IM vs Anesthesia

[donkeykong1]

MS-4 struggling choosing between these 2 specialties. Would greatly appreciate some wise advice

IM
pros: love hospital medicine, ability to work as much and wherever u want, could see myself being a hospitalist and then moving into a leadership position, and retiring into outpatient, loan repayment available

cons: salary is 200-250k, another 2 yrs of fellowship if i apply for rheum or endo or ai [not into cards or gi or heme/onc]

Anes:
pros: love the pharm and phys, fast results, minimal pt interaction, salary is 275-325k, outpatient surg center gigs available, pain fellowship eligible

cons: high stress situations, crna's, toxic OR environment, early hours and call, attendings saying the field is dead

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[TorMed]

I'm inly an MS2 but can relate to your dilemma. Those are the two that attract me even though they are very different. I'm Canadian and rheum pays a lot in my province so income is not as much of a difference.

 

[Winged Scapula]

Pulm Critical Care.

The pharm and phys you love. If inpatient, most patients will be ICU, so minimal patient interaction. Can be shift work/regular hours especially as you become more senior. Better salary than IM.

 

[synecdoche]

also interested in these specialties! does anyone know if the generally pessimistic outlook on the future of anesthesia also applies to less "desirable" parts of the country? is CRNA creep a state-by-state issue or a regional thing fueled by high competition?

 

[donkeykong1]

bump

 

[repititionition]

Pulm Critical Care.

The pharm and phys you love. If inpatient, most patients will be ICU, so minimal patient interaction. Can be shift work/regular hours especially as you become more senior. Better salary than IM.

I hear this a lot, but this pathway adds 2 years of training as well (anes=4 PCCM=6), which can be tough for some to justify.

You can shave off a year with the new-ish CCM-only pathway from IM, which is 3+2. Or one can, of course, always do CCM from anesthesiology, which is 4+1.

 

[W19]

Is gas also taking a big hit in term of salary? I worked in the OR with gas physicians (2008-2009) and the ones that talked about their salaries were making 400k+... The CRNA were in in the low 200s. The figure provided above (275-325k) seems low!

 

[GadRads]

Is gas also taking a big hit in term of salary? I worked in the OR with gas physicians (2008-2009) and the ones that talked about their salaries were making 400k+... The CRNA were in in the low 200s. The figure provided above (275-325k) seems low!

Wow. CRNAs make more than primary care physicians. Sad.

 

[donkeykong1]

Wow. CRNAs make more than primary care physicians. Sad.

Most CRNA's currently make more than IM, FM, Endo, Rheum, ID. Some highly specialized NP's and PA's make around 180-200k easily as well. Welcome to the real world of medicine

 

[Winged Scapula]

I hear this a lot, but this pathway adds 2 years of training as well (anes=4 PCCM=6), which can be tough for some to justify.

You can shave off a year with the new-ish CCM-only pathway from IM, which is 3+2. Or one can, of course, always do CCM from anesthesiology, which is 4+1.

Well you know, everything is heading toward more training, fellowship required etc.

Is 2 years a big deal in the grand scheme of things? I'd say, from the other side of the desk, that it is not, especially as the OP is thinking IM with a fellowship anyway. So best to do something he prefers/best fit and not worry about a small difference in training.

 

[Slack3r]

Well you know, everything is heading toward more training, fellowship required etc.

Is 2 years a big deal in the grand scheme of things? I'd say, from the other side of the desk, that it is not, especially as the OP is thinking IM with a fellowship anyway. So best to do something he prefers/best fit and not worry about a small difference in training.

Meanwhile, nurses can become equivalent to doctors in a fraction of the time! And they're more caring too!

 

[W19]

Meanwhile, nurses can become equivalent to doctors in a fraction of the time! And they're more caring too!

Not only that, they claim they are better than physicians too!

 

[Carbocation1]

Posted in the Gas forum:

"I was a CRNA that successfully completed my well-respected program, became certified, and worked for several years.

I left the career, in part, due to the rapid proliferation of CRNA mills that disgorge a stunning number of poorly-trained graduates who are inculcated early in their education that they are capable of the same level of functioning and critical thinking as an anesthesiologist. I was asked to precept some of these students whose knowledge base was so deficient that they resorted to spending hundreds (if not thousands) of dollars taking and re-taking the Valley Review Course and rote memorizing that company's "Anesthesia Sweat Book" and "Memory Master Cards" in hopes of increasing their chances of passing the national exam on the first attempt.

Consider that the didactics of my well-regarded program were often taught by "guest" CRNAs with no more preparation than a Master's degree and clinical experience. Exams could be passed with a quick memorization of the required reading assignments and a reasonably alert presence in lectures.

Consider that the AANA offers a three-day pain management course, costing $3,000. The very idea that a weekend workshop could possibly prepare a CRNA to function as an interventional pain management practitioner is asinine. In the organization's own words:
Purpose: The Jack Neary Advanced Pain Management I Workshop provides a combination of didactic and guided hands-on lab experience for interventional pain management techniques.
Target Audience: This workshop is being provided for CRNAs with limited experience in interventional pain management and CRNAs possibly interested in pursuing this specialty within their practice.

Consider a residency in another specialty."

Tenerife, 40 minutes ago

 

[anbuitachi]

MS-4 struggling choosing between these 2 specialties. Would greatly appreciate some wise advice

IM
pros: love hospital medicine, ability to work as much and wherever u want, could see myself being a hospitalist and then moving into a leadership position, and retiring into outpatient, loan repayment available

cons: salary is 200-250k, another 2 yrs of fellowship if i apply for rheum or endo or ai [not into cards or gi or heme/onc]

Anes:
pros: love the pharm and phys, fast results, minimal pt interaction, salary is 275-325k, outpatient surg center gigs available, pain fellowship eligible

cons: high stress situations, crna's, toxic OR environment, early hours and call, attendings saying the field is dead

Your pro with IM isn't really a pro. You need to be able to find a job that will allow you to do that. You make it sound like any hospital medicine can work as much as you want which isn't true. It's true if you open your own clinic though. The same can be said of anesthesiology. If you find the right job, you have a lot of freedom as well.

The con for IM isn't really a con either. Sure salary is 200-250k, but you have potential to make far more depending on how much you work. Just think about it, many hospitalists work 7 on 7 off, and get paid 250k. Work a bit more, and you easily break 300ks. Plus IM is 3 year residency, easy to find jobs afterwards. Do a fellowship, and its avg of 3 more years, and you get a big bump in salary (if cards, gi, hemeonc)

For your pro for anes, most of it is fine, but minimal pt interaction kind of goes against IM. Salary is dropping vs rising for IM. Pain is more and more competitive (can go into it from like 6 different fields now), and you pretty much need a fellowship to be competitive for a job.

Con for anesthesiology is pretty true.

 

[donkeykong1]

The more I talk to IM hospitalists, the more I learn that their lifestyle is not conducive to family life. Say they start at a base of 200k in the northeast, 7on/7off, only home 2 weekends a month, pick up 6 additional shifts each month at about 1200. so 200,000+[12x7200]=286,400, this is not enough to offset the hard work and hours put in as a hospitalist in my opinion.

Average for anesthesia in the northeast is about 300k, with 4-5 first call nights a month with post call day off+6 weeks vacation

I am not interested in cards [crappy stemi call+its becoming glorified primary care imo], gi [hate probing colon], heme/onc [too depressing and academic].

Pulm/cc sounds quite interesting, idk how many shift jobs are out there though. I feel more at ease in the OR where things are more controlled versus the ICU, and I wouldn't have to do the pulm clinic stuff.

Finally CRNAs serve a purpose. They are midlevel physician extenders. Why the hell would an Anesthesiologist stay in the room for an entire Hernia repair when they can go and easily pre-op 5 patients, run around the hospital doing some epidurals. You're always going to have those rogue midlevels in any specialty, not specific to anesthesia.

I really liked my pain rotation so anesthesia keeps the option open for that route. Also I hear anesthesia residents are the cream of crop for getting into pain. My dream job would be a split of pain and general anesthesia, time to go out there and get it!