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Yes, absolutely. And don’t get use started regarding out of the OR anesthesia requests.
Wanting to switch from PGY-3 Psych
Started by will96
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Please, let it out, we are all ears
Share the wisdom so future med students stumbling on this thread while researching their specialty choice 20 years from now can benefit from it.
I get where you're coming from, but simply noting that complications resulting in objectively life-altering financial judgments against us are rare, overlooks the frequent overall poor outcomes in patients we take care of.
With time and experience we get better at managing risk, but the risk is still there. And there's more to "risk" than just counting sentinel events or closed claims.
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Imagine a case where you encounter unanticipated life threatening bleeding. Patient goes to the icu intubated, eventually extubated, neurocognitively just isn’t the same. Sues, they find low blood pressure in the record around the time of bleeding and they find an expert to say that’s the cause, you didn’t resuscitate well enough-settlement
Imagine a surgeon takes 7 hrs for a hysterectomy. Patient wakes up with an ulnar neuropathy- anesthesiologist is responsible for upper body positioning, you are sued. Doesn’t matter the surgeon sucks.
Imagine you do a nerve block and the surgeon injures a nerve, surprise your nerve block is blamed. Or maybe that surgeon is slow and you are doing a 4hr mac case with the table turned and there is an airway issue. Wouldn’t have been a problem if they were quick, but you are blamed.
Imagine a spine case where the bp goes low for 20 minutes before it’s fixed by the crna, patient has incontinence or paralysis issues, you are sued for not perfusing well enough. Doesn’t matter you weren’t in the room, doesn’t matter if the surgeon was at fault.
These were just off the top of my head. There are infinite examples we take on risk just by signing the chart.
That's why our malpractice rates are 3 X that of a solo CRNA. Do you think the CRNAs are 3 x safer? We get paid on average 50-90% more per hour than a CRNA (supervised CRNA) for a variety of reasons one of them being we take the blame.
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You are all ears. We already know.
No matter how many times you’ve been through these situation they are still stressful
There is no comparison between the stress and risk level of Psych vs Anesthesiology- they are miles apart. Every year our patients get sicker, fatter and older while wanting more procedures under anesthesia. Every year more "out of Operating room" procedures are performed on these patients. Every year more patients are brought to the ASC that just ten years ago would have gone to the hospital.
Our technology has increased to compensate somewhat for these "riskier" patients but by no means have stress levels decreased if you are involved in the care of such patients. Any bad outcome (of which some are to be expected in a high risk group) will most likely involve the Anesthesiologist regardless of where the actual blame lies (even if there is any blame). We are an outcome driven society which means if there was a bad outcome someone or some group must be at fault.
One last thing is I love boring and routine because "exciting things" still happen way too often for my taste. The odds are you will most likely be sued at least once in your career (20+ years) as an Anesthesiologist regardless of whether you were at fault. Even the most meritless lawsuit will drain you mentally and takes its toll. There are no "good" lawsuits if you are named as a defendant.
All very good points, I remember reading your posts here decades ago way back when I was a boy, you have been both in the field and on these forums probably longer than anyone else, respect.
You have also probably dissuaded more med students from the field of anesthesiology via your posts here than anyone else too 😛
I think that # is closer to 25-30% more.
CRNA locum rates easily 250-300 an hour. MD locum rates 350-400..
Again, we are underpaid for the risk and liability we assume.
I would say I have a level of comfort where most days feel fine and on average the stress is low, though there is a constant tension (let's call it "vigilance") that never allows you to fully let your guard down, as any of that crap above that happens can happen at any time, including during the most straightforward surgeries on the healthiest of patients, where a bad outcome is completely unexpected. (Sorry, that was a really long sentence) There is a reason people describe anesthesia as "95% boredom and 5% sheer terror." Boring days are always welcomed.
Additionally, my threshold for what stresses me out has increased overtime. There is a certain amount tolerance that builds up. But that doesn't mean the stress isn't felt and doesn't mean it doesn't have physiologic consequences on our bodies.
The fact is, the stress is ever present and at times is exceptionally high. The insults to circadian rhythm are not helping either. While truly terrible outcomes ARE rare, it's not because bad things don't happen. It's because we legitimately save people MOST of the time when those bad things happen.
My Med school roommate and classmate went into Psych. While I earned more money than him year after year he did quite well peaking around $475k. He recently retired after decades in practice but still sees patients from his basement via Zoom. His professional income during retirement is currently $250K and he expects at least another decade plus seeing patients. My point is in his field he can work from home until age 75-80 well beyond my expiration date as an anesthesiologist not mention he hasn't taken any call in many years. Whatever field you choose make the most out of it.
I am so thankful I sit my own cases with federal tort reform.
Bro please stick with psych. I know so many people who have left pain altogether and got back to doing exclusive anesthesia. I don't know why you think you'd be so much happier doing pain. I know a lot of buddies in psych and as attendings are so happy. Great money, extremely low stress, high demand, bankers hours. Honestly please reconsider this.
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You really think so? What you said about psych I think is mostly true for pain. Except you can do procedures which is one of the things I miss. It's just 1 extra year.
