Peds vs. Anesthesia

[azxcv0987]

MS-3 here. Trying to figure out what I want to apply to next year, and I thought I would get a peds perspective.

Does anyone have something to add for peds pros and cons? Or does anyone want to say something about the pros/cons I have listed? I'm only a medical student, so I'm sure it's not a perfect list.

Pediatrics
Pros:
-Love working with kids (especially during my peds rotation)
-Very rewarding to make sick kids feel better
-Much easier to heal a sick kid than a sick adult (IM seemed to have more management of chronic diseases)
-Interesting pathology
-Good continuity of care with patients
-Could become a pediatric cardiologist

Cons:
-Salary. From what I read, peds cardiologists seem to be in the 200-250k range
-Harder residency lifestyle (more hours per week)
-I only got a HP in peds, and I don't know how that would affect my chances

Anesthesiology
Pros:
-I find physiology and pharmacology very interesting
-Great opportunity to do procedures
-Seemingly laidback work environment
-Very good salary (I've seen 300-400k from what I read)
-Good lifestyle (even during residency)

Cons:
-Missing out on much of that traditional doctor-patient relationship unless I do a pain fellowship afterwards
-Not as much opportunities for diagnostic reasoning (something I enjoy doing)
-The future of anesthesia doesn't look that great (cRNAs, decline of private practices, declining pay)

---

Members don't see this ad.

 

[SurfingDoctor]

PICU or Pediatric Anesthesia would fulfill a lot of criteria in both categories.

 

[mvenus929]

A HP would not necessarily lower your chances at a peds residency, depending on how you do on your fourth year rotations. I assume you also have some clerkships remaining, so keep your mind open to doing things other than the two options above.

 

[FrkyBgStok]

this is very general, but for me, i didn't like the OR that much. i absolutely love the science of anesthesia but wanted to the direct patient contact, so I plan on applying PCCM next year. to me, it is all the pros, none of the cons.

and i think the MGMA data for private practice peds cards is in the $310k range in my area with more for savvy people. but in my area, gas pays around the $400k range so it negates my previous point.

 

[azxcv0987]

A HP would not necessarily lower your chances at a peds residency, depending on how you do on your fourth year rotations. I assume you also have some clerkships remaining, so keep your mind open to doing things other than the two options above.

As a tangent, is it still possible to get into a top program with an HP on my clerkship? I've been told that usually 20-30% of students get honors FWIW. This was also my weakest shelf and rotation overall compared to the others, but I really enjoyed it.

My school actually had an accelerated pre-clinical curriculum, so I'm almost done with 3rd year. But I'm definitely keeping my mind open in case something else comes up.

this is very general, but for me, i didn't like the OR that much. i absolutely love the science of anesthesia but wanted to the direct patient contact, so I plan on applying PCCM next year. to me, it is all the pros, none of the cons.

and i think the MGMA data for private practice peds cards is in the $310k range in my area with more for savvy people. but in my area, gas pays around the $400k range so it negates my previous point.

I'm sure peds cards salary will almost always be lower than anesthesiology salary, but I just wanted to know if doing 6 years of training (3 + 3 in fellowship) would pay off, as opposed to anesthesia which has a shorter pathway and better pay.

 

[MEN2C]

I don't know what you mean by 'pay off'. As in who would make more? Anesthesia will make more than any pedi specialty.

With that said, pediatricians and pediatric subspecialties tend to be some of the happiest and most satisfied physicians out of all specialties, if that matters at all. And I don't regret picking peds one bit.

 

[Step Up]

HP in peds clerkship likely will make getting into the very top residencies (i.e. BCH and CHOP) difficult, but there are plenty of other great options. That said, this absolutely shouldn't factor into your decision on which speciality to chose. You certainly don't need to go to BCH/CHOP for residency in order to match into fellowship there. Furthermore, getting honors in your peds sub-Is will go a long ways towards getting into your residency program of choice.

I second that pediatric critical care fits your interests. Peds intensivists often staff outpatient sedation for MRIs and such, plus you manage all sorts of anesthesia in the PICU. You would do similar procedures to anesthesiologists, although of course, much less often.

If lifestyle and high income are paramount - go with anesthesia. You'll make a good income as a peds cardiologist or intensivist, but you won't be rich.

 

[michigangirl]

MS-3 here. Trying to figure out what I want to apply to next year, and I thought I would get a peds perspective.

Does anyone have something to add for peds pros and cons? Or does anyone want to say something about the pros/cons I have listed? I'm only a medical student, so I'm sure it's not a perfect list.

Pediatrics
Pros:
-Love working with kids (especially during my peds rotation)
-Very rewarding to make sick kids feel better
-Much easier to heal a sick kid than a sick adult (IM seemed to have more management of chronic diseases)
-Interesting pathology
-Good continuity of care with patients
-Could become a pediatric cardiologist

Cons:
-Salary. From what I read, peds cardiologists seem to be in the 200-250k range
-Harder residency lifestyle (more hours per week)
-I only got a HP in peds, and I don't know how that would affect my chances

Anesthesiology
Pros:
-I find physiology and pharmacology very interesting
-Great opportunity to do procedures
-Seemingly laidback work environment
-Very good salary (I've seen 300-400k from what I read)
-Good lifestyle (even during residency)

Cons:
-Missing out on much of that traditional doctor-patient relationship unless I do a pain fellowship afterwards
-Not as much opportunities for diagnostic reasoning (something I enjoy doing)
-The future of anesthesia doesn't look that great (cRNAs, decline of private practices, declining pay)

There's always the combined pediatrics-anesthesia residency ;-) Pediatrics-Anesthesiology Program

All kidding aside, just wanted to make sure you're aware of that option.

 

[2010houston]

Also consider what you think about clinic? I like peds, but HATED peds clinic despite having a great experience at a well run clinic w an excellent preceptor. And unless you’re a pedi hospitalist or PICU/NICU, it’s of course going to be a fair amount of any pedi job. I did anesthesia and haven’t regretted a minute.

 

[physicsnerd42]

I’m in one of the combined pediatrics-Anesthesia residency programs and I’m planning on doing Peds cardiac Anesthesia. Think about one of the combined programs. Otherwise, if I had to choose one or the other, I would choose Anesthesia. Let me put it to you this way: Many years we have a Peds resident match into Anesthesia (a large percentage of the Peds-anesthesia faculty at my institution is both Peds and Anesthesia trained); I’ve never heard of an Anesthesia resident go back to do Pediatrics. Heck, there’s even a PICU attending in my Anesthesia residency class.

From my experience, at least, the fear of CRNAs is overblown (and the same threat exists in Peds with NPs). Right now, at least, my Anesthesia classmates are having a much easier time getting awesome jobs (that pay much more) than my Peds colleagues.

Another thing I’d argue with is that I think that lifestyle is just as bad, if not worse, in Anesthesia as in Peds (including PICU, cards, etc). I feel more tired after a day on Anesthesia than a day on peds, probably because of the higher acuity in the OR. My time on Anesthesia is generally more stressful than my time on Peds because there’s a much higher probability of bad things happening at any moment.

I think both specialties have pluses and minuses that I’m happy to go into in more depth if you’d like. Different people open to both will gravitate to one or the other. That being said, I think there are reasons that people trained in both tend to gravitate to Anesthesia practice.


Sent from my iPhone using SDN mobile app

 

[MEN2C]

I can't speak to anesthesia specifically and it's not on this particular list but I'll just leave this here.


Gotta mean something. Bit of self selection of course, but speaking to my friends in IM and some surgical specialties, peds just doesn't "wear you down" like others.

Hell, I'm a resident, and don't tell my future employer this, but I'd choose pediatrics even if I only ever got paid a resident salary. I actually look forward going to work (except when I'm in clinic 😛) - can't put a price on that.


https://pdfs.semanticscholar.org/4b46/4eea58a3d718c3f1b338cbe75d5d5b09a9b7.pdf

 

[shepardsun]

I have a slightly different perspective than a combined program in that I did a peds and am now doing anesthesia residency on my way to PICU/peds anesthesia, so I can offer distinct differences of the residency experience of each vs. a combined program. Anesthesia definitely more exhausting on a moment to moment basis as physicsnerd said but I have so many more weekends off in gas then I ever did in my peds residency. Pluses and minuses to both but I gotta say I feel I am ten times the physician six months into my anesthesia training than I feel I was in my peds residency- in peds I always felt I needed a lot of support to take care of a sick patient, and now in anesthesia it's me at the head of the bed and I am ultimately responsible (with obvious exceptions, and with an attending always near by) for definitive airway management, resuscitation, etc. It fits my personality a lot more.

 

[BigRedBeta]

I have a slightly different perspective than a combined program in that I did a peds and am now doing anesthesia residency on my way to PICU/peds anesthesia, so I can offer distinct differences of the residency experience of each vs. a combined program. Anesthesia definitely more exhausting on a moment to moment basis as physicsnerd said but I have so many more weekends off in gas then I ever did in my peds residency. Pluses and minuses to both but I gotta say I feel I am ten times the physician six months into my anesthesia training than I feel I was in my peds residency- in peds I always felt I needed a lot of support to take care of a sick patient, and now in anesthesia it's me at the head of the bed and I am ultimately responsible (with obvious exceptions, and with an attending always near by) for definitive airway management, resuscitation, etc. It fits my personality a lot more.

No offense, but it sounds like you just needed to take the training wheels off yourself. But you're not the only one, it's extremely common for peds programs to not focus on independent practice especially for inpatients.

For the OP, finding programs that focus on building independent decision making can be done - but it's harder to find at so called "top" programs where there are a ton of fellows.

 

[NurWollen]

No offense, but it sounds like you just needed to take the training wheels off yourself. But you're not the only one, it's extremely common for peds programs to not focus on independent practice especially for inpatients.

For the OP, finding programs that focus on building independent decision making can be done - but it's harder to find at so called "top" programs where there are a ton of fellows.

Yeah, and now they want two more years of supervised training to practice hospital medicine.

Sent from my SM-G930V using SDN mobile

 

[zzsleepytinizz]

Hmm, I hate to burst your bubble. I am an anesthesiologist, and I can tell you that the OR is not a laid-back environment, and that residency is far from being a good lifestyle. I completed residency this past July, and I worked 72 24-shifts in my last year, and when I wasn't on call or post call I typically got to the hospital at 6am and stayed until 5:30/6pm. Also the work is very intense. We administer medications to patients that take away their ability to breath on their own, and cause various hemodynamic effects. What we do has the possibility of killing the patient every single day. Also, sometimes you get patient's who are on the verge of death to begin with who need emergency surgery and can barely tolerate the medications we give. While those hours may not sound so bad to you, you have to be hypervigilant the entire time, because things do go wrong, and it isn't as infrequent as you may think. You have to constantly be looking at the vital signs, scanning the surgical field for blood loss, checking your IVs, checking urine output, possibly even looking at arterial line tracings, pulmonary artery pressure tracings, and CVP. And there is definitely diagnostic reasoning in the OR. If you lose end-tidal you have to determine the cause quickly. You dont have the luxury to talk about it for 30-mins to an hour. You have to act fast, and be able to keep your calm when **** hits the fan, because when the patient codes everyone including the surgeon will be looking at you like a deer in headlights. Also, anesthesia is a very procedure heavy field. If you love procedures, and you love working in a high stress environment. We also get one 15-min break in the morning and another 30-mins for lunch. There are no other breaks. You can't sip water, you can't just go to the bathroom whenever you please.

Also it's definitely not low stress when you get called for an emergency airway at 3am, and the patient is 300lbs, and has a tracheal tumor while saturating 70% on a non-rebreather.

That being said, there are some good things about anesthesia. It just rubs me the wrong way when a medical student thinks they're going to pick it because of the lifestyle. We have the privilege of taking care of patients during some of the scariest moments of their life. I enjoy caring for my patients, and I really appreciate that the place their life in my hands and I take that responsibility very seriously.

 

[moonlightingthrowaway]

No offense, but it sounds like you just needed to take the training wheels off yourself. But you're not the only one, it's extremely common for peds programs to not focus on independent practice especially for inpatients.

I'm not sure what you mean by independent practice or decision making- sure, I can plan out a kid's vaccinations, put together a developmental referral, or manage a sick asthmatic or renal transplant on the floor on call by myself, but if they coded and needed to be intubated, lined, or aggressively resuscitated and you're anywhere near a tertiary peds hospital, you will be swarmed by a flood of intensivists/ED docs/attendings before you can even get your ambu bag out of the wrapper. No training wheels required. I'm not sure where you went for residency where you saw really sick kids but didn't have at least two levels of subspecialty/emergency support at all times.

 

[anbuitachi]

MS-3 here. Trying to figure out what I want to apply to next year, and I thought I would get a peds perspective.

Does anyone have something to add for peds pros and cons? Or does anyone want to say something about the pros/cons I have listed? I'm only a medical student, so I'm sure it's not a perfect list.

Pediatrics
Pros:
-Love working with kids (especially during my peds rotation)
-Very rewarding to make sick kids feel better
-Much easier to heal a sick kid than a sick adult (IM seemed to have more management of chronic diseases)
-Interesting pathology
-Good continuity of care with patients
-Could become a pediatric cardiologist

Cons:
-Salary. From what I read, peds cardiologists seem to be in the 200-250k range
-Harder residency lifestyle (more hours per week)
-I only got a HP in peds, and I don't know how that would affect my chances

Anesthesiology
Pros:
-I find physiology and pharmacology very interesting
-Great opportunity to do procedures
-Seemingly laidback work environment
-Very good salary (I've seen 300-400k from what I read)
-Good lifestyle (even during residency)

Cons:
-Missing out on much of that traditional doctor-patient relationship unless I do a pain fellowship afterwards
-Not as much opportunities for diagnostic reasoning (something I enjoy doing)
-The future of anesthesia doesn't look that great (cRNAs, decline of private practices, declining pay)

Good thing you are a MS3, you need to do a lot more research about the fields you are into. Look beyond your hospital. Talk to as many attendings as possible, both in and out of your hospital. I can tell you anesthesiology is not very laid back, the life style is not good either. You are constantly shifting between day and nights (I hate this part), your hours are unpredictable (because it depends on the surgeon), and probably wont be until you are in your last 1/5th of your career and has some say. Think about it, for almost every surgery, there needs to be an anesthesiologist. Therefore anesthesiologists lifestyle is similar to a surgeons, except the surgeon has the benefit of knowing his/her schedule and can plan around it. The anesthesiologist, not so much. Salary is still above average but if you look at the trends, this may not be for long. Salary has stayed flat (most other specialties increased), while work hours avg 61 hrs/week for attendings according to AAMC.org (one of the highest, higher than peds for sure).

Regarding the cons, you still diagnose stuff in the OR and in the PACU, just not often the same set of issues you see in peds. If something goes wrong you need to figure out why. You can also do ICU afterwards , not just pain

What i really like about anesthesiology is it really toughens you up as a doctor early on. You see a lot of crazy stuff and sick patients. You see some of the sickest of the sick in the OR and you are the one responsible for managing them while the surgeon cuts. You aren't surrounded by colleagues nearby like on the floor or ED to help