Rank Decision....I-Med or Gas?

[crockpot2005]

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Okay this goes out to the people who really were considering internal medicine or gas, or did i-med than gas. UTsouthwestern....etc.

My situation is strange, I couldn't decide between gas and i-med so I interviewed at programs for both, I'm a 4th yr US allopathic student in good standing etc. Anyway, the rank list deadline is coming soon, and I STILL can't decide! I applied to "middle/lower-tier" programs, who essentially comprise of FMGs/DO's and a few MDs. Several PDs told me they would rank me very highly if I chose them. Thus, I am not that concerned if I will "match", just what I will match into.

I just get frustrated....I feel like if I choose I-med, I will have a relatively stable career, but I will have a lot more hassle, work, and less pay, even with fellowship. Maybe 10-15yrs down the road I will regret it.

On the other hand if I choose gas, I know they are doing well now, but in 10-15 yrs what will happen? CRNAs might get more rights. And salaries might go down.

I like both fields, and it doesn't matter if I work with long-term care or short-term care of patients.

I really want to get the advice of the people who did a I-med residency...had an opportunity for a decent fellowship, and then decided to do gas. What are the reasons that you guys did this?

I guess my main question boils down to this....why sacrifice a stable, relatively well-paying fellowship job (like cards, pulm, nephro, GI, even rheum and endo to some degree) for gas, which while well-paying, does not have such a stable future?
And for all of you nay-sayers about fellowships....practically every US MD allopathic I-med resident I have talked to has said that getting any fellowship was possible, it just may take a matter of time (maybe a chief year or a year of research) to get one....even from mid-tier to lower-tier programs.

 

[Danger Man]

Perhaps, Grasshoppa, your answer is contained within the question...

Seriously, I do not want to spend a career in medicine, regardless of specialty, worrying about reimbursement issues or unforeseen turf battles. As if you have not heard the following before, go with your heart and enter the specialty that you feel best suits your personality, goals (both personal and professional) and income requirements.

 

[JackPB]

I feel like if I choose I-med, I will have a relatively stable career, but I will have a lot more hassle, work, and less pay, even with fellowship.

....

On the other hand if I choose gas, I know they are doing well now, but in 10-15 yrs what will happen? CRNAs might get more rights. And salaries might go down.

....

I guess my main question boils down to this....why sacrifice a stable, relatively well-paying fellowship job (like cards, pulm, nephro, GI, even rheum and endo to some degree) for gas, which while well-paying, does not have such a stable future?

There is no way in the world for anyone to know what will be more "stable," or which one will have "salaries go down." Anyone who makes predictions about the state of any specialty ten years from now is making a WAG - a Wild-Ass Guess.

For Pete's sake, don't make your decision based on the reasons you just mentioned! Pick your specialty based on what you want to do.

I do have several friends who finished a residency in another field like medicine or pedatrics before starting anesthesiology residency. For them, three years of another residency was preferable to 2+ years of whatever fellowship or practice they were considering.

As for myself, I did only a medicine internship year. I breathed a heartfelt sigh of relief when I walked out of that specialty into the anesthesiology department. Every time I walk into a medical floor or ICU, I still shudder. Now, as a CA-3, I find that the opportunities I am entertaining are better than those of my internal medicine colleagues. But that's just me. Pick your specialty based on what you want to do.

 

[MAC Man]

When in doubt look at resident/physician satisfaction. The anesthesiology residents and attendings are among the happiest in the hospital. They are happy in private practice. I've seen people leave IM for other fields, but I've not heard of anyone jumping out of anesthesiology. Besides you can always change your mind later, and it would be easy to switch to IM if you wanted to. You might have a tough time switching into a good gas program though.

Choose anesthesiology and thank me later.

Good luck in the match.

 

[MD Dreams]

I can only see four reasons why anyone would go into internal medicine.

1. They absolutely have their heart set on a fellowship and must do IM to get there

2. They love IM. Now, if I were to solve all the mysteries of this world, I would still never understand why anyone would or could love or even like medicine, but that's just my opinion

3. They have no choice. For example some FMG's who just want a foot in the door go this route

4. They are crazy

I'm doing my clerkship in an inner city hospital. Although this is probably the extreme, I can tell you that many of the residents are very unhappy. I really feel sad for some of them.

Having said this, I think there are aspects of anesthesia that some people, such as those geared more towards medicine, can't handle. Example, the stress, the procedures, the OR environment, etc. So it's important to make sure your personality matches.

Good luck nonetheless.

 

[threepeas]

do anesthesiology to pick up the great skills associated with airway management, critically ill patients, pain management, deep understanding of physiology, pharm, and anatomy and then do a CCM fellowship for one year. you will then be in a position to practice traditional medicine (H & P, DDx, Labs, Dx, Treatment plan, get you out of the OR) and also work in the OR on cool surgical cases and treat patients in a unique environment using the most dangerous but fun drugs and using great technology and equipment. To me anesthesiology and CCM produces one hell of physician. good luck though. dont worry about the career stuff as already mentioned, but with aging population CCM/anesthesia services will always be in demand and you wont be tied to a beeper or nagging patients.

 

[me454555]

You posted this in an anesthesiology forum, what kind of replies did you expect to get? Most people, myself included, are interested in anesthesia and can't see any other way to go. We will sit and tell you how good anesthesia is but thats just us, our opinions based on our values and our lives. You've got to make the decision for yourself.

Like another poster said, there is no way to predicit what will happen in the future and no way to guarantee your happiness in 10 years. Only thing you can do is live in the moment and figure out what you like best now and what you want to do in the future now. If that changes in the future, you can just change specialties. I know it would suck to spend more years in residency but even if you pick the residency that right for you in 5 years, it may not be right for you now and you may end up transfering into something else to truely be happy.

 

[jennyboo]

Can't plan your life that easily. I asked myself, "What do I want to learn and do NOW?" Anesthesia.

If in 10 or 15 years' time I get the itch to go and make a career change, well then it'll be a career change. If you don't like anesthesia enough to accept a mild degree of uncertainty and turf battle (and be happy anyway), then maybe ... well, you decide. 😉