Switching to Anesthesia from Psychiatry

[2Fast2Des]

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

Really?

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[vector2]

Really?

My impression is therapy is not particularly profitable unless you're running a cash only shop. To be fair, my experience pretty much comes from when I was a med student over half a decade ago and we spent a couple weeks out of the hospital at a community outpt psych practice. The MD would usually do a 30 min initial evaluation that was mostly centered around finding a DSM diagnosis. Then would write a script. Referral to LCSW or psyd if pt needed/wanted therapy. Follow up visits were 15 minutes...would go over any side effects, adjust meds, and review the impression notes from the therapist.

 

[deleted171991]

This

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

Sorry, but you're wrong. As in it USED TO BE a lifestyle specialty. Even just 10 years ago, an outpatient PP group could have 12+ weeks of vacation, on top of the 35-40 hour-weeks, even in my blasted geographical area. Plus they were making a ton of money (when compared to nowadays). I would have taken that gig for life; heck, I still would.

 

[agent_purple]

Sorry, but you're wrong. As in it USED TO BE a lifestyle specialty. Even just 10 years ago, an outpatient PP group could have 12+ weeks of vacation, on top of the 35-40 hour-weeks, even in my blasted geographical area. Plus they were making a ton of money (when compared to nowadays). I would have taken that gig for life; heck, I still would.

I'm new to the game, but I would argue that this is medicine and specialties in general now. Perhaps anesthesia is one that was late to catch up to the rest of the playing field. I think despite what specialty that interests you, if you can't do it more than 60-70 hours a week, it might not be for you.

 

[deleted171991]

I think despite what specialty that interests you, if you can't do it more than 60-70 hours a week, it might not be for you.

Dude, I hate Marxism, but you should have your head checked. This is 2019, and long workweeks should be the voluntary exception, not the obligatory rule. Working more than 50 hours/week is neither healthy nor safe (for our patients), not even in one's 20s.

I personally hate anything for 60-70 real working hours/week. I work to live, not live to work, hence leisure time should be more than work time. One of the reasons Americans are sicker than Western Europeans is being overworked for decades.

Unless one is greedy, one should aim for a long-term job that doesn't take more than 50 hours/week, ideally much less. Why? Because there is that group of people called family, another one called friends... No dying person has ever regretted not having worked more.

 

[Twiggidy]

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.

It's just post-match remorse. I feel like more people go through it than speak up about it. Just keep following your gut because it probably told you the correct action to take.

 

[Twiggidy]

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.

Finish psych a be a therapist via telemedicine. You may not need to leave your house

 

[IMGASMD]

Finish psych a be a therapist via telemedicine. You may not need to leave your house

You’re telling me they can actually work in their own pajamas rather than the hospital issued ones that I wear at work?! I am jealous.

 

[Twiggidy]

You’re telling me they can actually work in their own pajamas rather than the hospital issued ones that I wear at work?! I am jealous.

I saw a House Hunters International where some girl was doing telemedicine from Paris. I wanted reach through the screen a choke her I was so jealous. I'm not sure what rules have changed since then but man, I think people sleep on some of the options some of these other specialties offer as far as lifestyle.

I think people really need to weight ALL the pros and cons before they start switching specialties because the grass APPEARS greener.

 

[IMGASMD]

I saw a House Hunters International where some girl was doing telemedicine from Paris. I wanted reach through the screen a choke her I was so jealous. I'm not sure what rules have changed since then but man, I think people sleep on some of the options some of these other specialties offer as far as lifestyle.

I think people really need to weight ALL the pros and cons before they start switching specialties because the grass APPEARS greener.

Wasn’t that the rage with radiology a while ago? People can read films at Hawaii beach? Not sure it really worked out. I had the “pleasure” of working with a tele-stroke robot of sorts. ICU nurses cannot do a proper neuro exam for the neurologist 100 miles away. I end up had to conduct some parts of the test. I hope tele-psych works better.
Some of these robots, AI, whatever technologies that suppose to replace the “human touch” just isn’t there yet.

 

[MalloryWeiss]

You will have the best chance of matching into pain fellowship from an anesthesia background.

 

[anbuitachi]

Dude, I hate Marxism, but you should have your head checked. This is 2019, and long workweeks should be the voluntary exception, not the obligatory rule. Working more than 50 hours/week is neither healthy nor safe (for our patients), not even in one's 20s.

I personally hate anything for 60-70 real working hours/week. I work to live, not live to work, hence leisure time should be more than work time. One of the reasons Americans are sicker than Western Europeans is being overworked for decades.

Unless one is greedy, one should aim for a long-term job that doesn't take more than 50 hours/week, ideally much less. Why? Because there is that group of people called family, another one called friends... No dying person has ever regretted not having worked more.

Family... Friends..?? Where do I find these people

 

[AdmiralChz]

Wasn’t that the rage with radiology a while ago? People can read films at Hawaii beach? Not sure it really worked out.

An order of magnitude cheaper to use docs based in India or Australia, as the “Nighthawk” system does.

 

[IMGASMD]

An order of magnitude cheaper to use docs based in India or Australia, as the “Nighthawk” system does.

We had that at one of our hospitals, but the radiologist still comes in the morning to verify all the reads. But that was a few years ago. Not sure what the policy is now.

 

[Consigliere]

...because the grass APPEARS greener.

And the only reason why is because it is fertilized with bullsh_it.

 

[Twiggidy]

And the only reason why is because it is fertilized with bullsh_it.

Seriously. I'm not even trying to clown OP, but matching psych and then switching to anesthesiology just doesn't even make sense to me. The mindset of the fields are entirely different. If it were me I'd switch into IM and then at least I'd have a multitude of fellowship options, most of which are arguably better than a pain career (IMHO)

 

[maxxor]

We had that at one of our hospitals, but the radiologist still comes in the morning to verify all the reads. But that was a few years ago. Not sure what the policy is now.

CMS determined that medicare beneficiaries must have their reads provided by someone on US soil with US credentials. Some groups would send rads to a favorable timezone (australia, israel, or Guam/Hawaii) to do off-hours coverage, but provide prelims only. Then CMS decided they were paying too much for Radiology in general and the great cuts of 2007 happened, really limiting the profitability of telerad prelims. More and more groups are now just hiring dedicated night guys to do the final reads themselves.

 

[IMGASMD]

CMS determined that medicare beneficiaries must have their reads provided by someone on US soil with US credentials. Some groups would send rads to a favorable timezone (australia, israel, or Guam/Hawaii) to do off-hours coverage, but provide prelims only. Then CMS decided they were paying too much for Radiology in general and the great cuts of 2007 happened, really limiting the profitability of telerad prelims. More and more groups are now just hiring dedicated night guys to do the final reads themselves.

Thanks. Hard to keep up with all these rules...... I wonder what kind of locum opportunities are there for radiologist?

 

[Twiggidy]

Again, grass my SEEM greener....a thread in our radiology colleague's forum

Why would you ever go into Radiology?

 

[BiscoDisco]

Seriously. I'm not even trying to clown OP, but matching psych and then switching to anesthesiology just doesn't even make sense to me. The mindset of the fields are entirely different. If it were me I'd switch into IM and then at least I'd have a multitude of fellowship options, most of which are arguably better than a pain career (IMHO)

The thing is, I like general anesthesia too. I really love physiology and pushing meds to generate a response. I would be happy even if I didn't get into pain. I despise medicine and would be miserable in IM. Really, gas and psych (and the time spent in the interventional pain suite) were the only two things I could tolerate in all of medicine.

 

[deleted171991]

The thing is, I like general anesthesia too. I really love physiology and pushing meds to generate a response. I would be happy even if I didn't get into pain. I despise medicine and would be miserable in IM. Really, gas and psych (and the time spent in the interventional pain suite) were the only two things I could tolerate in all of medicine.

Food for thought: some of the best anesthesiologists I know were passionate about IM at some point of their lives (either did or wanted to do something related to IM). A lot of anesthesiology IS internal medicine; don't fool yourself.

I tend to despise people who despise IM. They tend to be pretty limited in knowledge, mostly knee-jerk monkey see monkey do.

 

[BiscoDisco]

Food for thought: some of the best anesthesiologists I know were passionate about IM at some point of their lives (either did or wanted to do something related to IM). A lot of anesthesiology IS internal medicine; don't fool yourself.

I tend to despise people who despise IM. They tend to be pretty limited in knowledge, mostly knee-jerk monkey see monkey do.

I guess i should clarify...i hate the endless rounding, long notes, treating the same (mostly preventable) conditions over and over again, the sitting around and pondering...

 

[Twiggidy]

I guess i should clarify...i hate the endless rounding, long notes, treating the same (mostly preventable) conditions over and over again, the sitting around and pondering...

This is like 95% of anesthesiology

I like to post this when people want to switch into anesthesiology just to provide them perspective of the world they will be entering and where they fall on the medicine totem pole. What do you notice about this list?

http://nymag.com/bestdoctors/content.html

 

[BiscoDisco]

This is like 95% of anesthesiology

I like to post this when people want to switch into anesthesiology just to provide them perspective of the world they will be entering and where they fall on the medicine totem pole. What do you notice about this list?

http://nymag.com/bestdoctors/content.html

My understanding was there was a lot of downtime during a case (I don't consider this sitting around pondering) but you also had to think quickly and make snao decisions. Is that not the case?

Ha..I do notice no gas in that list...

 

[Gern Blansten]

What do you notice about this list?

http://nymag.com/bestdoctors/content.html

They are all in the New York area??

 

[IMGASMD]

What do you notice about this list?

http://nymag.com/bestdoctors/content.html

Pain medicine is listed with the letter P.

 

[Twiggidy]

They are all in the New York area??

I know. They do the same year "articles" where I work now and Anesthesiology never shows up as a specialty

 

[Twiggidy]

Pain medicine is listed with the letter P.

I personally know a couple of those pain docs and they don't do a single unit of anesthesia in the OR. One does interventional pain and he admittedly tells residents they can never have a practice like his where you only do pain procedures. Maybe or maybe not true. The other I know on that list spends most of her time on TV

But the moral is, on these lists, you'll never see John Doe, MD general anesthesiologist as a top doc because no one picks a hospital because of the anesthesiologists they employ/contract.

I guess if the goal is to go into pain then sure make the switch

 

[Twiggidy]

My understanding was there was a lot of downtime during a case (I don't consider this sitting around pondering) but you also had to think quickly and make snao decisions. Is that not the case?

Ha..I do notice no gas in that list...

Yes. You do need to think quickly WHEN the time calls for it, but about 99.9% of us aren't hoping that happens. We SEEK the boring even in cardiac surgery. I don't need excitement, I'm getting to old for that s**t. Give me long, boring, and a paycheck. (Or short, boring, and a paycheck)

I think it's a big misconception for people switching into this field that it's "do react. do react. do react"......the old joke of "The ABCs of Anesthesia are 'Airway. Breathing. Coffee'" holds true for a reason.

 

[deleted162650]

Give me long, boring, and a paycheck.

Pretty sure that's a hooker's motto as well.

 

[Twiggidy]

Pretty sure that's a hooker's motto as well.

There is a gray area when comparing prostitution to anesthesiology.

 

[PPate]

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?

Hi, I have matched into TY in Miami, and am looking to swap into Psych, preferably in North Florida. Let me know if interested. Thanks!

 

[IMGASMD]

Hi, I have matched into TY in Miami, and am looking to swap into Psych, preferably in North Florida. Let me know if interested. Thanks!

Are you asking if someone would switch a categorical spot with your transitional year?
Rly?

 

[HinduHammer]

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.

@OpheliaButz
I'm a psych interested in pursuing interventional pain. I tried to PM you but it wouldn't allow me to start a convo. I had some specific questions about my personal situation that I would prefer not posting here if you have some time. Thank you.

 

[Consigliere]

Hi, I have matched into TY in Miami, and am looking to swap into Psych, preferably in North Florida. Let me know if interested. Thanks!

Now this is a smart fella!