Switching out of anesthesiology? (anesthesiology vs. surgery)

[Ellie321]

There are many posts about switching INTO anesthesiology...what about the other way around? Anyone switch OUT OF anesthesiology? For what reasons?

As an MS3 struggling with the decision of surgery vs. anesthesiology, I'm interested in hearing about the pros and cons from those that have a more in-depth experience with the field. Some background about me:

I love physiology and enjoy pharmacology, so it's no surprise that i find myself somewhat attracted to anesthesiology. As an MS3, I haven't had much formal exposure to the field (only peripherally during my surgery clerkship). However, what little I've experienced, I've really enjoyed. Having said that, I also really enjoy surgery (esp CT surgery)...one of the toughest, yet most rewarding rotations I've experienced so far.

A "few" questions:
- The "burnout" rate for surgery seems quite a bit higher than anesthesiology. And I see lots of posts about switching into anesthesiology from surgery. What about the other way around? Anyone switch from surgery into anesthesiology?
- What types of issues make anesthesiologists "burnout"?
- Stresses/unpleasant issues that anesthesiologists deal with that might not be apparent to a med student?
- I think I'm pretty aware of the sacrifices that surgeons make...what are the sacrifices one makes as an anesthesiologist?
- Any of you seriously considered surgery? What ultimately made you decide against surgery?
- is it easier to switch into anesthesiology from surgery vs. the other way around? (I really hope I'm not one of those that has an "epiphany" in the middle of residency and find myself wanting to switch)
- What do you dislike about anesthesiology?
- Besides the OR, where else do anesthesiologists play a role? (critical care/ICU

My pros/cons list according to my current understanding of anesthesiology...
Pros:
- being a master of physiology and pharmacology
- lots of procedures (aka instant gratification)
- shift work = more flexibility? (time off for research, travel, etc)
- anesthesiology collegues (almost everyone I've interacted with seem like happy, witty, well-balanced individuals with a strong team mentality...fun group to interact with)
- no clinics

Cons:
- CRNS/future of the field/job security? (but it seems like every field is having similar issues).
- job market? (although I hear it's pretty tight in other fields as well)
- working "for" surgeons (many times, it feels like the anesthesiologist is working for the surgeon, and not WITH the surgeon)
- constantly having to prove that you're not just a "glorified CRNA" ?

Please help me with any misconceptions of either pros or cons, and any additional pros/cons I should be aware of. I'm trying to find out as much about the field as possible so there won't be any unpleasant surprises down the road.

---

Members don't see this ad.

 

[Intensivist]

I'm thinking of switching out of anaesth into IM followed by CCM. IM here in Europe is a bit different than US type, with somewhat less paparwork, and clinic isn't such a drag, also less social worker stuff.
I entered anaesthesia primarily due to my vision of CCM from anesthesia point of view as opposed to IM one. But with the lack of profoud diagnostic w/u with anaesthetist/intensivists here, l'm thinking of switching to IM. I'm thinking of finishing one year of CA with couple of months ICU before switching, to gain as much as l can from anaesthesia, because they offer a lot. But decision is not final yet.
My advice would be to experience as much as possible of fields that interest you while in med school, intern year, you can't really know what fits you most until you taste it. I for one always put anaesthesia as choice No 1 and yet know realised that OR itself is not my cup of tea after all. I always knew l wanted to investigate, and not just treat, but thought that it is achievable to combine....

 

[CrazyJake]

Saw 2 surgery residents today in the ICU. both asked me if we had any Anesthesia spots open after the match.

Hahaha. Guess I've never met someone wanting to get out of Anethesia for Surgery..as above.

CJ

 

[Scully_med]

Hi,

I am a general surgery PGY-2, switching into anesthesiology next July.

I was so sure for so long that surgery was the right specialty for me, that it was kind of a surprise to find out after two years of pure denial that I actually found it boring to do hernia repairs and appendectomies... For two years, I have been more interested by what was happening on the "other side" and in the ICU.

At my location, each year there is at least one surgery resident that leaves for anesthesiology, but never the other way. That doesn't mean it never happens, but it is very less common. Everyone I know that did the switch is way happier now and doesn't regret it at all.

And now I myself decided to make the switch. Probably the hardest decision of my life, but the best!

Not every specialty fits everyone, it all depends of what you like the most... Choose with your heart and guts, and if you make a mistake, it's never too late to change... Good luck to you!

Scully_med

 

[Ellie321]

Thanks for the comments so far. Another question comes to mind: is it generally easier to switch from surg to anesthesiology?

 

[ctsicu]

yes, probably easier to switch out of surgery. however, if you asked me, i would say go into surgery.
you won't have the midlevel problem that anesthesia is having. i think its a very real and scary threat that will likely impact you during your career. i actually switched out of ent into anesthesia and while i love anesthesia, i have had a few moments of regret which only happened after i became an attending. i never knew the extent of the crna problem until then. but, that being said, you have to do what you love!

 

[ComfortableWolf]

yes, probably easier to switch out of surgery. however, if you asked me, i would say go into surgery.
you won't have the midlevel problem that anesthesia is having. i think its a very real and scary threat that will likely impact you during your career. i actually switched out of ent into anesthesia and while i love anesthesia, i have had a few moments of regret which only happened after i became an attending. i never knew the extent of the crna problem until then. but, that being said, you have to do what you love!

Hi,

If you have a second would you mind elaborating? Do you think having a CC, Cardiac or Peds fellowship under your belt changes things with regards to the CRNA problem. Do you find your job as an attending anesthesiologist fulfilling most of the time or do you have a constant hankering to be on the other side of the curtain?

Thank you
CW

 

[error404]

I generally think of anesthesiologists as people who can spell "epiphany."

/troll



Seriously, the best way to figure out what's right for YOU is to do a rotation. It's almost impossible to conceive of what we do and what it feels like from the other side of the curtain. I'm in anesthesia (which is the perfect field for me,) but my husband and my closest friend are surgeons (which are the perfect fields for them.) This is a very individual decision.

Or, you could just follow the old adage, "If the OR is your favorite place in the hospital, go into anesthesia. If the OR is your favorite place in the world, go into surgery."

~error404

 

[Masseter Spasm]

I always thought of being a surgeon as more of a life decision than a career decision. I think it comes down to this question: "Can I be content in medicine without operating." Most happy and successful surgeons simply could not imagine doing anything else with their life.

When people switch from a surgical field to another specialty, I think it stems from a failure to address this question and/or accept the burden that accompanies being a surgeon.

 

[Ellie321]

I generally think of anesthesiologists as people who can spell "epiphany."

/troll

Oh no you didn't! Did you just call me a troll? I'm just a confused med student attempting to decide what I want to do with the rest of my life. I know a lot of this comes down to personal likes/dislikes (and how much/what kind of BS one is willing to tolerate), but it's often helpful to learn about other people's pros/cons lists since my short rotations only give me a taste of the most superficial aspects of the field. Someone else may have insight into something I had no clue about.

Thanks for all the suggestions/comments so far. Would love to hear more, especially from those that also had a difficult time deciding between surgery and anesthesiology.

 

[Neon Goat]

Ellie, can you elaborate on what your likes/dislikes of your surgery rotations were? You mentioned your CT surgery rotation was one of the best and toughest rotations. What was best and toughest about it? Anything you disliked?
I'm just thinking this might help those experienced in the OR identify traits in you common to successful surgeons or anesthesiologists.
Also, when are you going to do an anesthesia rotation? Seems like that will really be the only way you can make this decision, and from what I've read, getting into a 1 month anesthesia rotation before 4th year is a good idea if possible.

 

[Ellie321]

Ellie, can you elaborate on what your likes/dislikes of your surgery rotations were? You mentioned your CT surgery rotation was one of the best and toughest rotations. What was best and toughest about it? Anything you disliked?
I'm just thinking this might help those experienced in the OR identify traits in you common to successful surgeons or anesthesiologists.
Also, when are you going to do an anesthesia rotation? Seems like that will really be the only way you can make this decision, and from what I've read, getting into a 1 month anesthesia rotation before 4th year is a good idea if possible.

Liked:
- immediate impact; instant gratification
- "no nonsense" attitude (if an issue doesn't alter patient care, no need to discuss in detail)
- fast, efficient rounds
- atmosphere in OR (everyone with common goal)
- hands-on learning
- DOING something rather than contemplating endless possibilities
- patients tended to be very appreciative (the operations usually improved quality of life, sometimes prolonging it)
- wearing scrubs every day

Dislike:
- clinics
- high emphasis on hierarchy (sometimes to the detriment of patients)
- tendency towards "malignant" attitudes which can make some days miserable (I and a few other students on the team were given the "silent treatment" by a few of the residents through most of the rotation. I think one attending had a med-students-do-not-exist-in-my-world view...never once responded to anything I said; never acknowledged students' presence in or out of the OR) (another attending frequently verbally lashed out at med students and residents. She really frightened me the first time she "exploded" in the OR .)
- dressing changes for chronic, infected, non-healing ulcers (the smell!!)
- the level of "paying your dues" before being allowed any sort of hands-on experience can feel a little discouraging at times (didn't apply to me as much as a student, but observed this among the residents)
- being completely dependent on those above you to gain any technical skill (reading can only get you so far...can't learn to operate unless you're allowed to operate)
______________________________________________________________

I came away from CT surgery with a somewhat different experience than Gen Surg. I experienced all the positives outlined above, but none of the negatives (except the last 2 points, which is probably universal for all of surgery). The attendings and fellow on service were not only great teachers, they were enthusiastic. I had opportunities I never dreamed of...like being 1st assist for various portions of several CABG cases. Gave me a high like no other.

I also spent some time with the anesthesia team on this rotation (both in the OR and on call). Lots of teaching, learning, hands-on experiences. I never understood why anyone would be the least bit interested in anesthesiology until this experience. In retrospect, I really just had no idea what anesthesiologists did besides roll patients and out of ORs.

The most difficult aspect of this rotation was the lack of sleep, although I usually wouldn't notice my level of exhaustion until leaving for home at night (a few days I slept in the call room even though I wasn't on call because I was too tired to walk the 20 minutes it took to get home).

I'm not able to do a formal rotation in anesthesia as a 3rd year. However, I have secured a spot early 4th year for a formal 4-week rotation. I really need to figure this out !!

 

[specialty]

I could not help but comment; I am in the same anesthesia/surgery predicament. Except I just took a year off to do an MPH and am starting my fourth year with (thankfully) an anesthesia rotation in a couple of weeks.

Ellie, let me know if you find any further answers to those questions.

Would it be conceivable/hard to switch out of anesthesia after intern year to surgery? Has this not ever been done in the history of medicine?

 

[PMPMD]

I've worked with dozens of people who switched INTO anesthesia. I've encountered one person who switched OUT of it, and he regretted it. Granted, this is anecdotal, and I would be less likely to encounter people who switched out, but I think the trend is clear.

 

[hoyden]

Any of you seriously considered surgery?
What ultimately made you decide against surgery?

Never. Not a female specialty IMHO.

 

[hivoltage]

I really just had no idea what anesthesiologists did besides roll patients in and out of ORs.
!

LOL.. this made me laugh a lot. Thanks for the laugh i really appreciated it. and I am NOT being sarcastic i Promise you that. It was funny. I guess thats what most people think of us. we are generally a passive bunch.

 

[hivoltage]

I just wanna add that if you hate call.. you will hate anesthesia. There is nothing but call if you work at a hospital.. thats the whole job. anybody can work daytime shifts.. I guess you can find a job with NO CALL but you will generally be on call once a week, with a pretty highprobablity of having to come in to WORK in the middle of the night.

 

[DentalDawg55]

I just wanna add that if you hate call.. you will hate anesthesia. There is nothing but call if you work at a hospital.. thats the whole job. anybody can work daytime shifts.. I guess you can find a job with NO CALL but you will generally be on call once a week, with a pretty highprobablity of having to come in to WORK in the middle of the night.

if you look at the job postings on gaswork.com you can see that theres a very wide variety of call schedules available...from q2 to qNever. If you dont mind making less you can take much less call. Thats okay with me!

 

[MCAT guy]

bump

 

[residentdoc2011]

Hello cticu,

I am also in a ENT residency currently at this moment and also am curious about switvhing into anesthesiology. While I enjoy some aspects of ENT, I am realizing that operating is not as appealing to me as I thought it was. I would like to hear more about your decision making process and such. Any advice and tips you have would be appreciated.

 

[UTSouthwestern]

As a person who switched from IM I can say that I don't have a regret and many of the people I trained with were surgery explants as well. None have regretted their switch. I would say that you really have to determine if you want to have a greater amount of control in your practice life before you switch into a field where your hours can largely be uncontrollable although not unbearable and thankfully without clinic unless you enter pain management.

This is a conundrum that a few surgery residents I have met could not reconcile. You should also consider that what you are experiencing as a surgery resident is not necessarily what you will experience in private practice. For example, for the general surgery residents, I have many general surgeon friends in private practice who absolutely love their practices and can tailor them to their tastes. Several do bariatrics only and earn 7 figure incomes with very reasonable work schedules (although to get to that level, you are probably doing 12-20 surgical cases (bands, sleeves, bypasses) a day). Two are colorectal only and while not high income earners, have very predictable schedules and enjoy a lot of time off with their families. Still others are specialized in esophageal work only and do 20-40+ EGD's and have turfed GI guys in the area.

One of my best friends is the sweetest ENT doc you will ever meet and she is happy working half days and leisurely operating twice a week with as many or as few cases as she wants.

Basically, don't base your decision entirely on what you are experiencing in your training. Talk to the private practice guys and make sure the switch is right for you. That being said, like a previous poster said, I have yet to meet anyone who switched into anesthesia who regretted it.

In IM, I had a fellow resident who switched into IM after her CA-1 year and was miserable and did a renal fellowship thereafter and finally found some financial and personal stability by opening her own dialysis center. Still she doesn't seem very enthusiastic about her job.

 

[residentdoc2011]

Hi UT SOuthwestern,

Thank you for your thoughts. It is one thing to hear from someone who was always interested in anesthesiology, but it can be more meaningful to hear from someone like yourself who has switched from something else into anesthesiology. I'm aware that life as a private attending can be very tailored, but I think that my decision making process to switch is luckily based on more than that. Of course, the resident lifestyle of a surgeon isn't the best, but I believe my desire to change is just based on interest and personality type as well. I think that my motivation to want to operate is certainly not as high as i thought it was previously (perhaps I am just different now as well). Also, I don't believe I crave the spotlight, which I think is important in surgery; I don't believe I crave or need the external validation from patients that may fuel many surgeons. Lastly, from what I have been reading in these forums, I believe my personality and desires seems to be better suited to being an anesthesiologist.

Any other thoughts?

 

[anynoise]

Hi UT SOuthwestern,


Any other thoughts?

I think if anyone does not like call, have to reconsider anesthesia since we are on call a lot. Yes you can find a job with no call, but majority of jobs you are on call with a high probability of coming in to deal with something for a few hours. Your hours as ut southwestern put it.. are mostly un controllable. You have no idea how your day is going to be and what patient you will meet. This can be bothersome. But the call mostly is what gets you after age 50. Who the hell wants to be getting up at 2 am to deal with a gurney flying down the hall with a pregnant lady screaming and yelling, "My baby", as you are putting monitors on and wondering can i intubate this lady.

 

[epidural man]

There are many posts about switching INTO anesthesiology...what about the other way around? Anyone switch OUT OF anesthesiology? .

There was a rumor about that happening once, but I'm not sure because no one could believe it. I'm not sure I believe it myself...it just seems so improbable.

 

[epidural man]

There are many posts about switching INTO anesthesiology...what about the other way around? Anyone switch OUT OF anesthesiology? For what reasons?

Okay, I've done some research. As it turns out, there was one person that actually did switch from Anesthesia to something else. It turns out he crashed his skate board, causing some minor brain damage - he was still smart, but lost a little cognitive function, so he was unable to still do anesthesia. He went into neurosurgery or something like that and seemed to do just fine.

 

[numbmd]

I was fully committed to surgery. However, I didn't match and was doing a preliminary year (lied to by my own school, but that's another story). I had applied to anesthesia to "cover my bases." I was still going into surgery and had applied for the match again. At the time anesthesia was non-competitive and the position I had applied for got back to me in two days.

Now I had a conundrum. I felt that I couldn't let my anesthesia spot dangle for over a month while I awaited the results of the surgical match, I had to decide. I went around to all of the surgeons I worked with and asked their input. ALL told me to switch! I went to the Department Chair, a Dr. Nance, and asked his guidance. He had been in surgery at various places for over 30 years. He gave me a list of over half of the anesthesia department who had started in surgery but subsequently switched into anesthesia.

You can figure out my next question... "Do you know anyone who switched out of anesthesia into surgery?" And his answer was a huge factor in my decision.

"Actually, I've never known anyone who has switched out of anesthesia."

Twenty years later, it's been a very fulfilling career, and I've been quite happy with my decision.

 

[b1ge10w]

Or, you could just follow the old adage, "If the OR is your favorite place in the hospital, go into anesthesia. If the OR is your favorite place in the world, go into surgery."

~error404

What if your favorite place in the hospital is the physician lounge?

 

[Sirach38]

.

 

[squoval]

.

 

[Laryngophed]

Surgery wouldn't be so bad, except for its one downside. At the end, you have to be a surgeon and can't be an anesthesiologist.