Surgery Vs. Anesthesia (srs life advice needed)

[Throwaway92]

After a pretty traumatic event over Christmas break. I really need to do some soul searching and wanted to gather some information. I've tried Reddit but for some reason, my posts never make it to the forum.

I'm a 3rd year medical student half-way through rotations having a crisis about what I want to do from here on out. I'm currently torn between Orthopaedics and Anesthesia. My stats are alright, 250 Step 1, one ortho project and two others currently working on. 3 honors in Psych, IM, and Surgery.

I am passionate about orthopedics. I love the people, the culture, the patients, the good outcomes, clinic. It all sounds wonderful. But then I think about the part where I may have to move away from my school/hometown (mid-west) which is very much a reality that will most likely come true. I want to be near family for my training, no matter what. This now seems to be my number one priority. To me, medicine is a job. Nothing more, nothing less. None of my family is in medicine, so they do not understand. This decision is entirely mine, making it all the more difficult.

I've been considering anesthesia as well and it seems to also resonate with what I want in medicine. More time to be with family. I am also very passionate about exercising and maintaining my general health. I understand with surgery, that may be difficult to sustain in residency and early on in my attending career. I would definitely have an infinitely easier time matching in my city if I went the anesthesia route.

I guess the TLDR is which would allow me more time off in the long run, to be with family, friends, pursue other interests and maintain my general health. Money is not a factor, either will give me more than what I would ever need. I don't want to be on my death bed saying I wished I had worked less and spent more time with family.

Thanks for reading.

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[DO2015CA]

If your local anesthesia program doesn’t want you then which one do you want. Geography for training is a short sighted criteria for choosing a specialty.

 

[Kpw101]

Would definitely argue against choosing a specialty based on location. You'd be trading 5 years in an undesirable location for potentially ~30 years in an undesirable career.

 

[FourniersGreenGang]

I could be totally off-base here but from my understanding you work like crazy in Ortho, with the exception of a couple subspecialties. I think anesthesia generally has a far superior lifestyle, and if you subspecialize in pain medicine you will get an even better lifestyle with excellent pay. Either way you are helping people live a better life.

 

[Kuratz]

I’ll echo that you shouldn’t choose a 30+ year career based primarily on where you can do your training. With that in mind I found myself in a similar situation choosing between radiology and ortho. I did an ortho sub-I early in M4 and quickly realized that really to go that route and put in the needed sacrifices you really have to love operating more than just about anything else. What the surgeons do is amazing, we need them, but they are in the trenches and the many wouldn’t have it any other way because they love it. Based on your priorities I don’t envision you’d be satisfied with the level of sacrifice either. You can always do a sub-I to really get a glimpse and still have time to pivot. I switched to radiology and while it was hard to make the mental transition after putting in the research, networking etc, I’m much happier. If anything the sub-I alleviated any “what if” scenarios down the road so I’m glad I did it. YMMV. Best of luck

 

[afib123]

You have to think about how much you like anesthesia. If you like it as much as ortho, go for it. If you don't then that's a tough decision which really you can only make depending on whether you value lifestyle more vs being an orthopedic surgeon.
I am also making a similar decision between two different specialities, so good luck to you.

 

[sovereign0]

The short version I picked up is that medicine is a job and nothing more, and family is more important to you than your career profession. Neither of those two things are really compatible with a surgical residency. Also, location is important and you'll have relatively little control over where you match if you go Ortho. Definitely anesthesia.

 

[ACSurgeon]

Be careful- it can be hard to get a job in your location in choice sometimes, and anesthesia had an issue a few years ago in my city (grads couldn’t find a job in town, had to do a fellowship or go somewhere else)...

Now you’ll certainly be able to be “close” to family in just about any specialty and any city, if you don’t define close as being in the same city.

 

[nimbus]

Lifestyle during training is definitely tougher in ortho but once you’re in practice, you will have more control and more options as an orthopedist. I’d say 20% of the anesthesiologists I know rarely or never work nights/weekends/holidays. That number for ortho is more like 70%. Plus you have to work like a dog to make average ortho money in anesthesia.

As an anesthesiologist, I have a hard time recommending anesthesia over ortho if you are interested in both.

 

[OrthoTraumaMD]

Anesthesia.


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[Angus Avagadro]

Ortho call is definitely worse than gas. However, subspecialty call is invading anesthesia, cardiac, trauma, neuro, etc. Meaning 3 or 4 docs on call a night, making call much more frequent. Wouldn't use lifestyle and ortho or anesthesia in the same sentence

 

[Throwaway92]

Anesthesia.

Could you elaborate a little more? The poster above you makes it seem like I'd have more control over my schedule as an ortho attending vs. Anesthesia attending.

I'm leaning towards doing a ortho rotation at my school early 4th year and then making the decision based off that as someone suggested above. I'll continue 3rd year though as If i am trying to attempt ortho. Trying to honor the rest of my rotations and continuing research.

 

[OrthoTraumaMD]

Could you elaborate a little more? The poster above you makes it seem like I'd have more control over my schedule as an ortho attending vs. Anesthesia attending.

I'm leaning towards doing a ortho rotation at my school early 4th year and then making the decision based off that as someone suggested above. I'll continue 3rd year though as If i am trying to attempt ortho. Trying to honor the rest of my rotations and continuing research.

You said location is the most important to you. You can’t rely on that with ortho residency. You have to be willing to match anywhere. Hence...anesthesia.


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[Tigerhawk77]

Plug for PM&R if you like orthopedic problems but not surgery lifestyle.

 

[Waterlover]

Surgery in general is a huge sacrifice, which includes putting career before everything. If you aren't okay with that, then do Anesthesia. If you have any hesitation about Ortho, do Anesthesia.

 

[medschoolzombie]

The short version I picked up is that medicine is a job and nothing more, and family is more important to you than your career profession. Neither of those two things are really compatible with a surgical residency. Also, location is important and you'll have relatively little control over where you match if you go Ortho. Definitely anesthesia.

You don’t have much control over where you match Gas either though due to how the match system works. Am I missing something?

 

[Tenk]

Your focus on life first and medicine as a job is usually what I always preach and what most attendings all agree with once they have been doing this for a decade. Your first total knee is amazing and different from your second or third. Your 300th total knee is the exact same as your 301st and 302nd. It just gets old. Sure, you’ll have interesting cases, but it will be the inverse of whatever you are feeling as a medical student on an interesting:boring ratio.

Geography is not a great reason to choose a specialty. Lifestyle most certainly is. Find the specialty you like the most that fits the lifestyle you want and don’t worry about the rest because you’ll be enjoying your life outside the hospital which is by far the most important aspect in life.

 

[Psai]

You don’t have much control over where you match Gas either though due to how the match system works. Am I missing something?

He's a very competitive applicant for anesthesiology and a middle of the road one for orthopedics.

I'd pick orthopedics. It's a lot easier to switch out than to switch in and you don't want to spend your life doing something you can't stand because you didn't want to spend a few years of your life in an area imo.

 

[Mtskies]

Your focus on life first and medicine as a job is usually what I always preach and what most attendings all agree with once they have been doing this for a decade. Your first total knee is amazing and different from your second or third. Your 300th total knee is the exact same as your 301st and 302nd. It just gets old. Sure, you’ll have interesting cases, but it will be the inverse of whatever you are feeling as a medical student on an interesting:boring ratio.

Geography is not a great reason to choose a specialty. Lifestyle most certainly is. Find the specialty you like the most that fits the lifestyle you want and don’t worry about the rest because you’ll be enjoying your life outside the hospital which is by far the most important aspect in life.

But geography and lifestyle are oftentimes extrinsically linked. What if someone is passionate about rock climbing or skiing? Okay, then you’re likely looking at the Rocky Mountains/west or the northeast.


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[docbsb2015]

My cousin is married to an orthopod. He told me his 4th kid is the first kid he’s really been around for any significant amount of time (ages 15-6). On the other hand he loves his job. This is just one example so obviously things vary. You just have to pick what you love to do and really focus on and be present with your family when you get the opportunity to spend time with them. Good luck.

 

[Mr.S]

I think your problem is NOT picking a specialty but it is getting over separation anxiety.. Thats the main issue

 

[premed1234567891011]

I think your problem is NOT picking a specialty but it is getting over separation anxiety.. Thats the main issue

We don’t know what’s going on with his family at the moment. I’m sure OP has a very good reason for wanting to be close to home.

 

[mimelim]

We don’t know what’s going on with his family at the moment. I’m sure OP has a very good reason for wanting to be close to home.

I'm not. From a bull**** gorilla math statistical standpoint, the reason is not a "good one". People have all sorts of hang ups for not leaving where they are from. Some good, some not so good. There is no way as strangers on the internet for knowing which is which.

That having been said, if this is simply, all jobs are the same to me, you should not go into surgery. There are easier ways to make money to live the rest of your life.

 

[Mr.S]

We don’t know what’s going on with his family at the moment. I’m sure OP has a very good reason for wanting to be close to home.

i understand that but thats something ya gotta get over if you are interested in orthopedics or anesthesia for that matter. If you want to likely match in a specific are than you have to do something like primarey care. There is a job in primary care in every single city in america. MULTIPLE

 

[doyouhaveaflag]

Another vote for anesthesia. You may like orthopedics from what you've seen as a third year student, but I think the reality of a five year residency in it, in which you work very long hours and see your co-residents way more than your family, will not end up being what you're looking for. I think you'd start resenting it before you finished.

I know you don't get to do much actual surgery as a third year student, but it was also striking to me that among the things you identified that you like about ortho, none were actually orthopedic surgeries ("people, the culture, the patients, the good outcomes, clinic"). Perhaps you felt that was implied. However, I'd hazard a guess that most people who are happy in surgery would say their favorite part about surgery is doing surgery. At least among the surgical residents I know, I haven't met one who said they like clinic.

 

[DokterMom]

"After a pretty traumatic event over Christmas break. I really need to do some soul searching"

Sounds like this trauma significantly impacted your decision framework and the impact is very fresh in your mind. This may be a permanent insight you want to redesign your entire life around, or it may be a scary 'bump in the road' that you get over. I'd give yourself time to investigate which it really is.

You mentioned doing elective rotations in each -- do that. It would be a lot easier to switch ortho-to-gas than the other way.

 

[el_duderino]

Compromising what you really want to do in order to stay close to family for a few more years is probably a poor decision. Don't let your fear of moving away drive you away from what you really want to accomplish with your career.

 

[ortnakas]

"After a pretty traumatic event over Christmas break. I really need to do some soul searching".

Sounds like this trauma significantly impacted your decision framework and the impact is very fresh in your mind. This may be a permanent insight you want to redesign your entire life around, or it may be a scary 'bump in the road' that you get over. I'd give yourself time to investigate which it really is.

This is the best advice you’ve gotten. Maybe you have a perfectly valid reason for being geographically restricted (it’s common in real life, if not on SDN), maybe you don’t. But either way, don’t make career/life decisions based on the events of one weekend. Do that soul searching first.

If you absolutely, truly have a reason you need to stay in your hometown, and that reason will be as real a few years from now as it is now, then don’t pick surgery; trying to match ortho and also stay in a single city is a match nightmare waiting to happen. If geography truly beats specialty choice in every way, pick IM/FM/something that gives you the longest rank list in the area.

 

[Tenk]

But geography and lifestyle are oftentimes extrinsically linked. What if someone is passionate about rock climbing or skiing? Okay, then you’re likely looking at the Rocky Mountains/west or the northeast.


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This doesn’t apply to picking a residency program because a residency program is a very temporary thing. You can do orthopedics in another state for residency then come back. It is far better to sacrifice a few years away to do a residency you enjoy and gives you a great lifestyle than end up with a crappy career just because you didn’t want to move a few years.

The inside of the hospital in Hawaii is the same as the inside of the hospital in Montana. Residency is not a freaking vacation time. It’s work, work, and more work. It matters far less where you do residency than what you’re doing your residency in because you’re going to be doing it the rest of your life probably.

 

[anbuitachi]

After a pretty traumatic event over Christmas break. I really need to do some soul searching and wanted to gather some information. I've tried Reddit but for some reason, my posts never make it to the forum.

I'm a 3rd year medical student half-way through rotations having a crisis about what I want to do from here on out. I'm currently torn between Orthopaedics and Anesthesia. My stats are alright, 250 Step 1, one ortho project and two others currently working on. 3 honors in Psych, IM, and Surgery.

I am passionate about orthopedics. I love the people, the culture, the patients, the good outcomes, clinic. It all sounds wonderful. But then I think about the part where I may have to move away from my school/hometown (mid-west) which is very much a reality that will most likely come true. I want to be near family for my training, no matter what. This now seems to be my number one priority. To me, medicine is a job. Nothing more, nothing less. None of my family is in medicine, so they do not understand. This decision is entirely mine, making it all the more difficult.

I've been considering anesthesia as well and it seems to also resonate with what I want in medicine. More time to be with family. I am also very passionate about exercising and maintaining my general health. I understand with surgery, that may be difficult to sustain in residency and early on in my attending career. I would definitely have an infinitely easier time matching in my city if I went the anesthesia route.

I guess the TLDR is which would allow me more time off in the long run, to be with family, friends, pursue other interests and maintain my general health. Money is not a factor, either will give me more than what I would ever need. I don't want to be on my death bed saying I wished I had worked less and spent more time with family.

Thanks for reading.

It depends on what is TRULY the most important for you. If i were you, i would apply to ORTHO with Anesthesia backup. You can rank ortho in your desired cities high, and anesthesia lower. With that said, for anesthesia , depending on where you are, if your desired location only has like 1-2 programs, you are also in no way guaranteed a spot there. Anesthesia is a MUCH bigger field than Ortho. Plenty of anes applicants have better stats than you do.

From the sounds of it you want to do Ortho, but are unsure simply due to location. Honestly you arent even guaranteed to get into Ortho with those stats so if you are really interested, just do what i suggested above, Apply both (mostly Ortho programs obviously), and rank based on your preference.

Also aside from location, ortho residency in general is harder than anesthesiology residency. However, after residency, ortho makes MUCH more money (pretty much highest paid physicians, can make millions doing procedures). In anesthesiology you are pretty much capped at a MUCH lower number. Also if you are satisfied with a lower amount of money for orthopedic surgeons you can have a great lifestyle, where as by far most anesthesiologists are employees so they are forced to take call, work nights/weekends/holidays so you are looking at very unpredictable schedules. Call tends to be rough too since you are covering overnight cases from every field, not just Ortho cases so its not unusual to be working non stop on call for 20+ hours as an attending

Another vote for anesthesia. You may like orthopedics from what you've seen as a third year student, but I think the reality of a five year residency in it, in which you work very long hours and see your co-residents way more than your family, will not end up being what you're looking for. I think you'd start resenting it before you finished.

I know you don't get to do much actual surgery as a third year student, but it was also striking to me that among the things you identified that you like about ortho, none were actually orthopedic surgeries ("people, the culture, the patients, the good outcomes, clinic"). Perhaps you felt that was implied. However, I'd hazard a guess that most people who are happy in surgery would say their favorite part about surgery is doing surgery. At least among the surgical residents I know, I haven't met one who said they like clinic.

The thing is most med students also dont even know what anesthesiologists do. they THINK they do.. but not really. cause to their untrained eye, the attending is just chilling half the time, cause the med student doesn't know what is going on.

 

[studentofsdn]

I'm a 4th year applying anesthesia right now and had the SAME dilemma as you, but the other way around. I really wanted to stay in my current city to be with my fiance and it played a role in my decision for choosing anesthesia (I too "just wanted a job"). I then had a traumatic personal event in the aftermath of which I realized a surgical sub was what I wanted. Unfortunately, I would have had to take an extra year to solidify my application, and with loans breathing down my back, the decision was clear to me. My personal traumatic event permanently changed my outlook on life and makes me regret not having hte foresight to be competitive for surgery. However, after rotating and understanding anesthesia, I have grown to love it and can see a route to gaining fulfillment from my career. But the surgical sub will always be the one that got away for me.

Conversely, I know multiple people in my own class that switched from surgical subs to anesthesia for reasons you mentioned that seem happy. But, IMO they don't sound like they will be deeply fulfilled with anesthesia because their reasonings for liking the field sound quite shallow. But, that may not matter to them, and it may not matter for you. Personally, as a result of my trauma, I have realized that I need to find a fulfilling reason in everything I do in life or I get incredibly lazy and depressed.

Do rotations in both and think deeply about your decision.

I would caution you that anesthesia lifestyle really isn't what it seems. They are some of the few physicians that take in-house call for the rest of their attendinghood (which like the guy above me said can be BUSY) and your schedule depends on how someone else booked their cases. You also miss out on the full ownership of the patient. Think about these things. If you want to DM me, I'll tell you more about my situation and insight and we can discuss further. Best of luck with your decision

 

[OrthoTraumaMD]

However, after residency, ortho makes MUCH more money (pretty much highest paid physicians, can make millions doing procedures). In anesthesiology you are pretty much capped at a MUCH lower number. Also if you are satisfied with a lower amount of money for orthopedic surgeons you can have a great lifestyle, where as by far most anesthesiologists are employees so they are forced to take call, work nights/weekends/holidays so you are looking at very unpredictable schedules. Call tends to be rough too since you are covering overnight cases from every field, not just Ortho cases so its not unusual to be working non stop on call for 20+ hours as an attending

Just fyi... Nearly all orthopaedic surgeons have to take call in practice, and those of us who are employees (most of us) also have unpredictability.
Just as an example, today I’ve been operating nonstop for 17 hours (I am on call right now and traumas coming in). I have 5 hours to go home and then I have a full day in the OR tomorrow. At least anesthesia gets to leave at some point—and take breaks. The surgeon stays til the work is done.




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[nimbus]

Just fyi... Nearly all orthopaedic surgeons have to take call in practice, and those of us who are employees (most of us) also have unpredictability.
Just as an example, today I’ve been operating nonstop for 17 hours (I am on call right now and traumas coming in). I have 5 hours to go home and then I have a full day in the OR tomorrow. At least anesthesia gets to leave at some point—and take breaks. The surgeon stays til the work is done.




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Do you consider your schedule typical for an orthopedist? How are your brethren in total joints, sports, foot and ankle, and spine doing? I’ve worked straight through the holiday and haven’t seen most of them in over a week.

I admit that our ortho trauma docs work insane hours like you. They take call 5-6 days in a row and often operate til 4am because they have clinic the next morning and they have more cases stacked the following afternoon.

The other orthopedists typically show up for a quick hip or wrist fracture, then go back to watching football at home. Many of them I haven’t seen in the hospital after 8pm in years. Meanwhile my partners and I still sleep in the hospital on a regular basis.

 

[anbuitachi]

Just fyi... Nearly all orthopaedic surgeons have to take call in practice, and those of us who are employees (most of us) also have unpredictability.
Just as an example, today I’ve been operating nonstop for 17 hours (I am on call right now and traumas coming in). I have 5 hours to go home and then I have a full day in the OR tomorrow. At least anesthesia gets to leave at some point—and take breaks. The surgeon stays til the work is done.




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Yea aren't you an ortho trauma doctor? that's very different than other ortho doctors? Joints, spines, sports? i think you are probably paid less too lol. Ive seen your posts in the past, it sounds like your job is much tougher than a typical ortho docs job.
Yea many ortho docs probably take call, but i imagine for most of them they are home call, where as many hospitals require anesthesiologist attending to be present in house 24/7. I can say i rare see ortho procedures going on after 8pm in my very busy hospital except for ortho oncology cases and large spines. However the OR is still very active far past 8pm, just not with ortho cases

 

[OrthoTraumaMD]

Yea aren't you an ortho trauma doctor? that's very different than other ortho doctors? Joints, spines, sports? i think you are probably paid less too lol. Ive seen your posts in the past, it sounds like your job is much tougher than a typical ortho docs job.
Yea many ortho docs probably take call, but i imagine for most of them they are home call, where as many hospitals require anesthesiologist attending to be present in house 24/7. I can say i rare see ortho procedures going on after 8pm in my very busy hospital except for ortho oncology cases and large spines. However the OR is still very active far past 8pm, just not with ortho cases

It’s very dependent on the hospital. My partners also take call, and if they are on call, they can also be there late. A lot of it is also dependent on the practice mentality, how much work you want to push off on your other partners. I take home call as well.


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[anbuitachi]

recently posted over in anesthesiology forum:
Residents in these medical specialties have the most regrets | American Medical Association

Anes has 2nd highest career choice regret.

 

[studentofsdn]

recently posted over in anesthesiology forum:
Residents in these medical specialties have the most regrets | American Medical Association

Anes has 2nd highest career choice regret.

Why do you think that is? Also do you have any co-residents that feel that way?

 

[anbuitachi]

Why do you think that is? Also do you have any co-residents that feel that way?

since path and anes took 1 and 2, my guess is it's because they both work a lot with surgeons, and we all know surgeons have the hugest egos. it's tough being around them so often

 

[OrthoTraumaMD]

since path and anes took 1 and 2, my guess is it's because they both wanted to be surgeons

Fixed that for ya


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[atomi]

Based on what you have written you sound like one of the many who will wash out of ortho training and land in anesthesia or radiology.

Just do anesthesia and save yourself the trouble and misery.

 

[anbuitachi]

Fixed that for ya


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LOL funny if only it were true! haha

 

[Wordead]

Why do you think that is? Also do you have any co-residents that feel that way?

I'm not gas but I'd guess that watching that CRNA / AA go home at 7 pm after their shift while you stay to finish their cases over and over again while they make 4 times your salary gets a bit annoying?

 

[el_duderino]

Also, a lot of people wash out into gas or path, or settle for it over surgery or something else.

 

[Angus Avagadro]

I'm not gas but I'd guess that watching that CRNA / AA go home at 7 pm after their shift while you stay to finish their cases over and over again while they make 4 times your salary gets a bit annoying?

My anesthesia buddies tell me residents aren't the only ones relieving crna and aas, attending do too.

 

[Psai]

Fixed that for ya


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We can't all be rich and beautiful. Need the proletariat to have the capitalist.

 

[Neopolymath]

The word you are looking for is radiology

 

[doc05]

After a pretty traumatic event over Christmas break. I really need to do some soul searching and wanted to gather some information. I've tried Reddit but for some reason, my posts never make it to the forum.

I'm a 3rd year medical student half-way through rotations having a crisis about what I want to do from here on out. I'm currently torn between Orthopaedics and Anesthesia. My stats are alright, 250 Step 1, one ortho project and two others currently working on. 3 honors in Psych, IM, and Surgery.

I am passionate about orthopedics. I love the people, the culture, the patients, the good outcomes, clinic. It all sounds wonderful. But then I think about the part where I may have to move away from my school/hometown (mid-west) which is very much a reality that will most likely come true. I want to be near family for my training, no matter what. This now seems to be my number one priority. To me, medicine is a job. Nothing more, nothing less. None of my family is in medicine, so they do not understand. This decision is entirely mine, making it all the more difficult.

I've been considering anesthesia as well and it seems to also resonate with what I want in medicine. More time to be with family. I am also very passionate about exercising and maintaining my general health. I understand with surgery, that may be difficult to sustain in residency and early on in my attending career. I would definitely have an infinitely easier time matching in my city if I went the anesthesia route.

I guess the TLDR is which would allow me more time off in the long run, to be with family, friends, pursue other interests and maintain my general health. Money is not a factor, either will give me more than what I would ever need. I don't want to be on my death bed saying I wished I had worked less and spent more time with family.

Thanks for reading.

Neither specialty is a good choice for you.

Ortho (not my field) is awesome, but the ortho residents are overworked everywhere. And life as an attending may be only marginally better.

Anesthesiologists are pretty much the only attendings taking in-house call, except maybe trauma surgeons. This isn't something you want to do when you are 50 years old. Also keep in mind that with so many CRNAs in many parts of the country, anesthesia groups need to bring on fewer young attendings, and only a small number end up getting partnership offers. I've seen this many times, it's happening everywhere.

Another poster mentioned PM&R. Consider this field. Those docs have excellent work life balance, and with your stats you will be competitive for top programs.