Specialty Interest

[jstargirl17]

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Hello,

I’m currently a third year student at the end of my clinical rotations

I haven’t decided on a final specialty yet

I’m really passionate about women’s health and really enjoyed my OB/GYN rotation

So my top two choices are OB/GYN and IM (with women’s health track). What I’m hesitant with about OB/GYN is the GYN surg aspect of it…

People have also mentioned OB anesthesia..

I was wondering what made you want to go into anesthesia?

I’m still deciding what I want to do… I’m between OB/GYN and IM with a women’s health track

I love the patient population and I’ve felt so connected to most of the patients on my OB/GYN rotation. I’m just wondering if I have what it takes to get through surgery (I like C-sections but the hysterectomies just are sooo long…)

With anesthesia I shadowed a couple of days with an anesthesiologist at MVH. Outside of getting to intubate the patient and put in fentanyl, I didn’t really do a whole lot… I was just sitting in the OR with the CRNA since the attending was just monitoring multiple ORs… so maybe I’m missing something in what they do? I just ended up sitting there just watching in the OR talking to the CRNA or not doing much (occasionally checking my phone)

I just want to know more since multiple people have told me that anesthesia is a good field and something to consider … so I just want to make sure I have all of the facts/info

 

[NicholasPavona]

 

[aneftp]

Hello,

I’m currently a third year student at the end of my clinical rotations

I haven’t decided on a final specialty yet

I’m really passionate about women’s health and really enjoyed my OB/GYN rotation

So my top two choices are OB/GYN and IM (with women’s health track). What I’m hesitant with about OB/GYN is the GYN surg aspect of it…

People have also mentioned OB anesthesia..

I was wondering what made you want to go into anesthesia?

I’m still deciding what I want to do… I’m between OB/GYN and IM with a women’s health track

I love the patient population and I’ve felt so connected to most of the patients on my OB/GYN rotation. I’m just wondering if I have what it takes to get through surgery (I like C-sections but the hysterectomies just are sooo long…)

With anesthesia I shadowed a couple of days with an anesthesiologist at MVH. Outside of getting to intubate the patient and put in fentanyl, I didn’t really do a whole lot… I was just sitting in the OR with the CRNA since the attending was just monitoring multiple ORs… so maybe I’m missing something in what they do? I just ended up sitting there just watching in the OR talking to the CRNA or not doing much (occasionally checking my phone)

I just want to know more since multiple people have told me that anesthesia is a good field and something to consider … so I just want to make sure I have all of the facts/info

I definitely would not recommend anesthesia for any med students the next 5 years. We need to deplete the supply.

Definitely if obgyn is ur passion. I’d suggest you go into it. One of my sisters who quit ob gyn after 4 years of attending due to 72 hr weekend ob calls. Said the hot newer fellowship is to go into subspecialty, geriatric gynecology which focuses on the unique gynecological needs of older women, integrating geriatric principles with gynecological expertise

 

[Dr. Anonymouss]

Just go into OB-GYN or do family medicine and then open a woman's health clinic. Not sure how you ended up over here in anesthesia.

 

[pgg]

OB anesthesia is one of the least tolerable slices of anesthesia. In rare instances, the pain can be tempered by lucrative practice arrangements, but all the money in the world can only do so much to dull the pain of a bull**** 6:55 AM shift change c-section, or the 2 AM flurry of epidurals that come from some sadistic OB/GYN's decision to start inductions in the evening.

And I say that as an anesthesiologist who kind of enjoys OB (during daylight hours).

 

[sevo00]

Don’t do anesthesia

 

[LivetoTell]

Not sure why anyone would choose a profession where you have to be up regularly at all times of a 24 hour period! It will slowly kill you both mentally and physically.

 

[PpfSuxTube]

If you're having any kind of impact, outside of the ordinary, on an OB patient as an anesthesiologist something has gone very wrong. Most often it's slap the epidural, spinal or tube in and move on...

The most common "complex" parturients are cardiac cripples but thats very rare and it's still just a titrated epidural and pray...

The most common emergencies are overnight where there's no time to do anything other than tube asasp.

The most common interaction you will have is just plain old epidurals where the expectation is it will work perfectly pain free inside 15 mins.

So if you want women's health don't do anesthesia for that

 

[GassYous]

OB anesthesia is one of the least tolerable slices of anesthesia. In rare instances, the pain can be tempered by lucrative practice arrangements, but all the money in the world can only do so much to dull the pain of a bull**** 6:55 AM shift change c-section, or the 2 AM flurry of epidurals that come from some sadistic OB/GYN's decision to start inductions in the evening.

And I say that as an anesthesiologist who kind of enjoys OB (during daylight hours).

Yep my wifes ob wanted us to come in the evening and we were like nope we will come in the morning. Delivered before dinnertime instead of at 5 am

 

[2Fast2Des]

Yea I mean this med student got us all figured out, pretty much what I do. Intubate, fent, snooze, tell the nurse to wake me up at the end.

This is the problem with our specialty, that when done right looks easy. The routine isn't all that exciting except for the 1 percent of times when shtf. I get the OP perspective, but clearly not a very educational experience they are having

 

[kidthor]

So my top two choices are OB/GYN and IM (with women’s health track). What I’m hesitant with about OB/GYN is the GYN surg aspect of it

Then do OB/Gyn and don't do gyn surgery? You can always be an OB hospitalist and just do OB. Most OB/Gyns end up transitioning into gyn surgery because the OB part becomes unmanageable.

 

[PpfSuxTube]

Yea I mean this med student got us all figured out, pretty much what I do. Intubate, fent, snooze, tell the nurse to wake me up at the end.

This is the problem with our specialty, that when done right looks easy. The routine isn't all that exciting except for the 1 percent of times when shtf. I get the OP perspective, but clearly not a very educational experience they are having

I mean its kind of a reverse compliment...

Its also kinda funny to see the chaos when other professions attempt to replicate what we do...

I attended many peri arrest situations on our cardiac ward and post op wards. A variety of ensemble cast show up depending on the time of day, patient, staffing etc... emerg, np's, cardiology, rt, surgeons, icu docs that are IM trained and can't even put an IV without the uss or glidescope...

Occasionally a stat surgical case will enter emerg or make it to the OR while one of us is scrambling to get relieved from some other case to attend... the big dog surgeon will often be absolutely lost. Just a chihuahua now. Theatre's nurses lost, screaming and running around like headless chickens. No one doing anything useful until we arrive. Then calm...


Stat sections. No matter how many times we do it, literally no one has a clue over and over again.


Its so simple but no one is capable of taking charge and directing. There's never an IV hanging, no one grabbed the glidescope, no monitors on, OB aren't scrubbing... but 10 people are milling around consoling the dad

 

[aneftp]

OB anesthesia is one of the least tolerable slices of anesthesia. In rare instances, the pain can be tempered by lucrative practice arrangements, but all the money in the world can only do so much to dull the pain of a bull**** 6:55 AM shift change c-section, or the 2 AM flurry of epidurals that come from some sadistic OB/GYN's decision to start inductions in the evening.

And I say that as an anesthesiologist who kind of enjoys OB (during daylight hours).

I’ve had a rash of 1-4am epidurals the last 3 months. Not even a busy hospital ob wise. But more OB docs hired. Doing 7 ob calls in a 2 weeks period is rough.

not sure when is a good time to start ob inductions. Our starts their induction between 10-12pm which may be bad. Cause that leads to 8p-12am epidurals as well.

I guess the optima time for indication is 6am. But many patients don’t want to wake up at 5am to head to hospital.

 

[Maz777]

Most of us actively avoid doing OB anesthesia. It's the worst possible practice in anesthesia. You are stuck with poorly trained proceduralists who seemingly enjoy doing most of their work in the middle of the night. And you are held captive to the whims of OB nurses who demand labor epidurals at the most inconvenient of times.

 

[PpfSuxTube]

who seemingly enjoy doing most of their work in the middle of the night. And you are held captive to the whims of OB nurses who demand labor epidurals at the most inconvenient of times.

For sure.

Theres very little oversight or checks and balances on OB like in the main OR. Many OB think they can do whatever they want whenever they want without consideration for staffing, efficiency, time of day, other services...

The majority of sections aren't emergent and totally predictable but they will still call them stats or rush them thru just before their shifts end.

it's as if logic and efficiency can't coexist with their patient cohort

 

[deleted87051]

Hello,

I’m currently a third year student at the end of my clinical rotations

I haven’t decided on a final specialty yet

I’m really passionate about women’s health and really enjoyed my OB/GYN rotation

So my top two choices are OB/GYN and IM (with women’s health track). What I’m hesitant with about OB/GYN is the GYN surg aspect of it…

People have also mentioned OB anesthesia..

I was wondering what made you want to go into anesthesia?

I’m still deciding what I want to do… I’m between OB/GYN and IM with a women’s health track

I love the patient population and I’ve felt so connected to most of the patients on my OB/GYN rotation. I’m just wondering if I have what it takes to get through surgery (I like C-sections but the hysterectomies just are sooo long…)

With anesthesia I shadowed a couple of days with an anesthesiologist at MVH. Outside of getting to intubate the patient and put in fentanyl, I didn’t really do a whole lot… I was just sitting in the OR with the CRNA since the attending was just monitoring multiple ORs… so maybe I’m missing something in what they do? I just ended up sitting there just watching in the OR talking to the CRNA or not doing much (occasionally checking my phone)

I just want to know more since multiple people have told me that anesthesia is a good field and something to consider … so I just want to make sure I have all of the facts/info

If you’re passionate about women’s health and want to provide counseling and guidance to women about their health issues, anesthesia (even OB anesthesia) ain’t it. Most of my patient interactions don’t go much beyond “when did you last eat?”, “Ever have problems with anesthesia?”, “we’ll take good care of you”, and “we’re all done, take some nice deep breaths.”

I like the specialty but I’m more passionate about the technical aspects of the specialty which I enjoy very much.

I don’t think anesthesia will give you the opportunity to make an impact in the way that you want.

 

[Dantrolene FC]

I definitely would not recommend anesthesia for any med students the next 5 years. We need to deplete the supply.

Definitely if obgyn is ur passion. I’d suggest you go into it. One of my sisters who quit ob gyn after 4 years of attending due to 72 hr weekend ob calls. Said the hot newer fellowship is to go into subspecialty, geriatric gynecology which focuses on the unique gynecological needs of older women, integrating geriatric principles with gynecological expertise

I know a chill job where the OBs take 2 days of call and 1 night of call per month. Not every job has to suck.

 

[Ezekiel2517]

As an attending once told me when I was a 3rd yrd medical student - how do you imagine yourself when you are an attending? Do you see yourself wearing scrubs in the OR, or in clinic or on the floors wearing dress clothes and a white coat? That alone should narrow things quite a bit. IM, OB/GYN, and anesthesiology are all quite different. Only one of those fields involves operating and only one of those fields is not "hands-on"/procedural and does not involve the OR. I guess you can technically be 100% nonsurgical or even outpatient as an OB/GYN but I'd guess the vast majority do not do that for most of their careers.

 

[jstargirl17]

As an attending once told me when I was a [emoji[emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]]]rd yrd medical student - how do you imagine yourself when you are an attending? Do you see yourself wearing scrubs in the OR, or in clinic or on the floors wearing dress clothes and a white coat? That alone should narrow things quite a bit. IM, OB/GYN, and anesthesiology are all quite different. Only one of those fields involves operating and only one of those fields is not "hands-on"/procedural and does not involve the OR. I guess you can technically be [emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji6[emoji640][emoji637]]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]][emoji[emoji638][emoji639][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]][emoji[emoji6[emoji640][emoji638]][emoji640][emoji640]]]% nonsurgical or even outpatient as an OB/GYN but I'd guess the vast majority do not do that for most of their careers.

I see myself wearing scrubs in the clinic, in the hospital, and obviously OR

I think after reading this thread, I don’t think anesthesia is the best fit for me since I like patient interactions and connections too much
And if I’m in the OR, I would rather be involved doing the C-sections than in the background

I appreciate everyone offering their insights and perspectives


I know that OB/GYN is going to be top notch if I want the most comprehensive women’s health training

 

[NicholasPavona]

I know that OB/GYN is going to be top notch if I want the most comprehensive women’s health training

Yeah good luck with that kid.

 

[pgg]

For sure.

Theres very little oversight or checks and balances on OB like in the main OR. Many OB think they can do whatever they want whenever they want without consideration for staffing, efficiency, time of day, other services...

The majority of sections aren't emergent and totally predictable but they will still call them stats or rush them thru just before their shifts end.

it's as if logic and efficiency can't coexist with their patient cohort

They have their own ORs, their own preop area, their own PACU, their own scrub techs. Peds and NICU staff rush to their call. They think they have their own dedicated anesthesiologists too. Any pushback can be met with "she's in pain" or "the baby _____" ...

In contrast to surgeons who have to post cases in the main OR and get in line behind all the other urgent/emergent stuff, they live on an island where everything belongs to them, where all resources exist to facilitate their work.


A week or so ago I was on call, and they had 3 c-sections stacked up to go in sequence starting around 10 PM. The first two had obvious indications to go soon (neither emergent) and I had no objections. I couldn't figure out what the third one was for, so I asked.

OB - "Oh, she's been NPO all day and just kept getting bumped."

Me (incredulous) - "So we're doing this because she's hungry?"

OB - "She's been waiting all day."

Me (scowling) - "Hunger is not an indication for a c-section. We're not doing an elective c-section at 2 AM."

OB - "Well ... it's not really elective."

...

A bit later they spontaneously came up with the idea of feeding her and posting her for 10 AM the next day. Truly, can't make this stuff up.

 

[PpfSuxTube]

They have their own ORs, their own preop area, their own PACU, their own scrub techs. Peds and NICU staff rush to their call. They think they have their own dedicated anesthesiologists too. Any pushback can be met with "she's in pain" or "the baby _____" ...

In contrast to surgeons who have to post cases in the main OR and get in line behind all the other urgent/emergent stuff, they live on an island where everything belongs to them, where all resources exist to facilitate their work.


A week or so ago I was on call, and they had 3 c-sections stacked up to go in sequence starting around 10 PM. The first two had obvious indications to go soon (neither emergent) and I had no objections. I couldn't figure out what the third one was for, so I asked.

OB - "Oh, she's been NPO all day and just kept getting bumped."

Me (incredulous) - "So we're doing this because she's hungry?"

OB - "She's been waiting all day."

Me (scowling) - "Hunger is not an indication for a c-section. We're not doing an elective c-section at 2 AM."

OB - "Well ... it's not really elective."

...

A bit later they spontaneously came up with the idea of feeding her and posting her for 10 AM the next day. Truly, can't make this stuff up.

Do you work in my hospital??
Seriously dude. We had that exact scenario a couple weeks ago.

We gave those exact same resource drains and excuses...

 

[deleted87051]

They have their own ORs, their own preop area, their own PACU, their own scrub techs. Peds and NICU staff rush to their call. They think they have their own dedicated anesthesiologists too. Any pushback can be met with "she's in pain" or "the baby _____" ...

In contrast to surgeons who have to post cases in the main OR and get in line behind all the other urgent/emergent stuff, they live on an island where everything belongs to them, where all resources exist to facilitate their work.


A week or so ago I was on call, and they had 3 c-sections stacked up to go in sequence starting around 10 PM. The first two had obvious indications to go soon (neither emergent) and I had no objections. I couldn't figure out what the third one was for, so I asked.

OB - "Oh, she's been NPO all day and just kept getting bumped."

Me (incredulous) - "So we're doing this because she's hungry?"

OB - "She's been waiting all day."

Me (scowling) - "Hunger is not an indication for a c-section. We're not doing an elective c-section at 2 AM."

OB - "Well ... it's not really elective."

...

A bit later they spontaneously came up with the idea of feeding her and posting her for 10 AM the next day. Truly, can't make this stuff up.

“Spontaneously” lol

 

[jstargirl17]

Xxx

 

[Smurfette]

They have their own ORs, their own preop area, their own PACU, their own scrub techs. Peds and NICU staff rush to their call. They think they have their own dedicated anesthesiologists too. Any pushback can be met with "she's in pain" or "the baby _____" ...

In contrast to surgeons who have to post cases in the main OR and get in line behind all the other urgent/emergent stuff, they live on an island where everything belongs to them, where all resources exist to facilitate their work.

A few years back, I was doing an ex lap on a fairly unstable patient with free air. The OB on call had some sort of stable add on from the ER and was told by the house supervisor that he had to follow my case. He was called hours before but had just finished clinic so he wanted to go NOW. He literally ran into my OR huffing and puffing about having to operate on his patient and could I wrap it up? I looked up at him, then resumed working. The room reeked (perf) and looked like a blood bath. The SA was holding a retractor precariously at an awkward angle as I tried to get into a tight spot and no one gave him any attention. He took a minute to realize no one cared about his case yet and ran out of the room. A few minutes later, the circulator was like "that was interesting. What did he think, you were going to just sew the patient closed immediately and be done just because he needed the OR?" to which the anesthesiologist responded "I think that's exactly what he thought and he was surprised to see there was actual serious work being done in here".

 

[CopaceticOne]

A few years back, I was doing an ex lap on a fairly unstable patient with free air. The OB on call had some sort of stable add on from the ER and was told by the house supervisor that he had to follow my case. He was called hours before but had just finished clinic so he wanted to go NOW. He literally ran into my OR huffing and puffing about having to operate on his patient and could I wrap it up? I looked up at him, then resumed working. The room reeked (perf) and looked like a blood bath. The SA was holding a retractor precariously at an awkward angle as I tried to get into a tight spot and no one gave him any attention. He took a minute to realize no one cared about his case yet and ran out of the room. A few minutes later, the circulator was like "that was interesting. What did he think, you were going to just sew the patient closed immediately and be done just because he needed the OR?" to which the anesthesiologist responded "I think that's exactly what he thought and he was surprised to see there was actual serious work being done in here".

People who act like their BS cases are emergent always seem to be the ones who don’t grasp it when a real emergency case takes priority.

At this point I give a very short clinical explanation why and tell them if they disagree they can talk to the other surgeon to determine priority. “Hi Dr. V, your stable patient that has been an add-on since this morning will need to wait because of a ruptured AAA that is coming up from the ED with Dr. T. If you disagree with case priorities, you’ll need to speak directly with Dr. T. I’m sorry, but I need to go get that case prepped. Have Dr. T call me if they are going to hold off on that case. Bye”

Ignore all the protests that follow… just not worth my stress.

 

[aneftp]

People who act like their BS cases are emergent always seem to be the ones who don’t grasp it when a real emergency case takes priority.

At this point I give a very short clinical explanation why and tell them if they disagree they can talk to the other surgeon to determine priority. “Hi Dr. V, your stable patient that has been an add-on since this morning will need to wait because of a ruptured AAA that is coming up from the ED with Dr. T. If you disagree with case priorities, you’ll need to speak directly with Dr. T. I’m sorry, but I need to go get that case prepped. Have Dr. T call me if they are going to hold off on that case. Bye”

Ignore all the protests that follow… just not worth my stress.

These situations are why I love solo cases with one doc only on call. It forces the surgeons to actually determine what’s a true emergency when only one doc anesthesia is available and no backup. You aren’t scrambling to call backup in. Or running act model trying to find a free body.

Now I have been at places where it’s only one room at a time PLUS OB. And only one provider. Urgent cs trumps ex lap. It can get dicey. Since cs can be done in less than 30-40 minutes.