So... I'm confused: Anesthesia vs. EM

[jeffmako]

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Hey everyone,

I'm in a bit of a conundrum. I'm trying to decide between applying to Anesthesia and EM next year and am wondering if anyone else has found themselves in the same position. Can you tell me what pushed you one way versus the other?

Thanks!

 

[The White Coat Investor]

Hey everyone,

I'm in a bit of a conundrum. I'm trying to decide between applying to Anesthesia and EM next year and am wondering if anyone else has found themselves in the same position. Can you tell me what pushed you one way versus the other?

Thanks!

This is easy. Would you rather talk to a patient or a surgeon?

 

[deleted77919]

This is easy. Go anesthesia. Nothing interesting about the field of EM, no reason to apply to any EM residencies. Nothing to see here. Move along.

 

[nitafurahi]

I find this to be a strange dilemma. I have noticed at both the places I've interviewed so far that the program was complaining about either losing residents to anesthesia, or delighted because the anesthesia program had lost residents to them.

The resident I was talking about this with last said "It makes sense, because I think they're similar mindsets"... I said "I guess in some ways, but the jobs are SO different!" and that's still how I feel. I guess we may have in common that we don't like rounding and wards medicine, and I suppose liking to do procedures as well. But EM seems so active and fun, and anesthesia seems so immobile and boring.... then again, I'm biased. 🙂

and as Desperado pointed out, in EM you get to talk to patients! I love talking to patients. But my good friends who are going into anesthesia hate dealing with patients and get great joy out of putting them to sleep. Some people think that EM is like that a bit because you don't have to be nice to the patients since you're not their primary care doctor and it doesn't affect your business. But anyone who has the attitude "great, I don't have to be nice to the patient" is someone I don't want to be my doctor, personally. Suppose that is a matter of opinion too...

 

[wadoc]

Hey everyone,

I'm in a bit of a conundrum. I'm trying to decide between applying to Anesthesia and EM next year and am wondering if anyone else has found themselves in the same position. Can you tell me what pushed you one way versus the other?

Thanks!

For EM vs anesthesia, consider the huge differences between the environments of the ED and OR. You'll never be in the OR as and EP. Does time fly for you in the OR, or are you luke-warm on it, looking at the clock, wishing something exciting would happen, and are glad to be out of there when it's over with? For a gas-passer, the OR is pretty chill for the most part: you read your paper, look at the vital signs and record them every few minutes, and the surgeons may or may not talk to you (although they have to be more collegial in the private world). Life is 90% boredom, 10% panic.

The ED environment is like clinic only things are happening, and it's important that you DO something about it--NOW. You don't have to be an adrenaline junkie to like it, but if you love it, you might have a problem. "Hi, my name is ____ and I'm an adrenaline junkie..." The students going into EM and EPs I know like the stories--wacky, exciting, tragic

Also, as in any specialty choice, think about the con's of each and which one you'll stomach easier.

The students I know going into anesthesia loved the procedures, loved the environment, and would rather take boring/uneventful days in the OR to people complaining about waits and dealing with drunks/addicts. They're ok with limited verbal interaction with patients--patients won't complain to you, but you may also miss out on gratifying discussions with them. Patients may see their surgeon as their primary doctor and their anesthesiologist as secondary, although they don't know their EP from Adam unless they're a frequent flyer.

 

[SLPI]

any other EM docs have reasons why they chose EM over Anesthesiology

also any comment on how night shift work is 10+ years in.

 

[Apollyon]

With anesthesia and EM folks, there's two camps - those that see them as similar, and those that see them as dissimilar.

I see them as more alike than not, for several reasons. Set shifts, dealing with colleagues that may or may not respect you, critical care/dealing with people critically ill, and procedures - all day, all the time.

For the mounds and mounds of uninteresting patients we see, those patients parallel the repetitive boring surgeries that the gas guys sit through.

Likewise, we are both specialists in resuscitation (including the airway).

Differences include fewer surprises in anesthesia. Most of our patients haven't been NPO for 12 hours. The knowledge base is different (mostly from the need to know inhaled anesthetics for gas).

As for night shift work, although I'm only 36, I've been working days and nights for my entire career (including my EMS days), and I'm doing all right so far. However, I may not be the best barometer.

 

[Roadie9]

I guess I will join the "dissimilar camp".

Anesthesia is about knowing what you will doing and where you will be 95% of your day. Some people love that. No surprises, no phone calls. And, most importantly, you're the specialist; no one tells you what to do.

EM is exciting, surprising. You don't know what will come rolling through the door in 14 seconds. And you're a generalist, which means a good part of your day will be spent making other docs work. Some people don't like that.

I really can't see any similarities other than both fields are really hot right now.

Closest to ER.... Maybe rural FP?

Closest to Anesthesia.... I really don't know.

 

[Apollyon]

Set shifts, dealing with colleagues that may or may not respect you, critical care/dealing with people critically ill, and procedures - all day, all the time.

Likewise, we are both specialists in resuscitation (including the airway).

I really can't see any similarities other than both fields are really hot right now.

I guess I wasn't clear enough.

 

[USCDiver]

I guess I wasn't clear enough.

Dude, you're the one who said there were two camps and this other dude chose the 'dissimilar camp'.

 

[Apollyon]

Dude, you're the one who said there were two camps and this other dude chose the 'dissimilar camp'.

Hmm...while I did say that, I think that I showed how I disagree. I mean, there are things I disagree with, although I can see the other point of view.

Would you disagree that EM and anesthesia are indeed specialists in resuscitation (including airway)?

 

[Roadie9]

OK, I buy the airway similarity🙂 And both can do CCM, that's true.

But when you look at what, say, the 45-year old attendings in each specialty do, it's very dissimilar.

EPs juggle several sick or whiny (or both) patients, while calling specialists with questions, doing procedures, discharging versus admitting, and so on.

Gas guys tend to sit down a lot, reading travel magazines, while keeping patients asleep.

I could see why some people would be drawn to anesthesia for the relaxed lifestyle. Personally, it's probably one of the few specialties I could not do (but to each his/her own).

 

[Apollyon]

Oh, I hear you - I mean, if they were the same, they would be the same, you know?

I just feel that there's more kinship in gas to EM than most other specialties (who may have a part, like Ob or IM or surgery, but are grossly missing that other part).

 

[LanceArmstrong]

I was considering between anesthesia and EM as well, because I am very interested in pain management. Then, I did an anesthesia rotation where I almost died from boredom, despite my best efforts to make it interesting and make it as hands on as possible. I realized I dont want to spend several years sitting in an OR bored out of my mind and talking to the bad surgeons - so this year I'm applying to EM even though anesthesia would have been easier to get for me as an IMG. -Peace.

 

[MightyShorty]

I debated between gas and EM for good part of my 3rd year. I came from the perspective that both have a mix of medicine/procedures, both are shift work so easy to combine clinical work with other duties like administration, research, etc. Obviously, I know the work itself is drastically different - see all the comments above. What pushed me over to EM? More fun dealing with patients that are awake (although sometimes I do wish they aren't), fast-pace (or at least I set the pace of dispo rather than surgeons dictating how long I have to stay), and work with other EM docs rather than being a lone anesthesiologist the OR - i.e. no surgeons yelling at me when the patients twitched on incisions. Also, my severe ADD won't allow me to focus on one single patient for more than 30 minutes. Once the tube and lines are in, I'm ready to leave. 😀 Not too crazy about getting into work at 6:30 am everyday either.

In terms of whether anesthesiology is more relax or not, I guess it depends on the practice. A lot of private practices I know have MDs running 4-6 rooms, supervising the CRNA's and they are beeeezy just running between rooms to make sure every patient is okay. So it's true a resident only take care of one patient at a time but once you're out, it depends on the practice. Also, it can get really stressful with difficult intubations - just think of all the fat people with no neck in this country!

 

[BKN]

Oh, I hear you - I mean, if they were the same, they would be the same, you know?

I just feel that there's more kinship in gas to EM than most other specialties (who may have a part, like Ob or IM or surgery, but are grossly missing that other part).

I'm in the dissimilar and "Get away from me, I have a cross and garlic" camp.

Seriously, I generally tell students who ask me this question that if you'd even consider Gas, you don't belong in EM. The jobs, required knowledge base and personalities are so different that I can't see any kinship.

Nothing against anesthesiologists, they're nice people. We aren't.😉

 

[kungfufishing]

Im nice people. Just ask me.

Gas and EM are pretty different. I suppose there is a small section of shared knowledge, but you could say that about EM and many other specialties. Pick one.

 

[LanceArmstrong]

if you'd even consider Gas, you don't belong in EM.)

Sounds pretty harsh ... kinda like you're either with me or against me

 

[BKN]

Sounds pretty harsh ... kinda like you're either with me or against me

Not trying to be harsh. I'm just suggesting that the personalities and interests are so different between the prototypes of each specialty. When I've heard somebody saying one or the other, and I've delved into their reasons, it always been life style. EM isn't a life style specialty.

 

[EMDrMoe]

Hey everyone,

I'm in a bit of a conundrum. I'm trying to decide between applying to Anesthesia and EM next year and am wondering if anyone else has found themselves in the same position. Can you tell me what pushed you one way versus the other?

Thanks!

I was EM all the way, and VERY glad I did my anaesthesia rotation late 4th year - that way my decision was made already. It definitely made me think twice though. Weird, I thought.

More than making lists of pros & cons, like much else in my life I went on what feels right. In surgery, I did NOT like the OR. But in anaesthesiology, I did. Different angle, I guess. I'd already done a lot in EM and can be having a bad day and have it get good when I go to the ED, so here I am...I guess in short, I didn't think too much (again, weird for me!).

 

[deleted87716]

I generally tell students who ask me this question that if you'd even consider Gas, you don't belong in EM. The jobs, required knowledge base and personalities are so different that I can't see any kinship.

EM isn't a life style specialty.

I was wondering when somebody was going to say that. 😉👍

 

[LanceArmstrong]

I was wondering when somebody was going to say that. 😉👍

RE: lifestyle specialties everyone knows there "a ROAD to happiness"

(rads, ophtho, anes, derm)

I would also say that path is kinda of a lifestyle specialty now for people who like that type of stuff and psych has a pretty lax schedule generally. Then of course FM is usually easy but ofcourse unpopular for other reasons...

 

[deleted87716]

RE: lifestyle specialties everyone knows there "a ROAD to happiness"

(rads, ophtho, anes, derm)

More like "ROAD apples" unless you really dig them. They all sound like a giant snooze-fest, to me. They couldn't pay me enough.

FM is usually easy but of course unpopular for other reasons...

Anyone who thinks FM is easy isn't doing it right. Same goes for EM, as far as I'm concerned. 😉

 

[LanceArmstrong]

Anyone who thinks FM is easy isn't doing it right. Same goes for EM, as far as I'm concerned. 😉

Please Explain -
I'm guessing that you mean that they just treat and release patients instead of counseling, advising, setting up multiple referals, etc. ?

 

[deleted87716]

Please Explain -
I'm guessing that you mean that they just treat and release patients instead of counseling, advising, setting up multiple referals, etc. ?

I'm assuming by "they" you mean FM docs who practice the "easy way?"

I don't know what the heck they do...not much, other than being a "doctor feel-good" and a referral/work excuse vending machine. Antibiotics for every URI, specialty referrals for everything possible (I know FPs who send all of their diabetics to endocrinologists, for example), no office procedures, and as much acute care as they can. I've received charts from some of these guys when their patients transfer to me, and it's truly mind-blowing...half-assed attempts to control BPs or lipids, spotty followup, tons of comorbidities ignored, etc. Some of the patients get quite a shock when I'm suddenly all over them like white on rice, when their last doctor was like, "You're doing fine...see me in a year." 😉

 

[amar_ml]

Hi People,
I'm 28yrs & I'm completing my MD in Anaesthesiology this march from Madras Medical College, India. I plan to do my residency in the same field in the US. can anybody advice me on the possibilities?

 

[deleted109597]

Hi People,
I'm 28yrs & I'm completing my MD in Anaesthesiology this march from Madras Medical College, India. I plan to do my residency in the same field in the US. can anybody advice me on the possibilities?

No.

 

[bartleby]

There are two similarities I can come up with between EM & Gas:

1. If you do your job right, you hopefully only see the patient once (and we LIKE it that way)

2. We both like intubating people

Differences (in addition to all the stuff posted above):

1. Anesthesiologists have to (or at least pretend to) laugh at surgeons' jokes. We don't.

2. Totally different pace of work. If you don't like having shorter work periods (but no call) and being BUSY while you're in the hospital, don't go into EM

3. If a significant part of the satisfaction you get from medicine is from diagnosing and curing disease, don't go into anesthesia.

 

[markneil]

why not do both? there are many board certified anesthesiologists + ER physicians. double trouble.

 

[odoreater]

why not do both? there are many board certified anesthesiologists + ER physicians. double trouble.

Many eh???

 

[canjosh]

why not do both? there are many board certified anesthesiologists + ER physicians. double trouble.

Really...

 

[markneil]

Many eh???

im just m1 but before i applied to med school i worked at several hospitals (county, a regional, community and one university)and i encountered about 4 anesthesiologists that were also board certified in ER. it wasn't blatantly obvious and i was kinda surprised that they did both; i wouldn't have known unless i asked them. all im saying is that they exist.

 

[markneil]

oh..but i've never met any ER docs that were anesthesiologists. doesn't mean they don't exist, though. hehe.

 

[Sessamoid]

What they have in common: similar lifestyles

What they have NOT in common: pretty much everything else.

 

[deuist]

oh..but i've never met any ER docs that were anesthesiologists. doesn't mean they don't exist, though. hehe.

I know of one physician who started in gas and then later switched to EM. As far I as know, he no longer practices anesthesiology. I think the reason for the switch from EM-->anes is burn out and the hope for a slower pace. They probably weren't very good with patients, either.

 

[deleted109597]

Emergency Medicine used to be a division of Anesthesia at Gainesville way back when. But that was because Anesthesia ran Critical Care.

 

[beaudubbs]

That's funny. I didn't realize that this thread existed as I posted a response in the trauma centers and pain clinics for money debate/thread started by someone considering EM vs Anes. I guess I fall into the dissimilar camp too. Other than "lifestyle" and some content overlap, I really can't appreciate much in common between the two. I do not think of anesthesiologists as resusitation specialists. To me (of admittedly limited contact with anesthesia because it bores me too much) they are airway specialists with education of resusitation in the OR during a very limited set of circumstances. I see that they are trained in resusitation mainly for the possibility of complications in surgery. This is distinctly different from the "come one come all" attitude in the ED, where resusitation is the norm and involves many patients too sick for surgery anyway. Furthermore, anestheisa as a route to critical care seems to be an "added bonus" to most of the individuals I know who are interested in the field. They usually envision most of their time in an OR putting people to sleep, or in pain clinic. Now, if you like physiology, needling and/or tubing patients who you just zonked, and can put up with barked commands from surgeons who want 0.5 more degrees of bed tilt for the rest of your life (because you will be making bank and traveling to exotic places in all your free time), anesthesia is the yellow brick road to your happiness. My main point here is just that I could personally never consider anesthesia despite people always saying they were somehow so similar because I saw very different skill sets involved. What makes a great anesth is different from an EP. Okay, I'm done babbling.👍