Picking anesthesia for cardiac or peds anesthesia

[harambe4ever]

I know many on this board discourage med students from picking anesthesia due to CRNAs, decreasing respect from other colleagues, so forth.

What is your opinion on a med student picking anesthesia solely to do fellowship in cardiac or peds anesthesia where they may be able to do their own cases, garner a little more respect, get better jobs...

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[patriot6]

Apply anesthesiology.

Limit your SDN activity.

Succeed.

 

[AdmiralChz]

Misery loves company. Each specialty has its issues, check out the other boards for details. Do what you want, it's your life.

Be wary of advice from random internet people. Talk to mentors, people in the field. I bet you'll find plenty who are happy with their career choice.

 

[Nivens]

Apply anesthesiology.

Limit your SDN activity.

Succeed.

This is a real thing. I think there's a real correlation with my overall happiness at work and how often I am reading this forum.

 

[harambe4ever]

Thanks all. I definitely plan on just doing whatever I want to do... which I'm still trying to decide

I'm just curious how the "PICK ENT OR ORTHO OR YOU WILL ALWAYS CRY YOURSELF TO SLEEP" crowd on here views peds/cardiac anesthesia as a career choice.

 

[Nivens]

Thanks all. I definitely plan on just doing whatever I want to do... which I'm still trying to decide

I'm just curious how the "PICK ENT OR ORTHO OR YOU WILL ALWAYS CRY YOURSELF TO SLEEP" crowd on here views peds/cardiac anesthesia as a career choice.

I know plenty of happy anesthesiologists (of both persuasions you asked about) and miserable ENTs and orthopods. Hell, most days I'm a pretty happy anesthesia resident, all things considered.

Happiness is mostly internal.

I should take my own advice.

 

[deleted162650]

This is a real thing. I think there's a real correlation with my overall happiness at work and how often I am reading this forum.

Same here but for me they're directly proportional. Makes me thankful that I don't have to deal with the BS that many on this board have to wade through on the daily. I can think of 6 posters here (just off the top of my head, myself included) who are very happy professionally and personally. What do we all have in common? We all work MD only in the Western 1/2 half of the country. Food for thought.

 

[Man o War]

Cardiac fellowship was a great move for me. There isn't a single specialty that is perfect, and everyone thinks everyone else has it so much better.
I do my own cases and our surgeons treat us as colleagues, not an interchangeable cog. They take up for us and dont tolerate nurses, admin, etc crapping on us. If we start a case, we finish it.
The group/environment you choose matters A LOT.
I'm happy and have been well compensated for my time.

 

[jthedestroyr]

If you want cardiac, I'd do IM -> cardiology then interventional or a mix of whatever you like. Cards people are already placing TAVRs. This is only done in severe pt pop, but approval I.E. It will be standard of care for mild to mod cases in next 5-10 negating the need for open i.e. cT surgeons and most likely us.

 

[patriot6]

If you want cardiac, I'd do IM -> cardiology then interventional or a mix of whatever you like. Cards people are already placing TAVRs. This is only done in severe pt pop, but approval I.E. It will be standard of care for mild to mod cases in next 5-10 negating the need for open i.e. cT surgeons and most likely us.

Three years of internal medicine.

+ 3 years of cardiology fellowship.

+ 1-2 years of interventional cards.

Followed by a lifetime of cardiology.

It sounds so terrible.

<3 anesthesia

 

[harambe4ever]

If you want cardiac, I'd do IM -> cardiology then interventional or a mix of whatever you like. Cards people are already placing TAVRs. This is only done in severe pt pop, but approval I.E. It will be standard of care for mild to mod cases in next 5-10 negating the need for open i.e. cT surgeons and most likely us.

I have to be honest, there's no way in hell I'm doing IM.

Also, how does TAVR replace cardiac anesthesiologists? Honestly asking here.

 

[Mman]

I have to be honest, there's no way in hell I'm doing IM.

Also, how does TAVR replace cardiac anesthesiologists? Honestly asking here.

He's opining that at some point cardiologist will do TAVRs without anesthesiologists in the room. There will be no patient having AVR surgery. They will just go to the cath lab, get some mild sedation, and get their valve put in percutaneously. Kind of like getting a heart cath.

Is that possible? Sure. Not sure I'd care about that possibility if I was choosing to do cardiac anesthesia as a career, though. Really only in a true academic center would you be doing 100% cardiac cases. In the real world, cardiac trained anesthesiologists take care of patients having all sorts of surgeries in addition to cardiac cases.

 

[pgg]

If you want cardiac, I'd do IM -> cardiology then interventional or a mix of whatever you like. Cards people are already placing TAVRs. This is only done in severe pt pop, but approval I.E. It will be standard of care for mild to mod cases in next 5-10 negating the need for open i.e. cT surgeons and most likely us.

Could be. Interventional cardiologists have been on the edge of putting CT surgeons out of business for a couple or three decades now. It's bound to happen any minute now, I guess.

 

[Man o War]

Could be. Interventional cardiologists have been on the edge of putting CT surgeons out of business for a couple or three decades now. It's bound to happen any minute now, I guess.

I saw a thread on here from the late 90s where people were saying not to go into cardiac anesthesia because it was about to become obsolete along with cardiac surgeons.
Glad I didn't follow that advice.

 

[deleted171991]

It ain't over till it's over. But when it's over, it's really over (as we know it). People have been talking about the CRNA threat for a while also, and guess what, there isn't much solo anesthesia left on the East coast anymore (and they can practice independently in half of the states).

Most people are bad at noticing changes over longer stretches of time, anesthesiologists included. That's how we can live with our 20 year older selves, when we look in the mirror. We are also bad at predicting speed of change, but not change itself. We don't know when self-driving vehicles will become the norm, but we already know that commercial drivers will be hugely affected. When I got into medical school, doctors were independent gods; now they are herds of (scape)goats.

Cardiac anesthesia could be a good gig for another 10 years, or for 30, nobody really knows. One thing is clear: change is coming. But I would be less concerned about what happens with cardiac anesthesia. Fellowship is just a year; I am sure most of us have wasted much more during our education. As a medical student, I would be more concerned about the future of the specialty I am betting on. It doesn't take a genius to figure out that things will not get much better in medicine, so I personally would avoid the specialties where the ship has already hit the iceberg.

Look at all the unhappy Trump voters. Many of them voted for economic reasons, also known as incapacity to adapt. They either didn't see change coming, or did nothing to avoid it (e.g. move to big cities, retrain etc.). Medical students should not make the same mistake; there is no safety net in real life, beyond one's family. The more invested in a profession one is, the more one has to lose. This particular specialty has a huge (upcoming) problem with its job market; we are producing too many providers already, and the numbers are still growing.

 

[harambe4ever]

He's opining that at some point cardiologist will do TAVRs without anesthesiologists in the room. There will be no patient having AVR surgery. They will just go to the cath lab, get some mild sedation, and get their valve put in percutaneously. Kind of like getting a heart cath.

Is that possible? Sure. Not sure I'd care about that possibility if I was choosing to do cardiac anesthesia as a career, though. Really only in a true academic center would you be doing 100% cardiac cases. In the real world, cardiac trained anesthesiologists take care of patients having all sorts of surgeries in addition to cardiac cases.

Don't cardiac anesthesiologists do more than AVR surgeries though? Sure that's a piece of the pie, but what about CABG, mitral valve replacement, aortic aneurysm, transplant, LVAD, etc. etc.?

 

[harambe4ever]

It ain't over till it's over. But when it's over, it's really over (as we know it). People have been talking about the CRNA threat for a while also, and guess what, there isn't much solo anesthesia left on the East coast anymore (and they can practice independently in half of the states).

Most people are bad at noticing changes over longer stretches of time, anesthesiologists included. That's how we can live with our 20 year older selves, when we look in the mirror. We are also bad at predicting speed of change, but not change itself. We don't know when self-driving vehicles will become the norm, but we already know that commercial drivers will be hugely affected. When I got into medical school, doctors were independent gods; now they are herds of (scape)goats.

Cardiac anesthesia could be a good gig for another 10 years, or for 30, nobody really knows. One thing is clear: change is coming. But I would be less concerned about what happens with cardiac anesthesia. Fellowship is just a year; I am sure most of us have wasted much more during our education. As a medical student, I would be more concerned about the future of the specialty I am betting on. It doesn't take a genius to figure out that things will not get much better in medicine, so I personally would avoid the specialties where the ship has already hit the iceberg.

Look at all the unhappy Trump voters. Many of them voted for economic reasons, also known as incapacity to adapt. They either didn't see change coming, or did nothing to avoid it (e.g. move to big cities, retrain etc.). Medical students should not make the same mistake; there is no safety net in real life, beyond one's family. The more invested in a profession one is, the more one has to lose. This particular specialty has a huge (upcoming) problem with its job market; we are producing too many providers already, and the numbers are still growing.

Thanks for your advice. I agree that future employability, job market, trend of the specialty and so forth are important. Just out of curiosity, what fields do you recommend if one doesn't want to be a surgeon or dermatologist? Primary care, EM have or are going to be having mid-level problems too. Cards/rads/rad onc bad job market. Ophtho/GI are kind of a one-trick pony which is scary for a 30-40 year career. Peds pays like crap.

I'm just not sure if there really are ANY good gigs in medicine anymore if one doesn't want to suffer through a surgery residency or have the 250+/AOA/etc for derm.

 

[deleted171991]

IMO, any specialty that has fewer chances of being overtaken by midlevels/technology in 10-20 years is better than anesthesia. I wouldn't count derm among them.

The more interventional the specialty, the safer you'll be, as long as it's not monkey skills and simple procedures (as most are in anesthesia). Midlevels will take over the latter. Even if they will be working under "supervision", do you really want to be legally responsible for 3-4-6-8 people?

The more complex (not just vast) the knowledge base the safer you'll be. Again, midlevels and/or technology will take over things based on pattern recognition and rot memorization. They used to not have access to our level of knowledge base; with technology and Internet, now they do. Plus experience and IQ matter. That's why, after a few years, the smart ones can successfully treat routine patients even in critical care.

The more acute the specialty, the sicker the patients, the higher chances you'll survive as a physician. When time matters, when there is no time for looking up stuff, trial and error, or undo, everybody wants a doctor. Anesthesia for most surgeries doesn't fall into this category. People need to be afraid even of the idea that a midlevel would practice the respective specialty on them.

The worse the lifestyle, geography etc., the safer you'll be. Midlevels are people, and people always tend to go for the low-hanging fruit first. That's why even anesthesia job(market)s are significantly worse on the coasts and in big cities, and better in BFE. You can almost tell the setting-/location-type the attendings who post here work in, just by the level of their happiness. Including mine: East Coast non-rural.

Last but not least, there is a big difference between future probabilities and current realities. While in most specialties the future may be bleak, in anesthesia things are already happening. It's a known entity, an already listing ship. If you could go back in time, would you sail on the Titanic? You might think SDN is biased towards the mental ward, but there is no smoke without fire. Most people don't become/stay happy/unhappy despite their jobs.

 

[GravelRider]

I have to be honest, there's no way in hell I'm doing IM.

Also, how does TAVR replace cardiac anesthesiologists? Honestly asking here.

Cardiologists have been one of the most aggressive groups of specialists in terms of defending and expanding their turf. We could all learn a lesson from them.

 

[Mman]

The more interventional the specialty, the safer you'll be, as long as it's not monkey skills and simple procedures (as most are in anesthesia). Midlevels will take over the latter. Even if they will be working under "supervision", do you really want to be legally responsible for 3-4-6-8 people?

I medically direct 2-4 AAs and CRNAs at a time and ACT practices like mine have been going on for decades without any excess risk (medically or legally). So if you don't mind working harder, people can still work in that model and will likely be able to for decades to come.

 

[nimbus]

IMO, any specialty that has fewer chances of being overtaken by midlevels/technology in 10-20 years is better than anesthesia. I wouldn't count derm among them.

The more interventional the specialty, the safer you'll be, as long as it's not monkey skills and simple procedures (as most are in anesthesia). Midlevels will take over the latter. Even if they will be working under "supervision", do you really want to be legally responsible for 3-4-6-8 people?

The more complex (not just vast) the knowledge base the safer you'll be. Again, midlevels and/or technology will take over things based on pattern recognition and rot memorization. They used to not have access to our level of knowledge base; with technology and Internet, now they do. Plus experience and IQ matter. That's why, after a few years, the smart ones can successfully treat routine patients even in critical care.

The more acute the specialty, the sicker the patients, the higher chances you'll survive as a physician. When time matters, when there is no time for looking up stuff, trial and error, or undo, everybody wants a doctor. Anesthesia for most surgeries doesn't fall into this category. People need to be afraid even of the idea that a midlevel would practice the respective specialty on them.

The worse the lifestyle, geography etc., the safer you'll be. Midlevels are people, and people always tend to go for the low-hanging fruit first. That's why even anesthesia job(market)s are significantly worse on the coasts and in big cities, and better in BFE. You can almost tell the setting-/location-type the attendings who post here work in, just by the level of their happiness. Including mine: East Coast non-rural.

Last but not least, there is a big difference between future probabilities and current realities. While in most specialties the future may be bleak, in anesthesia things are already happening. It's a known entity, an already listing ship. If you could go back in time, would you sail on the Titanic? You might think SDN is biased towards the mental ward, but there is no smoke without fire. Most people don't become/stay happy/unhappy despite their jobs.

All of these sound like reasons why cardiac anesthesia is here to stay. If you're happy to take care of patients no one else wants and take call and work at hours when no one else wants to work, you have job security.

 

[bigdan]

I am extremely happy with my choice to do anesthesiology. I happen to be in the Eastern US, and supervise CRNAs and residents. Trained in cardiac anesthesiology and critical care medicine.

Counting medical school, training, and current employment, I've provided patient care in 15 separate hospitals, and there are problems in each and every one. But I still enjoy immense job satisfaction with the work that I do. Things that I think help me stay happy: 1) I'm okay with me being the only one in the room that knows I did a great job/saved a life, 2) from where I sit, I am incredibly fortunate that I make the money I make all things considered 3) I enjoy the diversity of my current work. Each of these things could be explained away, I realize, by saying "He's crazy/delusional/"drinking the Kool-Aid", but fu*k it, I like it.

If a wand was waved, and the sky fell, and all anesthesiologists were instantly viewed as equal to CRNAs, I'd make around $150,000 for 36 hours/week of work. I paid off my loans (and those of wifey, who is also a physician) in the first 11 months out of training. I'm good with $150,000. Might not be enough for everyone, but it'd be fine for me.

Regarding cardiac anesthesiology in specific, the technical advancements in echo equipment has been amazing, even in the very short time that I've seen them. 3D echo can literally be done with the single push of a button, and we may see the day where the surgeon says "Show me the valve", someone (anesthesiologist or CRNA or AA or whomever) pushes the button, and the mitral valve pathology reveals itself. Surgeon fixes valve, is shown the valve again, and off we go. Or maybe that won't happen. Where I work now, we were doing TAVRs alseep, introducer with Swan, 2nd introducer for pacer wire, and art line, then afterwards, to the CTICU. We're doing them with sedation with Precedex, an art line, and to the PACU postop now. Can't really predict the future, or what will change. In the past year, I've had ICU people tell me that they do cardiac "as well as anyone", and cardiac people tell me "there's nothing special about ICU training", and non-fellowship trained people tell me "fellowships are a waste of time and money". I'm not sure who's right. But I'm happy with what I've chosen, and am getting what I want out of this profession. It's already been said, but I'll say it again: choose what you think you can see yourself doing everyday. It'll most certainly become a job at some point, so hopefully you like that job.

Good luck. I'd pick anesthesiology again if given the choice.

 

[Mman]

Each of these things could be explained away, I realize, by saying "He's crazy/delusional/"drinking the Kool-Aid", but fu*k it, I like it.

Pretty much the same for me. Some things are awesome, some things kinda suck, but when I wake up in the morning I enjoy going to work and when I leave at the end of the day I feel like I've made a difference.

 

[deleted171991]

All of these sound like reasons why cardiac anesthesia is here to stay. If you're happy to take care of patients no one else wants and take call and work at hours when no one else wants to work, you have job security.

Except that one doesn't need a fellowship for most of that.

There is a significant lifestyle component of happiness (and burnout). As generous and passionate and nice as @bigdan is, I doubt he will have the same opinions when he is 10 years older. There is stuff in life that should not be missed, at any price, even by middle class people like us. So while an excellent worker will almost always have a job, one shouldn't (have to) live to work.

 

[AdmiralChz]

Except that one doesn't need a fellowship for most of that.

There is a significant lifestyle component of happiness (and burnout). As generous and passionate and nice as @bigdan is, I doubt he will have the same opinions when he is 10 years older. There is stuff in life that should not be missed, at any price, even by middle class people like us. So while an excellent worker will almost always have a job, one shouldn't (have to) live to work.

To be fair, FFP, you have gotten extremely jaded and pretty snarky in just under a year of practice. Not everyone has these experiences and not everyone is miserable in an ACT model. I just signed a great gig in my hometown doing supervision with a healthy group making solid money. Will occasionally do my own cases including cardiac. Very excited for the future.

 

[nimbus]

Except that one doesn't need a fellowship for most of that.

There is a significant lifestyle component of happiness (and burnout). As generous and passionate and nice as @bigdan is, I doubt he will have the same opinions when he is 10 years older. There is stuff in life that should not be missed, at any price, even by middle class people like us. So while an excellent worker will almost always have a job, one shouldn't (have to) live to work.

You can burn out if you're doing something you don't love. I've been at this over 20years and my appreciation for this work and the people I work with has only grown over the years. I wake up every morning hoping I'll have the opportunity to make a difference. I live in a great place, still have time to socialize and have hobbies, and make a **** ton of money by most standards. I treat people well and they treat me well. We have chronic complainers where I work too and I think wtf are they complaining about. A lot of people would give up their nuts to be in our place.

 

[deleted162650]

^^ One of the 6.

 

[GravelRider]

Some of the British thought that the colonists in the American colonies were a bunch of whiners who should just be happy that they were a part of the largest and wealthiest empire in the world. They were so whiney that they dumped a whole bunch of tea in Boston Harbor in a big tantrum. Today we call them Patriots.

There are a lot of really cr@ptastic jobs out there. That is the reality. For every 1 great job there are about 40 bad jobs (76% of statistics are made up on the spot). There are regional variations, but telling everyone going into anesthesia to avoid the population centers of the east coast is not a solution in a profession that requires people to operate on. Physician burnout rates grow every year across all specialties. That is a real thing. Maybe it's an epidemic of complainers, but maybe there is a real problem going on. I very much enjoy practicing anesthesia, but I don't enjoy missing dinner with my family 4 nights a week and staying until the work is done simply because that is what physicians do without being compensated for it.

 

[Mman]

Some of the British thought that the colonists in the American colonies were a bunch of whiners who should just be happy that they were a part of the largest and wealthiest empire in the world. They were so whiney that they dumped a whole bunch of tea in Boston Harbor in a big tantrum. Today we call them Patriots.

There are a lot of really cr@ptastic jobs out there. That is the reality. For every 1 great job there are about 40 bad jobs (76% of statistics are made up on the spot). There are regional variations, but telling everyone going into anesthesia to avoid the population centers of the east coast is not a solution in a profession that requires people to operate on. Physician burnout rates grow every year across all specialties. That is a real thing. Maybe it's an epidemic of complainers, but maybe there is a real problem going on. I very much enjoy practicing anesthesia, but I don't enjoy missing dinner with my family 4 nights a week and staying until the work is done simply because that is what physicians do without being compensated for it.

Of course there are bad jobs. Sounds like you have one. But there are also good jobs. I eat dinner with my family at least 6 nights a week. Burnout is a problem in medicine, not just anesthesia. So if someone is already in medical school and deciding on a specialty, there is nothing especially terrible about anesthesia compared to everybody else.

That said, I'll tell my kids that they shouldn't go to medical school when it comes time to have that discussion.

 

[bigdan]

FFP -

You may be right. I may learn to *hate* this, as many on this SDN seem to. But right now, I don't. My first lawsuit might change that, or being away from home, or whatever. I can't predict it, and surely don't know what the future holds. Some of the guys at my place that are a little fried keep telling me "You don't know how bad you have it", but even if they're right, it's a little like believing in Santa: if it's real to me, what difference does it make?

So, right now, I'm making hay while the sun shines. FU account will currently allow me to live 24 months without changing a single thing in my life if I quit/get fired right now. Zero debt. Saving all I can, and living within my means. If/when I hate my job, I GTFO.

Danny likes the job, but Danny don't needs the job.

 

[spacegun]

No opinions about peds anesthesia so far?

 

[deleted171991]

FFP -

You may be right. I may learn to *hate* this, as many on this SDN seem to. But right now, I don't. My first lawsuit might change that, or being away from home, or whatever. I can't predict it, and surely don't know what the future holds. Some of the guys at my place that are a little fried keep telling me "You don't know how bad you have it", but even if they're right, it's a little like believing in Santa: if it's real to me, what difference does it make?

So, right now, I'm making hay while the sun shines. FU account will currently allow me to live 24 months without changing a single thing in my life if I quit/get fired right now. Zero debt. Saving all I can, and living within my means. If/when I hate my job, I GTFO.

Danny likes the job, but Danny don't needs the job.

I am not that different in my financial approach; I make more than I ever dreamed of, have come a very long way in the last 15-20 years, and I am beyond grateful to this country for that. I just don't like injustice, which includes me working fellow hours for the same money my OR colleagues make in much less time. Now that pisses me off. I will not uproot or stay away from my family just for the honor of working my butt off doing intensive care, even if I love it much more than anesthesia. There is no point in that. I don't live to work, not anymore. Life is short. Plus I can't imagine being happy long-term working your kind of hours; physician happiness and burnout correlate closely with working hours and stress. That's why many intensivists only work one week per month in the ICU. And I have had the pleasure of being a cog in an academic place, and know that it's not worth most sacrifices, not more than in any AMC.

There is no point in being the ICU superstar as long as I am valued the same as the guy with "ambulatory fellowship" who works 7-3. It makes about the same sense as choosing primary care medicine for less than CRNA salaries and more stress. Respectfully. Unfortunately, I am not the only one. There are a lot of CCM-trained anesthesiologists who chose to give up intensive care for a better life. I am sorry that many patients will continue suffering at the hands of those who practice yesterday's critical care, who don't keep up with the science and who shouldn't have ICU privileges in the first place, but I am not Mother Teresa.

 

[skypilot]

If a wand was waved, and the sky fell, and all anesthesiologists were instantly viewed as equal to CRNAs, I'd make around $150,000 for 36 hours/week of work. I paid off my loans (and those of wifey, who is also a physician) in the first 11 months out of training. I'm good with $150,000. Might not be enough for everyone, but it'd be fine for me.
.

That would be $250k for a 60 hour work week. The hospitals will choose the doc over the CRNA if salaries get that low, or the CRNAs will have to cut their salaries to compete. I am five years into my career as a generalist. I know I made the right choice and I am very happy in my career. I am saving my pennies, and ready to move to another location whenever it becomes necessary.