Switching to Anesthesia from Psychiatry

[BiscoDisco]

Hi all. I recently matched into a solid University psychiatry program. I considered anesthesia for a while in med school, primarily because I have a real interest in pain. Now that I've matched, I'm fairly certain I've made a big mistake. Deep down, I know I want to do gas and give myself an actual shot at a pain fellowship. This is all my own doing and I wish I was more honest with myself earlier.

That said, what can I do to get into an anesthesia program(my stats are quite competitive)? How likely/unlikely would it be to transfer after PGY1? Would all or part of this year count towards my intern year? Could I enter as CA1 or would I have to repeat intern year somewhere? Any other advice would be very much appreciated.

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[chocomorsel]

Hi all. I recently matched into a solid University psychiatry program. I considered anesthesia for a while in med school, primarily because I have a real interest in pain. Now that I've matched, I'm fairly certain I've made a big mistake. Deep down, I know I want to do gas and give myself an actual shot at a pain fellowship. This is all my own doing and I wish I was more honest with myself earlier.

That said, what can I do to get into an anesthesia program(my stats are quite competitive)? How likely/unlikely would it be to transfer after PGY1? Would all or part of this year count towards my intern year? Could I enter as CA1 or would I have to repeat intern year somewhere? Any other advice would be very much appreciated.

As someone who was in your shoes 12 years ago, my advice to you is don’t do it.

There are no guarantees you will match into a pain fellowship even from anesthesia.

Do your psych residency, enjoy that lifestyle, start your practice, make your own hours and never worry about a surgeon trying to bully you or waking up in the middle of the night for someone trying to die.

If you do well in psych, I bet you will have a decent shot at matching into pain. Do some electives and then you may probably realize how daily dealings with narcotic addicts really sucks the life out of you and change your mind.

 

[BiscoDisco]

As someone who was in your shoes 12 years ago, my advice to you is don’t do it.

There are no guarantees you will match into a pain fellowship even from anesthesia.

Do your psych residency, enjoy that lifestyle, start your practice, make your own hours and never worry about a surgeon trying to bully you or waking up in the middle of the night for someone trying to die.

If you do well in psych, I bet you will have a decent shot at matching into pain. Do some electives and then you may probably realize how daily dealings with narcotic addicts really sucks the life out of you and change your mind.

Really appreciate your insight. My understanding in talking to a couple mentors during school was that anesthesia offers a pretty good lifestyle as well. I also got the sense that income was something like 50-75% more.

As far as pain, I really want to get into the interventional side of things. Is this even possible from psychiatry or will you mostly be relegated to clinic work?; i.e. dealing with the addicts.

 

[ethilo]

Really appreciate your insight. My understanding in talking to a couple mentors during school was that anesthesia offers a pretty good lifestyle as well. I also got the sense that income was something like 50-75% more.

As far as pain, I really want to get into the interventional side of things. Is this even possible from psychiatry or will you mostly be relegated to clinic work?; i.e. dealing with the addicts.

I haven't been in this for very long, but being in a fantastic PP anesthesia group that protects lifestyle (MD-only, salary-based relief system, big hospital system) You still can't shake the things that will inevitably prevent us from being a truly lifestyle specialty:
-Having to take overnight call, work weekends, and holidays
-Never being absolutely sure you'll be home in time for dinner often until 30 mins before dinner

You might obviate these issues with an ambulatory surgery center practice or in a pain practice but your time in anesthesia will pretty much never be yours to control.

 

[deleted171991]

My understanding in talking to a couple mentors during school was that anesthesia offers a pretty good lifestyle as well. I also got the sense that income was something like 50-75% more.

You need better mentors.

Anesthesia is NOT a lifestyle specialty, unless one works in an ambulatory setting with no calls/weekends (in which case, guess what, the salary is comparable to psych).The reason people make more money in anesthesiology is because they work more and harder (just check our coronaries).

Pain is a lifestyle specialty, but pain is not easy to get into (and it's psych plus mostly futile pain management). Also, pain is not the walk in the park it used to be either; many docs work as employees, in stressful jobs, even go back to practicing anesthesia, even give up pain.

Unless you hate psych, I would finish that residency. Yes, psych is almost a pseudoscience when compared to many other specialties, but it may be the better deal. In this country, people spend a lot of money on psych (for lack of true friends and tight family relationships).

tl;dr: I agree with choco (which is unusual).

 

[nimbus]

Do child/developmental psych. Write reports for wealthy parents who want their below average kids to go to USC. Don’t accept insurance and have a waiting list.

 

[ERRES2288]

If “lifestyle” to you means 8-5 Monday-Friday with no call and no weekends, then anesthesia is not a lifestyle specialty. Sure we work some weekends and take call, but that doesn’t mean it’s not a lifestyle specialty. Anesthesia offers the ability to have large chunks of time off and the ability to go anywhere relatively easily. No overhead, no office to run, no SOAP notes, no H and Ps, no rounding, no calling consults.

All these things make it a lifestyle specialty in my eyes. I’d rather work some overnights and enjoy my post call day than be wasting away in clinic day in and day out.

 

[siliso]

Go to your psych residency and see how it goes. You made your choice for a reason and may be having buyers remorse. Anesthesia will still exist in years to come if you decide it’s really the only thing for you. Doing well in the place you matched to with high marks and recommendations will only help.

 

[Consigliere]

My understanding in talking to a couple mentors during school was that anesthesia offers a pretty good lifestyle as well.

I'd like for you to locate said mentors and administer a front kick to their testicles and say "that's from Consigliere....for lying!" Do EXACTLY what Choco said. The field of anesthesiology sucks right now and will be most definitely unwittingly swallowing when you finish residency.

 

[cf817]

Like everyone else has mentioned, I'd finish your residency and try to get to pain that way. I switched out of IM but it was risky and wouldn't recommend it. I love gas, but everyone is right, this is not a lifestyle specialty. Psych and gas are so different so it depends if you just don't like psych at all then I'd consider it. But almost everyone I know in psych has no regrets. Decent pay, esp PP (no insurance, cash pay), better hours.

 

[jthedestroyr]

Really appreciate your insight. My understanding in talking to a couple mentors during school was that anesthesia offers a pretty good lifestyle as well. I also got the sense that income was something like 50-75% more.

As far as pain, I really want to get into the interventional side of things. Is this even possible from psychiatry or will you mostly be relegated to clinic work?; i.e. dealing with the addicts.

Above advice is spot on as I work my 14th day straight while surgeons complain, the or gets moved around for spring break for them but we keep working.

Also as I did my 4th trauma of the night last night, I thought man, how nice would it be to be in my own bed instead of this gsw.

 

[siliso]

Jim is a hard worker and a team player who took great care of the patients but had a sincere change of heart about his career goals and we wish him all the best is infinitely greater support for your change of specialty if you decide to pursue it than Jim was a lazy POS who didn’t bother to show up and take care of business.

 

[Southpaw]

Lot of benefit in being not tied to the needs and whims of surgeons and hospitals. If I were starting psych and could stomach sitting in a clinic and talking to people about their problems I’d do it for a year and reevaluate.

 

[dannyboy1]

Above advice is spot on as I work my 14th day straight while surgeons complain, the or gets moved around for spring break for them but we keep working.

Also as I did my 4th trauma of the night last night, I thought man, how nice would it be to be in my own bed instead of this gsw.

Guys. In pretty much every field in medicine the way to make money is to see more patients and do more procedures. That’s it. Plenty of anesthesia docs working in surgicenters or as shift workers. Guess what, they make less. I would hope you are being paid very well for working 14 days in a row with lots of trauma call. If not, your job sucks and it’s time for a new one. If your goal is to make as much money as you can then there is no lifestyle specialty. I have seen dermatology offices open until 10 pm because patients want/need evening hours....

 

[NICMAN]

I was on the admissions committee of a residency that had a very strong pain program and anytime we had an applicant who was interested in pain it sent up red flags. If the applicant also had a very strong anesthesia background then it was fine but if the applicant was only going through anesthesia as a vehicle to pain medicine the the applicant’s file went into the DNR trash can. 4 years is a long time to nurse a resident who is only really interested in pain. The two fields are very not similar, and if you don’t love anesthesia at least as much as chronic pain then you will likely be a burden on the program.

 

[jthedestroyr]

I was on the admissions committee of a residency that had a very strong pain program and anytime we had an applicant who was interested in pain it sent up red flags. If the applicant also had a very strong anesthesia background then it was fine but if the applicant was only going through anesthesia as a vehicle to pain medicine the the applicant’s file went into the DNR trash can. 4 years is a long time to nurse a resident who is only really interested in pain. The two fields are very not similar, and if you don’t love anesthesia at least as much as chronic pain then you will likely be a burden on the program.

So maybe that's why I didnt match at wake due to my pain background when I interviewed, funny as im doing critical care. I think I would have liked to be in a program that the crna relieve their residents instead of residents relieving them.

 

[dannyboy1]

I was on the admissions committee of a residency that had a very strong pain program and anytime we had an applicant who was interested in pain it sent up red flags. If the applicant also had a very strong anesthesia background then it was fine but if the applicant was only going through anesthesia as a vehicle to pain medicine the the applicant’s file went into the DNR trash can. 4 years is a long time to nurse a resident who is only really interested in pain. The two fields are very not similar, and if you don’t love anesthesia at least as much as chronic pain then you will likely be a burden on the program.

Agree with this. Truth be told I have no idea why an anesthesiologist is a better fit for a pain fellowship then any other medical graduate. PM&R or neurology seem like a more natural progression.....

 

[BiscoDisco]

Agree with this. Truth be told I have no idea why an anesthesiologist is a better fit for a pain fellowship then any other medical graduate. PM&R or neurology seem like a more natural progression.....

But do you think there are enough programs out there that would give a psychiatrist a shot? Have you seen psychiatrists who are able to handle the hands on stuff to a level that makes them employable after just a year of fellowship?

 

[BiscoDisco]

I appreciate all of the advice. I'm going to see how this first year goes (I'll spend half of it doing psych) and re-evaluate. But one thing that I haven't seen answered - how hard will a transfer be AND would I have to repeat intern year?

 

[siliso]

Depends on you and probably. A psych internship is unlikely to fulfill requirements for an anesthesia ty or prelim.

 

[IMGASMD]

Do well your first few months. Talk to your own institution’s anesthesia PD. (Since you indicated you have good stats, therefore I assume you’re at a good big university hospital.) make good impression. They can do you a solid and sneak you in, find you a spot, tell you where any open spot pops up. That would be the general plan.
Listen to what others have said and make your own judgement. Like every job out there, some aspects you will like, some you will hate. Building a pain practice is not easy, joining one is not easy. You will have to deal with crappy patients. I’ve heard more than one anesthesiologists, some of these patients will subject themselves for multiple interventions just so you will keep prescribing opioids. One guy who came out his pain fellowship hated anesthesia so much, vowed to never do Anestheia again. Joined a pain group, kissed some ass, and made partner in a few years. Doing okay.
Good luck.

 

[IMGASMD]

I appreciate all of the advice. I'm going to see how this first year goes (I'll spend half of it doing psych) and re-evaluate. But one thing that I haven't seen answered - how hard will a transfer be AND would I have to repeat intern year?

I think psych internship is only maybe 1/2 year of medicine, if that? In that case, yes you’d have to repeat something.

 

[Gern Blansten]

If I were a pain fellowship director, taking a psych resident for an interventional pain fellowship spot would be a huge risk. The fellowship would likely be over by the time psych residency graduate got as good at interventional procedures as our current PGY-III anesthesiology residents. Their idea of an invasive procedure is pushing a button on an ECT machine after we've done all of the work getting the patient prepared. No offense, it's just that the two specialties could not be more different.
It would be too risky in my opinion.

 

[anbuitachi]

I appreciate all of the advice. I'm going to see how this first year goes (I'll spend half of it doing psych) and re-evaluate. But one thing that I haven't seen answered - how hard will a transfer be AND would I have to repeat intern year?

you will likely just be reapplying and most likely will repeat intern year. it depends on what your 1st year includes in your psych program.

 

[AdmiralChz]

Depends on you and probably. A psych internship is unlikely to fulfill requirements for an anesthesia ty or prelim.

There aren’t many requirements (I think maybe a rotation in EM, plus some peds and IM exposure it’s very vague). Some of my co-residents who didn’t have it had to do an EM or Peds rotation in CA-1 year, so it’s possible.

 

[AdmiralChz]

If I were a pain fellowship director, taking a psych resident for an interventional pain fellowship spot would be a huge risk. The fellowship would likely be over by the time psych residency graduate got as good at interventional procedures as our current PGY-III anesthesiology residents. Their idea of an invasive procedure is pushing a button on an ECT machine after we've done all of the work getting the patient prepared. No offense, it's just that the two specialties could not be more different.
It would be too risky in my opinion.

I’m inclined to agree, but to be fair when I think of psych doing pain I don’t think of interventional-based like with anesthesia - it’s much more medication and therapy based. Which is very important, but it’s more of a Suboxone/Methadone clinic versus ESIs.

 

[OTCAwesome]

If “lifestyle” to you means 8-5 Monday-Friday with no call and no weekends, then anesthesia is not a lifestyle specialty. Sure we work some weekends and take call, but that doesn’t mean it’s not a lifestyle specialty. Anesthesia offers the ability to have large chunks of time off and the ability to go anywhere relatively easily. No overhead, no office to run, no SOAP notes, no H and Ps, no rounding, no calling consults.

All these things make it a lifestyle specialty in my eyes. I’d rather work some overnights and enjoy my post call day than be wasting away in clinic day in and day out.

Agree, It definitely is what you make of it. Granted, I'm in the midwest, so the market out here is pretty much the best anywhere. The older guys in my group pull in around 450 plus full benefits for essentially no call and live a super cush life, while the younger guys like myself with negative net worth and student loans are pulling in >700 for M-F 7-5 (usually out between 2-4 unless on call) usually 1 first, 2nd and 3rd calls, 2 OB calls, one weekend per month. Supervise AAs (as a group will never hire CRNA) maybe 20% of the time, otherwise do all my own cases. If you work more, you get paid more. At least in the midwest, anesthesia is still pretty much the bees knees of medicine

 

[OpheliaButz]

FYI, I did pain out of psych. I do the full gamut of interventional procedure, from ultrasound to SCS implants, and have a mostly interventional practice. It can be done. The key is to play up the uniqueness of your psych background and that you’re interested in therapy, etc and then then spend all your time learning procedures.

 

[Gern Blansten]

FYI, I did pain out of psych. I do the full gamut of interventional procedure, from ultrasound to SCS implants, and have a mostly interventional practice. It can be done. The key is to play up the uniqueness of your psych background and that you’re interested in therapy, etc and then then spend all your time learning procedures.

Kudos to you. I would be curious to know how many like you are out there.

 

[dannyboy1]

If I were a pain fellowship director, taking a psych resident for an interventional pain fellowship spot would be a huge risk. The fellowship would likely be over by the time psych residency graduate got as good at interventional procedures as our current PGY-III anesthesiology residents. Their idea of an invasive procedure is pushing a button on an ECT machine after we've done all of the work getting the patient prepared. No offense, it's just that the two specialties could not be more different.
It would be too risky in my opinion.

Maybe your residency was different in my anesthesia residency but I never did any of the procedures that pain guys do. Did a ton of labor epidurals, occasional thoracic, lots of upper and lower extremety blocks. TAP and PECS. that was pretty much it. The ganglionic blocks, device implantation, epidurals under flouo, trigger point injections. (I.e all the pain stuff) not a one. This can be taught.

 

[Gern Blansten]

Maybe your residency was different in my anesthesia residency but I never did any of the procedures that pain guys do. Did a ton of labor epidurals, occasional thoracic, lots of upper and lower extremety blocks. TAP and PECS. that was pretty much it. The ganglionic blocks, device implantation, epidurals under fluoro, trigger point injections. (I.e all the pain stuff) not a one. This can be taught.

I did all of that as a resident, but it was a while back. Celiac plexus, lumbar sympathetic, stellates, SI joints, etc. Not too much of that being taught anymore, however, but I am glad I learned it and it has come in handy many times, especially knowing how to do stellate ganglion blocks on intubated patients in the ICU who have ischemic limbs.
My point, however, is that many of the needle driving skills are easily transferable to the chronic pain stuff. It has a lot to do with hand eye coordination and that will come easier for a well-trained anesthesiology resident than a top notch psych resident, in my opinion. Doesn't mean it is impossible, as demonstrated above, I just feel it is a much steeper hill to climb.

 

[hfzballer11]

I appreciate all of the advice. I'm going to see how this first year goes (I'll spend half of it doing psych) and re-evaluate. But one thing that I haven't seen answered - how hard will a transfer be AND would I have to repeat intern year?

Hey,

I just matched into anesthesiology last week (I'm a PGY-2 in PM&R). I went through a similar situation. I was deciding between two fields, chose the wrong one, and absolutely hated it. I gave it some time based on people's recommendations, but pulled the trigger last fall.
I don't know how much medicine you do as a psych PGY-1, but it may not be enough to satisfy the anesthesiology reqs, so you might have to start over as a PGY-1.

"Transferring" residencies is very difficult, there are alot of issues that arise such as ACGME funding and NRMP violations. It is much easier to just reapply, but still not easy. I spent my vacation days this year interviewing, and I stayed well after my normal workday to "rotate" with anesthesiologists to get LoR's. It all paid off for me and I am ecstatic, but it was definitely not easy. You can PM me if you want more info or have questions.

 

[chocomorsel]

Agree, It definitely is what you make of it. Granted, I'm in the midwest, so the market out here is pretty much the best anywhere. The older guys in my group pull in around 450 plus full benefits for essentially no call and live a super cush life, while the younger guys like myself with negative net worth and student loans are pulling in >700 for M-F 7-5 (usually out between 2-4 unless on call) usually 1 first, 2nd and 3rd calls, 2 OB calls, one weekend per month. Supervise AAs (as a group will never hire CRNA) maybe 20% of the time, otherwise do all my own cases. If you work more, you get paid more. At least in the midwest, anesthesia is still pretty much the bees knees of medicine

Need any locums? Here and there on my off weeks?

I actually interviewed w a group in Indie that sounded like yours. Sounded very fair but ex at that time said no.

How did you get into such a group? Connections? Gasworks? Seems like a solid group to make good money while also doing mostly your own cases.

How many hours a week do you work?

 

[OTCAwesome]

Need any locums? Here and there on my off weeks?

I actually interviewed w a group in Indie that sounded like yours. Sounded very fair but ex at that time said no.

How did you get into such a group? Connections? Gasworks? Seems like a solid group to make good money while also doing mostly your own cases.

How many hours a week do you work?

Unfortunately we're done hiring for the year, was just able to snag my buddy from residency an interview here.

It was mostly through connections as the group is in my wife and I's home town in Indiana, which is just an awesome place to practice medicine in general.

It's honestly not too bad, I'd say I average between 55-70 hours/week, all depends on how much call I take. We get paid by the hour, so if you work more, you get paid more, super fair group. The nice thing is too, if you leave early, you still get paid for your full shift until 5, even if you're post OB or something and you only do a few colonoscopies in the morning and you're out at 10.

I'm pretty sure you're crit care as well. I was hoping to start covering the units out here, but it would be a 35-40% pay cut, so I think we got a pretty good deal for our anesthesia services

 

[sevoflurane]

My next door neighbor is a psychiatrist.
Easy hours.
No call.
No weekends.
No BS
9-3
275k plus bennies.

 

[dannyboy1]

My next door neighbor is a psychiatrist.
Easy hours.
No call.
No weekends.
No BS
9-3
275k plus bennies.

Plenty of anesthesia “day doc “ positions offering similar.

 

[BiscoDisco]

My next door neighbor is a psychiatrist.
Easy hours.
No call.
No weekends.
No BS
9-3
275k plus bennies.

Wow 275 for 30 hrs a week...im Guessing since you said olus Bennie's he's not private practice? Seems like working anesthesia hours would be a lot closer to anesthesia pay ; 450....

 

[anbuitachi]

Unfortunately we're done hiring for the year, was just able to snag my buddy from residency an interview here.

It was mostly through connections as the group is in my wife and I's home town in Indiana, which is just an awesome place to practice medicine in general.

It's honestly not too bad, I'd say I average between 55-70 hours/week, all depends on how much call I take. We get paid by the hour, so if you work more, you get paid more, super fair group. The nice thing is too, if you leave early, you still get paid for your full shift until 5, even if you're post OB or something and you only do a few colonoscopies in the morning and you're out at 10.

I'm pretty sure you're crit care as well. I was hoping to start covering the units out here, but it would be a 35-40% pay cut, so I think we got a pretty good deal for our anesthesia services

That's a lot of hours!

 

[chocomorsel]

My next door neighbor is a psychiatrist.
Easy hours.
No call.
No weekends.
No BS
9-3
275k plus bennies.

Private ones in their own practice can make anesthesia money.

 

[chocomorsel]

That's a lot of hours!

Sounds like you can work more or less depending on how much money you want.

I personally wouldn’t want to work like that myself. But have interviewed at a group or two who all took as much vacation as one wanted and took as much or minimal call.

Maybe that’s his setup.

 

[BiscoDisco]

Private ones in their own practice can make anesthesia money.

Is this private practice? Cash only?

 

[AdmiralChz]

Private ones in their own practice can make anesthesia money.

But you have to be a psychiatrist...

 

[chocomorsel]

But you have to be a psychiatrist...

I personally enjoyed psychiatry. Yet here I am. Trying to make the best of it.

 

[chocomorsel]

Is this private practice? Cash only?

Have you been on the psych forum? Follow the ones who have their own practices and do a little inpatient on the side. Not the complete employees. They are banking. Take care of the rich and the poor while doing C and L. It seems real cool.
When I was a med student my psych attending did just that and had a nice life. I can guarantee you he was making more than employee money.
Locums psych is paying as much as anesthesia these days. There's a real need in these tormented days we live in. Have you seen the news lately?

 

[abolt18]

I came to appreciate the importance of a good psychiatrist on my med school rotation, but I found it to be far too emotionally draining. Very real mental illness -> very real life problems. The perfect example of entropy in real life.

 

[rakotomazoto]

Don't do anesthesiology residency just to get to pain medicine. You will regret that decision. Not a lifestyle specialty for most.

 

[DirtDocMD]

You won’t be dependent on a hospital, or surgeons, or finding an OR to work in, if you do Psych.

Get you a nice office, a nice aquarium, schedule your day the way YOU want to. No bitchy and/or incompetent nurses to put up with. The same goes for surgeons. Much less chance for malpractice issues.

Obviously, doing Pain will eliminate some of these issues, but folks can’t pay out of pocket for pain procedures like they can a Psych visit...

Anesthesia is changing (for the worse) every day. If you could be happy doing either, stick with Psych..

 

[2Fast2Des]

Only problem with Psych is you have to maintain interest and converse with someone for so long. As much as I enjoy talking with people, dear lord I cannot feign interest all day enough. I love the few minutes we have to chat and develop a rapport with patients and that's all I want. Any longer " Ok time to nap, *pushing prop*, que the background music"

 

[vector2]

Only problem with Psych is you have to maintain interest and converse with someone for so long. As much as I enjoy talking with people, dear lord I cannot feign interest all day enough. I love the few minutes we have to chat and develop a rapport with patients and that's all I want. Any longer " Ok time to nap, *pushing prop*, que the background music"

I was under the impression nowadays that most MDs just do a 15-30 min pill visit and then refer to their LCSW or psyD if the pt actually needs counseling or therapy

 

[coffeebythelake]

Don't do anesthesiology residency just to get to pain medicine. You will regret that decision. Not a lifestyle specialty for most.

This

Anesthesiology never was a "lifestyle specialty".
Those who call it that don't know what we actually do