If not Anesthesiology, what do you recommend students to go into?

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CidHighwind

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So I am a fourth year medical student, considering Anesthesiology. From reading this board, it seems like the vast majority of people here are down on the field, see the specialty as dead, ruled by CRNAs, etc. That being said, what job in medicine, besides derm, would you consider someone to go into? It seems like you guys get to do a lot of cool procedures, manage critical patients, and aren’t constantly working while at work (on my rotation the attendings would frequently be in the lounge watching Fox News and the resident in the room was scrolling through memes on their phone). That said, many of the attendings I met/worked with IRL seemed happy, liked their job, felt fairly compensated for their work, had an excellent work/life balance, and recommended that I go into the field. Since many here would recommend against going into Anesthesiology, what would you recommend instead, besides derm?

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This place is good for getting a more realistic picture of what anesthesiology is like regarding future compensation and the CRNA issue, but I certainly wouldn't make it your last word on the subject considering that 80% of the people who enthusiastically post about this topic are debbie downers. Most of the rockstars, hustlers and mercenaries with sweet anesthesia gigs are too busy enjoying life to be bothered with posting with us dregs of the anesthesia world :)
 
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This place is good for getting a more realistic picture of what anesthesiology is like regarding future compensation and the CRNA issue, but I certainly wouldn't make it your last word on the subject considering that 80% of the people who enthusiastically post about this topic are debbie downers. Most of the rockstars, hustlers and mercenaries with sweet anesthesia gigs are too busy enjoying life to be bothered with posting with us dregs of the anesthesia world :)

I mean, even if you guys aren’t pulling in high six figures like “the good old days”, you still make more money than most physicians. Managing 4 rooms at once vs only worrying about 1 patient does seem like it would be annoying, but from what I understand, anesthesiologists themselves made that change so they could bill for 4 rooms and not have to be in the room with the surgeon. Why is SDN such a magnet for burnouts, Debbie downers, gunners, and just unpleasant personalities?
 
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You’ll find much of the same complaining in each of the other specialty boards on the forums, it’s sort of what binds people together. I can find people very happy and very UNhappy in every specialty. Do something you’d enjoy.
 
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The question you have to ask yourself is, “If a corporation/hospital/government takes over this specialty, how much can I be abused?”. Turns out, “hospital based” specialties that require call are ripe for abuse.

Maybe anesthesia is the only thing that makes you happy. If that’s the case, do what you gotta do. OTOH, if you can be happy doing optho, derm, endocrine, allergy/imm, then you are much less likely to suffer late nights/weekends/holidays “generating revenue” for the “man”.,,,
 
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It seems like you guys get to do a lot of cool procedures, manage critical patients, and aren’t constantly working while at work (on my rotation the attendings would frequently be in the lounge watching Fox News and the resident in the room was scrolling through memes on their phone).
This is the first fallacy of the field right here. There's a big difference between residency and working in "the real world". Yes, there are practices where people drink coffee and babysit CRNAs but a good handful of us WORK. So the first expectation is that you won't graduate and work in an OR where you get to put your feet up and read the Daily News.
 
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I wasn't around for "the good ole' days" of medicine, and I'm sure things were a bit better, as my dad tells me, but honestly I am loving my choice to pick anesthesiology over other fields, so don't let the stuff around here deter you if you think it's the right fit. I walk by the medicine residents in the lounge writing notes on computers all day and it looks horrible. You won't be the hero (think offensive lineman rather than QB), but you'll feel like you're making a difference whether other people notice or not.

If I had to pick again and choose something else, I would go for radiology probably. They all seem pretty happy as well.
 
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I think anesthesiology, generally, is the best job in medicine. But, I'm obviously biased, because I have a great job in a great area with great colleagues, with a great family in a great house in a great neighborhood, with a great cost of living, in a state with great gun laws.
 
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To be honest, if anyone wants to make the BEST choice in medicine, you choose something that isn't "service related" which leaves medicine and surgery/surgical subspecialties. Any other field "depends" on another and that's where you find trouble.
 
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There are still great practices out there where you don't have to supervise CRNAs with legit non-predatory partnership tracks - do all your own cases, chill with the surgeons, take decent weeks of vacation, and help run the group if you are inclined. The pay could be lower than medically directing 4 milliant CRNAs who think you don't do anything other than just give them their breaks; though with some AMCs the difference might not be that much.
You need to figure out what is important to you. Location, practice type, pay, etc. Hopefully you'll find a job that hits most if not all your requirements.
 
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I was showing a brand-new CA-1 the ropes in his first couple of weeks, and at the end of the day I asked if he had any questions.

"Yeah... when do we sit down? I thought there would be a lot more sitting."
 
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I wasn't around for "the good ole' days" of medicine, and I'm sure things were a bit better, as my dad tells me, but honestly I am loving my choice to pick anesthesiology over other fields, so don't let the stuff around here deter you if you think it's the right fit. I walk by the medicine residents in the lounge writing notes on computers all day and it looks horrible. You won't be the hero (think offensive lineman rather than QB), but you'll feel like you're making a difference whether other people notice or not.

If I had to pick again and choose something else, I would go for radiology probably. They all seem pretty happy as well.
Writing those notes is not so bad. The problem is defensive medicine (and billing somewhat).

My institution is a behemoth with strong malpractice protections, so I tend to write my critical care notes as they were originally intended, for me and my colleagues. They are medical letters. They help me crystallize my thoughts, even look clever, definitely more than my anesthesiology cases. And I do hate writing notes (psst, I am still bad at it). But I would never choose a specialty based on that. Internal medicine is beautiful, and so are the relationships one develops with one's patients.
 
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Surgical specialty with no/low call burden and no emergencies (that you can't refer to an academic center).
You want to be out of the hospital as regularly as possible not fixing the worlds problems at night or week ends in the OR.
 
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I was showing a brand-new CA-1 the ropes in his first couple of weeks, and at the end of the day I asked if he had any questions.

"Yeah... when do we sit down? I thought there would be a lot more sitting."


Answer: In EP lab.
 
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Surgical specialty with no/low call burden and no emergencies (that you can't refer to an academic center).
You want to be out of the hospital as regularly as possible not fixing the worlds problems at night or week ends in the OR.

Depends... Those high supply hospitals pay $$$$$$$$.

Easily makes it worth it. Don't leave money on the table.

I'd rather make bank for 10 years and then cut back to part time, versus making ok money full time for 20 years.
 
OP: understand that while surgical subs (among other things) is the answer you will get here on this board, if you ask the surgeons many will tell you "anesthesiology". You've been brainwashed by 4 years of undergrad, the MCAT, 3 years of medical school, and the USMLEs, into believing all questions have a correct answer. Try and kick that way of thinking now, because a whole new world of calculated risks and uncertainty is out there waiting for you in internship, residency, and beyond. Best thing to do is have a really honest conversation with yourself about what you like and don't like (not what your favorite attending likes, not what your parents like, not what that doctor on TV that seems to get all the girls likes- what YOU like), and use that at a starting point. Just remember: build in a little buffer for life-changes. You might decide as a 20-something that working nights and weekends is OK, so long as you are doing exciting work, but remember you are making that decision for 30-something you, 40-something you, 50-something you, and probably 60-something you.
 
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OP: understand that while surgical subs (among other things) is the answer you will get here on this board, if you ask the surgeons many will tell you "anesthesiology". You've been brainwashed by 4 years of undergrad, the MCAT, 3 years of medical school, and the USMLEs, into believing all questions have a correct answer. Try and kick that way of thinking now, because a whole new world of calculated risks and uncertainty is out there waiting for you in internship, residency, and beyond. Best thing to do is have a really honest conversation with yourself about what you like and don't like (not what your favorite attending likes, not what your parents like, not what that doctor on TV that seems to get all the girls likes- what YOU like), and use that at a starting point. Just remember: build in a little buffer for life-changes. You might decide as a 20-something that working nights and weekends is OK, so long as you are doing exciting work, but remember you are making that decision for 30-something you, 40-something you, 50-something you, and probably 60-something you.
is working nights and weekends an unescapable part of anesthesiology?
 
Surgical specialty with no/low call burden and no emergencies (that you can't refer to an academic center).
You want to be out of the hospital as regularly as possible not fixing the worlds problems at night or week ends in the OR.
This all day
 
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is working nights and weekends an unescapable part of anesthesiology?
Two letters....OB

Babies aren’t born M-F, 9-5.

Also if the group covers any sort trauma or surgeons who are prone to emergencies (CV, vascular, gen surg)
 
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Two letters....OB

Babies aren’t born M-F, 9-5.

Also if the group covers any sort trauma or surgeons who are prone to emergencies (CV, vascular, gen surg)
But it's possible to avoid those situations if you find the right group set up (and take a salary hit)? All theoretical as by the time I start practicing the landscape will likely change a lot.
 
But it's possible to avoid those situations if you find the right group set up (and take a salary hit)? All theoretical as by the time I start practicing the landscape will likely change a lot.


Yes it’s very possible. Lots of people currently doing only daytime outpatient stuff. Many of these people take full call for a number of years, develop relationships within the community and transition to full outpatient when a opportunity opens up. Others stay in a full call situation but give away all their call to their greedy partners.
 
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But it's possible to avoid those situations if you find the right group set up (and take a salary hit)? All theoretical as by the time I start practicing the landscape will likely change a lot.
That’s true. There’s definitely “mom track” jobs out there and some pay handsomely. Most of the time to find these spots you have to know someone. There are a sprinkle of them on Gaswork but I’m always hesitant about Gaswork posts.
 
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The question you have to ask yourself is, “If a corporation/hospital/government takes over this specialty, how much can I be abused?”. Turns out, “hospital based” specialties that require call are ripe for abuse.

Maybe anesthesia is the only thing that makes you happy. If that’s the case, do what you gotta do. OTOH, if you can be happy doing optho, derm, endocrine, allergy/imm, then you are much less likely to suffer late nights/weekends/holidays “generating revenue” for the “man”.,,,

Quoted and bolded for truth.
 
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is working nights and weekends an unescapable part of anesthesiology?

With geographic flexibility and realistic expectations re compensation, you can find jobs that are M-F, 8-4 or whatever. But keep in mind that these are going to be largely GI center/outpatient ortho/plastic surgery center jobs with the case mix to match. You most likely aren't going to be doing big-whack belly cases, thoracics, hearts, etc (read: the stuff that gets medical students excited about anesthesia) in no-call positions.

What I'm trying to say is: don't pick anesthesia because you're drawn to the high-risk cases and cool physiology/procedures if you aren't prepared for the nights/weekends that come with being that kind of doc.

Though it's also worth mentioning that working a couple nights/weekends a month is not necessarily a one-way road to a lifetime of misery and regret, either. This stuff is highly individual. I'd rather work 1 weekend a month and a few weekday calls than spend all day in an office setting. Of course there is a point where the amount of call becomes so great the balance tips, and that balance point is subject to change with aging and changing life circumstances.
 
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My general advice for anyone is that anesthesiology is still a good field but for maximum happiness stay away from any job that involves OB. My opinion is the OB can really make this field a drag. Sure you can give instant gratification to a patient and for the most part they will be happy, but I’d rather be home at night or knowing at some point I can go home that night. With OB you’re married to the hospital with a horrible nursing culture.

It’s no surprise the one area of anesthesiology where CRNAs aren’t trying to take over is OB. Maybe they are some places but I would argue it’s rare

You want to be happy in anesthesiology forever, then don’t cover OB.
 
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I have spent a lot of time over the years with anesthesiologists sitting around on call waiting for delays to get worked out etc. In real life, they recommend anesthesia, primarily! If pushed to pick a different choice they say surgical sub/GI, but the grumpy ones always say they would "do business" like that means anything in reality. On here, it seems like people bitch a lot because medicine in general is worse than it once was and could get even worse for everyone.

The only surgeons in real life that don't recommend anesthesiology have been orthopedic surgeons who figured out that they can make a fortune doing exactly what they like and passing off all other aspects of care and stomping feet to get things changed instantly at work (genius.)

I'm just a student, but I posted this because I feel that despite this subforum being the best on SDN it is an echo chamber that my real life connections do not agree with in this regard. I'm sure the truth is somewhere in the middle as with most things in life.
 
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is working nights and weekends an unescapable part of anesthesiology?
Less work, less money. More work, more money. It’s true in every specialty (guess what, dermatology offices have evening and Saturday hours because that’s when patients can come in). I still maintain that anesthesia is one of the easiest jobs in medicine (if you are a generalist). no need for follow up, phone calls, insurance issues, patients calling you at night ect. Just knock em out, wake em up, and drop off in PACU (or just sign the CRNA’s chart and watch Fox News)....
 
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The only surgeons in real life that don't recommend anesthesiology have been orthopedic surgeons...

The point is, none of those surgeons recommending anesthesia because from their point of view it looks easy really understand what goes into being an anesthesiologist. We have a few orthopods who love to jeer when we take breaks or get relieved, and yet when we're taking 24 hour in-house call, they're home with their families. Yes, they sometimes come in on weekends (usually at a time that works for them), but the anesthesiologist doing that case in our shop is on a 24-hour shift.

The point is not to bash orthopedic surgeons, or surgeons in general- they work extremely hard, and there are things about their job I'm sure I would find intolerable (clinic, prior auths/insurance issues, unrealistic patient expectations). The point is all of these recommendations you are getting to "Do GI", "Do anesthesia", "Do derm", or "Do ENT" from people not in those fields are based largely on uninformed perception, stereotypes, and buyer's remorse. The only valuable opinions a general surgeon has regarding specialty selection pertain to the pros and cons of general surgery, and the same is true of the rest of us.
 
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The point is, none of those surgeons recommending anesthesia because from their point of view it looks easy really understand what goes into being an anesthesiologist. We have a few orthopods who love to jeer when we take breaks or get relieved, and yet when we're taking 24 hour in-house call, they're home with their families. Yes, they sometimes come in on weekends (usually at a time that works for them), but the anesthesiologist doing that case in our shop is on a 24-hour shift.

The point is not to bash orthopedic surgeons, or surgeons in general- they work extremely hard, and there are things about their job I'm sure I would find intolerable (clinic, prior auths/insurance issues, unrealistic patient expectations). The point is all of these recommendations you are getting to "Do GI", "Do anesthesia", "Do derm", or "Do ENT" from people not in those fields are based largely on uninformed perception, stereotypes, and buyer's remorse. The only valuable opinions a general surgeon has regarding specialty selection pertain to the pros and cons of general surgery, and the same is true of the rest of us.
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?
 
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?


Once you’re an attending, you won’t do any scut regardless of specialty. In fact we are the only specialty that empties foleys.
 
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Once you’re an attending, you won’t do any scut regardless of specialty. In fact we are the only specialty that empties foleys.
Why are you emptying the Foley for the nurse?
 
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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.
 
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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.
So, if you could do it over again, would you do IM or anesthesia, and why? Do you and your colleagues see the future of the field as better than IM/subspecialty or would avoid at all costs?
 
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The point is, none of those surgeons recommending anesthesia because from their point of view it looks easy really understand what goes into being an anesthesiologist. We have a few orthopods who love to jeer when we take breaks or get relieved, and yet when we're taking 24 hour in-house call, they're home with their families. Yes, they sometimes come in on weekends (usually at a time that works for them), but the anesthesiologist doing that case in our shop is on a 24-hour shift.

The point is not to bash orthopedic surgeons, or surgeons in general- they work extremely hard, and there are things about their job I'm sure I would find intolerable (clinic, prior auths/insurance issues, unrealistic patient expectations). The point is all of these recommendations you are getting to "Do GI", "Do anesthesia", "Do derm", or "Do ENT" from people not in those fields are based largely on uninformed perception, stereotypes, and buyer's remorse. The only valuable opinions a general surgeon has regarding specialty selection pertain to the pros and cons of general surgery, and the same is true of the rest of us.

Thank you. I still want to here from one of the usual naysayers and what they have to say on this issue (the guy with the eagles avatar, the plankton dude, blademda, etc). Also from what I gather, pretty much every specialty works nights and weekends. Even derm still takes home call.
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.

Ok, would you recommend someone choosing between Anesthesia and Rads to go into rads and/or IR? Why or why not? What about psych? I feel like many people here take IM subspecialties to be better than gas, but what about being a hospitalist? Would you say your job is better than working as an ED physician?
 
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Ok, would you recommend someone choosing between Anesthesia and Rads to go into rads and/or IR? Why or why not? What about psych? I feel like many people here take IM subspecialties to be better than gas, but what about being a hospitalist? Would you say your job is better than working as an ED physician?

You need to do some shadowing, what year medical student are you again? IM subspecialist, Anesthesiology, EM, psych, IR?! That’s a pretty broad interest base that doesn’t complement itself too well.

I agree with @Nivens fully here - it’s not possible to make an informed statement that my job is any better or worse than EM as you ask. I enjoy mine more but I fled the psych/primary care/Unsavory aspects as well as the many night/weekend shifts there. They probably enjoy having more days off. Like anything out there, every field has its pluses and minuses - do some shadowing to see what piques your interest.

And please, stop referring to this specialty as “gas”
 
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So, if you could do it over again, would you do IM or anesthesia, and why? Do you and your colleagues see the future of the field as better than IM/subspecialty or would avoid at all costs?

Quoting myself from a reply to a thread a while back titled "anesthesiologists: what career should I pick?" that sums up my final thoughts on this nicely.

"...some days I think I have the best job in the hospital, and some days I feel like literally any other specialty choice would have been better. The frequency of these two extremes more or less balance each other out. I would probably pick a different speciality if I could choose again, only because of things I learned about myself along the way that I didn't know when I applied, knowing full well I'd probably discover a lot of unpleasantness under that rock, too."
 
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Missed the first line - @CidHighwind (is that a Final Fantasy reference?) is fourth year student. It’s a little concerning you haven’t narrowed things down yet, which makes me wonder if you should lean more towards IM as that’s where such students go if they aren’t sure.

Set up some weekend shadowing stuff for anesthesia and IR if you’re really interested. Talk to attendings about their life and experiences, and residents if you have them. IR is a competitive field so be honest with yourself about your ability to match. Radiology is drastically different from both fields...
 
Missed the first line - @CidHighwind (is that a Final Fantasy reference?) is fourth year student. It’s a little concerning you haven’t narrowed things down yet, which makes me wonder if you should lean more towards IM as that’s where such students go if they aren’t sure.

Set up some weekend shadowing stuff for anesthesia and IR if you’re really interested. Talk to attendings about their life and experiences, and residents if you have them. IR is a competitive field so be honest with yourself about your ability to match. Radiology is drastically different from both fields...


I’ve narrowed it down between anesthesia and rads. It’s just that since so many people here seem to dislike anesthesia that it may be prudent to figure out why. Agree with you on IR, hence if I choose that I’ll either do ESIR or just the two year fellowship outright.
 
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I’ve narrowed it down between anesthesia and rads. It’s just that since so many people here seem to dislike anesthesia that it may be prudent to figure out why. Agree with you on IR, hence if I choose that I’ll either do ESIR or just the two year fellowship outright.

I thought IR sounded really cool when I was an MS3. Took me one morning of shadowing to realize it wasn't for me. At all. (notice I said not *for me*)

I totally get why you feel compelled to "get to the bottom of" the dissatisfaction that is a big part of this forum, but consider all the things that go into someone being unhappy that are completely independent of what specialty they chose:
-specifics of employment arrangement
-coworkers
-home/family life
-personal health
-financial trouble
etc, etc

I know very unhappy dermatologists, allergists, interventional cardiologists, hospitalists, surgeons (of all types), ED docs, pediatricians, and yes, anesthesiologists. I also know just as many people who are very happy doing all of those things. Stop thinking like a medical student: THERE IS NO ONE CORRECT ANSWER!

The only mistake you can make here is picking a specialty (or not picking it) for someone else's reasons instead of your own.
 
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You will find some outliers on this thread, many people come on here to brag when life is good or to complain and/or blow off some steam. There are anesthesiologists that do hate their jobs and are encroached upon by CRNAs. There are also lucky ones like me, left residency one year ago and joined a great PP group in the ideal location for my family. I have been treated quite well even though I am new and in hindsight, I wouldn't change a thing about my specialty choice or career trajectory.

It's good to gather some data and opinions, but at the end of the day you have to go with your gut and hope for the best, plan for the worst. You won't know if you made the right decision or not for several years and your answer might change at different points in your career. This choice is not forever, you can switch specialties later on, although it obviously requires more time/energy/money to change course later on. We all know people that switched into or out of anesthesiology for various reasons. These things do happen.
 
For what its worth, I remember reading the doom and gloom on SDN as a medical student and after taking it all in. Even though many people seemed quite unhappy, I personally still enjoyed the workflow of doing anesthesiology so much more than rounding and clinic. It still felt like my happy place in medical school, the thing I was interested in reading/learning about and the place where I felt most comfortable. There was quite decent exposure to anesthesiology where I went, so I like to think that I had a slightly better notion of what I was getting myself into than some schools where there is not an option to rotate in anesthesiology.
 
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For what its worth, I remember reading the doom and gloom on SDN as a medical student and after taking it all in. Even though many people seemed quite unhappy, I personally still enjoyed the workflow of doing anesthesiology so much more than rounding and clinic. It still felt like my happy place in medical school, the thing I was interested in reading/learning about and the place where I felt most comfortable. There was quite decent exposure to anesthesiology where I went, so I like to think that I had a slightly better notion of what I was getting myself into than some schools where there is not an option to rotate in anesthesiology.

This 1000x. And @CidHighwind, in case you think I'm picking on you, feel free to look back in my posting history. I asked all the same questions as you back in the day, and then again when trying to decide what fellowship to do. Trusted my gut both times. Pretty happy so far.
 
This 1000x. And @CidHighwind, in case you think I'm picking on you, feel free to look back in my posting history. I asked all the same questions as you back in the day, and then again when trying to decide what fellowship to do. Trusted my gut both times. Pretty happy so far.

I know you aren’t. There isn’t a single correct answer. That said, I feel like there’s a “wrong” answer for specialty choice based on personality and interests. There’s also choices for what to do if one doesn’t like anything. I just think that if so much is made on here about the negatives of a field, one thought is to dismiss them as uneventful, another is to try to figure out if there’s a seed of truth in the whining.
 
So I am a fourth year medical student, considering Anesthesiology. From reading this board, it seems like the vast majority of people here are down on the field, see the specialty as dead, ruled by CRNAs, etc. That being said, what job in medicine, besides derm, would you consider someone to go into? It seems like you guys get to do a lot of cool procedures, manage critical patients, and aren’t constantly working while at work (on my rotation the attendings would frequently be in the lounge watching Fox News and the resident in the room was scrolling through memes on their phone). That said, many of the attendings I met/worked with IRL seemed happy, liked their job, felt fairly compensated for their work, had an excellent work/life balance, and recommended that I go into the field. Since many here would recommend against going into Anesthesiology, what would you recommend instead, besides derm?

No one has given you the right answer.

Ready for it?

Reproductive medicine.

Cash pay. (And a lot of it). Patients (that are all young) all love you...even with poor results.

My guess is that liability issues are low.
 
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No one has given you the right answer.

Ready for it?

Reproductive medicine.

Cash pay. (And a lot of it). Patients (that are all young) all love you...even with poor results.

My guess is that liability issues are low.

ReproEndo seems amazing, but one must be a BALLER OBGYN resident to get a spot. My hospital has a really good obgyn program, and I couldn’t figure out for the longest time why there were so many men. Turns out they all go for REI.
 
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ReproEndo seems amazing, but one must be a BALLER OBGYN resident to get a spot. My hospital has a really good obgyn program, and I couldn’t figure out for the longest time why there were so many men. Turns out they all go for REI.

Agreed - REI s/p OBGyn would be awesome. But, you have to tolerate an OBGyn residency as an entry fee - and you must consider your options if you didn't match into that ultra competitive fellowship... Gyn Onc or MIS Gyn seem like the only good backups, and they are also rather competitive.
 
Breast surgery seems decent as well. But you have to make it through a surgical residency (and be female it seems)
 
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Urologist. Good lifestyle. Good Pay. Respected as a surgeon. The clinic I hear from urologists friends can be a bit of a pain.
 
Urologist. Good lifestyle. Good Pay. Respected as a surgeon. The clinic I hear from urologists friends can be a bit of a pain.

Need to be in a big group for lifestyle.

We have 10 in one group here in town = q10 weekends.

If you land in a town with 3 urologists = q3 weekends but better pay.
 
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