trying to decide between anesthesia and internal med

[kbommar]

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i'm a 3rd year at the ohio state college of medicine. i'm trying to decide between anesthesia and imed.

reasons for anesthesia:
i like the lifestyle of anesthesia. i'm a huge fan of physiology and pharm. but i also really like talking to patients. i'm interested in doing procedures and love doing things like drawing blood, injections, etc. (but don't tell me to become a nurse.) i think i would enjoy the job and would def enjoy not being in the hospital late into the day.

reasons for imed:
as far as imed, it was my favorite rotation so far. my teams for both months, however, were really laid back. most of my friends are going into internal med and we all have similar personalities. i actually enjoy rounding and presenting bc of the whole "team" atmosphere. if i did imed, i would probably work as a hospitalist for a few years and then specialize in GI.

other factors:
i want to go to chicago for residency regardless of what i do. one of my main problems is that though my patients always love me, my evals haven't been that great. part of the problem is that i come off as being "too laid back." this is one of the reasons why i wonder if anesthesia is a better fit for me.

i'm also concerned about the future of anesthesia. are anesthesiologists still going ot be making 200,000+ out of residency 10 years from now?

any info/insight/advice would be greatly appreciated.

 

[chicamedica]

i'm a 3rd year at the ohio state college of medicine. i'm trying to decide between anesthesia and imed.

reasons for anesthesia:
i like the lifestyle of anesthesia. i'm a huge fan of physiology and pharm. but i also really like talking to patients. i'm interested in doing procedures and love doing things like drawing blood, injections, etc. (but don't tell me to become a nurse.) i think i would enjoy the job and would def enjoy not being in the hospital late into the day.

reasons for imed:
as far as imed, it was my favorite rotation so far. my teams for both months, however, were really laid back. most of my friends are going into internal med and we all have similar personalities. i actually enjoy rounding and presenting bc of the whole "team" atmosphere. if i did imed, i would probably work as a hospitalist for a few years and then specialize in GI.

other factors:
i want to go to chicago for residency regardless of what i do. one of my main problems is that though my patients always love me, my evals haven't been that great. part of the problem is that i come off as being "too laid back." this is one of the reasons why i wonder if anesthesia is a better fit for me.

i'm also concerned about the future of anesthesia. are anesthesiologists still going ot be making 200,000+ out of residency 10 years from now?

any info/insight/advice would be greatly appreciated.

I'd recommend not doing anesthesia if you only like it for the lifestyle. Cause the lifestyle really isn't all that laid back. When you're on call, you dont sleep at all. You have someone's life in your hands, and it can take only a split second to go haywire on you and it can do so at 4 am when you haven't had a wink of sleep--and you still have to be 100% alert and on top of your game. My feeling is that this is why the stereotype of coffee + anesthesiologist has been formed. It's not a stereotype. It's a necessity.

I think the field just tends to be seen as laid-back because the anesthesiologists tend to be positive people. I've found that I needed to do much more reading and thinking on my anesthesia rotation than on my medicine rotations, cause the material is a lot more complex. And that is reason #101 i love anesthesia.

 

[ThinkFast007]

hey OP

i also had the dilemma b/w IM and Anesthesia. I LOVE chatting w/ patients and getting to know them. I really feel like I'm one of those guys that gets energy from being around ppl and talkign w/ them. Having said that I thought Anesthesia would be completely the opposite of what kind of guy I am.

I was wrong. Dude, after having rotated through a few departments, I found that anesthesia (atleast when properly done) is quite the 'ppl friendsly environ". Sure, if you want you could be mute and introverted, and probably could get the job done....I mean that happens in ANY field. But...lots of Anesthesiologists will tell you, that the first line of treatment when pts are anxious before surgery is the ANESTHESIOLOGIST. yup, not versed, but the ANESTHESIOLOGIST. If you are compassionate, funny, and just a 'people' person you can do the trick. Granted, I'm not advocating doing a Fem-Pop under the anesthetic of TLC, joking around, and a little MAC....but I think you get my point..

About the lifestyle thing. I'm a MSIV by the way. Sure, ppl do do it for 'lifestyle'. Why do you think it's a VERY HOT field to go into nowadays. But should that be YOUR ONLY MOTIVATION??? HECK NO. I'll agree w/ chica in the sense that that should not be you ONLY motivation. But look at the guys on here that are the top dogs and tell me they're not having the 'good life'.

JetPro---he's got a pimped out truck, and flies airplanes.
MilMD---has got a friggin Bike (enough said)....tell me how many MDs you know w/ a friggin bike !!! (no not a bicycle)
UTSW---dude's just cool all around
VentDep---look at the pic next to his username

So bottom line, these guys have a GOOD LIFE. Theyre paid,etc. BUT....like i said, dont do it only for those reasons. Do a rotation, or do what I did....during your surgery rotation chill out w/ the Anesthesiologists and be back there with them (i dont suggest you do that with the surgery team your on, but w/ say another surgery service). Doing that just closed the deal for me.

Yes, you gotta love pharm, physio, etc. But there's a lot out there outside of medicine. You live once, so live it up. From what I've seen, when you are in the hospital, you work. When you're done...you're done!

good luck bro

 

[Soon2BENT]

dude,
I'll try to be non-verbous as possible. Anesthesia. Anesthesia. Anesthesia.

I praying the match will fix my mistake. I'm going to do anesthesia no matter what. Personally, I think anesthesia is for people who dont enjoy 3 hour rounds, who want to throw pagers in the trash, who enjoy using their knowledge in a "real-time" atmosphere (ie, not lets treat this BP and see me back in 3 months), who can respond to any stressful situation and still be cool about it, and lets be honest, are probably the coolest of the field of medicine. Most people who are anesthesiologist are an anesthesiologist and a writer, or snowboarder, or triathlete, or (fill in the blank). I'm going to join the club soon (like I said, no matter what), and the fact that you're thinking about it, probably means you should too.

 

[greets fr. nyc]

i agree with the above... also depends what type of acuity you'd like. There's something for everyone in anesthesia: from pain managment to regional to cardiothoracic to transplants and crazy peds anesthesia and everything in between. Also room for business and organizational management types as well as researcher oriented folks (which are always in need)

Much of the reason I chose anesthesia is a deep-seated interest in critical care. I started out med school wanting to go into IM and the M-ICU (some of my best mentors were pulm-CCM peeps), but I just enjoyed taking care of the issues in the critically ill surgical patient much more, and liked spending time in the OR on the anesthesia side. So for example, in the ICU setting, you can have a dizzying array of internal medicine and surgical challenges, along with different types of patient/family interactions and the incumbant ethical dillemas, psychosocial issues, family issues, pain management concerns, etc, etc.

In other countries, critical care is almost unanimously run by anesthesia folks, though it's a relative minority in the US, and could always use more people from anesthesia. Without a doubt, I think they have something unique and significant to offer.

So the point is, the money will be there, and it may rise or fall, who knows(?) as in any other specialty, but if you chose to go into this field, you can expect to have something for your interests and personality within and outside of medicine.

 

[Danger Man]

Much of the reason I chose anesthesia is a deep-seated interest in critical care. I started out med school wanting to go into the MICU (some of my best mentors were pulm-CCM peeps)

Don't you mean PEEPs?

 

[greets fr. nyc]

haha (chuckle*)
😀

 

[kbommar]

thanks for all the responses. i'm pretty much 90% anesthesia right now. i'm planning on shadowing some anesthesia attendings over my spring break before i make the final decision.

i guess what it boils down to is doing something that i'll enjoy, that pays well, and that lets me be myself.

btw, any thoughts on the chicago anesthesia programs? from what i've heard, UIC is an awesome program and northwestern and rush are toxic.

 

[AwesomeO-DO]

i'm a 3rd year at the ohio state college of medicine. i'm trying to decide between anesthesia and imed.

reasons for anesthesia:
i like the lifestyle of anesthesia. i'm a huge fan of physiology and pharm. but i also really like talking to patients. i'm interested in doing procedures and love doing things like drawing blood, injections, etc. (but don't tell me to become a nurse.) i think i would enjoy the job and would def enjoy not being in the hospital late into the day.

reasons for imed:
as far as imed, it was my favorite rotation so far. my teams for both months, however, were really laid back. most of my friends are going into internal med and we all have similar personalities. i actually enjoy rounding and presenting bc of the whole "team" atmosphere. if i did imed, i would probably work as a hospitalist for a few years and then specialize in GI.

other factors:
i want to go to chicago for residency regardless of what i do. one of my main problems is that though my patients always love me, my evals haven't been that great. part of the problem is that i come off as being "too laid back." this is one of the reasons why i wonder if anesthesia is a better fit for me.

i'm also concerned about the future of anesthesia. are anesthesiologists still going ot be making 200,000+ out of residency 10 years from now?

any info/insight/advice would be greatly appreciated.

i too have been debating between these two fields, both IM as a hospitalist and anesthesiology have the lifestyle that appeals to me, and i feel like I'm the type of person who will be able to do any job, just as long as I DON'T HAVE TO DO OFFICE BASED MEDICINE!! sorry for yelling, but damn is it boring. But sometimes I worry I might burn out on the hospitalist gig after 5-10 years, and then where am I... pretty much my only option would be to join a clinic or start my own, and that would suck. If you burn out on anesthesia, where do you go? Actually I don't know, anyone?

 

[kbommar]

i've never heard of burnout in anesthesia. but i have heard of attendings deciding to only work from 6am-3pm with no call later in their careers.

the hospitalist job is what i was thinking about doing for a while. but do you realize you're basically running an entire service on your own? that means you have to put in all the bull**** orders and write notes for every single patient everyday. you won't have any residents or interns there to do anything for you.

you'll be in the hospital everyday including weekends while you're on. and i'm not sure how call works when you're a hospitalist but i've heard at some places night float doesn't cover the hospitalist service.

 

[LanceArmstrong]

i'm a 3rd year at the ohio state college of medicine. i'm trying to decide between anesthesia and imed.

reasons for anesthesia:
i like the lifestyle of anesthesia. i'm a huge fan of physiology and pharm. but i also really like talking to patients. i'm interested in doing procedures and love doing things like drawing blood, injections, etc. (but don't tell me to become a nurse.) i think i would enjoy the job and would def enjoy not being in the hospital late into the day.

reasons for imed:
as far as imed, it was my favorite rotation so far. my teams for both months, however, were really laid back. most of my friends are going into internal med and we all have similar personalities. i actually enjoy rounding and presenting bc of the whole "team" atmosphere. if i did imed, i would probably work as a hospitalist for a few years and then specialize in GI.

other factors:
i want to go to chicago for residency regardless of what i do. one of my main problems is that though my patients always love me, my evals haven't been that great. part of the problem is that i come off as being "too laid back." this is one of the reasons why i wonder if anesthesia is a better fit for me.

i'm also concerned about the future of anesthesia. are anesthesiologists still going ot be making 200,000+ out of residency 10 years from now?

any info/insight/advice would be greatly appreciated.

I found myself empathizing with 90% of your post. The only thing that is kinda holding me back is this relationship in my brain that I cant shake:

anesthesia = operating room + working for surgeons + no follow up

I think that as I get older and start to focus more on the human relationships in my life the lack of patient follow up and appreciation is going to make me feel as if though my time could have been spent better.

 

[jetproppilot]

I found myself empathizing with 90% of your post. The only thing that is kinda holding me back is this relationship in my brain that I cant shake:

anesthesia = operating room + working for surgeons + no follow up

I think that as I get older and start to focus more on the human relationships in my life the lack of patient follow up and appreciation is going to make me feel as if though my time could have been spent better.

Just make sure you consider that, ten years from now, are you gonna still be willing to sacrifice personal time/personal relationships/relationships with your children for your chosen craft?

I'm not trying to suggest a yay or a nay here.

I'm just keenly aware that as an MS 4 you are naive and full of piss and vinegar.

Ten years later, you wanna enjoy what you do, but still have time for yourself and your family. And if you've selected a very, very demanding specialty, that may not be possible, and your personal life may suffer.

Additionally, for all you grandiose, know-it-all-pro-surgery MS 4s out there, have you looked at the current reimbursements for your specialty??

It doesnt matter to you now, cuz you're single, and all you're financially responsible for now is your tuition, your rent, your food, and your Starbuck's habit.

Ten years from now, when youre a private practice heart surgeon with a family, don't you think you'll give a s hit what medicare pays you for a CABG, since >90% of your patients are 65 and older?

Oh, BTW, current day medicare pays a heart surgeon about 1800 bucks for the CABG and 99 days of post-op care.

Twenty years ago medicare paid a heart surgeon about ten-grand for the same procedure...oh, sorry...thats a lie, since 20 years ago it wasnt the same procedure... since the CABGS were mostly ASA 3s that needed a one-vessel bypass....open the chest, drop the LIMA, tie it in, and youre done.

Today, 3-4 vessel CABGs are the norm, on critically ill ASA 4 patients. For ONE-FIFTH the reimbursement of 20 years ago, with twice the work.

General surgery is no different.

And lets not even traverse the criminal-reimbursement of primary care specialties.

Yes, anesthesiologists are consultants to surgeons. But lets not kid ourselves, obviously-naive-Lance Armstrong. Lets say youve spent your life becoming a heart surgeon. Guess what?

Where do you think your cases come from????

Cardiologists.

Heart surgeons are consultants to cardiologists.

And if they dont like you, or if you suck at your trade, you're f ukked.

So dont be so naive to suggest to readers that anesthesiologists are the only consultant physicians. In essence, EVERY physician specialist is a consultant.

Don't kid yourself.

And don't kid the readers.

 

[jetproppilot]

Just make sure you consider that, ten years from now, are you gonna still be willing to sacrifice personal time/personal relationships/relationships with your children for your chosen craft?

I'm not trying to suggest a yay or a nay here.

I'm just keenly aware that as an MS 4 you are naive and full of piss and vinegar.

Ten years later, you wanna enjoy what you do, but still have time for yourself and your family. And if you've selected a very, very demanding specialty, that may not be possible, and your personal life may suffer.

Additionally, for all you grandiose, know-it-all-pro-surgery MS 4s out there, have you looked at the current reimbursements for your specialty??

It doesnt matter to you now, cuz you're single, and all you're financially responsible for now is your tuition, your rent, your food, and your Starbuck's habit.

Ten years from now, when youre a private practice heart surgeon with a family, don't you think you'll give a s hit what medicare pays you for a CABG, since >90% of your patients are 65 and older?

Oh, BTW, current day medicare pays a heart surgeon about 1800 bucks for the CABG and 99 days of post-op care.

Twenty years ago medicare paid a heart surgeon about ten-grand for the same procedure...oh, sorry...thats a lie, since 20 years ago it wasnt the same procedure... since the CABGS were mostly ASA 3s that needed a one-vessel bypass....open the chest, drop the LIMA, tie it in, and youre done.

Today, 3-4 vessel CABGs are the norm, on critically ill ASA 4 patients. For ONE-FIFTH the reimbursement of 20 years ago, with twice the work.

General surgery is no different.

And lets not even traverse the criminal-reimbursement of primary care specialties.

Yes, anesthesiologists are consultants to surgeons. But lets not kid ourselves, obviously-naive-Lance Armstrong. Lets say youve spent your life becoming a heart surgeon. Guess what?

Where do you think your cases come from????

Cardiologists.

Heart surgeons are consultants to cardiologists.

And if they dont like you, or if you suck at your trade, you're f ukked.

So dont be so naive to suggest to readers that anesthesiologists are the only consultant physicians. In essence, EVERY physician specialist is a consultant.

Don't kid yourself.

And don't kid the readers.

Same concept with general surgeons.

 

[avanb803]

I found myself empathizing with 90% of your post. The only thing that is kinda holding me back is this relationship in my brain that I cant shake:

anesthesia = operating room + working for surgeons + no follow up

I think that as I get older and start to focus more on the human relationships in my life the lack of patient follow up and appreciation is going to make me feel as if though my time could have been spent better.

Lack of follow up and appreciation? Apparently you haven't come across the 20 yr old chronic back pain drug seeking patient threatening to sue you for not giving them lortab? Is it just me, or does the image of this type of patient seem to stay in your head more than the good patients?

 

[LanceArmstrong]

Yes, anesthesiologists are consultants to surgeons. But lets not kid ourselves, obviously-naive-Lance Armstrong. Lets say youve spent your life becoming a heart surgeon. Guess what?

Where do you think your cases come from????

Cardiologists.

Heart surgeons are consultants to cardiologists.

And if they dont like you, or if you suck at your trade, you're f ukked.

So dont be so naive to suggest to readers that anesthesiologists are the only consultant physicians. In essence, EVERY physician specialist is a consultant.

Don't kid yourself.

And don't kid the readers.

"Obviously-naive"? "Don't kid yourself"? "Only your starbucks habit to support"? and my favorite - "full of piss and vinegar". 😱

Geez it doesnt take much in this forum to get a rebuke from you for just expressing my opinion of how I feel the field is suited for ME.

All I was saying is that when I'm 75 and retired and spent 50-60 or more hours a week on average doing my stressfull job and ignoring my family, I would like to think that there's a patient out there who's appreciative of me and might even remember me when I helped them out. Which I don't think I'll get by working as an anesthesiologist in the OR, maybe in pain management but definetely not in the OR.


👍

 

[AwesomeO-DO]

Lack of follow up and appreciation? Apparently you haven't come across the 20 yr old chronic back pain drug seeking patient threatening to sue you for not giving them lortab? Is it just me, or does the image of this type of patient seem to stay in your head more than the good patients?

but isn't this only the case if you work in a pain clinic. If not, then you only see patients for a pre-op, during the procedure, and recovery. You don't have long term patients (which in my opinion is AWESOME...... 0 🙂

 

[LanceArmstrong]

Lack of follow up and appreciation? Apparently you haven't come across the 20 yr old chronic back pain drug seeking patient threatening to sue you for not giving them lortab? Is it just me, or does the image of this type of patient seem to stay in your head more than the good patients?

I think pretty much anyone who's been in a hospital for more than a few hours has seen this type of patient. From my experience labeling patients as drug seeking is an over used brush off for people who we can't really do anything for. Am I saying that narcotic addictoin is not very common? No I'm not. Have I come across belligerent drug seeking patients? - you better believe it.

 

[supahfresh]

Same concept with general surgeons.

Let me ask you this jet. and by no means am I trying to knock any specialty because this is a problem that is happening in every specialty. The world is going to need heart surgeons. What's going to happen if nobody wants to put in the time for such s hitty reimbursement?

 

[BubbleHead]

reasons for anesthesia:
i like the lifestyle of anesthesia.

reasons for imed:
as far as imed, it was my favorite rotation so far.
any info/insight/advice would be greatly appreciated.

People tend not to pay attention to the obvious...

You wrote the above as your first resaons... did you decide to write these first, did you have a specific reason for ordering your reasons in this way?

If lifestyle is even a reason, you're a fool. Everything is cyclic and you have no way of knowing what it will be in 5-10 years.

Go with what you like and don't look back.

 

[kbommar]

People tend not to pay attention to the obvious...

You wrote the above as your first resaons... did you decide to write these first, did you have a specific reason for ordering your reasons in this way?

If lifestyle is even a reason, you're a fool. Everything is cyclic and you have no way of knowing what it will be in 5-10 years.

Go with what you like and don't look back.

like i was saying, i haven't done my anesthesia rotation yet. i'm going to be shadowing some anesthesiologists over my spring break before the rotation. but i agree that i shouldn't decide until i've actually done it.

as far as the order of the reasons for each, it wasn't intentional, but maybe there's some meaning in that i listed those first without even thinking to do it that way. i like medicine, but also i like doing procedures. therefore GI, cardio, and anesthesia come to mind. but i want to live a life where i spend more time with my (future) family and have free time to do other things i want to do in life.

i don't want medicine to dominate my life forever. i want to do other things like open a bar and keep playing in my band (or a new band once we all go off to different residencies).

 

[ThinkFast007]

People tend not to pay attention to the obvious...

You wrote the above as your first resaons... did you decide to write these first, did you have a specific reason for ordering your reasons in this way?

If lifestyle is even a reason, you're a fool. Everything is cyclic and you have no way of knowing what it will be in 5-10 years.

Go with what you like and don't look back.

kinda agree w/ teh above.

do whatever you think you would have 'love for'. sorry, a passion for.