Totally undecided between Anesthesia and IM

[TXKnight]

Is Anesthesiology the perfect middle ground between OR/procedure medicine and clinical med?
I really like IM hospital work but there's little/no procedures, and I like the more hands-on OR oriented medicine, specifically anesthesia. I hate surgery.
Having said that, I feel anesthesia lacks most of the clinical and patient interaction that being a Hospitalist brings. Not sure what to do and appseason is around the corner. Any insights/ideas?

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[Smurfette]

Is Anesthesiology the perfect middle ground between OR/procedure medicine and clinical med?
I really like IM hospital work but there's little/no procedures, and I like the more hands-on OR oriented medicine, specifically anesthesia. I hate surgery.
Having said that, I feel anesthesia lacks most of the clinical and patient interaction that being a Hospitalist brings. Not sure what to do and appseason is around the corner. Any insights/ideas?

Anesthesia--> critical care fellowship
Anesthesia-->pain fellowship
Can be in OR and also do some weeks of ICU or some outpatient pain clinics to get more (awake) patient interaction. But if you hate surgery, are you sure being in the OR is for you?

There's also IM-->critical care, where you'd get some little procedures as well.
How do you feel about EM? Interventional Radiology?

 

[Oso]

Agree w/ the above post regarding anesthesia -> CC or pain

You could also do IM -> GI or int cards , which would be a good mix of diagnosing things + procedures, in addition to pulm/CC

I think a big thing to consider will be whether you love being in the OR (anesthesia) or rounding on patients on the wards (IM). Also consider the acuity of anesthesia in general and relative continuity of IM.

I think the above suggestion to consider EM is also an excellent point

 

[TXKnight]

Anesthesia--> critical care fellowship
Anesthesia-->pain fellowship
Can be in OR and also do some weeks of ICU or some outpatient pain clinics to get more (awake) patient interaction. But if you hate surgery, are you sure being in the OR is for you?

There's also IM-->critical care, where you'd get some little procedures as well.
How do you feel about EM? Interventional Radiology?

and

Agree w/ the above post regarding anesthesia -> CC or pain

You could also do IM -> GI or int cards , which would be a good mix of diagnosing things + procedures, in addition to pulm/CC

I think a big thing to consider will be whether you love being in the OR (anesthesia) or rounding on patients on the wards (IM). Also consider the acuity of anesthesia in general and relative continuity of IM.

I think the above suggestion to consider EM is also an excellent point

Thank you. Yes! I strongly considered EM. I I ultimately decided against it because it seems that a bunch of Dr's retire ASAP from EM, and since I am an older student I can't afford that, in addition, I have to be mindful of which specialty can offer a rhythm more in-tune with an older doc, 60+ , so when I get there in twenty five years or so I can still practice safely and effectively. Surgery I hated the never-see-your-family ever lifestyle. Maybe a lot had to do with the preceptors I had for gen surg and trauma. They were something special, to say the least. CC sounds like a viable option....IR is pretty awesome, I don't have a 250+ step1 though

 

[AdmiralChz]

The best way forward is to do a rotation ASAP in anesthesiology, to see if it piques your interest. The specialty is, by definition, nearly entirely OR-based so if you hate that environment that’s a big hurdle. That being said, even without a fellowship you have a very wide catch-all of procedures/surgeries and patient populations you would care for.

You can break out of the OR by doing a pain/CCM fellowship as described above as wel. I love the field and do procedures quite often, but it is definitely more than that in terms of real-time decision making when literally seconds count. Check the field out, along with others.

 

[TXKnight]

The best way forward is to do a rotation ASAP in anesthesiology, to see if it piques your interest. The specialty is, by definition, nearly entirely OR-based so if you hate that environment that’s a big hurdle. That being said, even without a fellowship you have a very wide catch-all of procedures/surgeries and patient populations you would care for.

You can break out of the OR by doing a pain/CCM fellowship as described above as wel. I love the field and do procedures quite often, but it is definitely more than that in terms of real-time decision making when literally seconds count. Check the field out, along with others.

Thanks for the suggestion! I am signing up for an anesthesia rotation next month, maybe a pain clinic rotation as well. I really enjoy the OR, what I meant is the actual field of surgery is something that I would not consider, perhaps that has to do with some of the "PTSD" I got from dealing with the surgeons I dealt with

 

[adamkiewicz]

I too like the procedural aspect of anesthesia and liked parts of internal medicine (differential diagnosis, work up, and f/u on your treatment plan). I chosed anesthesia b/c I was able to come up with a safe anesthetic plan, implement, and see the outcome soon after. I didn't have to worry about poor patient compliance (on IM) and discharge plans (nursing home, LTAC, home). I can focus more on medicine.

On anesthesia side, none of your patients are your own. You have to communicate with your surgeons who are primary physicians for the patient. As anesthesia/CC it's the same story. The CV surgeons and trauma surgeons have a hard time not trying to direct care, luckily if you good reputation, they're comfortable with your management and leave you alone.

If you like clinical/patient interaction and want ownership of your patients, then IM with a hands own fellowship would work.

 

[chocomorsel]

As an aside, @adamkiewicz and @TXKnight, anesthesia CCM aren't just limited to the SICU or CV ICU. The ICU field is opening up to intensivists with all kinds of backgrounds. That's why it's a good idea to go to a fellowship that isn't all surgical and CV ICU. Unless you don't mind working with surgeons trying to constantly tell you what to do outside of the OR.

 

[TXKnight]

As an aside, @adamkiewicz and @TXKnight, anesthesia CCM aren't just limited to the SICU or CV ICU. The ICU field is opening up to intensivists with all kinds of backgrounds. That's why it's a good idea to go to a fellowship that isn't all surgical and CV ICU. Unless you don't mind working with surgeons trying to constantly tell you what to do outside of the OR.

Thank you for this! It's super useful to have people contributing on this post, specially attendings and/or Residents.
I gather you saying other CCM paths could potentially provide both some patient "ownership" and the procedural aspect of anesthesia/CC? If so, that to me sounds like the best of both worlds.

 

[TXKnight]

As an aside, @adamkiewicz and @TXKnight, anesthesia CCM aren't just limited to the SICU or CV ICU. The ICU field is opening up to intensivists with all kinds of backgrounds. That's why it's a good idea to go to a fellowship that isn't all surgical and CV ICU. Unless you don't mind working with surgeons trying to constantly tell you what to do outside of the OR.

Thanks for the reply! it's very informative. It's good to know some people had the same dilemma at some point in ther career. What do you think of Pain Medicine as an alternative path to clinical "ownership" of patients along with the procedural nature of this fellowship?

 

[chocomorsel]

Thanks for the reply! it's very informative. It's good to know some people had the same dilemma at some point in ther career. What do you think of Pain Medicine as an alternative path to clinical "ownership" of patients along with the procedural nature of this fellowship?

If you can deal with that cohort of patients, then it’s a great field into ownership and truly being your own boss.