Unless you'll be going into CCM, you won't really have those same opportunities ever again to make that patient-physician connection. If that's important to you, I would say general anesthesiology is not for you. I get that to some extent in the cardiac ORs if the patients get multiple procedures, but it's not all that common under those circumstances either. Most of your patient interactions will be consenting them for anesthesia +/- procedures and answering their questions. I find some value in being able to walk into a room and make people laugh, smile, or feel at ease within the first few minutes, but it doesn't go beyond that for the majority of your career, IMO.
We "do" a lot in anesthesia, but during residency, you're "doing" those things for about 60-70 hours a week. Compare those hours to psych, plus the frequent in-house call (depending on the residency), plus dealing with all different types of personalities in the OR as well as outside of it, plus the acuity of the cases and the necessity for you to not only "do" but be able to think quickly and put those thoughts to action without necessarily all of the information at hand... this type of pace and energy is not usually required in psychiatry, and it's hard to appreciate until you become a resident.
Some jobs have good vacation (with concomitant pay decrease), but a lot of academic jobs have limited vacation/CME type stuff as well with lower pay as well. Overall, I would say the market is okay. All of the graduates I know in my class and the couple below us have had no issues (myself included).
We do save lives undoubtedly, as most physicians do in some way or another. I would think long and hard about a career in anesthesiology. It's definitely not for everybody.
I guess one thing that I'm struggling with is how much satisfaction I will get from the day-to-day of anesthesia. While I loved those few meaningful patient-physician connections I got in med school, I also really loved attempting and finally getting an US guided IV. It felt satisfying to get that IV in when the nurse couldn't. I felt like I had a real skillset that others couldn't do, whereas in psych everyone thinks they are doing your job better (nurses, psychologists, pharmacists). I get that some CRNAs think this way too though.
Also I am struggling with the 'do what you love' versus the 'be smart' mentality. On paper, psych is great in terms of lifestyle, potential to make money if that's what I really want, and also really save lives (as you alluded to, psychs also save lives by preventing suicides and homicides by keeping people in when others would let them loose).
In short, I miss the adrenaline of EM and surgery; and Anes seems to have that, a skillset, and cerebral aspect of problem-solving and pharmacology. But like psych, it also sounds good on paper. I've heard differing opinions on the phsyician-patient relationship, and that its kind of what you make of it -- if you want to be in-and-out you can do that, but if you want to make a meaningful connection it's also possible. Lastly so far in inpatient psych at least, the meaningful connections aren't really there as the patients are often psychotic or intoxicated and we are just stabilizing them.
Are you early, mid, or late career, would you do it again, and do you recommend it to current med students?
You are a month in. Stick it out. I often regret not sticking to my original plan of doing psych.
If you really feel that you must "work with your hands" to be happy, I recommend knitting, piano, card games, video games, basketball, or fishing. I am sure the list is endless.
Once you are established and are helping psych patients and see their turn around there will be plenty who thank you and remember you because you establish long term relationships. You don't have to work in addiction. I absolutely hated working with addicts.
As anesthesiologists, no one remembers us. We are constantly being rushed to "move the meat". There are threads here on how to "improve turnover times". You are at the beck and call of the surgeon. You will most likely have to work nights and weekends at least initially and of course throughout residency.
I will tell you right now the need for psychiatry is abundant. I mean have you seen what's going on with the world? You think people's mental health is the same as it was six months ago? Psychiatrists are needed now more than ever and demand is going through the roof. Pay is going up and wait times are insane. And I as a locus make the same as a psychiatry locums just FYI. And my job involves life and death more often than yours ever will (ICU work as well).
Just please don't be that psychiatrist who does "cash only" because most people who are really really struggling with serious psych issues can't afford those fees. I find psychiatrists who only treat the patients who can afford $200-300 an hour to be doing the psych community a disservice. Maybe do some kind of sliding scale or weekend work where you help out poorer inpatients or something or bill out of network if you feel the insurance company is screwing you or something.
Stick it out. You are only a month in. The freedom to have your own practice and make your own rules especially the way healthcare is going in this country is priceless.
I hear you, and I realize it's only been a month, but if I'm going to make a change, I need to hustle and start getting experience by shadowing, LORs, and talking to my PD since application season is right around the corner. Intellectually, I totally agree psych is great. It's just that, so far, psych is not what I imagined being a physician would be. There's so little medicine; my attendings consult for essentially normal ECGs with like an axis deviation; subclinical hypothyroidism; simple iron deficiency anemia. Our ITE exam is mostly Jungian personality types, ethics, Maslow's hierarchy, attachment styles. I've heard the boards are different and similar to Neuro boards, but so far it's just not stimulating to me. Unfortunately that higher calling to be on the front lines of psych since everyone is suffering just doesn't move me at the moment, because most of the people suffering need lifestyle modification (better diet, exercise, sunlight, working on themselves with journaling, reading, making new relationships) -- not pharmacological intervention. I know it sounds petty, but I wanted to be doing the 'doctor thing' -- wearing my white coat and greeting patients, in the hospital looking at imaging and hearing the monitors beeping and showing waveforms...not trying to obtain a history from a homeless meth addict at 2 am, get nearly assaulted by a schizophrenic homicidal pt telling me to get out and go fight the war against whitey, or figure out whether a psychotic patient is actually suicidal or just needs a place to stay for a couple days (its almost always the latter).
I totally agree about the being my own boss, and the way healthcare is going, I see that psych (and derm, etc) is the last bastion of freedom in medicine, but, dang, I have to like it first and foremost, right?
Ill give a different perspective than the previous two posts..
Anesthesiology does in fact have the things you are looking for.
There is often a very meaningful patient-physician connection. Patients want to get to know the person who will be taking such important care of you during such a critical time in your life, even if you dont follow them, you certainly "own" them while they are unconscious at your hands for hours during surgery. Anesthesiologists should be looking to establish that connection in their brief time with patients, but some hide behind a drab personality and act more as a technician, which is not comforting to patients.... the guy whos taking care of me while im asleep, yeah he seems like a good trustworthy guy so i feel better about this whole procedure
Pay is good, most jobs start at 350-400k.
Vacation is good, most jobs start at 6-8 weeks.
Lifestyle is not bad but its definitely not psych hours. You will be up late in the OR, you will be on call overnight (not just answering pages from home or rounding in the mornings and then going home) You will see blood and guts. You will make mistakes and people will die at your hands, youd be going from the least intense field to the most (arguably)
What to do?
You should know that many new docs feel how you do about a new field. Psych will most likely grow on you. I would give it until Thanksgiving.
If by thanksgiving you are still wondering about anesthesia, start making plans to get into a PGY1 prelim program the next year.
Then at the end of the year you can decide to go to that prelim program or stick with psych.
Then when you are in the prelim program you need to open your mind to what you want to do so this doesnt happen again.
Decide between anesthesia and EM and never look back..
Thanks for this rather practical advice, and I appreciate your assessment of anesthesia. Question, do you know if I decided to pursue Anes, whether I would have to apply for TY and Anes programs, and rank them both separately? Meaning, would I have to give up my psych spot and potentially match into a TY year but not any Anes programs? That would be the worst of all worlds. I really enjoyed EM, but I've decided that I won't take the hit to my circadian rhythms. I'm sure Anes has its hits too, but not the cyclical flipping that is so detrimental to health and happiness that EM has.
Also it sounds like you like it. Do you still like it, are you early, mid, or late career, and would you personally recommend it to med students contemplating it given the career outlook right now?