Ophthalmology resident interested in Anesthesia

[anonobanano]

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I am a PGY-2, soon to be PGY-3 ophthalmology resident. Not really enjoying ophthalmology much and have always been very interested in anesthesia. I would like to switch if I can, but I know it is super competitive now. My hospital does not have an anesthesia residency.

What would be the optimal path to make this happen? Apply to Advanced spots this Fall to start after PGY-4?

 

[CopaceticOne]

There is nothing you like about ophtho? Like literally nothing? If there is something you like about it, just focus on that for your future

Only if you hate ophtho should you switch.

Biggest reason - you can control your life more as an ophthalmologist than as an anesthesiologist. In addition, I’m not aware of mid-levels trying to distort reality and claim they better than actual ophthalmologists.

 

[Gern Blansten]

There is nothing you like about ophtho? Like literally nothing? If there is something you like about it, just focus on that for your future

Only if you hate ophtho should you switch.

Biggest reason - you can control your life more as an ophthalmologist than as an anesthesiologist. In addition, I’m not aware of mid-levels trying to distort reality and claim they better than actual ophthalmologists.

Optometrists have been fighting for the ability to perform cataract surgery for at least a decade if not longer. Haven’t kept up to see if they have made any inroads. Name the specialty, and I will tell you who wants to encroach upon them. Sometimes mid levels (NP critical care or derm fellowships), sometimes other specialties (eg; cardiologists and interventional radiology), and sometimes other degreed specialists like midwives ( wanting to perform c-sections), PharmDs (prescribing rights / vaccines), or podiatrists ( wanting to operate up to the knee). But everyone wants something more and almost no specialty is immune. Anesthesiology is just further along in the process than most.

 

[PpfSuxTube]

You're crazy

 

[UscGhost]

Only switch if you absolutely hate it. After a few years, its all the same. They key is lifestyle, work life balance, economics, stress, flexibility, etc

Try to find aspects of optho that will cater to the lifestyle you seek. Academic, private, lasik, whatever..

The opportunity cost of switching is massive at this point. You would potentially have wasted 3 years of earnings potential.

 

[dabears505]

Bro I'll trade you my anesthesia for optho spot

 

[eyeeye_captain]

I don’t say this to be rude, but there are only a little over 100 ophtho residencies, and I can’t think of more than a couple that don’t have an adjacent anesthesiology residency. Those programs have, at best, a tenuous reason to exist, with 2 such programs closing this year.

It may be that you don’t dislike ophtho as much as you think, but that you’re in a rinky dink program like the Nazareths of the world that make the field look bad.

You’ve posted before about feeling like clinic is monotonous (and it can be), but I suspect that’s because you aren’t seeing the multitude of absolute disasters I endured in training. Great for training, but I hope to never have them here in the real world.

There’s no guarantee you’ll like anesthesiology any better when you potentially (probably with a lot of luck) get in, and when the gas folks are actively telling you it’s a bad move, I’d consider their advice.

 

[kidthor]

OP - you're out of your mind. Stay with optho. Maybe do an optho fellowship for a minor pivot. If you really want to do anesthesia then do a retrobulbar block or or a subTenon and call it a day.

 

[CopaceticOne]

If you really want to do anesthesia then do a retrobulbar block or or a subTenon and call it a day.

😂🤣😂

 

[DirtDocMD]

Don’t do this to yourself.

Get out of the hospital for a day or two, take a look around, talk to some people. Ask them, “Do you LOVE your job, like it, tolerate it, or hate it??”.

Not many people on this earth get to have a job with an over $1 million a year earning potential, great hours, CONTROL of their schedule (you don’t HAVE to work yourself into the ground, unless YOU want to), etc, etc.

You’re like these goofball Docs at the hospital chasing “excitement”, messing with the nursing staff, when you’re already married to wife/mother/saint/beauty of the year.

Yes, I changed residencies (went from Family Practice to Anesthesia), but it’s because I quickly KNEW my personality wasn’t suited to talking with 30-40 different patients a day to solve one of their problems, feigning empathy, only to have another problem next week. I had to admit I wasn’t one of those “pleasant bedside manner” sort of people. The added money of Anesthesiology was a benefit, but my ability to “call the shots” on my schedule and avoid call, early in my career, definitely took a hit.

If it’s totally unsuitable for your personality, I can possibly understand, but don’t do it as some sort of new “challenge”, or endorphin rush, or greener pasture.

 

[eyeeye_captain]

do a retrobulbar block

Not to get too far off topic, but are any of you folks doing (or even training on) these anymore? I’ve asked around and everybody turns green.

I’m old enough to have done them in clinic for lasers. Still have a referring doc doing them for every cataract. Fantastic if you know what you’re doing.

 

[abolt18]

Not to get too far off topic, but are any of you folks doing (or even training on) these anymore? I’ve asked around and everybody turns green.

I’m old enough to have done them in clinic for lasers. Still have a referring doc doing them for every cataract. Fantastic if you know what you’re doing.

Never learned. Never will. Friend of mine went to a surgery center for a while where they expected him to do eye blocks (though I don't think any retrobulbars) and they taught him how. He hated it.

 

[DirtDocMD]

Not to get too far off topic, but are any of you folks doing (or even training on) these anymore? I’ve asked around and everybody turns green.

I’m old enough to have done them in clinic for lasers. Still have a referring doc doing them for every cataract. Fantastic if you know what you’re doing.

Trained at a very busy, well-rounded program, in the early 2000’s. My attendings flat-out refused to do, or to teach us, retrobulbar blocks. I’m not just talking 1-2, it was agreed “policy” amongst all of them. Told us there was no extra pay to be made, and that we didn’t want any part of the liability associated with it.

They were right….

 

[CopaceticOne]

Not to get too far off topic, but are any of you folks doing (or even training on) these anymore? I’ve asked around and everybody turns green.

I’m old enough to have done them in clinic for lasers. Still have a referring doc doing them for every cataract. Fantastic if you know what you’re doing.

Did training at an institution with a very busy comprehensive eye center - nope! I never did a single block for an eye, nor did I ever hear of anyone doing one.

Those are 100% for the ophthalmologist 😁

 

[eyeeye_captain]

Fair enough, I’ll keep knocking out my own (not that I’ve ever had someone else do one other than residents).

Back to the regular programming.

 

[JOHNBROCHILL]

Not to get too far off topic, but are any of you folks doing (or even training on) these anymore? I’ve asked around and everybody turns green.

I’m old enough to have done them in clinic for lasers. Still have a referring doc doing them for every cataract. Fantastic if you know what you’re doing.

Absolutely not I have no business sticking needles anywhere near the eye.

If it was expected of me and they would teach me on the job I would refuse, and if that was a problem I'd be looking for a new job.

 

[Gern Blansten]

Fair enough, I’ll keep knocking out my own (not that I’ve ever had someone else do one other than residents).

Back to the regular programming.

Our group used to do a lot. I have done probably 50 or so in my career but decided ten or so years ago that I don’t do enough to have proficiency. So I stopped doing them. Got out with zero bad outcomes.
A couple of partners did them regularly. Probably a few hundred a year. Low complication rate overall in good hands. BUT, when a complication does occur, it’s typically a devastating one.
Thankfully, most ophthalmologists have figured out how to operate without that block. If they haven’t, they can do the block themselves, IMO.

 

[eyeeye_captain]

Our group used to do a lot. I have done probably 50 or so in my career but decided ten or so years ago that I don’t do enough to have proficiency. So I stopped doing them. Got out with zero bad outcomes.
A couple of partners did them regularly. Probably a few hundred a year. Low complication rate overall in good hands. BUT, when a complication does occur, it’s typically a devastating one.
Thankfully, most ophthalmologists have figured out how to operate without that block. If they haven’t, they can do the block themselves, IMO.

Since I’ve said my piece for the OP, I’ll go down the rabbit hole one last time.

A RBB has the advantage of better/longer anesthesia, akinesia, and extra pupillary dilation over topical. I have colleagues that claim that sub-Tenon’s is the same but just takes longer, but technically speaking, never is longer so I guess their BS is correct. Done correctly, it’s an awesome local/regional.

That said, it’s almost impossible to argue it’s standard of care for cataract these days. If you don’t know how to do a canthotomy/cantholysis, you’re potentially in big trouble. So yeah, I don’t blame you folks for staying the hell out of Dodge.

 

[sevo00]

Dude you can open your own clinic and print money. Don’t switch

 

[anesthesiadoc]

I have anesthesia buddies at the Mass Eye & Ear who do a ton of them. I don’t get it.

 

[Ashers]

Not to get too far off topic, but are any of you folks doing (or even training on) these anymore? I’ve asked around and everybody turns green.

I’m old enough to have done them in clinic for lasers. Still have a referring doc doing them for every cataract. Fantastic if you know what you’re doing.

I did it in my regional fellowship. I hated them. I eventually focused on other blocks when I realized in the real world, I didn't need to do them.

 

[cittykat]

Just be sure you know what you’re doing.

Anesthesiologist blamed for causing blindness in 5 cataract patients at Massachusetts clinic: 9 takeaways - Becker’s ASC

A cataract eye surgery center in Massachusetts is the subject of controversy after five patients receiving cataract surgery in May 2014 went blind from the procedure, the Boston Globe reports.

www.beckersasc.com

 

[anonobanano]

Not to get too far off topic, but are any of you folks doing (or even training on) these anymore? I’ve asked around and everybody turns green.

I’m old enough to have done them in clinic for lasers. Still have a referring doc doing them for every cataract. Fantastic if you know what you’re doing.

Talk about thread hijack.. lol

 

[anonobanano]

Don’t do this to yourself.

Get out of the hospital for a day or two, take a look around, talk to some people. Ask them, “Do you LOVE your job, like it, tolerate it, or hate it??”.

Not many people on this earth get to have a job with an over $1 million a year earning potential, great hours, CONTROL of their schedule (you don’t HAVE to work yourself into the ground, unless YOU want to), etc, etc.

You’re like these goofball Docs at the hospital chasing “excitement”, messing with the nursing staff, when you’re already married to wife/mother/saint/beauty of the year.

Yes, I changed residencies (went from Family Practice to Anesthesia), but it’s because I quickly KNEW my personality wasn’t suited to talking with 30-40 different patients a day to solve one of their problems, feigning empathy, only to have another problem next week. I had to admit I wasn’t one of those “pleasant bedside manner” sort of people. The added money of Anesthesiology was a benefit, but my ability to “call the shots” on my schedule and avoid call, early in my career, definitely took a hit.

If it’s totally unsuitable for your personality, I can possibly understand, but don’t do it as some sort of new “challenge”, or endorphin rush, or greener pasture.

I appreciate the thoughtful replies. It just feels so incredibly unsuited for my personality. I am so bored and uninterested and none of the ophtho fellowships sound interesting to me.

 

[Southpaw]

I appreciate the thoughtful replies. It just feels so incredibly unsuited for my personality. I am so bored and uninterested and none of the ophtho fellowships sound interesting to me.

What made you pursue ophtho over anesthesia?

 

[anonobanano]

What made you pursue ophtho over anesthesia?

I worked for an ophthalmologist as a pre-med and gained an interest in the field, also in medical school I was very attracted to the lifestyle ophtho offers with the ability to be a surgeon and do life-changing procedures in minutes with immediate results. I always saw myself as more of a "doer" than a "watcher" as in anesthesia in the OR, but my intern year changed my perspective on medicine a lot.

 

[abolt18]

I appreciate the thoughtful replies. It just feels so incredibly unsuited for my personality. I am so bored and uninterested and none of the ophtho fellowships sound interesting to me.

As a PGY-2, are you really getting to operate a lot? Do any real or significant cases? I'm sure you're getting next to no real autonomy if you are operating. You may find your perspective and experience shifts as you get more opportunities to play a bigger role in the operations?

 

[Southpaw]

I worked for an ophthalmologist as a pre-med and gained an interest in the field, also in medical school I was very attracted to the lifestyle ophtho offers with the ability to be a surgeon and do life-changing procedures in minutes with immediate results. I always saw myself as more of a "doer" than a "watcher" as in anesthesia in the OR, but my intern year changed my perspective on medicine a lot.

How did your intern year change your perspective on medicine? I imagine life (and lifestyle) will get better for you as you proceed through residency. Each year will get better. You’ll feel more comfortable. You’ll operate more. You’ll gain more autonomy. Also I bet as time goes you’ll have some very rewarding patient interactions.

 

[eyeeye_captain]

As a PGY-2, are you really getting to operate a lot? Do any real or significant cases? I'm sure you're getting next to no real autonomy if you are operating. You may find your perspective and experience shifts as you get more opportunities to play a bigger role in the operations?

Almost everywhere it’s minor procedures at most (small plastics stuff, some lasers). Some bits and pieces of work in the OR but I’ve never really heard of anywhere doing primaries at point (nor should they). OR time and responsibility ramps up in PGY-3, but it’s very program dependent on how much you get. Some are very backloaded to PGY-4.

I’m trying to understand the mental shift in intern year. You do know that you’re not just a “watcher” as an anesthesiologist, right? If you’re trying to say you realized you prefer general physiology and a lower overall volume of procedures, ok. Or if you just want to be in the OR and can’t live the clinic life, ok. Something like that, hey, cool.

I suspect the “doer” attitude (if still lurking) isn’t seeing as much to be done as you want at the moment. Your knowledge base isn’t strong enough at your stage to pick up on the little things at this point either. You don’t get bigger/cooler stuff until you know what you’re doing - graduated autonomy protects you and patients.

PGY-2 is easily the worst year. Medical school teaches you all of nothing about the field. You’re scrambling. Call sucks. Been there at a workhorse program, my coresidents and I have some form of shared PTSD.

But it gets better. You’d be applying as a PGY-3 with limited home program resources and no opportunity to do any rotations even if you did, so you’re not like the gen surg home resident with the connections to switch in a currently competitive market. Every anesthesiology attending in the thread is telling you this is not the best idea. I’ll leave it to them to give you any practical advice if you’re dead set on it. There’s no shame in switching specialties, it happens all the time. It just sounds like you’re at a low point and pulling the ripcord a little early.

 

[Gern Blansten]

As stated above, I would not make the switch until you have given ophthalmology a fair chance, which may be 2 more years. Life as an ophthalmology intern likely has very little overlap with what life as an ophthalmologist in the real world is like. The same could be said for anesthesiology or almost any specialty. And, if observing things but not doing things is bothersome to you, that will not get better with anesthesiology. In fact, it will frequently become worse.
You are currently watching someone well-trained and competent and seeing how it should properly be done. As a supervising anesthesiologist, it will be the opposite. You will be watching a CRNA do a job you know you could do far better if you just did it yourself. And, because of politics, culture, clinical demands, and staffing ratios, you will not typically offer advice on how they could do it better, because it will not be a teaching environment and they do not want to hear your feedback. If you critique them, they will complain to their chief and you will become the person none of them want to work with.

 

[TheLesPaul]

I wanted to quit ophtho after PGY2 because you get so good at being a doctor your PGY1 year and your buddies are all off saving lives in the CCU and MICU and you're learning 'better 1 or 2'. but once you get to be a surgeon which isn't until PGY4 tbh it's much better.

 

[Gator7]

No don’t do it.

Finish up, get a real job and find joy outside of the hospital.

 

[Burned_Out]

Can anyone tell me how I can switch out of my career as an anesthesiologist so I can go into optho.? I need a good retirement gig.

 

[Southpaw]

Can anyone tell me how I can switch out of my career as an anesthesiologist so I can go into optho.? I need a good retirement gig.

Right?! This has been my thought through this thread.

 

[A Deep Breath]

I know miserable ophthos, but at a lower rate than anesthesiologists.

I know ophthos who seem to love coming to work. I don't know any anesthesiologists like that.

The strongest argument for this switch would be the schedule flexibility offered by anesthesia, but you haven't mentioned that, and it doesn't apply to most people.

Anesthesiology will not be some wonderland of fascinating work you can't wait to get back to. The watching rather than doing part is sometimes nice for parts of some cases (like MAC cataracts), but we deal with plenty of stressful BS. We're usually on guard to make sure bad things don't happen because we weren't paying enough attention. The times we aren't sitting in a chair can feel rushed. There's a good chance you'd end up supervising as an anesthesiologist, which is similar to clinic in that we're mostly talking to patients all day.

 

[abolt18]

I know miserable ophthos, but at a lower rate than anesthesiologists.

I know ophthos who seem to love coming to work. I don't know any anesthesiologists like that.

The strongest argument for this switch would be the schedule flexibility offered by anesthesia, but you haven't mentioned that, and it doesn't apply to most people.

Anesthesiology will not be some wonderland of fascinating work you can't wait to get back to. The watching rather than doing part is sometimes nice for parts of some cases (like MAC cataracts), but we deal with plenty of stressful BS. We're usually on guard to make sure bad things don't happen because we weren't paying enough attention. The times we aren't sitting in a chair can feel rushed. There's a good chance you'd end up supervising as an anesthesiologist, which is similar to clinic in that we're mostly talking to patients all day.

I do love coming to work. I just don't love it at night or on weekends. And I love going home even more than I love coming to work.

But now you can say you know ONE anesthesiologist who loves going to work.

 

[kidthor]

I do love coming to work. I just don't love it at night or on weekends. And I love going home even more than I love coming to work.

But now you can say you know ONE anesthesiologist who loves going to work.

Same here. Noting that I solely do peds anesthesia, I do really enjoy being able to take care of my patients and keep them safe. But I don't like being on call or working late... Also I love that when we're done with work, we're DONE. No managing a clinic, no long term patient follow up (for better or worse).

All that said OP should still stick to optho.