Switching from Psych to Anesthesia - Advice?

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yanks26dmb

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Currently an intern at a fairly well-regarded University psych program (unfortunately no anesthesia program here). I was torn between anesthesia and psych for a while, I ultimately picked psych because I thought I'd enjoy the interpersonal aspects of psychiatry more than the hands on/physiology of anesthesia. While I still really enjoy psychiatry, I can't help but feel like a social worker or an adult baby sitter a lot of times. I could be happy enough doing psych, but I think the nature of anesthesia, the ability to earn more are pulling me hard right now. I'm guessing I'd have a lesser quality of life in anesthesia though(?) Any thoughts/advice?
 
Like being on night call? Working weekends and holidays? Working for a corporation? Hospital administrators and corporate anesthesia directors deciding how hard you’re gonna work? Mid-levels running around, saying they know as much and can perform as well as you? Hey, man, tear your azz...

(There’s the “pessimistic” view...)
 
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Haha Salty. So true. Most on this board know I wanted to be a shrink and changed my mind last minute. I still regret it often. Money is not everything and a nice lifestyle beats working like a dog for more money anyday.
Besides, these days I see locum psych jobs making the same per hour as I am. The money for psych is getting really good. And you can work for yourself and make your own schedule and answer to no surgeons, and no administrators.
DO NOT SWITCH!!!
My two cents.
 
dhb said:
You have to look further than what you do in residency.
If you end up working in your office you'll not be doing so much social work and if you work in a hospital interns will be doing the scut work...
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It's not even the scut work itself. We have social work at my hospital who handle everything. It's moreso the fact half the problems our patients have are social work related. It feels like we're there to give them a pill and continue to hospitalize while we wait for social work to figure out their living, etc situation. It just doesn't seem like we do very much in a lot of cases.
 
chocomorsel said:
Haha Salty. So true. Most on this board know I wanted to be a shrink and changed my mind last minute. I still regret it often. Money is not everything and a nice lifestyle beats working like a dog for more money anyday.
Besides, these days I see locum psych jobs making the same per hour as I am. The money for psych is getting really good. And you can work for yourself and make your own schedule and answer to no surgeons, and no administrators.
DO NOT SWITCH!!!
My two cents.
Click to expand...
As is often the case, I wholeheartedly agree with you.
 
I know one psychiatrist working at a hospital and nursing home pulling in close to 500k in total. There is definitely money to be made in psych especially now with the market being hot. It just depends on how you hustle and how much you want to work.

Also, if you switch, you might have to do intern year over again since most psych programs do 6 months of psych their first year and this will not be transferable if you do anesthesiology.
 
When medical students ask the question "Psych or Anesthesia, which should I choose?", I always recommend Psych, at least because they need to have their heads checked anyway. Absolutely different beasts. Now Psych vs IM I can get.

The only way I can see Psych and Anesthesia in the same sentence is with people who still believe that anesthesiology is a lifestyle specialty. Which it isn't; quite the opposite.

So, regardless of the CRNA menace, I would think looooong and hard whether anesthesiology is the right specialty to switch into. I would try to figure out better my own personality (disorder) and see what specialty would fit it best.

For example, I am a pretty good anesthesiologist (and physician) knowledge-wise, but I don't kowtow to surgeons, nurses and other healthcare workers, and I couldn't care less about procedures (they are a means to an end). All of these make me a good intensivist, and the ICU is my happy place (even if I have to stay late), but I am definitely a bad fit for American ORs and butt-kissing. The more healthcare workers and "team" crap I have to deal with, and the more lack of respect I have to fight, the unhappier I am; I am an old school doctor who mostly cares only (and a lot) about his patients. I would have probably been super happy in concierge IM. What's YOUR head problem?
 
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I was good at psych and the lifestyle was appealing during internship. Found it pretty interesting at the start too. However, I felt like a complete fraud of a doctor doing psych (I get they're not frauds, that's just how I felt). Spend the entire day on my arse, can't put in a cannula, prescribe drugs I have no idea how they work/what they interact with, surrounded by personality disorders clogging up actual sick people, everything gets put off till tomorrow, nothing ever changes, so many patients deteriorating slowly over years and nothing to be done to help, no immediate gratification. My main issue was being surrounded by depressed people made me feel depressed.

Swapping to anaesthesia was the best thing I ever did.
 
twospadz said:
Also, if you switch, you might have to do intern year over again since most psych programs do 6 months of psych their first year and this will not be transferable if you do anesthesiology.
Click to expand...

Mostly true! You’ll have to make sure you fulfill RRC requirements with so many rotations in IM, Peds and EM (1 month for the latter two). It is VERY flexible how to fulfill that, and nearly all that come into our program as a CA-1 from another field just had these rotations built into their first year and got less elective time at the end.

We had someone that went the reverse, from anesthesia to psych (wasn’t cut out for on-the-second decisions, to be kind.............) - he had to redo much of his intern year because the surgical-based PGY-1 didn’t cross over as much.

We’ve kept in touch. He works much more than me (during the week) with no weekends, and makes quite a bit less. In the phase of establishing your outpatient practice, i don’t think many would argue it’s a “lifestyle” specialty. He takes 2 weeks off a year and has entertained just taking 1 - it’s a significant loss of income. This will change of course with time as his practice becomes more established and he doesn’t need to bust his butt as much. We are both very happy, though. Different strokes.
 
yanks26dmb said:
It's not even the scut work itself. We have social work at my hospital who handle everything. It's moreso the fact half the problems our patients have are social work related. It feels like we're there to give them a pill and continue to hospitalize while we wait for social work to figure out their living, etc situation. It just doesn't seem like we do very much in a lot of cases.
Click to expand...
This is the nature of the inpatient heavy first two years of psych. Some programs have more mood disorder type units where you will see greater improvement in patients or just a different flare of personality disorders. As taxing as these exposures are, life gets better in psych, but you do need these exposures to see the complete range of psychiatric severity. So when you are out on your own doing XYZ, you'll think to yourself "I got this" or better yet, when the patients come to you because their psychologist who only trained on the worried well tells them they have bipolar, you can correct that and point out no its not bipolar but mild severity borderline PD.

There are some hospitals in different locations where the percentage will be less of the severe mentally ill (social work housing dispositions) and more of acute safety concerns to treat their depression; higher functioning population. You will eventually see patients get better. ECT works wonders. Suboxone works wonders. Getting people who snore (OSA) on CPAP works wonders. In general, patients can and do get better. My current private practice, I enjoy going to work every day and love the freedom, flexibility, no hospital politics, no admin to deal with, etc. 70% or more of my patients are improving, and only smaller fraction are simmering with pathology XYZ.

woopedazz said:
I was good at psych and the lifestyle was appealing during internship. Found it pretty interesting at the start too. However, I felt like a complete fraud of a doctor doing psych (I get they're not frauds, that's just how I felt). Spend the entire day on my arse, can't put in a cannula, prescribe drugs I have no idea how they work/what they interact with, surrounded by personality disorders clogging up actual sick people, everything gets put off till tomorrow, nothing ever changes, so many patients deteriorating slowly over years and nothing to be done to help, no immediate gratification. My main issue was being surrounded by depressed people made me feel depressed.

Swapping to anaesthesia was the best thing I ever did.
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Sorry that was your experience, depression does and can get better. One of my favorite conditions to treat.
 
I have a buddy who is a psychiatrist and I am so envious. Never an emergent case. Call can sometimes be handled over the phone and patient seen next day. Hours can be long, but never crazy. Gets over 250k. I would choose that in a heartbeat over what I'm doing
 
I liked psych in med school and I think most of my classmates enjoyed the rotation even if it wasn’t ultimately for us as a career. Our attendings were notoriously entertaining to round with.

I liked most of my rotations, including OB, yet I couldn’t be happier ending up in anesthesia. As others have said on this board, you need to separate out what you are a good fit for and not just be convinced by a charismatic or a generally well liked attending to spend a life time in a specialty that you may not belong in.

Don’t let people convince you that if you’re a happy person, like your rotations, and have an interest in multiple specialties, that that’s a negative for you. Talk to people in real life and figure out who you actually want to be like in the future.
 
dabears505 said:
I have a buddy who is a psychiatrist and I am so envious. Never an emergent case. Call can sometimes be handled over the phone and patient seen next day. Hours can be long, but never crazy. Gets over 250k. I would choose that in a heartbeat over what I'm doing
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If all you want is 250k there are plenty of mommy track anesthesia jobs out there.
 
My two cents, as someone who dropped out of anesthesia residency and is now in psychiatry residency..

This is a really difficult question to answer because it depends on you.

For me, the OR and procedures were incredibly stressful and I didn't enjoy the increased cortisol levels of always worrying and waiting for something to go wrong at a moment's notice. I was a good medical student but just wasn't suited for anesthesia. My life now is soooooo much easier and lower stress, it's not even comparable. There's practically nothing that happens in psychiatry that stresses me out. I see my coresidents stress out about things which to me seem laughable. There's borderline patients and agitated patients, whatever. You click a few buttons in the EMR to order Haldol and restraints, or set boundaries and keep a straight face while they throw a tantrum. It's hard to be an excellent psychiatrist, and I find therapy challenging, but to do the basic day to day work without killing people is incredibly easy compared to anesthesia.

If you go from psychiatry to anesthesia you may regret that you've made your life much more stressful. I go home every day laughing about how easy my life is now compared to when I was doing anesthesia. It sucks that I'm not making attending money yet like my friends, but I'm very happy with my lifestyle overall and moonlighting is just around the corner to let me buy some toys.
 
neverdone said:
My two cents, as someone who dropped out of anesthesia residency and is now in psychiatry residency..

This is a really difficult question to answer because it depends on you.

For me, the OR and procedures were incredibly stressful and I didn't enjoy the increased cortisol levels of always worrying and waiting for something to go wrong at a moment's notice. I was a good medical student but just wasn't suited for anesthesia. My life now is soooooo much easier and lower stress, it's not even comparable. There's practically nothing that happens in psychiatry that stresses me out. I see my coresidents stress out about things which to me seem laughable. There's borderline patients and agitated patients, whatever. You click a few buttons in the EMR to order Haldol and restraints, or set boundaries and keep a straight face while they throw a tantrum. It's hard to be an excellent psychiatrist, and I find therapy challenging, but to do the basic day to day work without killing people is incredibly easy compared to anesthesia.

If you go from psychiatry to anesthesia you may regret that you've made your life much more stressful. I go home every day laughing about how easy my life is now compared to when I was doing anesthesia. It sucks that I'm not making attending money yet like my friends, but I'm very happy with my lifestyle overall and moonlighting is just around the corner to let me buy some toys.
Click to expand...


A different kind of stress in anesthesia😉

forums.studentdoctor.net

How to end a conversation with a patient?

Something that I've been pondering. How do you guys finish off a conversation with a patient after an anesthetic or during a post-op PACU check? I'm a 'see you later' kind of guy in normal conversation, but obviously in our line of work I don't think out patient would want to have to see the OR...
forums.studentdoctor.net forums.studentdoctor.net
 
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