". It's a pick your poison type-thing.
-hospital based (call, answering to the man, etc.)
True PP is becoming very rare in all specialties, but yes, we are a service specialty and that comes with it's frustrations.
-surgeons controlling schedule
True, but our schedule is more predictable than many specialities because we are "interchangable".
-CRNA/midlevel issue
Happening everywhere in medicine, but yes this is definitely a thing in anesthesia.
-Highly stressful and high boredom depending on the case type
Both specialties have boring parts. I can't stand sitting in rooms in stable cases, but I have colleagues that love it. I think part of it is I don't like to BS on my phone/study/read/surf the internet in cases. I don't look down on people that do- I just can't split my attention that way. I can't imagine my day has a higher or lower proportion of "intellectually stimulating work" than any other specialty. Could be wrong. As for the stressful part, yeah we have some hairy moments. Those are the ones where I feel most like a doctor.
