Lara

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I don't have my anesthesiology week until late this month and I'm getting desperate for input. I've done peds and a month of surgery, from which I'm basing my thoughts about gas (I've tried to observe as much as possible).

I liked peds *substantially* more than medicine, and would enjoy the didactics. I like the thought of working in a children's hospital. A number of people including peds attendings have said they could see me as a pediatrician. Job satisfaction seems to be on the high side - because of the pay, you don't go into it without a genuine desire.

Negatives include getting sick all the time (I hate colds as much as the next person). Many parents will undoubtedly lack confidence in me since I'm tiny and look like a young teenager...of which I'm reminded at least weekly if not daily. It's one thing when I can call myself a student, another when I'm their actual doctor. And of course the low compensation with most fellowships taking 3 years (requiring research) for very little compensatory increase in income, and a more restricted job market. Keep in mind I'll be 200-225K in debt from med school. :(

Anesthesiology would allow me to be part of surgeries without being a surgeon (too physically demanding). I like the OR in general and the thought of doing cases/procedures. I like the idea of being involved with pretty much everything going on in the hospital. I'm really not great at physical exams (part of the reason for my preferring kids, as they're easier for me) and that would be less of a concern in anesthesia. I don't think I'd get bored, though that remains to be seen. Overall satisfaction seems huge among residents, with lots of turnover from other fields. And yes, the income is a big plus. I want to adopt after residency (it's my only option), live in Boston/NYC/SF if a job opens, travel and give back to my parents as well.

Negatives? I'm not sure I'd be as interested in the didactics compared to peds. I don't like the thought of being chained to the OR when hungry or needing to pee, etc...though at least I can sit down. And I don't know how easy the procedures will come to me, especially since difficult intubations on large guys require physical strength - and kids aren't exactly easy either. I'm also very laid-back (in terms of taking my time to do things) and don't know how I'd handle the occasional moments of panic.

Trouble is, I don't know if my week or even a fourth year elective can resolve these particular issues one way or the other.

Yeesh...any thoughts? I could use some advice!
 

beriberi

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Sounds like you have come up with a lot of reasons that anesthesia is right for you. Also, usually anesthesiologist are not chained to the OR--they have a better relief system than surgeons. Training is what helps you overcome panic--you shouldn't be comfortable with people crashing at this point in your career.

A lot of people look like teenagers in medical school. The trick is, calling your self Dr. and wearing a long white coat almost universally solves the problem. Your young appearance should not direct your career choice.

One thing to think about: anesthesia requires a transition year or prelim year (typically med or surg). There are a few places in the country (mostly large children's hospitals) that will allow people to do a ped pre-lim year (and then go into derm, rads, gas, rad-onc, etc.) with the thought/hope of subspecializing in children once the primary residency is done. Because PGY2 programs that require a prelim/transition year have a match that is done simulaneous with the PGY1 they would not know what kind of internship you had until after you secured a spot (as long as it met their requirements).
 
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Lara

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On the flip side, my appearance should be less threatening to kids. :) I guess I can deal with parents, they weren't an issue in my peds rotation...and I wouldn't be concerned if I *was* truly confident in my own clinical skills. I just hope I get to that point sooner than later, because lack of confidence is the last thing I can afford to project.

Now I feel I should give more reasons as to why I like peds. :D I just loved the newborns, there's nothing like the grasp reflex. I like the fact that kids are generally healthy and not responsible for their health problems. I also like the developmental behavior and preventive medicine aspect of peds, something I guess I'd forego in anesthesia. Parents are generally invested in their child's health and I can forgive the overworrisome ones. I do like the continuity of care, I just don't know whether it's worth it enough as far as salary goes.

Would I be safe doing a peds intern year as far as the new ICU-intensive requirements for anesthesia go? I'm also worried I'd be at a substantial disadvantage during residency compared with those doing transitional or prelim med. But I'd much rather do peds, if I could match into one of those programs.

Oh, one more thing I thought about - in peds anesthesia I'd be seeing kids crying and in pain on a daily basis (often enough without the luxury of knowing they'll be just fine), and even more anxious parents. That might be hard to take long term.

It's funny how for peds I already know where I'd want to apply, whereas anesthesia is a lot more unclear (but at the same time more open for me in cities like Boston). I just wish I could know which field I'd be most fulfilled in come 20 years. Hopefully someone who's more experienced in both could give their pros/cons. In the end, should it come down to whether or not I want the OR?
 
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I wouldn't worry about doing a peds prelim year and it being a disadvantage compared to those who did a medicine year. i am finishing peds residency and starting anesthesia residency next year (as part of combined picu/anesthesia fellowship). its been forever since i've taken care of adults and i'm going to be basically learning adult gas for two years.
 

rhinosp_33

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To beriberi-- which hospitals offer the peds internship? i couldn't find much info about it ..

Lara.. sounds to me you like peds more. however, you havent done an anesthesia rotation yet so it's hard to tell. try to schedule the anesthesia rotation very early in your 4th year, and see how you like it. try doing pre-ops, sticking around for the majority of the case, etc. also, you mentioned didactics --- anesthesia has alot of physio stuff vs peds. whether thats a good or bad thing, is up to you.

i wouldnt worry too much about physical apperance/strength .. i've seen alot of smaller stature female/male anesthesiologist before. regarding seeing kids crying in pain as a peds anesthesiologist... not really true. yes, you may see this in the preop but i wouldnt say its a big part. also, one of things i most enjoyed bout peds/anesthesia was seeing kids come out of surgery and feeling you had a concrete impact in their lifes thru cases such as lumbar fixture/cardiac cases/or even a simple tonsil/adenoid..
 

Chimera

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michigangirl, where do you plan on doing your combo fellowship next year? I was interested in potentially doing this as well. What were your motivations if you don't mind me asking.

Just curious.
 

beriberi

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Here are the programs that pop up when you search on Freida for peds (offers prelim positions).

California


Cedars-Sinai Medical Center Program
Los Angeles, California 320-05-31-027

University of Louisville Program
Louisville, Kentucky 320-20-21-088

Children's Hospital/Boston Medical Center Program
Boston, Massachusetts 320-24-21-403
Massachusetts General Hospital Program
Boston, Massachusetts 320-24-31-103

University of Missouri-Columbia Program
Columbia, Missouri 320-28-11-123
University of Missouri at Kansas City Program
Kansas City, Missouri 320-28-11-124
Washington University/B-JH/SLCH Consortium Program
St Louis, Missouri 320-28-11-125

UMDNJ-New Jersey Medical School Program
Newark, New Jersey 320-33-21-135

SUNY Health Science Center at Brooklyn Program
Brooklyn, New York 320-35-21-173
North Shore-Long Island Jewish Health System/Schneider Children's Hospital Program
New Hyde Park, New York 320-35-21-155

University of North Carolina Hospitals Program
Chapel Hill, North Carolina 320-36-21-178

Cincinnati Children's Hospital Medical Center/University of Cincinnati College of Medicine Program
Cincinnati, Ohio 320-38-21-185

University of Oklahoma Health Sciences Center Program
Oklahoma City, Oklahoma 320-39-11-196
University of Oklahoma College of Medicine-Tulsa Program
Tulsa, Oklahoma 320-39-21-197


Geisinger Health System Program
Danville, Pennsylvania 320-41-11-200


Vanderbilt University Program
Nashville, Tennessee 320-47-21-227

University of Texas Southwestern Medical School Program
Dallas, Texas 320-48-21-230
University of Texas Health Science Center at San Antonio Program
San Antonio, Texas 320-48-21-235

Medical College of Wisconsin Affiliated Hospitals Program
Milwaukee, Wisconsin 320-56-21-249



The one person I know who did this, however, secured a position (at a program on this list, very competitive) outside the match. I am not sure these programs are truly set up to take people from the match for just one year.

Also, a good, rigorous peds year will teach you more than a crappy medicine/transitional year. I don't think you will be at a great disadvantage (other than not being familiar with all of the antihypertensives, which is why epocrates exists.)
 

lh2004

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Lara,

I am currently doing a transitional year and will be starting anesthesia residency in July. I am hoping to go into Peds Anesthesia when all is said and done. I chose peds anesthesia over straight peds mainly because I liked the procedures/pharmacology/brief but intense interactions with patients, and disliked the routine visits, numerous social issues, and little procedures in general peds.

I did a pediatric anesthesia rotation as a 4th year medical student at a small children's hospital where I had constant 1:1 teaching with attendings and was allowed to perform many procedures. This might be an option for you (maybe even do 2 weeks of adult anesthesia and 2 weeks of pedi anesthesia) if your schedule allows.

As far as a peds prelim year, I think it's a great idea if you know you want to do peds anesthesia. I chose transitional mainly because I wanted to stay in the same city for internship and residency; plus I wanted a broader based internship in case I decide to do general anesthesia or another subspecialty. Feel free to contact me with questions.