IM vs. Anesthesia: help me decide

[dozitgetchahi]

So I'm trying to set up aways for fourth year and I came up to an unexpected roadblock: I can't ultimately make a decision between IM and anesthesia. I will say that no matter what I write past this point, I think I would ultimately be equally satisfied in either specialty. Some background:

- USMLE step 1 - 237, COMLEX step 1 - 588
- Going allo
- Liked rads a lot, but decided against it because it seemed matching would involve simply applying everywhere and hoping I got in; being married with a newborn, I'm somewhat geographically limited.

Anesthesia:

Pros: I'm fascinated by it. When I was on my surg rotation, I usually wished I could've just stood by the anesthesia workstation during every surgery - that's where the real action seemed to be, at least to me. I think I'd enjoy doing it. I like pharm and physio a lot. The lifestyle is a bonus, but not the major reason I'd be pursuing it. Brief patient contact (both a plus and minus for me); no issues with following up on patients with nasty personalities, dealing with most of the BS that IM has to put up with, etc. No rounding (but I don't hate rounding all that much). Anes residencies seem to be (marginally) less grueling than those for IM (but still quite challenging, obviously).

Cons: The anesthesiologists were treated like garbage by surgeons and OR staff at one of the hospitals I did my surg rotation at, and that gave me serious pause. I'm not sure if that was just a particularly malignant place or what, but it wasn't reassuring. One of the parts of the surg rotation I hated the most was constantly putting up with the ****ty personalities of surgeons, scrub nurses, etc...being around these people all day most days of the week for years might get a bit tiring. The CRNA issue seems to be a serious problem as well - will there be jobs for anes grads in the future? Also, the current model of having an anesthesiologist supervise a number of CRNAs/AAs makes the whole job substantially less interesting from my point of view - rather than directly managing your patients in the OR (the coolest part IMHO), you basically seem to be walking around evaluating pre-op patients, intubating, and then standing around in the pre-op holding the rest of the time...not quite so interesting (I'm sure many gas docs don't practice like this, but most of the ones I dealt with did). Also, I can't seem to shake the feeling (again influenced by how gas was treated at that particular hospital) that anesthesiology might really just be an "ancillary" speciality. Not sure why this bothers me so much. Brief patient contact, and the feeling that you're not really in the crux of the patient's care.

IM:

Pros: I'm fascinated by many IM subspecialties - heme/onc, ID, rheum, A&I, even endo. I like the broad general knowledge base. I like feeling like you're more of the focal point in terms of patient care. I like how some of these specialties offer a possible combination of clinic/hospital work. The future of some of these specialties seems slightly more secure than that of anes (at least from what I'm seeing lately).

Cons: I'm not overly excited about being a hospitalist or general outpatient IM doc, which means putting my family through another nail-biting match in a few years. Rheum, ID, and endo job opportunities seem to be horrible of late, and going that far just to not find a job would suck beyond belief (as would doing a little bit of rheum/ID/endo supplemented with general IM to pay the bills, although I don't hate general outpatient IM nearly as much as being a hospitalist). That leaves A&I and heme/onc (hate the lifestyle of cards, and GI doesn't do all that much for me), both of which are becoming brutally competitive. Matching and then having to move cross-country would suck too, and you often have to in order to swing a match with either of those. Completing the fellowship in any of the above often means going for 6 years of training post-med school, and the wife is already getting ancy about how long this process is taking. Many IM residencies suck hard in terms of time obligations (but again, probably not that much worse than many anes residencies).

Am I overlooking anything to tip the balance here? Does anybody see anything here I don't that would make this more of an obvious decision?

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[st2205]

You've listed a lot of (very valid) secondary issues with choosing between the two. Outside of that, which one do you enjoy the most? Independent of enjoyment, do you favor one over the other for secondary reasons? 20-30 years from now, do you see equal passion for both of them? Which one would be more satisfying being a real expert in knowing all of the ins-and-outs?

 

[HooliganSnail]

It is clear that you've put a lot of thought into the decision (BTW congrats on excellent board scores). I think that the biggest factor is what kind of life you want outside of medicine. In 10 years do you want to be able to watch your kid's little league games, that kinda stuff. Internal Medicine gives you more options, because almost all of the "ologists" are sub-specialties of IM. It also allows you way more patient contact, rather than sitting in the OR all day. There are way more opportunities that just being a hospitalist or a private practice doc too. I'd say if your not sure now you should chose the field that gives you the most choices down the line and that is definitly IM.

Disclaimer: I'm a hard core primary care wannabe

Good Luck with choosing, and congrats on Wife and new baby!

 

[PeepsLove]

I'm anesthesia so my opinion is a little biased. But my advice to you would be to set up 3 months of anesthesia and 3 months of IM at the beginning of your 4th year. That way at least you have had "auditions" in both. By doing this you'll also get to check out how other non-malignant hospitals operate. At my facility there is great camaraderie between surgeons, anesthesia, and staff. After a few months of seeing differents sides of both fields, you might have a better idea. Also try not to limit yourself too a narrow geographical area. I had several friends with great scores get burned by doing that. I'm also married with 2 kids. The last one born 2 months before I started internship. It's tough on the family but they'll understand.

 

[dozitgetchahi]

I'm anesthesia so my opinion is a little biased. But my advice to you would be to set up 3 months of anesthesia and 3 months of IM at the beginning of your 4th year. That way at least you have had "auditions" in both. By doing this you'll also get to check out how other non-malignant hospitals operate. At my facility there is great camaraderie between surgeons, anesthesia, and staff. After a few months of seeing differents sides of both fields, you might have a better idea. Also try not to limit yourself too a narrow geographical area. I had several friends with great scores get burned by doing that. I'm also married with 2 kids. The last one born 2 months before I started internship. It's tough on the family but they'll understand.

I wish I could do something like what you're proposing, but unfortunately I have 3 away blocks to work with in the fall before interviews, etc start in earnest.

I'm also planning to expand my geographical span a bit, but I will say that my current experience is that going far away from family caused a lot of strain/unhappiness in my marriage and I'd generally prefer to avoid doing that again. I will rank whatever programs promise to deliver the best education I can reasonably hope to match into, but I'd hope I can get on board with the programs in Chicago/Cleveland/Philly. There's some good programs in each of those towns.

As a last detail - I only managed an HP in internal medicine. Does anyone feel this changes the game substantially? I am hearing very different things about the importance of having an honors grade in your chosen specialty.

 

[XRanger]

Can you try to do 1 month of IM and 1 month of anesthesia? aways aren't really important for both IM and anesthesia unless there's only 1 geographical location that you wanna go to. So I would just schedule as many IM and anesthesia electives in your home institution.
I have a friend who was IM all the way through until he did his anesthesia rotation a month before application is due and now he's going to anesthesia