What was your reason for ultimately choosing gas over EM?
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Anesthesia (vs EM)
Some important caveats before I start:
-Since you asked why choose gas over EM, I'll focus on propping up anesthesia against EM. But it's also possible to ask why choose EM over gas, and then focus on propping up EM over anesthesia.
-I'll still try to be very objective though.
-Some of the pros/cons could fit in the opposite category, depending on your personal preferences.
-Ultimately it's all just my opinion, nothing more.
Similarities between anesthesia and EM
-Both involve a lot of variety in patient population and disease (EM is more like being an acute GP or FM, whereas anesthesia you see all types of patients and ages needing all types of surgeries)
-Both allow for shiftwork
-Both have acute care to some degree (though anesthesia is basically all acute care)
-Both get to do procedures (though EM does more procedures meant for treatment than anesthesia)
-Both get to play with fun toys (e.g., ultrasound, laryngoscopes) (though anesthesia has more cool gadgets obviously like the anesthesia machine and workstation)
-Both currently average pay >$300K
-Both don't bring patients to the hospital like cardiologists or surgeons do
-Both are more at the mercy of hospital administrators, AMCs, etc.
-Both can involve high legal liability for malpractice (fairly or unfairly)
-Both don't require a lot of overhead
-Both are mobile, meaning you can pick up and move if you really want
-Both are (mostly) hospital-based specialties
-Both don't require building a referral base, etc., before starting to earn good money
-Both allow for medical missions
-Both face some midlevel threats (though anesthesia seems worse)
Pros
-Acute care (if that's what you like) vs EM where it's a mixture of acute care and other things you find in PCP
-No need to deal with difficult patients, or not for long
-No need to do some of the uglier things in medicine (e.g., rectal exams, drain pus from infected body parts)
-In other words you will face less overall BS than in EM (though anesthesia has its own BS, see "Cons")
-You are an expert in physiology and pharmacology (though EM is expert in quickly working up and managing the undifferentiated patient, the emergent patient, etc.)
-Generally more regular hours than EM (but see "Cons" about hours too)
-Don't regularly have to work nights, weekends, holidays (though sometimes you might, depending on your group)
-Cases are usually more planned than EM (excluding for example emergency ORs or add-ons) where anyone and anything could walk through the door
-Higher pay potential than EM
-Not in the "fish bowl" that is the ED
-Generally busy at the beginning and end of cases, but in the middle there is some down time (depending on the case, and obviously you're still very vigilant throughout the case)
-If you are doing your own cases, it's nice to be able to focus on a single patient at a time, and not always have to "move the meat" (though in private practice, you are facilitating surgeries for surgeons and hospitals, so you are trying to rush every case along)
Cons
-You always have to deal with surgeons, many of whom can be (shall we say) less than pleasant people
-You have to be ok with not being the "captain of the ship" (e.g., "Hey, anesthesia! Tilt the bed!")
-No or not very much diagnosing and working up patients
-Longer hours than EM overall
-Early mornings
-Not all cases will necessarily end when you expect them to end
-Currently a worse job market than EM
-CRNAs (AANA) argue they are as good as anesthesiologists, and they have a growing influence in the healthcare system and market
-The ACT model is the future (and it's already about 50% of all practices) -- i.e., having to supervise 1:1 to 1:4+ CRNAs
-Less likelihood of always being able to do your own cases, which may mean you're not doing a lot of (routine) procedures, but running from room to room "putting out fires"
-Tied to the OR
-Either bored stiff or scared stiff (99% sheer boredom, 1% sheer terror) such as when a patient crashes, and you won't necessarily have a team including other attendings to help like in EM (sometimes you will, but often not)
-EM is a more team oriented specialty than anesthesia, where you are more "on your own" (though there are other anesthesiologists in other ORs, they are either doing their own cases or supervising CRNAs or AAs)
Just some of my thoughts. I'm sure there's a lot more that can be added.