Switching into Anesthesiology

[Gator1990]

Hey everyone,

New to the forum here but have been reading for years for advice.

I’m currently an EM resident - PGY-1, but am realizing that EM just isn’t for me (its a lot of stuff that I don’t want to delve into). I seriously considered anesthesia during my 4th year of medical school but allowed my fears of encroachment, job security etc. to take over which I know is stupid. The only specialties I contemplated at the time were Em and anesthesia. So I just wanted some advice on how to go about applying to anesthesia for advanced applicants? Or if any others have done it if they could share any helpful information. I’m terrified of letting my PD know and just want to make sure i have a game plan before approaching him. Any helpful advice would be greatly appreciated. Thanks guys

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[mostwanted]

If you have an anesthesia dept, start by getting in touch with them and see if they have accepted any people in your predicament.


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[CUBR]

Get in touch with the PD of your anesthesia program at your hospital. Our program takes one advanced applicant a year, the last couple years have been people from other specialties in our hospital. If you have a good current PD, he or she should have your best interest in mind, so if this is what you really want to do, he or she should be supportive since I don't think they want to work with an unhappy resident. I would also do some additional anesthesia rotations if possible to 1. make sure anesthesia is right 2. show your abilities and interest. In the meantime, keep working hard in the ED.

 

[Mazshax]

I agree with everything suggested above, but I wanted to add a couple of things that may effect your planning.

1. If you go through the match next year and apply for advanced positions, keep in mind that those will be for a PGY-2 position starting the NEXT July. i.e. the advanced positions matched in March 2019 will start in July 2020, which would actually be immediately after you finished you EM residency. It may be worth looking into R positions, which are the same as advanced positions, but start the same year. (July 2019 in the previous example) It is possible, although unlikely that there is an unfilled R position is out there for July 2018. Something could pop up right at the beginning of July if a resident no-shows for some reason.

2. It is possible that your intern year will not count as a CBY for anesthesia. I'll paste the stated requirements:
"At least six months of fundamental clinical skills of medicine education must include experience in caring for inpatients in family medicine, internal medicine, neurology, obstetrics and gynecology, pediatrics, surgery or any of the surgical specialties, or any combination of these.
During the first 12 months of the program, there must be at least one month, but not more than two month(s) each of critical care and emergency medicine."

There is usually some flexibility in what is considered a qualifying intern year, but you would have to clarify with any program that you were applying to.

 

[Gator1990]

Thank you all for your help and advice. Unfortunately there isn’t an anesthesia program where I’m at. I will still continue to try and hope for the best

 

[Twiggidy]

Can I just add as a thinking point? .......You're worry about encroachment isn't completely insignificant. It's a real thing in this field. That's one thing. I honestly would encourage you to really think things through and think about ALL your post residency options. Residency sucks for all fields and I'm sure ER is included but you're life as an ER attending, especially in private practice, will be much different than as a resident. Also research all the career options available for ER doctors post residency. It's not just working it ERs and I'd argue you may have more flexibility for interesting jobs than an anesthesiologists. Just make sure your switch to anesthesia is for the right reasons because I think it can be sugar coated during med school. My rotation in med school was literally "intubating room to room and home by noon"........that is NOT anesthesia.

 

[rakotomazoto]

My rotation in med school was literally "intubating room to room and home by noon"........that is NOT anesthesia.

Soo true! Anesthesiology is a great field, but med students don't usually get the best sense of what it will really be like. Today I am doing a 12 hour ENT case. Very exciting for the first hour, but then long periods of monitoring. And surgeons run the OR's, don't let anyone deceive you. They own the patient, not you. Mid levels are everywhere. There are plenty of potential downsides.

But for me and many others, I think it is a great fit and I have no regrets. I considered EM among other things and I think it also has the potential to be a nice specialty or pretty awful, depending on the details. Switching specialties will solve some of your problems, but might lead to others, some unanticipated.

 

[chocomorsel]

Gonna agree with a couple of the other posts. Why?
Stay put, and do some kinda fellowship or something. This field, like many other fields has its issues. You are trading one set of drama for another. At least in the ER, you are your own captain.
As many people on here act like being at the beck and call of a scalpel jock, and not being their equal is not a big deal because “we laugh all the way to the bank”, trust and believe that s hit does get to anyone who’s an adult, works hard and has a spine.

I am counting the days when you will hardly find me in the OR. I got some PGY something trying to give me a smart ass mouth and I am about to let her know some s hit soon as this case is over.

Sure there are those magical practices out there where the surgeons are awesome and always polite, don’t treat you like you are beneath them, are understanding when you have to cancel a case or don’t turn over the room in time, but I guarantee you those are in the minority.

Stick to the ER, do your 14 shifts a month, make bank and wash, rinse, repeat. Medicine overall is starting to suck and there is no greener pasture.

 

[chocomorsel]

Oh, and of course let’s not forget our lovely CRNA friends who love and respect us so much.

 

[Young Chi]

If one went into anesthesiology with the intent of completing a fellowship (cardiac, icu, or pain), would these "respect" issues still be as pronounced?

 

[lverbmb]

Caveat I’m still a resident (pgy4) but I really think how you get treated in the operating room or anywhere else in the hospital depends mainly on you. Be vested in the case, speak up in a diplomatic way, know the patient as well as the surgeon does, and make suggestions for the good of the patient and I feel surgeons (even difficult ones) will at least leave you alone. I wouldn’t choose any other speciality to do- and I do have experience in other specialities as I’m in one of the double board programs. I’ve seen things in the OR that I think is bad form and basically showing the rest of the room that you aren’t vested in the case (you can imagine... pulling out a book to read, opening a personal lap top and sitting with your back to the monitor). I make a point to know what part of the case we are at at all times and stand and stare over the drapes during critical times. Some anesthesiologist are really passive aggressive and I feel that isn’t necessarily the way to win respect (although it is instant feel good sometimes).

In my residency program we have a lot of people who have switched in or finished another residency- all of them could have done any subspecialty they wanted (IM trained one from UCSF and one from Stanford, a general surgery switch in and a pediatric intensivist from Hopkins). None of them regret switching into anesthesia so I think that is something to be said.

I know people will probably harp on me for still being a resident but I love the job- I love long cases, I love high turn over short cases. I encourage people interested in the field to really check it out. In a past life I was an ED charge nurse... I wouldn’t do ED ever...

 

[Man o War]

Caveat I’m still a resident (pgy4) but I really think how you get treated in the operating room or anywhere else in the hospital depends mainly on you. Be vested in the case, speak up in a diplomatic way, know the patient as well as the surgeon does, and make suggestions for the good of the patient and I feel surgeons (even difficult ones) will at least leave you alone. I wouldn’t choose any other speciality to do- and I do have experience in other specialities as I’m in one of the double board programs. I’ve seen things in the OR that I think is bad form and basically showing the rest of the room that you aren’t vested in the case (you can imagine... pulling out a book to read, opening a personal lap top and sitting with your back to the monitor). I make a point to know what part of the case we are at at all times and stand and stare over the drapes during critical times. Some anesthesiologist are really passive aggressive and I feel that isn’t necessarily the way to win respect (although it is instant feel good sometimes).

In my residency program we have a lot of people who have switched in or finished another residency- all of them could have done any subspecialty they wanted (IM trained one from UCSF and one from Stanford, a general surgery switch in and a pediatric intensivist from Hopkins). None of them regret switching into anesthesia so I think that is something to be said.

I know people will probably harp on me for still being a resident but I love the job- I love long cases, I love high turn over short cases. I encourage people interested in the field to really check it out. In a past life I was an ED charge nurse... I wouldn’t do ED ever...

THIS. And I’ve been doing this for a long time.
Much like in life, you will work with people who just suck and treat you like crap. They treat everyone that way. You don’t have to be a door mat.

 

[Dr.whom]

The surgeon may bring the patient to the OR, but once you are involved, that is your patient too. As long as patient care is your priority, you never have to let the surgeon tell you what to do. They can’t do surgery without anesthesia and we’re not as replaceable as some people here lead you to believe. The key is to be with a group who will have each other’s backs.

Regardless, most surgeons out in private practice are quite cordial and will understand if you have issues with a case. Most surgeons I work with wants what’s best for their patients.

 

[Twiggidy]

If one went into anesthesiology with the intent of completing a fellowship (cardiac, icu, or pain), would these "respect" issues still be as pronounced?

no one cares about your fellowship....trust me, as someone who did a fellowship. most practices want a warm body that won't kill the patient.

 

[Twiggidy]

The surgeon may bring the patient to the OR, but once you are involved, that is your patient too. As long as patient care is your priority, you never have to let the surgeon tell you what to do. They can’t do surgery without anesthesia and we’re not as replaceable as some people here lead you to believe. The key is to be with a group who will have each other’s backs.

Regardless, most surgeons out in private practice are quite cordial and will understand if you have issues with a case. Most surgeons I work with wants what’s best for their patients.

It's fine and statements like these are for the most part true, but let us not forget we are a service industry. Put up enough resistance and you become a disruption, and disruptions are expendable, especially in places where supply outweighs demand.

 

[anbuitachi]

If one went into anesthesiology with the intent of completing a fellowship (cardiac, icu, or pain), would these "respect" issues still be as pronounced?

I would say yes. Because if you do ICU or pain, you can completely change your practice. There'd be no CRNAs disrespecting you. if you open your own pain clinic, you are probably the boss.. If you are the ICU attending, you may still get the usual disrespect from surgeons, but not the CRNAs. But then again, who is going to do a yr of fellowship just for the possibility of having more respect?

 

[Twiggidy]

If one went into anesthesiology with the intent of completing a fellowship (cardiac, icu, or pain), would these "respect" issues still be as pronounced?

these are tickets OUT of the OR and ways to be your own boss. Peds/Cardiac you have to maintain a balance of keeping surgeons happy and not killing patients. Usually those two things are easily maintained....sometimes not (see thread about ASA status and the discussion of OB and NPO status)

 

[deleted171991]

If one went into anesthesiology with the intent of completing a fellowship (cardiac, icu, or pain), would these "respect" issues still be as pronounced?

Yep! Except maybe for pain. If you don't own patients you are NOT a doctor, in the eyes of the administrators (the only people who matter) and that penetrates the way everybody in the hospital sees you, especially if your group employs CRNAs. You are a doctor mostly for the 5 minutes after you saved the surgeon's butt. And their memory is short. Unless you are part of a strong anesthesiology group, nobody really gives a crap, not more than one gives about radiologists, for example. You are a faceless tech. Maybe one they are friends with, but don't allow yourself to be fooled.

Critical care after anesthesia is a ticket to nowhere. It maybe nicer outside of the OR but, unless you work in a closed ICU, you are not so far from being just another one of the surgeons' bitches (and anesthesia still pays better). And the lifestyle sucks, unless your ICU is a joke or you have good fellows. It's beautiful medicine though, nothing more interesting in anesthesia, nothing!

Medicine nowadays is just a job, i.e. the place where you work to pay your bills. Don't look for happiness in medicine, it's not there anymore. Anesthesia is not any different. Make bank while you can and, when you become financially independent, find a career that makes you happy, or just spend time with your family.

 

[deleted171991]

Caveat I’m still a resident (pgy4) but I really think how you get treated in the operating room or anywhere else in the hospital depends mainly on you. Be vested in the case, speak up in a diplomatic way, know the patient as well as the surgeon does, and make suggestions for the good of the patient and I feel surgeons (even difficult ones) will at least leave you alone. I wouldn’t choose any other speciality to do- and I do have experience in other specialities as I’m in one of the double board programs. I’ve seen things in the OR that I think is bad form and basically showing the rest of the room that you aren’t vested in the case (you can imagine... pulling out a book to read, opening a personal lap top and sitting with your back to the monitor). I make a point to know what part of the case we are at at all times and stand and stare over the drapes during critical times. Some anesthesiologist are really passive aggressive and I feel that isn’t necessarily the way to win respect (although it is instant feel good sometimes).

In my residency program we have a lot of people who have switched in or finished another residency- all of them could have done any subspecialty they wanted (IM trained one from UCSF and one from Stanford, a general surgery switch in and a pediatric intensivist from Hopkins). None of them regret switching into anesthesia so I think that is something to be said.

I know people will probably harp on me for still being a resident but I love the job- I love long cases, I love high turn over short cases. I encourage people interested in the field to really check it out. In a past life I was an ED charge nurse... Iwouldn’t do ED ever...

Good luck to you!

There are basically two kinds of people who are not vested: those who have never been (the garbage who shouldn't be in healthcare, many with more than two letters after their names) and those who are not anymore. And let me tell you, more people belong to the latter group than you'd imagine as a resident (it's called burnout). Why? Because they have seen, again and again, that nobody really gives a **** about how "vested" you are, not even the patients. You are the tech that puts people to sleep and allows the surgeons to do their jobs. Part of the OR staff (circulators, scrub techs, cleaning people etc.). Don't fool yourself. It's a job; you may make much more than the barista at Starbucks, but you're not seen as much different (just more educated). The only time you are more than that is if you work in a market/job where you are difficult to replace. I have met surgeons who "forget" who I am the moment their patients are out of my ICU. Nobody really cares if you are much better than good enough; they only care if you do what they want, cut corners for them and kiss their butts.

Let me quote you an interaction with one of the scrub techs (I am middle-aged and board-certified in anesthesia and critical care): "What's your name? Dr. FFP. No, not that. I mean your first name." And this is an uneducated tech. She would never have the guts to talk to a surgeon like that. We are so stupid, as a specialty...

And I am not old enough to have forgotten the times when I was a wide-eyed resident myself, and the world was my oyster. It's just that there aren't enough patients getting hurt anymore for people to care about anesthesiologists in the real world.

 

[skankhunt42]

Man I feel a strong ass rant coming on...but I will try to keep it productive and cordial.

I used to do Emergency Medicine as an attending. I finished my first residency and now I am doing my second residency in Anesthesia. I love it and don't regret my decision to take the plunge again.

I could rant long and hard on people railing on the field of anesthesiology here. But remember- 1 the average SDN poster is a bit cynical. And two, people who have only done anesthesia really lack perspective. Sure they will bitch about mean surgeons or scrub techs calling them by their first names. But they never dealt with drug seekers in the ER, juggling 12 patients at once. Having an angry family demand there febrile child be admitted for further testing etc. A rough day in the OR does not comapir remotely to a rough day in the ER for me. Albiet I am just an Anesthesia resident so my perspective may shift as a gas attending. But I challenge everyone here to find ONE person who switched from something into Gas and regrets it.

My advice to you is go for it and switch. But for a variety of reasons, I would ask you to consider long and hard finishing your EM residency. For one, when you apply to Anesthesia next year, you will be faced with choosing advanced spots (start a year later) or Physician only (immediate start in that July.)

Physician only spots (what I did) are actually surprisingly competitive. You are up against IM/ CC fellows having a change in heart, surgeons who are 3 years in having a change of heart, people who have completed IM/Peds. Moreover, there are many less spots- something like 25 programs nationwide do this.

Next year if you apply for an advanced spot, you are competing against Med4's. As someone who has walked the walk, you would be highly coveted and valued havng (I assume) done well in your EM program. This way you keep your PD on your side as you send a message you are not a quitter.

Then the big bonus will be- you will be boarded in EM. You can moonlight 1x per month and double your salary. And the EM board is like a life vest, if truly the CRNA's take everyone's job like people warn you about.

PM me if you want to talk more.

 

[DeadSpace]

Then the big bonus will be- you will be boarded in EM. You can moonlight 1x per month and double your salary. And the EM board is like a life vest, if truly the CRNA's take everyone's job like people warn you about.

Very solid advice. That's the problem with anesthesia, we all need a plan B in mind before starting residency. This may be the saddest part of choosing this specialty.

 

[AdmiralChz]

Very solid advice. That's the problem with anesthesia, we all need a plan B in mind before starting residency. This may be the saddest part of choosing this specialty.

I think that’s a bit excessive, I don’t have a plan B and am totally fine with it. Do a fellowship if you’re that scared of the world. But regardless we have much better job security and longevity than the majority of other professional jobs, or even primary care jobs.

I moonlight in an ED now for extra $ in fellowship, I cannot wait to never have to work there again. The procedures and sick patients are worth it... but the drug seekers, psych problems and non-emergency cases are draining to say the least. Plus, most shifts are afternoons or nights. No thanks!

 

[chocomorsel]

Caveat I’m still a resident (pgy4) but I really think how you get treated in the operating room or anywhere else in the hospital depends mainly on you. Be vested in the case, speak up in a diplomatic way, know the patient as well as the surgeon does, and make suggestions for the good of the patient and I feel surgeons (even difficult ones) will at least leave you alone. I wouldn’t choose any other speciality to do- and I do have experience in other specialities as I’m in one of the double board programs. I’ve seen things in the OR that I think is bad form and basically showing the rest of the room that you aren’t vested in the case (you can imagine... pulling out a book to read, opening a personal lap top and sitting with your back to the monitor). I make a point to know what part of the case we are at at all times and stand and stare over the drapes during critical times. Some anesthesiologist are really passive aggressive and I feel that isn’t necessarily the way to win respect (although it is instant feel good sometimes).

In my residency program we have a lot of people who have switched in or finished another residency- all of them could have done any subspecialty they wanted (IM trained one from UCSF and one from Stanford, a general surgery switch in and a pediatric intensivist from Hopkins). None of them regret switching into anesthesia so I think that is something to be said.

I know people will probably harp on me for still being a resident but I love the job- I love long cases, I love high turn over short cases. I encourage people interested in the field to really check it out. In a past life I was an ED charge nurse... I wouldn’t do ED ever...

Meh.... Give it a few years. You will see.

You can only stand up for yourself for only so long if your superiors don't back you up. Then as stated you will be seen as the problem. Not the surgeon.

And also, what the hell else am I supposed to do on long, boring, two hour cases or longer? Look at the screen for hours on end? Bull**** with the surgeon about their golf game and vacations the whole time? They are actually doing something that requires more than just listening to beep, beep, beep..... and the q5 minute ding!!!!

What the hell else does one do besides read? I do squats sometimes. But come on. You are still green and looking at the world through rose colored glasses.

And FYI, any decent anesthesiologist more often than not know their patients BETTER than the surgeon. We actually read the charts and review the tests that they or we have ordered.

You are replaceable technician and a cog in the wheel to plenty of surgeons and administrators. They care about you very rarely. And I am cordial, nice goofy person and far from passive aggressive. However, I don't go out of my way to kiss anyone's ass or brown nose which surgeons thrive on and which often lead to a nice buddy buddy relationship. And when crossed or yelled at I do tend to fire back. But that **** wears you down mentally. Constantly having to be on the defense.

I do know really nice, non arrogant surgeons. They are usually OMFS or Podiatrists. But best believe they are in the minority. The field just doesn't attract many nice people and that's the real truth.

 

[chocomorsel]

What are the fellowships ER docs can do besides ICU and Peds?

 

[Twiggidy]

Medicine nowadays is just a job

should be on a banner outside of every medical school

 

[Twiggidy]

Let me quote you an interaction with one of the scrub techs (I am middle-aged and board-certified in anesthesia and critical care): "What's your name? Dr. FFP. No, not that. I mean your first name." And this is an uneducated tech. She would never have the guts to talk to a surgeon like that. We are so stupid, as a specialty...

This.....

 

[W19]

Good luck to you!

Let me quote you an interaction with one of the scrub techs (I am middle-aged and board-certified in anesthesia and critical care): "What's your name? Dr. FFP. No, not that. I mean your first name." And this is an uneducated tech. She would never have the guts to talk to a surgeon like that. We are so stupid, as a specialty...

And I am not old enough to have forgotten the times when I was a wide-eyed resident myself, and the world was my oyster. It's just that there aren't enough patients getting hurt anymore for people to care about anesthesiologists in the real world.

Some people are just rude... What make you think the tech would never talk to a surgeon like that? What should the specialty do to change that image?

 

[W19]

You can only stand up for yourself for only so long if your superiors don't back you up. Then as stated you will be seen as the problem. Not the surgeon.


I do know really nice, non arrogant surgeons. They are usually OMFS or Podiatrists. But best believe they are in the minority. The field just doesn't attract many nice people and that's the real truth.

Lol... I got blasted in SDN when I say that... If you are a med student, look at your classmates who are going into surgery (mostly general surgery, ortho and neurosurgery) and tell me what you think.

I hope to have minimal interaction with these guys/gals as a IM resident/attending...

 

[chocomorsel]

Some people are just rude... What make you think the tech would never talk to a surgeon like that? What should the specialty do to change that image?

Because they don't. Surgeons garner a hell of a lot more respect than we do. Not always in every scenario but in a majority of the situation. I used to ontroduce myself with my whole name and somehow, some nurses/techs find that as permission to call me by my first name. Patients will ask my first name as well. And it's not just cuz I have a foreign last name. My American girlfriends get it too.

I do admit though that out West I was treated quite respectfully buy the nurses and techs. I think it's got something to do with Physician only anesthesia. But best believe many of those surgeons were jerks to me.

My opinion, though limited, is that more OR presence instead of only CRNA presence gets you more respect. But there are different variants out there.

What irks me is that often anesthesiologists will say things like "I don't care about respect, I laugh my way to the bank" like we've sold our souls and self respect to money. Really?

 

[skankhunt42]

Very solid advice. That's the problem with anesthesia, we all need a plan B in mind before starting residency. This may be the saddest part of choosing this specialty.

Didn't mean this per se. I more mean the value of sticking out EM for one more year and gaining BE/BC in the field might be worth the extra year. If you all could do one year of a field and get boarded in it, many people would. The OP will be applying during his/her 2nd year of EM. I think sticking it out for 1 more year would probably be worth it.