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switching into anesthesiology

Discussion in 'Clinical Rotations' started by needadvice, Sep 13, 2001.

  1. needadvice

    needadvice Member 7+ Year Member

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    Sep 12, 2001
    hey everyone, i need your help and advice. i am currently a categorical internal medicine resident at a fairly large research university in the northeast. i am strongly considering a switch into anesthesiology. i know this is a difficult and awkward situation. any advice regarding navigating this process will be appreciated.

    furthermore, i would really like to move to chicago. i was surprised that only two programs there did not fill. does that mean that other programs are unlikely to take an applicant like myself?

    i graduated in the top quarter of my medical school class; 222/238 board scores. medicine award.

    feedback, advice, comments?

    best.
     
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  3. Morgus

    Morgus Junior Member 7+ Year Member

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    Aug 3, 2001
    Dallas
    Hi,

    I've talked to my friends in anesthesiology and they think you're in an excellent position. "Street-sense" is the operative word in our advice to you!

    First, you have to do 1 year of medicine followed by 3 years of anesthesiology in any programs we know of, so you've already gotten the 1 year of med out of the way. You are not at a disadvantage.

    Second, the mere fact that 2 programs in Chicago DIDN'T FILL is a virtual guarantee that you can get SOME program in Chicago, if geographical location is of prime importance to you (as it is to me). You'll probably get one of the better programs if you play your cards right, however, so don't think you have to settle for the lesser ones.

    Third, make some *behind the scenes* connections with ALL the anesthesiology programs in Chicago and have some frank conversations with them, without letting anyone at your current medicine program know anything. Since you already went through the "match" already once, it's my understanding that you can approach programs and get in outside the "match" (quotation marks around "match" expressing my negative view of an atavistic system that stacks the deck in favor of institutions, leaving the MD applicants less power than college students applying TO medical school). To analogize from pro sports, you're now a "free agent". It happens all the time in residencies, but you hear little about it.

    Fourth, (and I speak from experience on this--do a search for other postings under my screen name), while high board scores and rank GUARANTEE nothing, they certainly don't hurt if you have the things they are really looking for--being a team player and having a psychosocial profile that fits in with the department's psychosocial milieu--that's 90% of getting a particular program. If you've already got some proven performance in the hospital in a residency, you are 1000X LESS RISKY for a program to take than someone who has merely just graduated from medical school. And you have high scores anyway.

    Fifth, let's say you had 4 programs available (I don't know how many there are in Chicago). Connect with the very LEAST desirable (to you) program first, and use it as a DRY RUN. Make your mistakes with it, use the feedback to re-tune your approach, and then proceed with the rest. If residents are treated like cannon fodder by residencies, then we have a perfect right to treat them the same way. Don't ever think that they are ethical in how they deal with the applicant pool. They just want to get what they want with the least risk and trouble, and if some of the applicants get burned in the process, so be it. You should operate just as ruthlessly in dealing with them, of course under the cloak of stealth. I'm as pro-resident as they get. "In the uncorrupted vigor of the master soul, desire is its own justification..."--Nietzsche

    I hear that the money and opportunities in anesthesiology are getting better all the time, as opposed to what was happening with a glut of anesthesiologists in the early and mid 90's. No possibility of work when not on scheduled duty sounds good to me--we're all too overworked as it is. What is your assessment? Also, if our advice works for you, let me know so we can add it to our "street-sense" database.

    Best regards,
    Dr. Morgus :cool:
     
  4. drusso

    drusso Physician Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

    6,225
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    Nov 21, 1998
    Over the rainbow
    I'm just curious what interests you about anesthesiology. I was considering anesthesia (pain management actually) until I recently completed a month rotation in it. I was not very impressed.

    Where I did my rotation, CRNA's ran almost all the cases (the docs were only around for induction and extubation), the anesthesiologists were somewhat condescended to by the surgeons (one surgery resident confided in me that he prefers CRNA's running his cases because they are easier to "get along with" which I interpretted as "bully." The surgeons' attitude in the OR was that when something goes wrong blame 1) the patient, 2) the nurse, 3) the anesthesiologist. Personality wise the anesthesia docs seemed a little "flat" and/or "beaten down" and seemed to spend too much time trying to placate surgeons.

    I appreciated the experience: Got good at intubations with both Mac and Miller blades; got to do some spinals and epidurals; good review of autonomic pharmacology and physiology. To me, anesthesia might be a good means to an end---critical care or pain management. It might have been more interesting in a different environment. I'd like to hear some other thoughts. Everyone did feel that the field was turning around salary-wise. The lifestyle seems reasonable too, but I think PM&R (my other consideration) is better in that respect. With appropriate fellowship training in interventional pain techniques (which more PM&R docs are doing) I would be more than happy to forego three years in the OR under the thumb of angry surgeons.
     
  5. scrubs

    scrubs Junior Member 7+ Year Member

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    Sep 14, 2001
    I would just like to put in my two cents..?

    This is the first time I am writing in the SDN forum, so please bear with me!

    I am currently a first-year anesthesia resident at a major university hospital in Chicago, and I am actually going to try to switch to medicine. Let me give you my synpopsis of the pros and cons of this field:

    THE CONS:
    1) The most important negative, I feel, about this specialty is that it is exceptionally stressful. You sit at the patient's bedside monitoring vital signs and constantly wait for bad things to happen - a drop in their oxygen saturation, hypertension, or worse hypotension, tachycardia, bradycardia, etc. It is exhausting constantly being on your guard to be able to react immediately if something should go wrong. It is like being a critical care nurse in all honesty. Granted things go well 95% of the time, but you can not be complacent.

    2) You are not autonomous in your practice. Much of what you do is in an attempt to make the surgeon happy. You must get their consent for many things (using muscle relaxants, starting lines that could get in their way, etc.), and they always manage to be in your way. It's not their fault, it's just the way things are.

    3) There is absolutely no respect from anyone in the OR - not the patient, not the nurses, not the surgeon, not the surgery residents or medical students, and where I work, often not the anesthesia attendings. Nobody appreciates what you do. An operation for a very sick patient could go by perfectly smoothly (while you transfuse blood, hang fluids, draw arterial blood gases or draw blood for labs, push pressors, etc) and the only one who know that you have done any of this is you. No one else will care or remember. In this field, you can not be the kind of person who needs external reward (i.e., patients thankfulness or other colleagues appreciation of your work).

    4) As much as I would not like to believe it, you are completely replaceable - by another resident, by an attending, by a nurse anesthetist, or even a well-trained medical student. I have been amazed with the degree of ease that nurse anesthetists manage such cases as open heart surgery, liver/kidney transplants, and neurosurgery. Believe me, MD's, as much as I hate to admit it, are completely replaceable in this field.

    5) You are in the OR all the time. This may seem like a plus, and I thought it would be, but it can get almost claustrophobic being in 1 room for 12 hours a day. I get up at 4:45 am everyday to be in the OR at 6am. I leave anywhere from 5-7pm. I get a (strict) 15 minute break to leave the OR between 9-10 am, and I get a (strict) 30 minute lunch break between 11-1. Other than those 45 minutes I am in one room the whole day. This schedule is actually pretty common (check out www.scutwork.com, where other anesthesia residents evaluate their programs). The surgeons are busy doing their work and the nurses are helping them, so you don't even talk or discuss things with other people. It's actually almost lonely in a way...

    5) You must enjoy reading about pharmacology (the pharmacokinetics of drugs - their half-lives, vapor pressures of gases, etc.) and physics (the physics of gas flows, the mechanics of how the machine works, etc.).

    So having told you those negatives, let me give you some positives...
    THE PROS:

    1) We only have call 3 times per month, which is very nice. This may be a little less than most programs, however.

    2) When call is over, you leave at 7-8 am. That is a really nice feeling! BUT if you are up all night with trauma patients (or any patient for that matter) transfusing blood, drawiing blood gases, pushing pressors, etc., you will f\eel the need to collapse at that point ...

    3) When you are on, you are on, when you are off, you are off - you do not have to keep your pager on when you are outside the hospital. You will not get paged unless you are on call.

    4) The future MIGHT get better after residency if you don't mind the cons I listed above. More importantly, at least you will be paid better as an attending. The question is, will you like what you are doing well enough that you will want to do it full-time to make a living.

    So those are my feelings (sorry if it took me a long time to get through it). For most people no one field is perfect, so you must find what it is you really like. Anesthesia is a good field, but you have to really like basic sciences and must be willing to be very adaptable (to be subservient?) to surgeons to be happy in this field.

    The only good advice I can give to anyone is to spend A LOT of time (including taking call) on a rotation doing whatever it is you think might interest you. That will give you some idea a) if you like it, b) of what it will be like in the future.

    I hope this has helped, please let me know if I can provide any other information!

    Good luck in your endeavors...
     
  6. scrubs

    scrubs Junior Member 7+ Year Member

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    Sep 14, 2001
    Sorry, I forgot to mention that if you know for sure you want to do anesthesia, getting a position should not be a problem...

    Let me know, and I can provide you with some information about the programs around here..
     
  7. I love the insights being dispensed here. You mentioned anesthesiology is extremely stressful, but I was wondering how stressful is anesthesiology compared to general surgery or radiology?
     
  8. Hi Scrubs,

    You mentioned you were at a Chicago program? Which program are you at (If you would reveal your location?)...Actually, I was wondering what was your opinion of the Chicago anesthesiology programs-particularly Northwestern & Rush?

    Any advice would be greatly appreciated!
    Thanks!
    Cheers,
    TRG
     
  9. scrubs

    scrubs Junior Member 7+ Year Member

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    Sep 14, 2001
    Hi All!

    First I would like to say that if you really like what you are doing, you will overlook the negatives. That may sound "hokey," but it is so true.

    As for whether anesthesia is more stressful than surgery or radiology is probably a matter of opinion. Surgeons have a lot of stress that anesthesiologists don't have: complications from their surgeries (bleeding and infections), the responsibilities of maintaining and building a practice, the possibility of malpractice litigation (usually higher than anesthesiologists), and having to be on call and operate in the middle of the night. As for radiologists, I don't really know what is stressful for them. I mean, they are not really in critical situations very often; I suppose that is why they enter the field. Regardless, these are just my opinions and observations - I strongly recommend talking to and spending time with residents and attendings in any professions in which you are interested. Like I said, if you really like what you do, you will see past these negatives in your practice. It's all a matter of what one can and wants to personally handle in their lives.

    As for me personally, I would prefer not to divulge my program's name as I am potentially considering a switch in fields. When I interviewed as a 4th year medical student, the Chicago programs I interviewed at were Loyola, Rush, Northwestern, and U. of Chicago. Here were my opinions of each (in brief):

    Loyola - Good clinical experience at the time, but when I was interviewing, there were a considerable number of faculty leaving. One resident told me that his workload was increasing significantly as a result of the lack of people to cover the OR's.

    Rush - I interviewed with extremely nice faculty. I think there are close to a thousand operating rooms there (just kidding). Actually seemed to be a really solid program. The only thing that concerned me about Rush is that they have one of the best and biggest nurse anesthetist schools in the country there. The residents, however, told me that it did not affect their education or clinical experience.

    Northwestern - Again a very big hospital (brand new and beautiful!). From what I understood, it was mostly upper class/north shore and largely healthy patients. Not a level 1 trauma center, so not too much in the way of trauma. A variety of clinical experiences as residents rotate through Northwestern, the VA, Evanston (northern suburb), Children's Hospital, and Prentice Women's Hospital.

    U. of Chicago - Clearly the most highly regarded program in Chicago. They seemed to have a rigorous didactic schedule (certainly better than most of the places I interviewed). The one thing that stood out on the day I interviewed was that the residents seemed very tired and not very enthusiastic.

    Anyway, it's best to ask a bunch of people about these places. You have to remember, though, that when I was interviewing (fall 1999) there were still very small residency classes and they were still really recruiting to boost their programs. Please talk to others and find out what they think about their programs now.

    Another thing I would like to mention as I did earlier is to review some of the evaluations that residents have posted on www.scutwork.com. It's pretty neat to see what others think about their program when they are anonymous.

    Take care all!
    Hope I helped a little!
    Please let me know if you have any specific questions!
     
  10. Hey Scrubs,

    Just wanted to say thanks for the review of the chicago programs! Best of luck to you!

    Cheers,
    TRG
     
  11. am

    am Junior Member 7+ Year Member

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    Aug 4, 2001
    Scrubs, how about the program at the University of Illinois-Chicago? :confused:
     
  12. scrubs

    scrubs Junior Member 7+ Year Member

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    Sep 14, 2001
    Hi am!

    I did not interview at the University of Illinois at Chicago, but I do have a friend there who is quite happy. However, he did a rough year of general surgery as his first year - so I'm sure things look great now : )

    Anyway, he says he has no call in-house call during his entire first year!!! They do take "second-call," which means they stay late (8-10pm) usually once a week. However, sounds like they pay for the call during their 2nd and 3rd years. Also they rotate through Michael Reese, Christ Hospital (I think) - a community hospital in suburban Chicago, and one of the VAs. And one very nice thing about them is that they have a 1/2-hour conference every morning from 6:30-7 am just to go over board questions or topics. (I think I should have considered this program more seriously!). I think he is very happy, but I would solicit other residents' opinions - especially the upperclass residents.

    They have a really friendly website, check it out: www.uic.edu/com/mcas.

    Hope this helps...
    Take care!
     

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