Residency competitive- Anes vs. ER ?

[fiddler1]

Any thoughts about which is more difficult to obtain in our ever changing world. Did any of you out there have a hard time choosing between the two?

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[chicamedica]

Any thoughts about which is more difficult to obtain in our ever changing world. Did any of you out there have a hard time choosing between the two?

I considered EM early in med school before I even knew what the practice of anesthesiology entailed, but as I rotated through both fields during MS3 I realized that EM, in practice, was like 90% primary care & triage, and only like 10% resuscitation/trauma, if even that much. During my EM rotation, even if a trauma did arrive, the EM residents stayed with the less acute patients while the surgical trauma team and the anesthesiology resident on call (and maybe ONE em attending) would rush over to the trauma. (and the latter was more interesting to me). The triaging of ED patients was also disappointing in a way because we'd start all this work-up, but we'd sometimes not even see the results or find out what pathology the patient ended up having. But otherwise, it's a fun specialty, and i suppose you can do rotations with paramedics and go out into the field to get to resuscitate very acute patients. imo, anesthesiology is much more complex in terms of thinking about physiological changes on a minute-to-minute or sec-to-sec basis, and that challenge was one of the things that swayed me towards anesthesiology and away from EM. However, in EM you get to diagnose a broader span of pathology, like orthopedic problems, dermatologic issues, etc (even though where i'm at, at least with the ortho, the ortho resident on call is the one who ends up taking care of the fractures, etc). Another difference between the two is that in EM, you juggle like 3-4 different patients at the same time (and in a rushed way at that), while in anesthesiology you focus 100% on each patient individually from start to finish. I personally prefer the latter dynamic, because in the ED i feel like I'm not devoting as much attention to each patient as i would have liked. even though i could function in a multitasking environment, i'd rather do something like FP or IM where i actually get to do some follow up and where I can pay more attention to each patient than in a place like the ED.

I mean, these are all aspects that were personal decision for me. It all depends on the dynamic that you prefer and that you thrive in, as well as your vision of what the practice of medicine is most meaningful to you. You should do some introspection and decide that for yourself. For example, some people thrive on chaos and find anesthesiology too mundane. There is some overlap in commonly encountered concepts, especially as far as resuscitation, and some pharmacology go. however, the two fields also deal with different knowledge bases, so whichever one is more interesting to you, should also factor into your desicion.

 

[lvspro]

I considered EM early in med school before I even knew what the practice of anesthesiology entailed, but as I rotated through both fields during MS3 I realized that EM, in practice, was like 90% primary care & triage, and only like 10% resuscitation/trauma, if even that much. During my EM rotation, even if a trauma did arrive, the EM residents stayed with the less acute patients while the surgical trauma team and the anesthesiology resident on call (and maybe ONE em attending) would rush over to the trauma. (and the latter was more interesting to me). The triaging of ED patients was also disappointing in a way because we'd start all this work-up, but we'd sometimes not even see the results or find out what pathology the patient ended up having. But otherwise, it's a fun specialty, and i suppose you can do rotations with paramedics and go out into the field to get to resuscitate very acute patients. imo, anesthesiology is much more complex in terms of thinking about physiological changes on a minute-to-minute or sec-to-sec basis, and that challenge was one of the things that swayed me towards anesthesiology and away from EM. However, in EM you get to diagnose a broader span of pathology, like orthopedic problems, dermatologic issues, etc (even though where i'm at, at least with the ortho, the ortho resident on call is the one who ends up taking care of the fractures, etc). Another difference between the two is that in EM, you juggle like 3-4 different patients at the same time (and in a rushed way at that), while in anesthesiology you focus 100% on each patient individually from start to finish. I personally prefer the latter dynamic, because in the ED i feel like I'm not devoting as much attention to each patient as i would have liked. even though i could function in a multitasking environment, i'd rather do something like FP or IM where i actually get to do some follow up and where I can pay more attention to each patient than in a place like the ED.

I mean, these are all aspects that were personal decision for me. It all depends on the dynamic that you prefer and that you thrive in, as well as your vision of what the practice of medicine is most meaningful to you. You should do some introspection and decide that for yourself. For example, some people thrive on chaos and find anesthesiology too mundane. There is some overlap in commonly encountered concepts, especially as far as resuscitation, and some pharmacology go. however, the two fields also deal with different knowledge bases, so whichever one is more interesting to you, should also factor into your desicion.

Post examined, poster reviewed, seen and agree, addendum below.

I liked both, and similairly to chica, my rotations through each heled me decide. If I could use one word to describe the deciding factor it would be...
acuity. ER didn't really have that many emergencies, whereas in anesthesia it was like things were always happening, and you're constantly responding to either changes in your pt, or calls from the floors/units/ER for pt's that are really crumping.

Other recommendations.
I have a problem with shift work, and found that even though the hours were reasonable in ER, I was always tired because my inernal clock was way out of whack. Even though we take call, it's better than shifting shifts 2x/wk, with no change until 12 year partner status IMHO.
Fellowship is something I'm considering, and ER fellowships weren't all that attractive, or even very lucrative, for that matter. Anesthesia opens up the possibility for you to develop a more procedural approach to pts in pain, and a more clinical approach with CC. I won't even mention the possibility of playing with TEE's, and bypass machines etc... Anyhow, I was interested in surgery b4 anesthesia, and may follow-up on this interest by doing a pain fellowship. On the other hand, if you really liked IM, and the whole "what is the laundry list differential for XXXXX" then CC is a reasonable fellowship for you.
Hope this helps

 

[DrDre']

The above posters did a great job responding to the 2nd question. On the issue of competitiveness, I believe they are very similar. I was very interested in ER until the end and a good friend is an EM RD. I think I have a good understanding of the issue.

Total number of slots are similar and the amt of good students going into both fields is similar. I don't think either is necessarily easier to get into, unless you are talking specific progs. If that is the case, apply to MLK in EM and USF for anesthesia.

EM does have some preference to exp as an EMT or paramedic- It is not required. I also believe that it helps in anes but is not as common or "stereotypical".
All the best,

 

[jetproppilot]

Any thoughts about which is more difficult to obtain in our ever changing world. Did any of you out there have a hard time choosing between the two?

I was a firefighter/paramedic before/during college (Cedar Hammock Fire Department, then Manatee County EMS). I went to med school to be an ER doctor/medical director of an EMS system.

I am testimony to how med school experiences influence you, no matter how strong your initial (pre-med-school) aspirations are.

U of Miami had no ER residency when I was there. And I loved my anesthesia rotation as a med student.

So here I am 14 years after graduating from med school.

With no regrets.

 

[Noyac]

I entered the match for ER. I did a anesthesia rotation b/c I thought it would be a good skill builder b/4 entering Emergency Medicine, you know airways and lines. I was a ER tech in undergrad and part time in med school. It just goes to show you how little you know as a premed and med student. I thought ER was so kool, acute care and trauma. Well after 2 weeks into my anesth rotation I was so depressed. I knew I had signed up for the match in the wrong specialty. All the anesth attendings were happy and very similiar to myself. All the ER attendings were burnt out and depressed with an awful out look on medicine and society in general. Now this is just my impression but it had a huge impact on me. I struggled with the decision to pull out of the match and try to scramble for a anesth position. It wasn't so risky since I had surgery, IM and a transitional year all available to me if things didn't pan out. I pulled out and scrambled for anesth. I ended up at Univ. of New Mexico and all is history. Best choice I ever made. At least for me that is.

 

[jetproppilot]

. Best choice I ever made. At least for me that is.

Me too, Noy.

I moonlighted my a ss off in residency at a pretty busy ER.

I LOVED it for the first year.

I distinctly remember a night shift during my last (third) year moonlighting at this hospital, writing a note on a patient on a particulary "trolly"....or would it be troll-ly night, thinking What The Fu k Am I Doing Here?

Not knocking ER as I think its a good choice as well. Like Noy said, I'm giving you my perspective for me. Not generalizing.

And like I've prosed in previous posts, as a fourth year med student picking a specialty....its extremely hard to look at the global picture when you're chest-deep in excitement, enjoying all the new stuff you are exposed to. Kinda like the honeymoon period of a marriage.

Just try and continue to say to yourself..."Will I be happy doing (you fill in the blank here with whatever specialty) in ten years, when my priorities have changed?"

 

[DrDre']

Like my G, Jet
I was a paramedic for 4 years. Although I loved that job, you get exposed to the negatives of EM.

Every EM doc told me to NOT go into medicine or to NOT go into EM.

I have MANY ER doc friends who have been doing it for 20-30 yrs. They all hate their jobs.

Working nights and weekends is worse than being on call like in anes.


Pts are generally glad to see you in anes. In EM, they are there to lie to you, get a meal, get narcs, get attn, etc.

Rarely is there an emergency etc.

If you work in academia in EM, you will never do anything fun- all the other services will do the good stuff.

If you go EM, you have to do community residency and practice to have an interesting job, IMOH..

 

[nimbus]

Both offer decent pay+hours, but if you like one I doubt you could tolerate the other.


ER-->chaos, juggling multiple patients, dealing with social issues, trying to get consultants to come in.

Anes-->controlled focused orderly environment, no guns in the OR, one patient at a time (if you practice MD only).

I know several ER docs who switched to anesthesia, but not the other way around. That said, my best friend is an ER doc who can't stop talking about his work whenever we get together.

 

[DreamMachine]

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[fiddler1]

Thanks for sharing your experiences and toils that led to anes. I'm pretty sure anes is the field for me, it's just cool to hear that other people went through similar brain work prior to final decision.
Now I have to kill step II (in 4 wks) to compensate for my crappy step I.

 

[Apollyon]

I know several ER docs who switched to anesthesia, but not the other way around. That said, my best friend is an ER doc who can't stop talking about his work whenever we get together.

There's one guy in the program I graduated from (EM) that did his prelim and CA-1 year, and HATED the OR, so he switched out.