Struggling Anesthesiology Resident

[DoubtingGas]

Hello Pain Medicine Docs,

I am a CA1 at a great anesthesiology program who is really struggling with my life choices. Obviously depression is multi factorial, and it's hard to parse how much is a dislike of anesthesiology vs. a dislike of being a resident in general, but I am concerned that I made a real mistake with my specialty choice. From the outside I am doing well, I receive great evals, I am probably in the upper half of my class in terms of progression and knowledge, but I simply do not enjoy going to work every day. I don't think I hate anesthesiology, but I increasingly can't see myself doing this for a career. As a medical student, I saw anesthesiology as a procedural specialty with some medicine as well. Now that I am a resident, I realize it's the opposite and I just don't have the passion for the mediciney side that my co-residents and attendings do. I have so little interest in studying the physiology and pharmacology required to excel at anesthesiology, and I know I will start falling behind my colleagues who obviously have a passion for anesthesiology.

I was on the fence about anesthesiology in med school, but was lucky enough to do two, 2-week rotations in pain medicine at two different institutions and they were the best rotations of fourth year. It solidified my choice of anesthesiology. I found the procedures fascinating, I liked the challenging psych component to the patient population, and I always enjoyed the flow of clinic in a variety of specialties. I still think my goal is pain medicine, but since I was wrong about how much I thought I would like anesthesiology, I am now second guessing my interest in pain medicine as well. Unfortunately, at my program we do not have chronic pain rotations until CA2 year, though I have been meeting with the pain faculty to get involved in some projects. My fear is that if I don't find joy in pain either, then I will be a CA2 without clear career goals. At that point I honestly don't know what I would do.

The only other specialty I seriously considered in medical school was radiology, with an interest in IR. I ultimately (and mistakenly I now realize) thought I was "better" at anesthesiology and went down that path. I now realize that it's simply easier for med students to do things in anesthesiology, and that no one starts "good" at radiology. My stats are good enough to likely get an R spot in Radiology, but I obviously don't know for sure if I will enjoy that any more either. If I were to switch it would oviously be a one-way road, as I am sure I would not be able to switch a second time. I also know that a couple radiologists have done ACGME pain fellowships as well, so I could still end up at the same end goal via radiology (albeit with several additional years, of course)

So I suppose here are my questions to wiser folks.

1. Did anyone else struggle to love anesthesiology but power through to find fulfillment in pain? Was it worth it?
2. Does anyone here wish they had done radiology and especially IR instead given the procedural overlap?
3. Any other general words of advice for my situation. I'm open to any and all feedback.

Thank you all in advance. I've enjoyed reading this forum over the past couple years.

It might be worth noting as well that my ultimate goal is to end up in a small town/rural practice. Part of my concern about anesthesiology is certainly that many of the places I have looked at living are currently CRNA-only or ratios of 8:1 which sounds horrendous. While it seems like pain practices are still sustainable in rural communities.

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[Ferrismonk]

This is a hard thing to answer well, but I think you are mistaken to think that radiology is less medicine-y. They must know volumes of what every little medical process could show up on imaging. Remember, you're (likely) a MEDICAL doctor. Every specialty has good chunk of medical knowledge in it.
I think anesthesiology definitely has a large medicine component to it and also is very procedure based. Pain certainly has a large procedural component, but you're also seeing people in clinic making diagnoses and ruling out dangerous medical stuff.

Frankly, it sounds like you're just burned out. There's no shame in changing specialties, but make you you really want to. What do you LIKE reading about? I don't get too excited about anesthesia reading anymore, but I read a ton of pain stuff for fun (like this forum). Do you like reading Xrays? Are you fascinated by that little line that shouldn't be there? I find that knowing what you like to read about tends to be the best indicator of where you'll be happiest. If you really don't know, take a few post-call days and see if you can shadow other specialties.

 

[TIVAndy]

i remember enjoying OB - lots of epidurals, acute pain - lots of blocks, chronic pain - obviously.. as you advance in year it'll likely get better. if you want to switch consider PMR

 

[Bostonspine]

i remember enjoying OB - lots of epidurals, acute pain - lots of blocks, chronic pain - obviously.. as you advance in year it'll likely get better. if you want to switch consider PMR

Remember PM&R is 3 more year of medicine TBI, stroke, SCI, EMG, sports. No escaping medicine in medicine but do some self care. Once board certified you can always go into industry or management.

 

[clubdeac]

stay in anesthesia. I almost switched to radiology but then fell asleep during my interview day while having to shadow one of the diagnostic radiologists. I just couldn't sit in a dark room all day. I think anesthesia is a good field and you'll have your pick of pain fellowships if you work hard and get good LOR. You could even do half and half when you get out.

You have to remember that so much of your day to day job satisfaction comes from who you work with, your environment and your boss. I've been doing pain for 10 years now and have worked in 3 different settings. I love what I do now in my current setting. At one of my jobs however I was close to jumping off a cliff despite having the same job description

 

[drusso]

Hello Pain Medicine Docs,

I am a CA1 at a great anesthesiology program who is really struggling with my life choices. Obviously depression is multi factorial, and it's hard to parse how much is a dislike of anesthesiology vs. a dislike of being a resident in general, but I am concerned that I made a real mistake with my specialty choice. From the outside I am doing well, I receive great evals, I am probably in the upper half of my class in terms of progression and knowledge, but I simply do not enjoy going to work every day. I don't think I hate anesthesiology, but I increasingly can't see myself doing this for a career. As a medical student, I saw anesthesiology as a procedural specialty with some medicine as well. Now that I am a resident, I realize it's the opposite and I just don't have the passion for the mediciney side that my co-residents and attendings do. I have so little interest in studying the physiology and pharmacology required to excel at anesthesiology, and I know I will start falling behind my colleagues who obviously have a passion for anesthesiology.

I was on the fence about anesthesiology in med school, but was lucky enough to do two, 2-week rotations in pain medicine at two different institutions and they were the best rotations of fourth year. It solidified my choice of anesthesiology. I found the procedures fascinating, I liked the challenging psych component to the patient population, and I always enjoyed the flow of clinic in a variety of specialties. I still think my goal is pain medicine, but since I was wrong about how much I thought I would like anesthesiology, I am now second guessing my interest in pain medicine as well. Unfortunately, at my program we do not have chronic pain rotations until CA2 year, though I have been meeting with the pain faculty to get involved in some projects. My fear is that if I don't find joy in pain either, then I will be a CA2 without clear career goals. At that point I honestly don't know what I would do.

The only other specialty I seriously considered in medical school was radiology, with an interest in IR. I ultimately (and mistakenly I now realize) thought I was "better" at anesthesiology and went down that path. I now realize that it's simply easier for med students to do things in anesthesiology, and that no one starts "good" at radiology. My stats are good enough to likely get an R spot in Radiology, but I obviously don't know for sure if I will enjoy that any more either. If I were to switch it would oviously be a one-way road, as I am sure I would not be able to switch a second time. I also know that a couple radiologists have done ACGME pain fellowships as well, so I could still end up at the same end goal via radiology (albeit with several additional years, of course)

So I suppose here are my questions to wiser folks.

1. Did anyone else struggle to love anesthesiology but power through to find fulfillment in pain? Was it worth it?
2. Does anyone here wish they had done radiology and especially IR instead given the procedural overlap?
3. Any other general words of advice for my situation. I'm open to any and all feedback.

Thank you all in advance. I've enjoyed reading this forum over the past couple years.

It might be worth noting as well that my ultimate goal is to end up in a small town/rural practice. Part of my concern about anesthesiology is certainly that many of the places I have looked at living are currently CRNA-only or ratios of 8:1 which sounds horrendous. While it seems like pain practices are still sustainable in rural communities.

What about psych? Can still apply to pain fellowship after residency.

 

[soccrwz]

first year is the hardest because its completely new, what your feeling is not unique to you, talk with your other residents, it will get better, once you get your rhythm down you'll really start to enjoy it

 

[paindoctor2014]

It gets better. Ca1 year is very hard.

one of the good things about anesthesia is the multitude of fellowships you could do and almost completely change directions.

pain, critical care, sleep, ob is a good one. there is a Group where I practice that does 24 hour ob. Q3-4 days. Hell you could even do undersea and hyperbaric medicine.

 

[Baron Samedi]

I agree with all the advice you've received.

One thing I would consider is, if you are truly not enjoying anesthesiology and not just experiencing burnout, that many subspecialty fall back on their primary specialties and certain jobs will want you to practice in both fields.

For example, some hospital employed anesthesia pain guys choose to do some OR time and may be expected to take anesthesia call. There are other people who do a fellowship and eventually decide to go back to their primary speciality for a myriad of reasons.

Some of this can be mitigated by the jobs you take(ie private practice).

 

[NJPAIN]

Don't make any hasty decisions during your CA1 year. I was miserable during my CA-1 year at a very highly regarded program as well. I seriously looked into switching programs but in those years it was like slave trading. My "master" would need to release me to my new "master" and I feared the repercussions of letting my chairman know that I wanted to leave . I then decided to just stick it out and things got better as I climbed the totem pole.

The physiology and pharmacology are important but you are only seeing academic practice at the moment. I think that you will observe a very different practice style with less attention to the details in private practice.

 

[specepic]

Good advice here. I would add:

1) 2020 sucks a bit in general, ride it out

2) Consider seeking mental health support, you may be a little physiologically depressed

3) Try to have some life balance

4) 1 st year of residency is least fun

5) many fellowship options

6) the grass is rarely greener

 

[epidural man]

OP.

Just want to reiterate something you likely know: PAIN MEDICINE is very different from Anesthesiology. Stay in it, Hang in there and keep your eye on the prize.

I like the psych idea also.

I have taught a ton of residents. They all want to quit at some point. Keep that in mind.

 

[painballer27]

What about psych? Can still apply to pain fellowship after residency.

How attainable do you think a pain fellowship is coming from a psych residency? And do you think there'd be any issues with finding employment after as opposed to those that are anesthesia or PM&R trained?

 

[lobelsteve]

How attainable do you think a pain fellowship is coming from a psych residency? And do you think there'd be any issues with finding employment after as opposed to those that are anesthesia or PM&R trained?

Not impossible, but puts you behind the 8-ball. Easiest route to pain is Anes>PMR>Neuro or FP>Psych. My opinion.
Would recommend getting research done with name on a few papers.

 

[MitchLevi]

One of my cofellows during my fellowship was a psychiatrist.

 

[painballer27]

One of my cofellows during my fellowship was a psychiatrist.

Do you know if they do all the interventional procedures in their practice?

 

[Ducttape]

whether they do interventional procedures at their practice is a function of what they want to do and their fellowship training theoretically should not have any real bearing on their practice patterns.

 

[MitchLevi]

Do you know if they do all the interventional procedures in their practice?

She did 4 yrs of ortho residency before psych, and does all the same things as anyone else.

 

[Agast]

I think psychiatry residents would actually have a leg up over family medicine. The psych overlay for pain can be overwhelming and so many times you wish you could refer your patient to a psychiatrist (but most of them don't take insurance.)

 

[stsa84]

I got to know a psych trained pain fellow while I was rotating in pain as a med student. She was not as technically skilled as the anesthesia trained fellows, and there was a noticeable skill gap at the end of the fellowship. She's now a few years out, and is doing more surgical procedures than most folks I know, and doing them skillfully. She was trained on the job, and her skills improved quite a bit. I believe getting into fellowship required a personal friendship with the program director though...

 

[Baron Samedi]

As faculty I would say the difficult part of pain fellowship is the clinical reasoning, not as much the technical skills. All of our fellows are proficient proceduralists by the end of their training -- some still struggle with decision-making. A thoughtful psychiatrist would likely perform well with some extra attention paid to developing procedural skills.

 

[jsaul]

Do you know if they do all the interventional procedures in their practice?

I know a psychiatrist in my neck of the woods who does pain. He is very aggressive and does all the procedures including pain surgeries.

 

[Pain Applicant1]

Hello Pain Medicine Docs,

I am a CA1 at a great anesthesiology program who is really struggling with my life choices. Obviously depression is multi factorial, and it's hard to parse how much is a dislike of anesthesiology vs. a dislike of being a resident in general, but I am concerned that I made a real mistake with my specialty choice. From the outside I am doing well, I receive great evals, I am probably in the upper half of my class in terms of progression and knowledge, but I simply do not enjoy going to work every day. I don't think I hate anesthesiology, but I increasingly can't see myself doing this for a career. As a medical student, I saw anesthesiology as a procedural specialty with some medicine as well. Now that I am a resident, I realize it's the opposite and I just don't have the passion for the mediciney side that my co-residents and attendings do. I have so little interest in studying the physiology and pharmacology required to excel at anesthesiology, and I know I will start falling behind my colleagues who obviously have a passion for anesthesiology.

I was on the fence about anesthesiology in med school, but was lucky enough to do two, 2-week rotations in pain medicine at two different institutions and they were the best rotations of fourth year. It solidified my choice of anesthesiology. I found the procedures fascinating, I liked the challenging psych component to the patient population, and I always enjoyed the flow of clinic in a variety of specialties. I still think my goal is pain medicine, but since I was wrong about how much I thought I would like anesthesiology, I am now second guessing my interest in pain medicine as well. Unfortunately, at my program we do not have chronic pain rotations until CA2 year, though I have been meeting with the pain faculty to get involved in some projects. My fear is that if I don't find joy in pain either, then I will be a CA2 without clear career goals. At that point I honestly don't know what I would do.

The only other specialty I seriously considered in medical school was radiology, with an interest in IR. I ultimately (and mistakenly I now realize) thought I was "better" at anesthesiology and went down that path. I now realize that it's simply easier for med students to do things in anesthesiology, and that no one starts "good" at radiology. My stats are good enough to likely get an R spot in Radiology, but I obviously don't know for sure if I will enjoy that any more either. If I were to switch it would oviously be a one-way road, as I am sure I would not be able to switch a second time. I also know that a couple radiologists have done ACGME pain fellowships as well, so I could still end up at the same end goal via radiology (albeit with several additional years, of course)

So I suppose here are my questions to wiser folks.

1. Did anyone else struggle to love anesthesiology but power through to find fulfillment in pain? Was it worth it?
2. Does anyone here wish they had done radiology and especially IR instead given the procedural overlap?
3. Any other general words of advice for my situation. I'm open to any and all feedback.

Thank you all in advance. I've enjoyed reading this forum over the past couple years.

It might be worth noting as well that my ultimate goal is to end up in a small town/rural practice. Part of my concern about anesthesiology is certainly that many of the places I have looked at living are currently CRNA-only or ratios of 8:1 which sounds horrendous. While it seems like pain practices are still sustainable in rural communities.

The dark side: In residency, I didn't like some rotations but I knew if I just closed my eyes they'd be over in a couple of months. I kept my mouth shut and pushed through until they were over but that's different than being miserable. There's nothing worse than waking up every day dreading going to work. I guess you'll have to determine if you truly hate your entire specialty or just what you're doing right now. If you have to jump ship, just do it and don't worry too much about it. You're young enough that you can easily rebuild yourself no matter which direction you go in.

Now the bright side: there is a lot to look forward to as a rural pain doc. I'm one and I couldn't be happier. I have a few years until I'm 50 and I'm on the cusp of retiring. I started other businesses here which are growing and I have a very strong sense of friendships and community in my little town. These feelings are very important. I own a farm and I feel like I'm living my dream. I don't think these opportunities are as readily available in the cities. If you can push through for a few years you can easily do what I'm doing.

If you're worried about being locked into a certain specialty you probably should do something broader than anesthesia. Consider PMR as you can pretty much go in any direction your want when you're done.

Also, you can always shadow and take weekend courses once you're out to learn new things and move your practice in whatever direction you want. One great thing about rural areas is that it's not that difficult to be successful no matter what you do. It's much easier to find success here than in a big city.

Feel free to PM me about questions you have regarding rural life and independent pain practices.

 

[Pain Applicant1]

Lol!! I just realized the original post was from 2020. Who was the wise guy who resurrected this post to confuse me?

 

[painballer27]

Lol!! I just realized the original post was from 2020. Who was the wise guy who resurrected this post to confuse me?

It was me lol. Sorry should have said that