Please ease my fears about anesthesia?

[aimedicine]

One can always do anesthesia after IM residency. Many people have done that.

Bro that’s 6 to 7 yrs of training...poor ROI. Honestly if you don’t like anesthesia don’t waste your time. I remember reading this board many years ago as MS3, I was very concerned about choosing anesthesia for the reasons mentioned in this forum. Fast forward 5 yrs later, I’m on the verge of signing with a PP gig where I would be able to make 600k a year. It’s not the 700-900k gig people often boast about here in the good old days but high paying jobs are still out there. I guarantee you the lifestyle that I will be able afford won’t be that much different than the cards/G.I/ortho guys you guys always idolize.

So to the original OP, i hope this eases your fear a little about anesthesia.

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[nimbus]

Bro that’s 6 to 7 yrs of training...poor ROI. Honestly if you don’t like anesthesia don’t waste your time. I remember reading this board many years ago as MS3, I was very concerned about choosing anesthesia for the reasons mentioned in this forum. Fast forward 5 yrs later, I’m on the verge of signing with a PP gig where I would be able to make 600k a year. It’s not the 700-900k gig people often boast about here in the good old days but high paying jobs are still out there. I guarantee you the lifestyle that I will be able afford won’t be that much different than the cards/G.I/ortho guys you guys always idolize.

So to the original OP, i hope this eases your fear a little about anesthesia.

I agree anesthesia is still a good choice. Just sayin it’s still an option after IM residency.

 

[spacegun]

One can always do anesthesia after IM residency. Many people have done that.

True, but I was trying to reply to those people who are saying don’t pick anesthesia. Like anesthesia shouldn’t be an option. Instead they’re saying pick cards, GI, or a surgical subspecialty instead of anesthesia.

 

[pgg]

Some people mentioning surgical subspecialties, cardiology, GI, but these are hard to match into. I've known people applying for surgical subspecialties who didn't get in so they chose anesthesiology instead. And no guarantee someone who does IM will match into GI or cards (let alone interventional cards). Then they end up in IM. I guess that means they have to enjoy being a hospitalist or PCP. Maybe that's fine for some people but I don't know if it's for me. In other words, we can say anesthesiology sucks, but the question is compared to what? Ortho/plastics/GI/interventional cards might all be better than anesthesiology, but personally to me anesthesiology is better than FM, general IM, general peds. It's always relative to some other specialty.

The unwritten subtext to every post in that vein is "be brilliant and the world is your oyster"... and on SDN everyone is brilliant.

Anyone who can match to ortho or ENT or interventional cardiology probably has what it takes to be a top 10% anesthesiologist. That's a pretty good life.

 

[Cantaloupe5]

I wonder if attendings on this subforum that advise students to go into derm, ortho, ENT, etc have any idea how competitive those fields have become. Maybe you could waltz into any specialty you wanted ~30 years ago, but nowadays a 250+ Step 1, AOA, 10+ pubs are essentially required, unless you want to the roll the dice with lesser stats and risk not matching. And unless you're a day 1 gunner, there's no way you're gonna get that many pubs by application time, so research years are becoming popular. I've even heard stories of top, perfect applications slipping through the cracks and failing to match.

GI/Cards aren't exactly gimmies either - getting stuck in IM would be my worst nightmare.

 

[UnoMas]

I wonder if attendings on this subforum that advise students to go into derm, ortho, ENT, etc have any idea how competitive those fields have become. Maybe you could waltz into any specialty you wanted ~30 years ago, but nowadays a 250+ Step 1, AOA, 10+ pubs are essentially required, unless you want to the roll the dice with lesser stats and risk not matching. And unless you're a day 1 gunner, there's no way you're gonna get that many pubs by application time, so research years are becoming popular. I've even heard stories of top, perfect applications slipping through the cracks and failing to match.

GI/Cards aren't exactly gimmies either - getting stuck in IM would be my worst nightmare.

Many of these are also the ones that got into Anesthesia when half of the slots went unfilled and all you needed was a pulse to get in. One of the attendings at my home program is pretty vocal about students should go into ortho, ENT, GI, Cards instead of Anesthesia and then usually laugh about how his board score would have never gotten him into the specialty if he were to apply today.

Also advice like that doesn't account for any of the student's likes and dislikes. I, too, would rather quit it altogether if I were forced to do IM for the rest of my life, or see patients in clinic, follow up appointments etc. Also there is no guarantee that these specialties that 'own the patients' won't go sideway in the near future especially when everyone is going to be employees to the hospital/health system and midlevels are going full-assault on all fronts.

 

[nimbus]

I wonder if attendings on this subforum that advise students to go into derm, ortho, ENT, etc have any idea how competitive those fields have become. Maybe you could waltz into any specialty you wanted ~30 years ago, but nowadays a 250+ Step 1, AOA, 10+ pubs are essentially required, unless you want to the roll the dice with lesser stats and risk not matching. And unless you're a day 1 gunner, there's no way you're gonna get that many pubs by application time, so research years are becoming popular. I've even heard stories of top, perfect applications slipping through the cracks and failing to match.

GI/Cards aren't exactly gimmies either - getting stuck in IM would be my worst nightmare.

Those specialties have always been extremely competitive. They have always required focused effort beginning in M1 year.

Is orthopedics more competitive today than when my attending matched? An analysis of National Resident Matching Program data for orthopedic PGY1 applicants from 1984 to 2011 - PubMed

The NRMP data from 1984 to 2011 supported our hypothesis that intercandidate competition intensity for orthopedic PGY1 positions has not increased over time. The misconception that orthopedics is becoming more competitive likely arises from the increased number of applications submitted per...

www.ncbi.nlm.nih.gov

https://www.ncbi.nlm.nih.gov/m/pubmed/25715349/?i=4&from=/24836166/related

 

[Twiggidy]

I wonder if attendings on this subforum that advise students to go into derm, ortho, ENT, etc have any idea how competitive those fields have become. Maybe you could waltz into any specialty you wanted ~30 years ago, but nowadays a 250+ Step 1, AOA, 10+ pubs are essentially required, unless you want to the roll the dice with lesser stats and risk not matching. And unless you're a day 1 gunner, there's no way you're gonna get that many pubs by application time, so research years are becoming popular. I've even heard stories of top, perfect applications slipping through the cracks and failing to match.

GI/Cards aren't exactly gimmies either - getting stuck in IM would be my worst nightmare.

I think the people who do chose this field just need to be very informed about what they are getting into. Academic anesthesia is very different from private practice anesthesia (in good and bad ways) so I think many people get a false impression of this field when they're medical students (*raises hand*), interns, and early residents. It really takes a certain personality to have a career with longevity and there are things you have to accept where "the anesthesiologists" sits on the hierarchy of the hospital totem pole. Some people can't accept that so that's where you really need to consider another specialty if you can't "fit in" to the field. These things aren't taught in residency.

I really think a lot of us like our jobs, but I think a lot of us have accepted our role in this medicine game.

 

[Cantaloupe5]

Those specialties have always been extremely competitive. They have always required focused effort beginning in M1 year.

Is orthopedics more competitive today than when my attending matched? An analysis of National Resident Matching Program data for orthopedic PGY1 applicants from 1984 to 2011 - PubMed

The NRMP data from 1984 to 2011 supported our hypothesis that intercandidate competition intensity for orthopedic PGY1 positions has not increased over time. The misconception that orthopedics is becoming more competitive likely arises from the increased number of applications submitted per...

www.ncbi.nlm.nih.gov

https://www.ncbi.nlm.nih.gov/m/pubmed/25715349/?i=4&from=/24836166/related

Is match rate the best metric for competitiveness? Medical students are pretty good at self-selection. Per the 2018 charting outcomes, the match rates for FM and ENT were 95.3% and 95.6%, respectively.

 

[BLADEMDA]

Is match rate the best metric for competitiveness? Medical students are pretty good at self-selection. Per the 2018 charting outcomes, the match rates for FM and ENT were 95.3% and 95.6%, respectively.

Yes, they are very good at self selection. Why would anyone risk not Matching into a residency? Certain step scores are expected for each specialty. If your score is way below the average Matched candidate for a competitive specialty then you won’t get a spot.

 

[Twiggidy]

Yes, they are very good at self selection. Why would anyone risk not Matching into a residency? Certain step scores are expected for each specialty. If your score is way below the average Matched candidate for a competitive specialty then you won’t get a spot.

And that's really the gist. We self select to put ourselves in the best position for success. I think that's why some are saying, "Hey, if you have a 260 step 1, some research, and are in the top 10% of you class, more power to you if you love anesthesia, but you also could possible have some better options for a career in medicine, especially if you thing is 'doing procedures'" A person with a 260 is probably good enough to get a good IM residency which will be one good enough to be on the radar for a good cards or GI fellowship. But, if you're sort or average or above average and are just doing what you need to do to graduate, you can probably get a half decent anesthesia spot. As I said, just know what you're getting into. You won't be "the man/woman" like your classmate who's a Interventional cards or surgeon and brings clients to the hospital. That's the role you'll have to accept. It's literally, "Do good anesthetics. Do make waves."

 

[pjl]

And that's really the gist. We self select to put ourselves in the best position for success. I think that's why some are saying, "Hey, if you have a 260 step 1, some research, and are in the top 10% of you class, more power to you if you love anesthesia, but you also could possible have some better options for a career in medicine, especially if you thing is 'doing procedures'" A person with a 260 is probably good enough to get a good IM residency which will be one good enough to be on the radar for a good cards or GI fellowship. But, if you're sort or average or above average and are just doing what you need to do to graduate, you can probably get a half decent anesthesia spot. As I said, just know what you're getting into. You won't be "the man/woman" like your classmate who's a Interventional cards or surgeon and brings clients to the hospital. That's the role you'll have to accept. It's literally, "Do good anesthetics. Do make waves."

lol...he called the patients "clients."

 

[Dawkter]

And that's really the gist. We self select to put ourselves in the best position for success. I think that's why some are saying, "Hey, if you have a 260 step 1, some research, and are in the top 10% of you class, more power to you if you love anesthesia, but you also could possible have some better options for a career in medicine, especially if you thing is 'doing procedures'" A person with a 260 is probably good enough to get a good IM residency which will be one good enough to be on the radar for a good cards or GI fellowship. But, if you're sort or average or above average and are just doing what you need to do to graduate, you can probably get a half decent anesthesia spot. As I said, just know what you're getting into. You won't be "the man/woman" like your classmate who's a Interventional cards or surgeon and brings clients to the hospital. That's the role you'll have to accept. It's literally, "Do good anesthetics. Do make waves."

You can always do interventional pain and bring your own patients to the hospital/ASC.

 

[hununuh]

Is match rate the best metric for competitiveness? Medical students are pretty good at self-selection. Per the 2018 charting outcomes, the match rates for FM and ENT were 95.3% and 95.6%, respectively.

% of US grads (MD) is a better metric for competitiveness. At 60%, Anesthesia is not a competitive field at all. No offense to IMGs or DOs, but you don't see as many IMGs or DOs in competitive specialties like ENT, Derm, or Ortho as you see in Anesthesia. I don't think there is a single DO or IMG resident in those fields at my institution. You can say that certain programs are "DO Friendly" or "IMG Friendly", but all it really means is that they can't attract US MDs for whatever reason. Truly competitive Anesthesia programs rarely have IMGs or DOs for this reason, and those that match at top programs are nearly perfect applicants apart from their pedigree.

 

[Cantaloupe5]

I think the people who do chose this field just need to be very informed about what they are getting into. Academic anesthesia is very different from private practice anesthesia (in good and bad ways) so I think many people get a false impression of this field when they're medical students (*raises hand*), interns, and early residents. It really takes a certain personality to have a career with longevity and there are things you have to accept where "the anesthesiologists" sits on the hierarchy of the hospital totem pole. Some people can't accept that so that's where you really need to consider another specialty if you can't "fit in" to the field. These things aren't taught in residency.

I really think a lot of us like our jobs, but I think a lot of us have accepted our role in this medicine game.

And that's really the gist. We self select to put ourselves in the best position for success. I think that's why some are saying, "Hey, if you have a 260 step 1, some research, and are in the top 10% of you class, more power to you if you love anesthesia, but you also could possible have some better options for a career in medicine, especially if you thing is 'doing procedures'" A person with a 260 is probably good enough to get a good IM residency which will be one good enough to be on the radar for a good cards or GI fellowship. But, if you're sort or average or above average and are just doing what you need to do to graduate, you can probably get a half decent anesthesia spot. As I said, just know what you're getting into. You won't be "the man/woman" like your classmate who's a Interventional cards or surgeon and brings clients to the hospital. That's the role you'll have to accept. It's literally, "Do good anesthetics. Do make waves."

I agree, students need to have realistic expectations before entering anesthesiology. If you have an ego, want the spotlight in the OR, need constant pats on the back, then you're going to very unhappy. But I think it's perfect for people like me with type B personalities that just want to do their work, clock out, and leave work at work.

Also, most students that are drawn to anesthesiology would be miserable in IM and it's subspecialties. There's a study in JAMA about physician burnout that anesthesiology ranks 2nd in career-choice regret (20.6%) but much lower for specialty-choice regret (6%). This makes a ton of sense if you think about how a lot of students arrive to anesthesia - you go through your clinical years and realize how soul-sucking it is to round for hours, to spend 75% of the day on a computer doing paperwork, to deal with dispo nightmares, to run see patients in clinic all day and then chart at home, etc. It can feel like you made a huge mistake going into mistake. Anesthesia looks pretty attractive at this point despite all its issues.

 

[aimedicine]

% of US grads (MD) is a better metric for competitiveness. At 60%, Anesthesia is not a competitive field at all. No offense to IMGs or DOs, but you don't see as many IMGs or DOs in competitive specialties like ENT, Derm, or Ortho as you see in Anesthesia. I don't think there is a single DO or IMG resident in those fields at my institution. You can say that certain programs are "DO Friendly" or "IMG Friendly", but all it really means is that they can't attract US MDs for whatever reason. Truly competitive Anesthesia programs rarely have IMGs or DOs for this reason, and those that match at top programs are nearly perfect applicants apart from their pedigree.

If you look at charting outcome for the match...the mean step 1 and 2 scores for both DOs and MDs that matched anesthesia is very similar...like within 2 to 3 points. So programs that have more DOs aren’t really less competitive...just more receptive to DOs. As time progresses, other specialty would also have to open up their doors to more DO applicants as they begin to realize the quality of education isn’t necessarily any less in DO schools. As proven by average usmle scores of osteopathic medical students...which continues to increase year after year.

 

[Twiggidy]

You can always do interventional pain and bring your own patients to the hospital/ASC.

that's true

 

[Twiggidy]

I agree, students need to have realistic expectations before entering anesthesiology. If you have an ego, want the spotlight in the OR, need constant pats on the back, then you're going to very unhappy. But I think it's perfect for people like me with type B personalities that just want to do their work, clock out, and leave work at work.

Also, most students that are drawn to anesthesiology would be miserable in IM and it's subspecialties. There's a study in JAMA about physician burnout that anesthesiology ranks 2nd in career-choice regret (20.6%) but much lower for specialty-choice regret (6%). This makes a ton of sense if you think about how a lot of students arrive to anesthesia - you go through your clinical years and realize how soul-sucking it is to round for hours, to spend 75% of the day on a computer doing paperwork, to deal with dispo nightmares, to run see patients in clinic all day and then chart at home, etc. It can feel like you made a huge mistake going into mistake. Anesthesia looks pretty attractive at this point despite all its issues.

The attractiveness of pure OR anesthesia is that you get to do a bunch of stuff, sit in relatively one area all day, take some notes and get paid for it. That really isn't a terrible gig. People going into it just need to realize it's a service industry

I don't think anyone needs to "fear" going into anesthesiology. There are jobs EVERYWHERE. I get recruiting emails everyday and I get recruiting calls everyday. You just have to be ok practicing in not the most desirable place sometimes or maybe not for the pay some of your buddies are being paid. I also believe fellowships don't guarantee, but maybe improve job security, especially if you find yourself in academics. I agree with Blade in that the way things are moving, a good academic job is the most secure thing out there and if you can get one, take it. Show up. Do a good job and you'll collect a check until retirement. I personally feel private practice is way less secure. There's always a game to play even when you're doing a good job.