Would you do an Anesthesia/EM 6 year residency?

[Dawkter]

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After a bit of thought on the supposed 5 year anesthesia residency with more critical care exposure, thought I would pose this question. Would anyone consider doing a 6 year residency that gets you dual certified in BOTH anesthesiology and emergency medicine? Theoretically, you could admit a patient in the ED, follow them to the OR, and care for them in the ICU post-op with the skill set provided by that training. Also seems as though the personality type attracted to both of these specialties is fairly similar.

 

[Depakote]

I'll stick to the OR

 

[bcat85]

I'll stick to the OR

For sure. In theory, you're right. You could care for a patient from admission to the ICU post-op, but I suspect that in practice you would have to pick one. I suspect this would end up being a path for medical students who are unable to make up their mind between EM and anesthesia.

 

[pie944]

After a bit of thought on the supposed 5 year anesthesia residency with more critical care exposure, thought I would pose this question. Would anyone consider doing a 6 year residency that gets you dual certified in BOTH anesthesiology and emergency medicine? Theoretically, you could admit a patient in the ED, follow them to the OR, and care for them in the ICU post-op with the skill set provided by that training. Also seems as though the personality type attracted to both of these specialties is fairly similar.

6 pm: Start ER shift as attending.
9 pm: Acute appendicitis, going to the OR. Leave the ER you are managing and go to OR which you have somehow avoided.
10 pm: Finish case, but patient aspirated on induction now going to ICU. Take patient to ICU. Manage the patient in the ICU(fluids, pressors, +/- steroids depending on your view)

You lie to your friends and I will lie to mine, but lets not lie to each other. Theory and reality are often far from each other, this is one of those cases.

Write out a list of pros and cons for each speciality and be honest with yourself.

 

[lane]

Why not just do a 14 year cardiology/surgery/anesthesiology residency so you could provide clearance, go to the OR and intubate the patient, manage their anesthetic, AND scrub in to perform the operation? You'd certainly have enough training to take them to the ICU and provide care there too in between your various other consults, caths, and OR cases.

Unfortunately no one has the time or resources to dedicate all of their attention directly to only one patient. It makes no sense. Just do your best to pick whichever specialty appeals to you more and go with it.

 

[Spinach Dip]

Why not just do a 14 year cardiology/surgery/anesthesiology residency....

Oh God. Don't say things like that where pre-meds might read them.





OP - That's an interesting idea... and one I might consider if it meant increased pay or increased job security from the postulated mid-level creep. But until such a combined residency becomes standardized and well known, I will go with the 'normal' 4 year route.

 

[ssmallz]

Why not just do a 14 year cardiology/surgery/anesthesiology residency so you could provide clearance, go to the OR and intubate the patient, manage their anesthetic, AND scrub in to perform the operation? You'd certainly have enough training to take them to the ICU and provide care there too in between your various other consults, caths, and OR cases.

Unfortunately no one has the time or resources to dedicate all of their attention directly to only one patient. It makes no sense. Just do your best to pick whichever specialty appeals to you more and go with it.

Maybe after 14 years of training we can finally differentiate ourselves from CRNAs 👍 never mind, they'll have a weekend course for that w/a whole lot more letter's after their names 😡

 

[Icefrog]

If you're taking care of patients in the ER, and you have to send one to have surgery and are going to provide anesthesia, who's going to take care of your patients down in the ER?

You can't do both at the same time. If you're in the ER, you're stuck there for a shift. No one is going to let you leave 20 patients hanging out in the ER while you go to the OR.

Also, let's face it . . . ER is 90+% outpatient, clinic stuff that anesthesiologists don't care for, and even ER docs themselves hate. I wouldn't do 2 extra years just to learn how to do a primary and secondary survey on a trauma. They send them to the OR right away so anesthesiologists manage the "fun" stuff anyway.

 

[Jay K]

I would do it, but not for the theoretical reasons you gave. It'd give me more opportunities for locums work in places I'd want to work.

 

[Idiopathic]

that course would not get you critical care certification and so unless you are the only doc in a small hospital its unlikely you would be caring for this patient in the ICU

The hallmark of being a good anesthesiologist is delivery of safe and effective care in an efficient manner, and being able to turn around and do it again in 30 minutes or less. not possible if you have stretched yourself so thin.

unless you want to split up your months with half ED-half OR anesthesia, in which case just subspecialize in one or the other and get your variety that way

 

[Dawkter]

Agreed that theoretically, it would be ridiculous to follow one patient at a time throughout their care. At the same time, think about what a skill set you would have and how diverse your job practice would be. You could do shifts in the ED for half a month and you could also work in the OR half the month. You would be completely indispensable to the hospital based solely on how many services you could offer.

I disagree with the notion that the more general your skill set the more replaceable you become. In fact, anesthesia is so specific that a nurse is able to learn the practice in 2 years of training and be a formidable threat to our specialty. Keeping your knowledge base more general makes it difficult for midlevels to grasp the breadth of material needed to practice.

 

[BLADEMDA]

After a bit of thought on the supposed 5 year anesthesia residency with more critical care exposure, thought I would pose this question. Would anyone consider doing a 6 year residency that gets you dual certified in BOTH anesthesiology and emergency medicine? Theoretically, you could admit a patient in the ED, follow them to the OR, and care for them in the ICU post-op with the skill set provided by that training. Also seems as though the personality type attracted to both of these specialties is fairly similar.

No. Bad move

 

[imfrankie]

I'd do a combined ICU/Anesthesia or a triple ICU/Anesthesia/ER if it were only one extra year beyond the double (and I were young). I don't think I'd do the ER/Anesthesia six.

 

[survivordo]

Seems like the VAST majority of ER cases have very little do do with anesthesia or critical care. I think you are better off sticking with anesthesia/critical care if this is your interest. Let the ED docs stick to getting their sick patients out of the ED and into the proper specialist's hands as soon as possible.

Survivor DO

 

[cowbydoc]

I'm a board certified ER doc now back in residency for anesthesia. My one word answer:
NO!

Splitting specialties whether it is this theoretical residency or EM/IM, EM/Peds or whatever is generally not a smart move. The vast majority of time people will just shift into one of the specialties and never use the other so it is just wasted time and effort.

 

[Dawkter]

I'm a board certified ER doc now back in residency for anesthesia. My one word answer:
NO!

Splitting specialties whether it is this theoretical residency or EM/IM, EM/Peds or whatever is generally not a smart move. The vast majority of time people will just shift into one of the specialties and never use the other so it is just wasted time and effort.

Why the decision to leave ER if you don't mind me asking?

 

[sylvanthus]

I'm a board certified ER doc now back in residency for anesthesia. My one word answer:
NO!

Splitting specialties whether it is this theoretical residency or EM/IM, EM/Peds or whatever is generally not a smart move. The vast majority of time people will just shift into one of the specialties and never use the other so it is just wasted time and effort.

You may want to look at this article before you make generalizations about EM/IM trained graduates. http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2009.00503.x/full

 

[Mentalist]

Why not just do a 14 year cardiology/surgery/anesthesiology residency so you could provide clearance, go to the OR and intubate the patient, manage their anesthetic, AND scrub in to perform the operation? You'd certainly have enough training to take them to the ICU and provide care there too in between your various other consults, caths, and OR cases.
QUOTE]



Cant stop laughing

 

[davefromcamp]

You couldn't really be good at both, there is more in common with critical care so you could keep up your skills. Talk to pain docs about their OR abilities.

 

[caligas]

Medicine has specialties for a reason; so we can be really good in ONE field.

 

[KLPM]

Medicine has specialties for a reason; so we can be really good in ONE field.

I thought it's because so we can be really bad at everything else.

 

[Laryngophed]

A million "no"s to the OP's question.

 

[Dwindlin]

I'll break the mold. Yes I would have done it. Not sure what ultimately I would have been able to do with both, but I do know I had an extremely hard time ultimately deciding between the two specialties.

 

[Kahreek]

i would say, do it if you are not sure if you want gas or er, because you wont be practicing both at the same time.

 

[Libertas]

am I the only one who doesn't understand at all being interested in both ER and anesthesiology? I really don't see how they have anything in common (that matters)

 

[Jay K]

am I the only one who doesn't understand at all being interested in both ER and anesthesiology? I really don't see how they have anything in common (that matters)

You don't have to bring your work home with you.

 

[etudiante04]

Lack of continuity of care is a common theme.

 

[etudiante04]

Instead of trying to accommodate combined training in both specialties, why not revamp undergraduate medical education (medical school) training to make these specialties as distinct as possible, (and available) so that students will be more decisive about choosing a specialty when the time comes?

 

[KLPM]

Lack of continuity of care is a common theme.

Someone once told me they chose anaesthesia because they won't have to dictate notes.

 

[Spinach Dip]

Someone once told me they chose anaesthesia because they won't have to dictate notes.

Sounds legit.

 

[michaelrack]

Agreed that theoretically, it would be ridiculous to follow one patient at a time throughout their care. At the same time, think about what a skill set you would have and how diverse your job practice would be. You could do shifts in the ED for half a month and you could also work in the OR half the month. You would be completely indispensable to the hospital based solely on how many services you could offer.

I disagree with the notion that the more general your skill set the more replaceable you become. In fact, anesthesia is so specific that a nurse is able to learn the practice in 2 years of training and be a formidable threat to our specialty. Keeping your knowledge base more general makes it difficult for midlevels to grasp the breadth of material needed to practice.

Being able to offer many services does NOT make you indispensable to a hospital. Take it from someone who is certified in Psychiatry and Sleep Medicine, and is in the process of recertifying in Internal Medicine (exam passed, quality improvement project pending).

I know a lot of docs who have done combined residencies- this can lead to personal enrichment, but not usually financial enrichment.

If you want to do 6 years of training (like I did), be my guest- just don't be under the misconception that it will help you get a job.

 

[BLADEMDA]

If you want to do 6 years of training then pick one area of medicine where it makes sense. ER and Anesthesiology makes no sense.

Peds plus Anesthesia
Internal medicine plus Anesthesia plus critical Care
Anesthesia plus Cardiac plus Critical Care
Anesthesia plus Pain plus Cardiac

All of the above is a much better way to spend 6 years.

 

[etudiante04]

If you want to do 6 years of training then pick one area of medicine where it makes sense. ER and Anesthesiology makes no sense.

Peds plus Anesthesia
Internal medicine plus Anesthesia plus critical Care
Anesthesia plus Cardiac plus Critical Care
Anesthesia plus Pain plus Cardiac

All of the above is a much better way to spend 6 years.

Thanks for your advice.

 

[step213]

If you want to do 6 years of training then pick one area of medicine where it makes sense. ER and Anesthesiology makes no sense.

Peds plus Anesthesia
Internal medicine plus Anesthesia plus critical Care
Anesthesia plus Cardiac plus Critical Care
Anesthesia plus Pain plus Cardiac

All of the above is a much better way to spend 6 years.

blade, just curious on your thoughts of whether the combined IM/anesthesia programs plus a year of CCM are worth the extra year vs. just doing anesthesia then a CCM fellowship.