MS4: IM->Anesthesia or Buyers Remorse?

[GotToGetThatGPAUp]

Hey all, I'm a MS4 who applied IM. I'm a strong applicant (got IVs at all the 'Big 4') and was deadset on Pulm/CC

Unfortunately my school has very limited elective time and I had zero exposure to anesthesia until the last couples months. Always been interested in procedures so took an anesthesia rotation and got to work with some awesome anesthesiologists. Had a blast on cardio thoracic. Anesthesia is essentially everything I love about crit care, the technical aspects are awesome, the physiology is *french kiss* and now I'm at an impasse

Am I feeling this way because I realize I made the wrong choice or is it because it's the choice I did not make and the grass is always greener on the other side, this is the exciting new thing. I also just came off an IM rotation where all the residents treated procedures like menial work and it gave me the ick lolol


Anyways thoughts, advice? How do I approach these feelings to divvy out what I should do for myself and what actions should I be taking if I realize anesthesia is the right route?

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[thinkorswim]

Only you can figure out whether you really made the wrong decision. The obvious solution is to spend more time with anesthesiologists to figure out if it’s truly what you want to do. This may mean going in on your own time if you don’t have any elective time remaining.

If you do decide to switch, then it’ll depend on where you are in the match process. If your rank list is in, you have no choice but to start your IM residency and then reapply during intern year (there are some programs that will match you directly into CA1 year so you don’t need to repeat your intern year and won’t lose a year). If the rank list isn’t in, then you have the choice of doing the above or taking the year off. Good luck!

 

[GassYous]

It doesn't matter as much because your im intern year counts for year 1 of residency. You can reapply for the match next year, many programs have spots for people who switch and there are some that have several advanced spots although the move lately has been towards 4 years of categorical.

When I was an intern I was pretty hyped about medicine for some reason and thought seriously about switching fields. Now I'm glad that I didn't.

I know someone who switched from im to anesthesia and back to im without any issues. All top programs.

Also know several people who finished im residency, worked a bit as a hospitalist and went back for anesthesia. But it's more competitive these days.

 

[GotToGetThatGPAUp]

Thanks for y'all's replies

It doesn't matter as much because your im intern year counts for year 1 of residency. You can reapply for the match next year, many programs have spots for people who switch and there are some that have several advanced spots although the move lately has been towards 4 years of categorical.

When I was an intern I was pretty hyped about medicine for some reason and thought seriously about switching fields. Now I'm glad that I didn't.

I know someone who switched from im to anesthesia and back to im without any issues. All top programs.

Also know several people who finished im residency, worked a bit as a hospitalist and went back for anesthesia. But it's more competitive these days.

Do you happen to know why they went IM -> Anesthesia and back to IM? Curious if they were in a similar thought process as myself

Thanks!

 

[kidthor]

Ehhh hard to say. I personally think that viewing IM resident teams is a bit skewed, because yeah they do end up doing a bunch of scut work - but then actual hospitalists or primary care docs get burdened with a bunch of nonsense too (prior auth, endless forms, productivity metrics). I personally would find CT anesthesia as hellacious because the surgeons are generally annoying and the acuity can be super high all the time (depending on where you are of course). Regular old anesthesia is in high demand now but it could change.

Anyway all of medicine is on a death spiral because of increasing corporatization and consolidation. So I’d say just pick what you truly like and go with it….

BTW don’t forget about IR if you’re into procedures without too much collateral hassle.

 

[sevo00]

Just do IM and then cardiology plenty of procedures. Plus make bank

 

[kidthor]

Just do IM and then cardiology plenty of procedures. Plus make bank

Yes although you’d get demand ischemia from the financial stress of paying for private school for your second ex-wife’s chauffeur’s horses.

 

[aneftp]

Anesthesia can drastically change in 3-4 years.

I know how to run hospitals but these admin all run the wrong playbook how to control cost.

The only cost control is surgery center these days.

If and when hospitals figure out how to control OR costs. Anesthesia costs can be rein in.

Like I mentioned previously. I’d do some type of Uber surge pricing model to compensate anesthesia. This limits the cherry picking of many staff. Rewards those who want to work odd hours.

That’s just one way

The other way is just to say to surgeons and procedurists. You have x time use it or lose it. They can go to competing hospitals if they want.

You reward the private surgeons who bring the most consistent business. Don’t cater to surgeons who try to leverage one hospital against another. Everyone knows the games everyone plays

 

[lotsapain]

Anesthesia can drastically change in 3-4 years.

I know how to run hospitals but these admin all run the wrong playbook how to control cost.

The only cost control is surgery center these days.

If and when hospitals figure out how to control OR costs. Anesthesia costs can be rein in.

Like I mentioned previously. I’d do some type of Uber surge pricing model to compensate anesthesia. This limits the cherry picking of many staff. Rewards those who want to work odd hours.

That’s just one way

The other way is just to say to surgeons and procedurists. You have x time use it or lose it. They can go to competing hospitals if they want.

You reward the private surgeons who bring the most consistent business. Don’t cater to surgeons who try to leverage one hospital against another. Everyone knows the games everyone plays

Ha.... yes most docs with leadership experience can run a hospital while admins can't do medicine.... indeed, I have seen it first hand if people think getting rid large Anesthesia management firms and have hospitals control the OR is a solution they have another thing coming.... now the buffer is gone and you are the proverbial "bitch" when the cmo calls you to tell you will be doing "this that and the other..... because I said so" ...

No hospital unless you are a major player (ie Sinai, NYU etc etc) who has a waiting list of surgeon to come in is able to say to surgeons "either do all your cases by 4pm or go elsewhere" because most hospitals are in "beggars can't be choosers" scenarios with surgeons especially in rural markets unless of course you have very strong leadership, very high quality staff on the floors etc..... "if hospitals could fly" is an ideal book to read unfortunately no one has the balls.... trust me I lived this more then once

 

[lotsapain]

Ehhh hard to say. I personally think that viewing IM resident teams is a bit skewed, because yeah they do end up doing a bunch of scut work - but then actual hospitalists or primary care docs get burdened with a bunch of nonsense too (prior auth, endless forms, productivity metrics). I personally would find CT anesthesia as hellacious because the surgeons are generally annoying and the acuity can be super high all the time (depending on where you are of course). Regular old anesthesia is in high demand now but it could change.

Anyway all of medicine is on a death spiral because of increasing corporatization and consolidation. So I’d say just pick what you truly like and go with it….

BTW don’t forget about IR if you’re into procedures without too much collateral hassle.

As many here said, do the IM residency, you have tremendous choices afterwards.... multiple fellowships where you can do procedures CC, Cardiology, GI, etc etc..... if you have the time you can then do anesthesia residency if you really want that.... just because you like CT anesthesia as a medical student it does NOT translate to same when you are an attending.... everything is fun in medical school and even in residency at times things change drastically when its your license and your mental health on the line and in a very focused specialty such as anesthesia you will be locked in for the rest of your life..... just remember that (and no pain fellowship would not be a solution).... leave yourself choices if you already have a great IM residency spot in a top institution its a huge plus not a minus.... the world is your oyster there are plenty of people who are double boarded in IM then Anesthesia ...... going the other way will be harder ie Anesthesia then IM. As was said above IM PGY1 still counts towards your 4 years of anesthesia total.

and yes medicine IS on a death spiral we did it to ourselves due to greed and laziness ..... CRNAs, NPs admins taking over.......

 

[medicine2wallstreet]

As many here said, do the IM residency, you have tremendous choices afterwards.... multiple fellowships where you can do procedures CC, Cardiology, GI, etc etc..... if you have the time you can then do anesthesia residency if you really want that.... just because you like CT anesthesia as a medical student it does NOT translate to same when you are an attending.... everything is fun in medical school and even in residency at times things change drastically when its your license and your mental health on the line and in a very focused specialty such as anesthesia you will be locked in for the rest of your life..... just remember that (and no pain fellowship would not be a solution).... leave yourself choices if you already have a great IM residency spot in a top institution its a huge plus not a minus.... the world is your oyster there are plenty of people who are double boarded in IM then Anesthesia ...... going the other way will be harder ie Anesthesia then IM. As was said above IM PGY1 still counts towards your 4 years of anesthesia total.

and yes medicine IS on a death spiral we did it to ourselves due to greed and laziness ..... CRNAs, NPs admins taking over.......

Reasonable overall advice.

Medicine is not on a death spiral.

Anesthesiologists have never been compensated better in their history than today. Crna's are not taking over. Don't listen to this guy OP.

 

[anaesthetic]

Reasonable overall advice.

Medicine is not on a death spiral.

Anesthesiologists have never been compensated better in their history than today. Crna's are not taking over. Don't listen to this guy OP.

I wouldn't listen to anyone who doesn't know the difference between plurals and possessives by their mid-twenties.

 

[medicine2wallstreet]

Relax. It corrected it for me.

 

[TexasMed22]

Hey all, I'm a MS4 who applied IM. I'm a strong applicant (got IVs at all the 'Big 4') and was deadset on Pulm/CC

Unfortunately my school has very limited elective time and I had zero exposure to anesthesia until the last couples months. Always been interested in procedures so took an anesthesia rotation and got to work with some awesome anesthesiologists. Had a blast on cardio thoracic. Anesthesia is essentially everything I love about crit care, the technical aspects are awesome, the physiology is *french kiss* and now I'm at an impasse

Am I feeling this way because I realize I made the wrong choice or is it because it's the choice I did not make and the grass is always greener on the other side, this is the exciting new thing. I also just came off an IM rotation where all the residents treated procedures like menial work and it gave me the ick lolol


Anyways thoughts, advice? How do I approach these feelings to divvy out what I should do for myself and what actions should I be taking if I realize anesthesia is the right route?

Do IM, then do a fellowship in a specialty that won't require you to regularly leave your house on call at night when you're 50

 

[lotsapain]

Reasonable overall advice.

Medicine is not on a death spiral.

Anesthesiologists have never been compensated better in their history than today. Crna's are not taking over. Don't listen to this guy OP.

Of course, another snowflake - if it isn’t his opinion don’t listen to it. A wonderful idea.

 

[anbuitachi]

Reasonable overall advice.

Medicine is not on a death spiral.

Anesthesiologists have never been compensated better in their history than today. Crna's are not taking over. Don't listen to this guy OP.

i hear in the 1980s, compensation was much much higher than it is today

 

[luckybuck]

i hear in the 1980s, compensation was much much higher than it is today

How much did they make in 1980s? I feel like it was def higher in terms of buying power because 1 dollar in 1985 would be worth almost 3 dollars today. So if you made 500k then it would be like making almost 1.5 M today...

 

[anbuitachi]

How much did they make in 1980s? I feel like it was def higher in terms of buying power because 1 dollar in 1985 would be worth almost 3 dollars today. So if you made 500k then it would be like making almost 1.5 M today...

no idea. just my colleague telling me he made 1.2m a year back then

 

[BLADEMDA]

I agree the 1980s and 1990s were very good decades for those is stable groups as partners. But, today a locums can clear $1 million by taking a little call and working 50 hours per week. I'd say that's still pretty darn good by any standard in medicine.

 

[Arch Guillotti]

Anesthesiologists have never been compensated better in their history than today.

We are working much harder and making much less than in year’s past. You really don’t know much about private practice.

 

[NightyNight]

Reasonable overall advice.

Medicine is not on a death spiral.

Anesthesiologists have never been compensated better in their history than today. Crna's are not taking over. Don't listen to this guy OP.

It’s better for now because a bunch of old folks retired and drove up demand so there is a robust 1099 market.

Most docs are not well compensated based on the hours committed. I count backup hours as active if I’m sleeping with one eye open and ringer on full blast.

And don’t forget inflation compared to 1980s and early 1990s

 

[medicine2wallstreet]

We are working much harder and making much less than in year’s past. You really don’t know much about private practice.

Well that's because increased CRNA compensation has creeped into your bottom line of private practice.

It's never been better in terms of first year compensation for new graduates. Over half a million is standard now. Just three years ago it was 350 start maximum.

 

[Arch Guillotti]

Well that's because increased CRNA compensation has creeped into your bottom line of private practice.

It's never been better in terms of first year compensation for new graduates. Over half a million is standard now. Just three years ago it was 350 start maximum.

uh no

 

[Angus Avagadro]

How much did they make in 1980s? I feel like it was def higher in terms of buying power because 1 dollar in 1985 would be worth almost 3 dollars today. So if you made 500k then it would be like making almost 1.5 M today...

I think your financial analysis is good. My first job out of fellowship at the Uni was 99k/ yr + benefits.

 

[Sriddymopboi]

Well that's because increased CRNA compensation has creeped into your bottom line of private practice.

It's never been better in terms of first year compensation for new graduates. Over half a million is standard now. Just three years ago it was 350 start maximum.

You have no idea what you're talking about. 350k in 2019 is now 430k inflation adjusted. The same house that was 500k is now 800k AND mortage rates have gone from 3 to 7%. Buying power is LESS today.

 

[medicine2wallstreet]

I didn't say anything about buying power. I said about real dollars. 350k in 2021 is 421k in 2024 dollars. So 500k is still well past 421k in a starting salary.

I understand inflation.

Salary and compensation increases have been dramatic. EVEN with inflation.

I said absolutely nothing about mortgages and all that nonsense. No one in America has been exempt from that. That is a completely different discussion.

Adjusted for inflation salaries have never been higher for starting grads. That is a fact.

Nothing quite like a dinosaur anesthesiologist trying to explain the concept of inflation like I don't understand it exists. Same type of person also just happens to run all these private practices that exploit new grads.