your thoughts: Anesthesia/Cardiac Anesthesia vs. Cardiology

[amherstguy]

if you love pharm, phys, and procedures. also taking into account residency length and other considerations- whats a better way to go: interventional/invasive cards or anesthesia w/ a possible cardiac fellowship?

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[ProRealDoc]

if you love pharm, phys, and procedures. also taking into account residency length and other considerations- whats a better way to go: interventional/invasive cards or anesthesia w/ a possible cardiac fellowship?

First question you should ask yourself is Do I like internal medicine?

 

[NotAMD]

i am also interested in this topic mainly since im thinking about choosing cardiac vs other anesthesia specialties.. heres what i think so far as a new ca1

cardiology: you have to endure internal medicine residency (painful), you have to do well and match into cardiology (want to move across the country?), then you can do EP or interventional, both are good, or do general office cardiology stuff. i think its too much thinking about not enough doing, and when you do get a chance to do procedures its the same exact thing over and over.. caths, ep studies, echo reads..caths are bad ass but otherwise kinda boring

cardiac anesthesia: your an anesthesiologist, you are kind of bad ass in the sense that you can handle anything, code expert, airway expert if someone crashes, less geeky more getting the job done, hand arrythmias, do TEEs routinely which is cool and cardiologists dont normally do (TTEs primarily), and you have an END point with the patients, get them through surgery, period, with cardiology you are fighting off the inevitable most of the time
however, the anesthesia cardiac docs seem (in general) like the more TYpe A, high-strung residents in general in my experience (though limited)

 

[guitarguy09]

First question you should ask yourself is Do I like internal medicine?

Exactly! I like physiology more than I like internal medicine. Too much social work and frustration in internal medicine in my opinion... Plus, now don't get me wrong I'm not speaking in absolutes, but I feel like there is less "textbook" medicine in anesthesia (many ways to skin a cat in each situation) and I like idea of the freedom to develop my own style for particular situations (as opposed to the overwhelming amount of "evidenced-based medicine" which essentially gives me the impression of "textbook" medicine when I think of cards). This of course is a complete oversimplification of the whole picture but their is a sliver of truth to it if you think about it.

Plus you get to wear scrubs all day

Best of luck with your decision... I'm of course a little biased...

 

[Hockeyguy]

Both great fileds. I think its a few years longer to get to interventional cardiology. IM/Fellowship/CATH or EP. But I'm not sure though.

Mario

 

[Licoricestick]

when you do get a chance to do procedures its the same exact thing over and over.. caths, ep studies, echo reads..caths are bad ass but otherwise kinda boring

Most of anaesthesia is routine too - or becomes routine - putting a tube in over and over and over again isn't all that different from doing a cath over and over and over again. On the other hand the cardiologists probably think the primary PTCAs for STEMIs are just as cool and lifesaving as I think putting an emergent tube into someone is.

Of course if you can put up with the complete lack of procedural work during internal med training and the (I suspect) longer duration of training (don't know what it's like in the US but in Australia you need to do at least one fellowship and a PhD - most of our new consultant cardiologists are in their late 30s/early 40s) - go for it.

Me? Anaesthetics all the way!
I like the fact that on Friday I could tube the patient I saw who was in type 1 respiratory failure despite being on BiPAP. The physician whose patient she was came up and saw her - and agreed that she needed a tube...but could he do anything about it? Nope! Could he put in the arterial line that I had placed the day before so they could do the serial blood gases? Nope!
And that was the acute pain round - I wasn't even rostered to emerg or theatres!

An anaesthetist (anesthesiologist for those from the US) and a general medicine physician both walk into the room of a cyanosed patient. How do you tell which is which?
The physician stands at the end of the bed trying to figure out why the patient is cyanosed...then he'll treat them.
The anaesthetist puts oxygen on and assists respiration if required...whilst trying to figure out what is the cause.

 

[BLADEMDA]

All Medical Students and PGY-1's should pay attention to the FINAL version of the health care bill which Obama will sign. Then, re-read the above quote.

Blade

 

[Bertelman]

Blade, that quote describes what you do every day on this board.

 

[Dawkter]

Anyone here who was between cardiology and cardiac anesthesia that has any additional input? I am planning on going the cardiac anesthesia route as I feel it is more procedural and hands on. However, a month into my anesthesia sub-I and definitely missing certain aspects of the patient contact.

 

[lazylikeapanda]

If you are interested in being the definitive expert in heart physiology and anatomy, interesting in performing procedures to definitively help a patient, managing complex dysrhythmias, be the go to person for a final read on an ekg or echo, then you should consider being a cardiologist. If you'd like to take care of sick as dog patients for a finite period of time (i.e surgery), perform and read perioperative echos, play with drips and lines then consider anesthesiology followed by a cardiac anesthesia fellowship. However as an anesthesiologist you'll never place a cardiac stent, do cardiac ablations, or be the go to person to interpret the significance of that funny looking ecg wave form. https://www.google.com/search?hl=en...n4DgBQ&ved=0CB0QvwUoAQ&q=dysrhythmias&spell=1

 

[cchoukal]

Interventional cardiologists attract patients to hospitals and generate revenue. Cardiac anesthesiologists do neither. In the future, this may become an important distinction. Should it guide your choice of specialty? If you're on the fence, it is at least worth considering the impact this one distinction will have on your job security, political capital, and day-to-day satisfaction.

 

[Bertelman]

Anyone here who was between cardiology and cardiac anesthesia that has any additional input? I am planning on going the cardiac anesthesia route as I feel it is more procedural and hands on. However, a month into my anesthesia sub-I and definitely missing certain aspects of the patient contact.

I love what I do. I actually think I have just the right amount of patient contact. I get to spend 15-20 min a day or more speaking to them pre-op. Often have real conversations, allay real fears.

I also considered cardiology when I was a med student because I loved the organ and pathology. Just preferred anesthesia, although I kind of knew that prior to med school. I think you may not get an accurate representation of our exposure to patient care as a med student because you are generally hidden in a closet until it is time to drop the tube. I think anesthesiologists have a good opportunity to meet with patients pre-op and post-op, and have quality interactions.

If you ever miss patient interactions, just troll the PACU or pre-op. There's like 100 patients going through a day that would probably just love to talk a doctor's ear off.

 

[sevoflurane]

Interventional cardiologists attract patients to hospitals and generate revenue. Cardiac anesthesiologists do neither. In the future, this may become an important distinction. Should it guide your choice of specialty? If you're on the fence, it is at least worth considering the impact this one distinction will have on your job security, political capital, and day-to-day satisfaction.

Well put. Interventional and EP are very attractive when you think of job security and quality of life. They do exceedingly well at our place... and with a big group, they have a lucrative vaca package and income.

Cardiac anesthesia is still awesome... so long as your CT surgeons are good people and good surgeons. Working with a pompous CT surgeon is a drag (I'm very lucky in this respect).

 

[yesno]

What do cardiac anes do that makes them different from regular anes? Why do you need to subspecialize?

 

[HuskerMed1816]

I absolutely love everything I have seen in cardiac anes. But what worried me is all the talk about anes being faded out more and more for CRNA positions. Working at a hospital and hearing near daily talks about NPs doing the hospitalist role along with the profound changes to medicine with Obamacare and funding a growing elder population only adds to the worry.

 

[Per4mer8]

honestly, figure out what you like, then do it. Are all the changes coming a worry?? Yes, but whats worse; Picking a field you love then making less than the field makes now or picking what you think will be a lucrative field unchanged by the future only to find out it too changes and you never loved it to begin with?

 

[Requiem]

To any of the former students who posted in this thread: What did you end up deciding/ How did you come to that decision?

Also, if there are any current students thinking about this as well I'm definitely interested in hearing your thoughts on the pros/cons of each field!