What would you do if you were me?

[X46412]

---

Members do not see this ad.

I’m a nontraditional med student in the military, coming into medicine later in life. I entered med school via HPSP after over 15 years of active duty in the Army. By the time I finish residency and complete my active-duty service obligation, I’ll be in my early 50s — and I’ll have over 20 years of service and a full military pension.

Here’s where I’m at: • Anesthesiology: I enjoy the work. The physiology, procedures, and acute management keep me engaged. On a scale, the day-to-day work feels like a 9/10. But the lifestyle (residency grind, hours, etc) feels more like a 7/10. • Psychiatry: The work itself doesn’t excite me as much. It still excites me, just not as much as the day to day of anesthesia. I’d rate psych work a 7/10, but I really like the people, the training environment, and the residency lifestyle — closer to a 9/10. • I’m in my 40s now with kids from a previous marriage in one state, a spouse and younger child with me in another, and aging family in yet another. My wife is pregnant and we will have another one shortly!

Psych keeps me closer to to parents/siblings (flight under an hour to parents but over 7 from older kids), while anesthesia aligns better with being near my older kids (2 hour flight potentially. 4 hour flight if I get the east coast residency location). Either way, I’m making trade-offs.

My assessment is that Psych is all but 100% acceptance for me, where as anesthesia is maybe 80% (and I don’t think I’d drag my family and myself through a TY or GMO tour to try and reapply anesthesia, so I’m banking on categorical slots).

What would you do if you were me? Thanks!

 

[Goro]

First off, many thanks to you for your service to our country.
Second, follow your dream.
3) my oldest matriculant was in his early 50s. He's still in practice, in his 70s.
4) Adcoms love veterans!
5) Worry about specialty after getting into med school
6) Good luck!

 

[X46412]

I’m an M4 and will match shortly!

 

[LucidSplash]

I’m an M4 and will match shortly!

You need to think lifestyle beyond residency. Residency is temporary, specialty is for the rest of your working life. Which is not to say pick anesthesia over psych, but worry less about the residency life and more about out the life after. These are two very different specialties.

 

[X46412]

Sooo what would you do?

 

[Goro]

I’m an M4 and will match shortly!

My apologies! My reading comprehension is fading in my old age.
Pick the most chill specialty.

 

[Ho0v-man]

If I were you I’d stop having kids. How are you not tired…like all the time?

Then I’d pick psych because you actually like it and the lifestyle is anything you want after training. Both will feel like jobs after a while so pick the thing you like that you can do long term. People in their 40s and 50s in anesthesia are trying to get out and FIRE.

 

[X46412]

Stop having kids is the plan for sure! Thanks for the advice!

 

[Med Ed]

Psych without question. Your future family and 50+ body/brain will thank you.

 

[X46412]

Thank you!!

 

[X46412]

Psych without question. Your future family and 50+ body/brain will thank you.

Thank you!

 

[X46412]

If I were you I’d stop having kids. How are you not tired…like all the time?

Then I’d pick psych because you actually like it and the lifestyle is anything you want after training. Both will feel like jobs after a while so pick the thing you like that you can do long term. People in their 40s and 50s in anesthesia are trying to get out and FIRE.

Stop having kids is the plan for sure! Thanks for the advice!

 

[X46412]

My apologies! My reading comprehension is fading in my old age.
Pick the most chill specialty.

No worries. Thank you!

 

[Taddy Mason]

I’m younger but was non-trad and torn between IM and psych. With psych there’s consult-liaison psych which I found I really enjoyed and scratched some of the itch I was missing from IM and I would assume could do the same for you with anesthesia (e.g., physiology, acuteness). I did an addiction fellowship and actually get to do a lot of pain management for OUD patients which anesthesia really doesn’t like to touch, and often works pretty closely with anesthesia on a regular basis. Addiction psych also has a lot more medicine in it like consult-liaison psych (I do addiction C/L work). You can also do a pain management fellowship from psych which could be a good middle ground between anesthesia and psych.

 

[X46412]

I’m younger but was non-trad and torn between IM and psych. With psych there’s consult-liaison psych which I found I really enjoyed and scratched some of the itch I was missing from IM and I would assume could do the same for you with anesthesia (e.g., physiology, acuteness). I did an addiction fellowship and actually get to do a lot of pain management for OUD patients which anesthesia really doesn’t like to touch, and often works pretty closely with anesthesia on a regular basis. Addiction psych also has a lot more medicine in it like consult-liaison psych (I do addiction C/L work). You can also do a pain management fellowship from psych which could be a good middle ground between anesthesia and psych.

Thanks! I am interested in addiction! I thought CL would scratch my medicine itch but during my psych interview rotation every consult basically boiled down to a pt being on X ward and saying they were depressed or had SI and boom -> psych CL was called (all the medicine had already for the most part been figured out by the primary team). This was the same with every ED consult. I’m glad to hear it can be different.

 

[Taddy Mason]

Thanks! I am interested in addiction! I thought CL would stretch my medicine itch but during my psych interview rotation every consult basically boiled down to a pt being on X ward and said they were depressed or had SI and psych CL was called (all the medicine had already for the most part been figured out by the primary team). This was the same with every ED consult. I’m glad to hear it can be different.

Yup. Helping to manage delirium, cardiac issues and psych meds (not to brag but I can read and interpret EKGs better than most general IM docs out of necessity), GI absorption and psych meds, renal issues and psych meds…catatonia that’s too unstable for inpatient psych, NMDA receptor encephalitis, 5-HT syndrome, helping to wean sedation in the ICU and iatrogenic withdrawal, transplant evals, just to name a few. With ED consults there isn’t a lot of medicine per se but you have to keep your eye out for things the ED missed (which unfortunately happens way more often than it should), and neuro issues masquerading as psych ones (also part of C/L). Part of this is dependent on the C/L culture where you train/practice but should be a regular aspect of work if you’re at an academic or tertiary medical center.

 

[X46412]

Yup. Helping to manage delirium, cardiac issues and psych meds, GI absorption and psych meds, renal issues and psych meds…catatonia that’s too unstable for inpatient psych, NMDA receptor encephalitis, helping to wean sedation in the ICU and iatrogenic withdrawal, transplant evals, just to name a few. With ED consults there isn’t a lot of medicine per se but you have to keep your eye out for things the ED missed (which unfortunately happens way more often than it should), and neuro issues masquerading as psych ones (also part of C/L). Part of this is dependent on the C/L culture where you train/practice but should be a regular aspect of work if you’re at an academic or tertiary medical center.

Now all of this sounds very mentally stimulating and great! Thank you!

 

[Tenk]

I’m a nontraditional med student in the military, coming into medicine later in life. I entered med school via HPSP after over 15 years of active duty in the Army. By the time I finish residency and complete my active-duty service obligation, I’ll be in my early 50s — and I’ll have over 20 years of service and a full military pension.

Here’s where I’m at: • Anesthesiology: I enjoy the work. The physiology, procedures, and acute management keep me engaged. On a scale, the day-to-day work feels like a 9/10. But the lifestyle (residency grind, hours, etc) feels more like a 7/10. • Psychiatry: The work itself doesn’t excite me as much. It still excites me, just not as much as the day to day of anesthesia. I’d rate psych work a 7/10, but I really like the people, the training environment, and the residency lifestyle — closer to a 9/10. • I’m in my 40s now with kids from a previous marriage in one state, a spouse and younger child with me in another, and aging family in yet another. My wife is pregnant and we will have another one shortly!

Psych keeps me closer to to parents/siblings (flight under an hour to parents but over 7 from older kids), while anesthesia aligns better with being near my older kids (2 hour flight potentially. 4 hour flight if I get the east coast residency location). Either way, I’m making trade-offs.

My assessment is that Psych is all but 100% acceptance for me, where as anesthesia is maybe 80% (and I don’t think I’d drag my family and myself through a TY or GMO tour to try and reapply anesthesia, so I’m banking on categorical slots).

What would you do if you were me? Thanks!

I’m an attending in my 40s.

Definitely psych. Way better hours and lifestyle, especially with a family and in your 50s.

 

[X46412]

I’m an attending in my 40s.

Definitely psych. Way better hours and lifestyle, especially with a family and in your 50s.

Thanks Tenk! What specialty are you an attending in?

 

[Tenk]

Thanks Tenk! What specialty are you an attending in?

EM. Most anesthesia gigs require some degree of being on call or night shifts or loss of normal circadian rhythm. I’d say this has been my biggest gripe with EM after having kids besides the whole pandemic thing. As I get older, it only gets harder.

 

[X46412]

You need to think lifestyle beyond residency. Residency is temporary, specialty is for the rest of your working life. Which is not to say pick anesthesia over psych, but worry less about the residency life and more about out the life after. These are two very different specialties.

Sooo what would you do?

EM. Most anesthesia gigs require some degree of being on call or night shifts or loss of normal circadian rhythm. I’d say this has been my biggest gripe with EM after having kids besides the whole pandemic thing. As I get older, it only gets harder.

that makes sense. Thanks again doc!

 

[Tenk]

Sooo what would you do?

that makes sense. Thanks again doc!

Sure, if you have any specific questions feel free to message me. I have multiple friends who are in psych and they all seem very happy. Thank you for your service and best wishes with whatever you choose.

 

[LucidSplash]

Sooo what would you do?

that makes sense. Thanks again doc!

I can’t answer that for you. I’m a surgeon so I would never pick psychiatry; psych is great for those who want to do it, and heaven knows we need more mental health advocates in this country. But I’m not you so I can’t say which is better for you. Your original post seemed to focus a lot on the lifestyle in training, and I think that’s a mistake, so I always encourage people to focus more on the lifestyle available after training.

 

[X46412]

I can’t answer that for you. I’m a surgeon so I would never pick psychiatry; psych is great for those who want to do it, and heaven knows we need more mental health advocates in this country. But I’m not you so I can’t say which is better for you. Your original post seemed to focus a lot on the lifestyle in training, and I think that’s a mistake, so I always encourage people to focus more on the lifestyle available after training.

Thank you for your input, doc! Much appreciated.

 

[X46412]

Sure, if you have any specific questions feel free to message me. I have multiple friends who are in psych and they all seem very happy. Thank you for your service and best wishes with whatever you choose.

Thank you sir!