Switching from EM to anesthesia

Started by GolDRoger
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GolDRoger

GolDRoger

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Hi everyone,

Wondering if I would have the possibility of switching into anesthesia from an emergency medicine categorical position. Today I soaped into an emergency medicine program. I initially applied to surg but went unmatched despite a great and strong application

I was honestly shocked to find out that I didn’t match as I had been told by multiple programs that I was ranked to match. Unfortunately that’s just the name of the game. I then decided to pivot into EM but since I was in such a state of shock, I didn’t give it much thought whether this is something I want to do or not. Now I’m locked in. Wondering if I would be able to pivot into anesthesia after my PGY1 year

Thanks everyone for your input!

**By the way, I realize that my PGY1 em year may not count, I'm totally okay with that, I'm just trying to switch I don't mind what it takes to get there. And I did rotate in anesthesia multiple times 2nd/3rd year, I have a couple letters and a couple mentors, I do have a strong interest.
 
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U did the right thing. U got a residency slot. Any residency slot. Being an unemployed doctor without a residency is even worst.

Life happens. Take it one day at a time. Go into EM. See how u like it first. There are plenty of people who didn’t match into the speciality of their first choice and ended up with great careers.

Considering u pivoted from ortho already into EM. And now want anesthesia.

It’s not sure thing. Start ur EM career. But make connections and start asking around. Hopefully u are at full academic center with other specialities like anesthesia. That’s really ur best shot. If the slot opens up at ur new home facility.

Enjoy EM. It’s not a bad career. Tons of flexibility unlike ortho
 
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aneftp said:
U did the right thing. U got a residency slot. Any residency slot. Being an unemployed doctor without a residency is even worst.

Life happens. Take it one day at a time. Go into EM. See how u like it first. There are plenty of people who didn’t match into the speciality of their first choice and ended up with great careers.

Considering u pivoted from ortho already into EM. And now want anesthesia.

It’s not sure thing. Start ur EM career. But make connections and start asking around. Hopefully u are at full academic center with other specialities like anesthesia. That’s really ur best shot. If the slot opens up at ur new home facility.

Enjoy EM. It’s not a bad career. Tons of flexibility unlike ortho
Click to expand...
Yeah, I hear you. I'm not trying for anesthesia out of nowhere though, i did want it at one point but then ended up going ortho, i rotated in anesthesia my 2nd, 3rd, 4th year, just liked ortho more. I love the OR essentially. Just would never do gen surg. I regret not dual applying or applying to a transitional year/prelim
 
GolDRoger said:
Hi everyone,

Wondering if I would have the possibility of switching into anesthesia from an emergency medicine categorical position. Today I soaped into an emergency medicine program. I initially applied to --- but went unmatched despite a great and strong application (260 step 2, 10+ pubs, great LORs, etc etc).

I was honestly shocked to find out that I didn’t match as I had been told by multiple programs that I was ranked to match. Unfortunately that’s just the name of the game. I then decided to pivot into EM but since I was in such a state of shock, I didn’t give it much thought whether this is something I want to do or not. Now I’m locked in. Wondering if I would be able to pivot into anesthesia after my PGY1 year

Thanks everyone for your input!

**By the way, I realize that my PGY1 em year may not count, I'm totally okay with that, I'm just trying to switch I don't mind what it takes to get there. And I did rotate in anesthesia multiple times 2nd/3rd year, I have a couple letters and a couple mentors, I do have a strong interest.
Click to expand...

I made this swap (EM>Anes) and never looked back - very happy with that decision.

The good news:
1) You should get credit for most/all of your intern year. There are some requirements that EM may not meet (I ended up having to do an extra 2 months of residency), but most of it should count.
2) Anesthesia has a long history of taking surgical trainees who "see the light" - and most programs have the ability to take 1-2 "immediate start" residents who have completed an intern year.

The bad news: you will need support of your PD in order to make the swap, and if they already needed SOAP to fill they are likely to view losing a resident as a big problem (since they cannot easily fill your spot). They are likely to be upset at you SOAPing in and then immediately heading for the exit, even if you work your ass off and are the best resident they've ever had. Every program will want a PD letter to even consider your application. You will have to go back through the match.

Hard to know what the best play is here. You would need to approach your PD by October-ish at the latest to get your ducks in a row in time for the match. There's a non-zero chance they decide that it's better for them to try and burn you to the ground and force you to stay than find another warm body when they already had to SOAP to fill. They also have the option to go ahead and fill your spot (leaving you jobless if you don't match), but that may be a hollow threat depending on how much trouble they have recruiting.

The safer play is probably to apply as an EM PGY-2 (you have time to build up some cred with your PD and it doesn't look like you matched just to run for the exits), but you lose a year of your life.


Also, FWIW: you're probably identifiable from this post. I might delete your goal specialty from your original post to decrease that risk.
 
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We are not here to bash other specialists. I think EM is still a great career choice. Things happen in life for various reasons.

The universe is amazing and life works out for most of us out there. I’m sure half of us around 2016 wished we were someone else besides anesthesia with a bad job market and EM is on the up and up.
 
aneftp said:
We are not here to bash other specialists. I think EM is still a great career choice. Things happen in life for various reasons.

The universe is amazing and life works out for most of us out there. I’m sure half of us around 2016 wished we were someone else besides anesthesia with a bad job market and EM is on the up and up.
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by 2016 the anesthesia market was recovering as more jobs were opening up. 2011-2015, there wasnt a good job to come by easily at all locums or perm. I remember CompHealth called me and said they had 1 permanent anesthesiology job listing in the entire country if i was interested. Actually, the job market turned right around the same time that Mednax was booted out of the Charlotte NC practice. That is when things started opening up in earnest.
 
EM match was decent this year.

www.acep.org

Match Results Amplify Enthusiasm for EM

A record number of medical students matched into emergency medicine, according to results released Friday by the National Resident Matching Program. More than 3,000 applicants matched into the specialty. Read more about this year's Match results.
www.acep.org www.acep.org
 
cittykat said:
EM match was decent this year.

www.acep.org

Match Results Amplify Enthusiasm for EM

A record number of medical students matched into emergency medicine, according to results released Friday by the National Resident Matching Program. More than 3,000 applicants matched into the specialty. Read more about this year's Match results.
www.acep.org www.acep.org
Click to expand...
65 unfilled, while not 500+ from a few years ago, it’s hard to know how competitive these spots are until charting the outcomes is released in the Fall with step scores, AMG/IMG spread etc. It’s well established that EM expanded residency slots way, way too quickly and many new programs at for-profit hospitals are sketchy. They dodged a bullet avoiding increasing their training from 3–>4 years recently as well, that would have been a disaster.

I imagine as preferences change the shift work mentality will continue to be very attractive. Problem with EM as opposed to every other specialty is mornings are the least busy and afternoons/evenings/weekends are the busiest, shifts that many don’t want to work.

Compare to anesthesia with thousands of positions and *ZERO* open spots. It’s remarkably competitive regardless of the curmudgeonly voices on this forum.
 
Hospitals are sponsoring more and more residencies and more AA and srna programs popping up. I don’t know how long the market will be like this. 2030/2031 will be a time I don’t see myself working more than 2-3 days here or there
 
ER can be good gig if you don’t care too much. If every little thing bothers you it will be stressful. There’s a lot you can’t control in the ER unlike the OR. Can make 300-350/hr 1099 though. 325 x144x 12=561,600. Good money.
 
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ERRES2288 said:
ER can be good gig if you don’t care too much. If every little thing bothers you it will be stressful. There’s a lot you can’t control in the ER unlike the OR. Can make 300-350/hr 1099 though. 325 x144x 12=561,600. Good money.
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And no “calls” in EM

Every shift in EM pays

Unlike anesthesia “beeper” calls/or even backup calls.

Anesthesia people are suckers for beeper and backup paid essentially equivalent of $50/hr in many places
 
aneftp said:
Hospitals are sponsoring more and more residencies and more AA and srna programs popping up. I don’t know how long the market will be like this. 2030/2031 will be a time I don’t see myself working more than 2-3 days here or there
Click to expand...
Here is the issue: You need 3-4x the number of doctors(anesthesia) to cover the work on account of everyone who is working Part time, only nights, only days. Gone are the days where you interviewed for a job and you basically worked when they told you to work or you did not get the job or you weren't offered partnership. 60+ hours. part time work was hard to come by back in the day. Where we;re headed we need 3000-3500 graduates just to cover the work based on all the part timers and I am not even factoring the attrition. We don't have that, we have 1800 spots this year about. It's a complete mess.
The CRNAs are clamoring for independence based on all of the above information and the dummies in Washington salivating for a quick fix are like... OK.
But this clamoring is leading to MDs advocating for AA programs opening up.
 
aneftp said:
And no “calls” in EM

Every shift in EM pays

Unlike anesthesia “beeper” calls/or even backup calls.

Anesthesia people are suckers for beeper and backup paid essentially equivalent of $50/hr in many places
Click to expand...
That’s a hard value proposition for a hospital administrator. Think of a community hospital not a trauma or major OB center.

Your ED person has volume and work at all times generating RVUs/income/charges. Doing actual work every shift.

Your anesthesia person is sitting at home waiting for a call, generating zero revenue. Most nights certainly more than 50-75% there’s no call back. You think the call OR team sitting at home is getting full pay? Beware your wishes, if they are going to pay you expect liberalized add on policies overnight. This is why many/most places a have a beeper rate and a call back rate. As a full time person what’s important is you need to make sure you have that next day off after a call.
 
AdmiralChz said:
Your ED person has volume and work at all times generating RVUs/income/charges. Doing actual work every shift.
Click to expand...
That is not exactly true. There patient load ebbs and flows just like off-hours in the OR. In severe storms / bad weather I’ve seen non-trauma center EDs completely empty.

The only difference is 1) to what extent the expected load may be and 2) that EM people are physically in the building as there isn’t home beeper call.
 
NPJR said:
Here is the issue: You need 3-4x the number of doctors(anesthesia) to cover the work on account of everyone who is working Part time, only nights, only days. Gone are the days where you interviewed for a job and you basically worked when they told you to work or you did not get the job or you weren't offered partnership. 60+ hours. part time work was hard to come by back in the day. Where we;re headed we need 3000-3500 graduates just to cover the work based on all the part timers and I am not even factoring the attrition. We don't have that, we have 1800 spots this year about. It's a complete mess.
The CRNAs are clamoring for independence based on all of the above information and the dummies in Washington salivating for a quick fix are like... OK.
But this clamoring is leading to MDs advocating for AA programs opening up.
Click to expand...
Chaos is good!
AdmiralChz said:
That’s a hard value proposition for a hospital administrator. Think of a community hospital not a trauma or major OB center.

Your ED person has volume and work at all times generating RVUs/income/charges. Doing actual work every shift.

Your anesthesia person is sitting at home waiting for a call, generating zero revenue. Most nights certainly more than 50-75% there’s no call back. You think the call OR team sitting at home is getting full pay? Beware your wishes, if they are going to pay you expect liberalized add on policies overnight. This is why many/most places a have a beeper rate and a call back rate. As a full time person what’s important is you need to make sure you have that next day off after a call.
Click to expand...
but as other posters mention. ED at community hospitals have down time especially on weekend mornings.

There is downtime in their specialties as well.
 
sanityonleave said:
I made this swap (EM>Anes) and never looked back - very happy with that decision.

The good news:
1) You should get credit for most/all of your intern year. There are some requirements that EM may not meet (I ended up having to do an extra 2 months of residency), but most of it should count.
2) Anesthesia has a long history of taking surgical trainees who "see the light" - and most programs have the ability to take 1-2 "immediate start" residents who have completed an intern year.

The bad news: you will need support of your PD in order to make the swap, and if they already needed SOAP to fill they are likely to view losing a resident as a big problem (since they cannot easily fill your spot). They are likely to be upset at you SOAPing in and then immediately heading for the exit, even if you work your ass off and are the best resident they've ever had. Every program will want a PD letter to even consider your application. You will have to go back through the match.

Hard to know what the best play is here. You would need to approach your PD by October-ish at the latest to get your ducks in a row in time for the match. There's a non-zero chance they decide that it's better for them to try and burn you to the ground and force you to stay than find another warm body when they already had to SOAP to fill. They also have the option to go ahead and fill your spot (leaving you jobless if you don't match), but that may be a hollow threat depending on how much trouble they have recruiting.

The safer play is probably to apply as an EM PGY-2 (you have time to build up some cred with your PD and it doesn't look like you matched just to run for the exits), but you lose a year of your life.


Also, FWIW: you're probably identifiable from this post. I might delete your goal specialty from your original post to decrease that risk.
Click to expand...
Thank you so much for your reply! Do you mind if I reach out to you?
 
GolDRoger said:
Thank you so much for your reply! Do you mind if I reach out to you?
Click to expand...
It’s a different era of anesthesia. Much harder to switch to anesthesia these days. Open slots are slim and far in between

10-15 plus years ago. Chances of getting open anesthesia slot likely 30-40%. 30 years ago 100% chance of getting open slot.

These days you maybe have a 1-2% getting a slot.

Good luck

It’s not the end of the world.
 
I still maintain EM has a better future than Anesthesia. Unless they find a way to treat and deal with patients who dont have an emergency before they come to the emergency room. If they figure that out ER docs demand will plummett.
 
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NPJR said:
I still maintain EM has a better future than Anesthesia. Unless they find a way to treat and deal with patients who dont have an emergency before they come to the emergency room. If they figure that out ER docs demand will plummett.
Click to expand...
Why do you think that? Up to 60% of true hospital based ED visits are run of the mill symptoms that can be handled at urgent care centers staffed by NP and PA.

On the flip side

In the anesthesia world. Many Asa 1-3 GI centers are already crna only. Some bread and butter true asc with general cases are moving towards “collaborative” models where docs do their own cases and crnas do their own case. This has been going on for years.

But in my opinion there is room at the table for everyone. Our only saving grace (in the anesthesia world) is crnas are so greedy. More than arnp at the Emergency medicine level

Are arnp routinely getting paid $200/hr-250/hr to staff urgent care centers? Are arnp demanding $300-350/hr at emergency dept?

That’s what crnas are demanding. Or they won’t work.
 
aneftp said:
Why do you think that? Up to 60% of true hospital based ED visits are run of the mill symptoms that can be handled at urgent care centers staffed by NP and PA.

On the flip side

In the anesthesia world. Many Asa 1-3 GI centers are already crna only. Some bread and butter true asc with general cases are moving towards “collaborative” models where docs do their own cases and crnas do their own case. This has been going on for years.

But in my opinion there is room at the table for everyone. Our only saving grace (in the anesthesia world) is crnas are so greedy. More than arnp at the Emergency medicine level

Are arnp routinely getting paid $200/hr-250/hr to staff urgent care centers? Are arnp demanding $300-350/hr at emergency dept?

That’s what crnas are demanding. Or they won’t work.
Click to expand...
Collaborative practice wont take off like they want it to. The point of collaborative practice is for the anesthesiologist to have ultimate liability in something they have zero control of. Will be hard to sell en masse that to any MD with half a brain. Plus with collaborative practice the MD is not immediately available.

Our salaries are already in the toilet, what do you think is going to happen when the payors equate your work to a nurses'? Do you think they will give you a pay increase?
We will be all sitting stools (chained to the anesthesia machine) for 10 hours a day for nurses pay. At least the ER Docs have the ability to use the restroom or eat when they want. And they work 10 days a month.
 
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aneftp said:
Why do you think that? Up to 60% of true hospital based ED visits are run of the mill symptoms that can be handled at urgent care centers staffed by NP and PA.
Click to expand...
I do not think the number is that high 60%.

They are run of the mill symptoms to the NP but to someone who has any training there is something more sinister behind those symptoms. The task: FInd out what it is.

You think an NP can do that?
 
aneftp said:
Hospitals are sponsoring more and more residencies and more AA and srna programs popping up. I don’t know how long the market will be like this. 2030/2031 will be a time I don’t see myself working more than 2-3 days here or there
Click to expand...

Things don't change that quickly. I predict at least 10 to 15 good years possibly more as boomers retire
 
coffeebythelake said:
Things don't change that quickly. I predict at least 10 to 15 good years possibly more as boomers retire
Click to expand...
Boomers born between 1945-1964 (give or take)

So almost all qualify for full social security at age 67. The last cohort are just at social security age.

I don’t see more than 10% of them working full time in 10 years (the youngest boomer will be 72). Maybe 20-25% work part time but it’s so variable what part time means
 
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It’s like the stock market. No one really knows. Even the super extensive RAND studies are always wrong.
 
The biggest factor that will affect the future job market is the larger proportion of anesthesia residents graduating seeking family friendly jobs which will require that jobs are filled with 2 or more people whereas in the past it was filled with one dude who neglected his family for the sake of his medical carreer.
 
NPJR said:
The biggest factor that will affect the future job market is the larger proportion of anesthesia residents graduating seeking family friendly jobs which will require that jobs are filled with 2 or more people whereas in the past it was filled with one dude who neglected his family for the sake of his medical carreer.
Click to expand...
Absolutely, and I think that is more or less universally true amongst all of medicine (and white collar jobs in general) with the possible exception of some pathologic surgical sub specialties (cardiac and neuro come to mind).
 
NPJR said:
The biggest factor that will affect the future job market is the larger proportion of anesthesia residents graduating seeking family friendly jobs which will require that jobs are filled with 2 or more people whereas in the past it was filled with one dude who neglected his family for the sake of his medical carreer.
Click to expand...
100%
 
coffeebythelake said:
Why not? Increasing medical utilization as boomers age, same boomers leaving workforce, and relatively small workforce even with ramping up which doesn't happen instantly.
Click to expand...

I don't think you can say that the anesthesia job market will be good for another 10-15 years and point to the macroeconomic factors in play as the sole underlying reasons. That's just too simple cause & effect analysis. There are always lots of little microeconomic things, often in play at each institution, that govern demand for our services. Faced with the workforce shortage, I am seeing hospitals do lots of flex scheduling. They're asking folks to come in later and work late to cover the rush of add-ons. They are very aggressive with block time utilization and will give and taketh away from underperforming surgeons. I've even seen them eliminate block times for entire surgical specialties which are producing the least economic value to the health system. They are also changing the makeup of the anesthesia dept. by focusing more on care team models and replacing "no longer cheap" CRNA's with AA's. This also means hiring less docs. They are closing down OR's because they have calculated that hiring locums to staff them is not always cost effective. They are limiting cases booked after 3 pm because they refuse to pay OT to locums. You can replace locums with perm help, but you still have to pay those folks too if you expect them to work extra.

I come from a family of anesthesiologists (well, just my sister and I) and have followed the anesthesia workplace trends since the early 90's. Anesthesia has always been a cyclical job market. I don't believe it's different this time. I hope we don't go back to predatory AMC's and PP groups as the defacto jobs in our field. But the court may swing back in their favor the more crowded our field gets.

I think the ASA's prediction of 2032 as the year where there is a balanced job market is pretty much spot on. But that doesn't mean things will swiftly change come 2032. You will notice the suck coming on in the job market a few years earlier than that.

The last 5 years since the pandemic have been the greatest of my career. Locums has enabled me to earn enough to walk away if I wanted to at this point vs. my original expectation of working the next 15 years. But peak locums hiring has already passed and I see everyone tightening their belts. It will only get worse from here.
 
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GolDRoger said:
Hi everyone,

Wondering if I would have the possibility of switching into anesthesia from an emergency medicine categorical position. Today I soaped into an emergency medicine program. I initially applied to surg but went unmatched despite a great and strong application

I was honestly shocked to find out that I didn’t match as I had been told by multiple programs that I was ranked to match. Unfortunately that’s just the name of the game. I then decided to pivot into EM but since I was in such a state of shock, I didn’t give it much thought whether this is something I want to do or not. Now I’m locked in. Wondering if I would be able to pivot into anesthesia after my PGY1 year

Thanks everyone for your input!

**By the way, I realize that my PGY1 em year may not count, I'm totally okay with that, I'm just trying to switch I don't mind what it takes to get there. And I did rotate in anesthesia multiple times 2nd/3rd year, I have a couple letters and a couple mentors, I do have a strong interest.
Click to expand...
Ok, sit down and listen to me.

Are you ready? Listen to me.

1) It doesn't matter which specialty has a "better future." Emergency Medicine is Hell on Earth. If getting punched in the face for 10 straight hours were a medical specialty and had a "better future" than anesthesia, would you do it? Don't sign up for a career of getting punched in your face for 10 straight hours.

2) Never ever EVER forget the Golden Rule of the EM/Anesthesiology debate:
Your absolutely worst day in Anesthesiology is still better than your best day working in the Emergency Department.
NEVER FORGET THIS.

3) Lastly, Anesthesia residencies have droves of washouts from other fields. In my residency class alone, we had a Pediatrician, Ob/Gyn, and ER doc, all board certified, and all switching fields into Anesthesia. You don't see this much in the other direction to other specialities, and when you it's usually a problem child, ie drugs or a dysfunctional lost confused person searching for something.

Send me a message.
You'll remember this post decades later and say, Wow that unknown guy on SDN saved my life.
 
Do whatever makes you happy and things always work out.

30 yrs ago, I was deciding between EM vs Anesthesiology vs radiology. Decided on EM but 3 yrs in, had the itch to go into radiology.

400k/yr income x 5 yrs was too much to stomach. Fast forward 20 yrs, essentially retired at 50 working 2 dys/month.

Point is you can't predict the future. Do what you enjoy and things always work out. Just like the stock market, can't market time. A hot field today is a crappy field tomorrow. If you like Anesthesiology and hate EM, switch. If you are switching b/c you think the $$$ is better, you will regret it.
 
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