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!

 

[DrDre']

This is a fairly common dilemma. I considered both as well. That said, they are SO different. Do 1 or 2 months of each and you should know which one. Beware if you are choosing either for lifestyle. I have MANY older friends who are burnt out ER docs that think the lifestyle sucks in its own way.


Do a search for more info.

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!

 

[TheSandMan]

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 actually found myself in the exact same situation, as did another person my year. did a sub-i in both and was still having a tough time.
what pushed me over towards anesthesia was when i saw an urgent consult on a neurology rotation of a young guy with cauda equina syndrome who ended up paraplegic. he had been seen in the ed twice before, both times had good workups by excellent ed physicians, but his initial symptoms really did not seem to warrant an MRI. if i was one of those ed physicians, even though i know i did everything right, it would still be hard to sleep at night for a while. In EM, you see such large and varied population, that you are going to miss some major things, no matter how good you are. Not really a flaw, but a reality about the field that i never thought about until my neuro rotation. on the flip side, you will be catching alot more serious diagnosis than you will be missing.

 

[Conflicted]

I dont know how much i can add but ill try.


I have an amazing amount of respect for EM. Never knowing whats coming in the door, flying by the seat of your pants, investigating symptoms like a crime scene, its all pretty cool. However, my friends in EM who are 10+ years all hate it and now call it a "job".

Here is what they told me:

- The liability is such that doing anything but admitting and testing is being a "cowboy". None of them feel they can really make decisions based on their clinical skill and must do testing for everything due to lawyers.

- They feel its the new family practice. None of them wanted to get into EM for family practice, they wanted emergency. As FPs have become overburdened there are more and more people coming to the ER for basic stuff. It seems to be very frustrating.

- Shift work sounds good but it can be a hard job. Unlike the RNs, the Docs (at least where ive worked) dont have sicktime and find it near impossible to get coverage for vacations. This may be a local phenom. im not sure.

- Hospitals dont care how dangerous a situation your in and neither does state or federal law. While there may well be 50 people in the waiting room and 5 ambos lined up at the door they can all keep coming while your on divert. What sucks is that the physician is ultimately responsible (read:liable) for anything that happens on hospital property per EMTALA. This is one of the biggest concerns i hear. There has been some news articles lately about EPs who have been charged with manslaughter for sending a middle aged fellow with "epigastric pain" home who subsequently died. As well as some suits where people died in the waiting room while the ER was slammed.

I thought this information might be useful to you. Its certainly something to think about anyway. The anesthesiologists here can tell you how those issues may compare to anesthesia.

 

[BlackScorpion]

Conflicted, you were also deciding between EM vs. Anesthesiology? I thought you were a crna

 

[salmonella]

I'll put in my 2 cents, solely based on what I've heard from people:

EM
-I think it's so sad that pretty much every hospital service hates them, at least where I work, for "weak admits", unreasonabe consults, practice CYA medicine, being "glorified triage nurse", having too low of threshold for intubating....
-In some ER, gen surg takes care of all the trauma cases, so they get all the adrenaline rush while you are doing an H and P on some drug addict who comes to ER for primary care
-You are most likely going to be a hospital employee. In EM it's harder to have private practice and be your own boss
-Occupational hazards: you will be at the frontline getting exposed to unknown diseases (TB, flu, hantavirus, sars, who knows); also watch out for the combative patients who love to punch and stab
-Night shifts may not sound that bad now, but it really sucks when you are 40s and 50s and still have to work nights
-As mentioned in earlier post, EM doesn't really have an area of expertise. It's basically general medicine/family practice in an acute setting
-The increasing liability and dropping reimbursement are concerning

 

[Conflicted]

No, I worked in an ER for many years as an RN and have many EP friends. I believe the issues I mentioned should ring true for anyone who has experience in the ER as attendings/staff. Its a very tough place to work for all staff.

Conflicted, you were also deciding between EM vs. Anesthesiology? I thought you were a crna

 

[burntcrispy]

If you decide to go into ER you had better like clinic. I just finished the ER month of my internship and I never thought I would look forward to going back to medicine wards but those patients wore me out. Like an above poster said, most traumas are run by the surgery folks. The clinic whiner patients will far outnumber the interesting true emergent cases.

The only thing ER and Anes have in common is shift work. Do some rotations, search the forums and you'll figure it out. You can't really pick something based on future projections of income potential because that stuff changes so much nobody knows whose going to be making bank in the future. Derm and cosmetic plastic surgery are the best bets as far as that goes. People will self-pay premium prices for thier vanity all day long.

 

[jennyboo]

They're very different. You have to try each rotation and see which one you like better. For most, it becomes fairly obvious after having tried both of them. Three hours into my EM rotation as a medical student, I knew what I was going to do -- NOT EM.

If you're interested in doing away electives for whatever field you chose but haven't decided yet, I'd suggest applying for aways in both fields early on (January or February, to get rotations at popular places) for the same months and cancelling your applications after you choose your field. The cost of applying for aways is minimal and this way you have both bases covered until you've finally decided.

 

[crockett]

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!

It depends what you want?

See patients practice real medicine or push some drugs put in the tube and read a magazine.

With tort reform sweeping over the county, you are not likely to get sued, unless you manage not to kill your patient but permanently disable them for at least 5 years. With the new lower liability limits most lawyers are not interested in representing the family of someone who died but the possibility of getting 1/3 to ½ of the money to cover a lifetime of expensive nursing home care is enough to interest a lawyer.

Pay difference, anesthesia pay and employment outlook is cyclical. pay is at the top of the cycle and headed down.

Anesthesia is being flooded with management companies whose mission is to steal every dime of their employee's money. The net effect is that good paying anesthesia jobs will become increasingly hard to find. If you chose anesthesia you will have to work for a nonworking absentee owner of the anesthesia contract, who everyone knows to be a crook. This crook has bribed the dishonest hospital administrators into give him the exclusive contract so if you want to practice anesthesia you will have no other choice but to work for a crook.

 

[markneil]

It depends what you want?

See patients practice real medicine or push some drugs put in the tube and read a magazine.

real medicine?

 

[Green912]

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 in the same boat about five months ago. I was a paramedic for ten years before going back to school and thought EM was for me. However two months of it cured me of that business. Unfortunitly you simply have to wait until you've had good exposure to both before you'll know what's your fit.

 

[fakin' the funk]

I will echo the comments of others and add a few of my own...

EM and anesthesiology, while both in the "procedures oriented, semi-lifestyle, gonna see people die" arena, are very very different.

IMO, EM is more 'mediciney' than anesthesiology - in some places you're these patients' primary care doc, and you will be relying on all your H & P skills all the time. Your patients are from every demographic. I really respect the pure knowledge base that EM docs have. It's internal medicine, just faster.

Anesthesiology is more procedure-oriented and far less general. The knowledge base is more focused and you certainly don't have to "deal" with patients as much.

I remember seeing a figure of something like 40% of a EM doc's time is spent charting? What is it in anesthesiology, like <2%?

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!

 

[markneil]

as far as pharmacology in a critical setting is concerned, i would think anesthesiologists would know much more than EP (due to more critical care exposure?), but on the other hand i guess it's a different kind of knowledge base; EP deal with snake bites, etc. i've seen a couple of anesthesiologists board-certified in both EM and anesthesia. i'm wondering if this is common.

 

[crockett]

as far as pharmacology in a critical setting is concerned, i would think anesthesiologists would know much more than EP (due to more critical care exposure?), but on the other hand i guess it's a different kind of knowledge base; EP deal with snake bites, etc. i've seen a couple of anesthesiologists board-certified in both EM and anesthesia. i'm wondering if this is common.

When I was an intern I worked with an ER attending who was an anesthesiologist who was tired of anesthesia and was practicing in the ER. I doubt he had any ER residency training.

One of the weaker residents a year a head of me only worked four months in anesthesia then started working ER.


With more and more ER residency trained physicians available I expect this will become less and less prevalent for non ER trained physicians to practice in the ER Not being ER trained myself I do not see why a competent primary care Doctor could not practice in the majority of the smaller hospital ER locations. Although saying that to an ER board eligible ER attending will not win you any points.

 

[DrDre']

My friend, who is a grandfathered in EM-boarded doc who trained in FP says that whenever they hire an FP, it takes them 3 years to figure out what they are doing in ER. Coincidentally, the length of an EM res.

Many types of docs can survive in an ED setting, but there is a reason for specialization in every field, esp in the busier and faster EDs.

When I was an intern I worked with an ER attending who was an anesthesiologist who was tired of anesthesia and was practicing in the ER. I doubt he had any ER residency training.

One of the weaker residents a year a head of me only worked four months in anesthesia then started working ER.


With more and more ER residency trained physicians available I expect this will become less and less prevalent for non ER trained physicians to practice in the ER Not being ER trained myself I do not see why a competent primary care Doctor could not practice in the majority of the smaller hospital ER locations. Although saying that to an ER board eligible ER attending will not win you any points.

 

[crockett]

My friend, who is a grandfathered in EM-boarded doc who trained in FP says that whenever they hire an FP, it takes them 3 years to figure out what they are doing in ER. Coincidentally, the length of an EM res.

Many types of docs can survive in an ED setting, but there is a reason for specialization in every field, esp in the busier and faster EDs.

I think it is criminal that they closed the practice tract in an ER and FP. Your buddy could have only done and internship then took the FP board which fails maybe 5% of those take it, then taken the ER board before they closed the practice tract. So now the EM Board is run mostly by Doctors who are not ER residency trained. They are keeping physicians with similar or more training than themselves taking the EM board exam and being EM board certified. Yet they are constantly churning out propaganda about how every ER needs to be staffed by ER boarded physicians.

 

[PiPhiDoc]

I did 3 years of EM training before changing to anethesiology. I'm now a private practice anesthesiologist at a large community hospital/level 2 trauma center.
Basically, my decision to change from EM stemmed from the fact that I found myself becoming increasing frustrated with
1. Iirritable consultants who resented having to come to the ED to take care of patients
2. irritable patients who were in the ER for complaints that should have been seen at a primary care office during daylight hours
and
3. An increasingly irritable ME from never seeing my family and friends (remember, kids, some practices in EM have a "buy in" of a certain number of nights/weekends/holidays), feeling like I RARELY made a diagnosis or made anyone feel better, and the serious emotional baggage that comes from walking into a room filled with complete strangers to tell them that their parent/spouse/kid were dead.

Not that I don't have frustrating days in my job, but I LOVE anesthesia - I find the fact that I get to make people feel better every day, that I get to work in a team environment, I get to do cool procedures and work with my hands, and I never, ever have to write outpatient prescriptions for narcotics incredibly satisfying. I did not regret changing one single day of my second residency, and during my first six months of private practice it has just gotten better and better.😀

 

[KayBee]

PiPhiDoc, hi.

You mention that there are a lot of procedures involving using your hands.Unfortunately i've always though that anesthesiology is just sticking a tube in someone's mouth and waiting for complications,(sorry, just my ignorance). Could you mention a few of these procedures please? Thx

 

[ambientbaby]

I am a third year student in the same dilemma as the original poster. Please keep the comments and advice flowing. Very interesting!!

 

[HalO'Thane]

Could you mention a few of these procedures please?

Single Lumen Intubations, Double Lumen Intubations, Fiberobtic Intubations, A-Lines, Central Lines, Swanz-Ganz Catheterizations, Epidurals, Spinals, Peripheral Nerve Blocks, Trans-Esophageal Echos.

There are very few non-surgical fields that come close to doing the amount of procedures that anesthesiologists do on a routine basis.

 

[PiPhiDoc]

Well said, HalO'thane.

I should also mention the procedures done in the ER that I DON'T miss:
fecal disimpaction, pelvic exams, rectal exams....

 

[Arch Guillotti]

PiPhiDoc, hi.

Unfortunately i've always though that anesthesiology is just sticking a tube in someone's mouth and waiting for complications,(sorry, just my ignorance).

yeah that's pretty ignorant

 

[Mman]

Unfortunately i've always though that anesthesiology is just sticking a tube in someone's mouth and waiting for complications

A well trained monkey could stick the tube in, but he couldn't evaluate the patient preoperatively to figure out what monitors were needed (a-line, CVP), what sort of iv access was needed, and what type of anesthetic plan was needed (tiva, inhalational, epidural or spinal, peripheral nerve block, etc.), nor would could it understand and treat the renal, cardiovascular, hepatic, pulmonary, cns, etc. physiology to keep the patient alive and well.

If I was found unconscious in the hallway of the hospital, I'd rather be found by an anesthesiologist walking by then anybody else as I doubt anybody else is as good at resuscitating a patient (though the EM folks would be a close 2nd).

 

[anesthesiaman]

I found this website helpful in deciding. It's funny, but actually based on a weighted analysis.

AM

 

[anesthesiaman]

apparently others have had this same problem too!

http://www.decisionking.com/example.asp