Gen surg prelim to anesthesia?

[sing robert]

I know this isn't the first time this has happened, but I really wanted to talk about this with some neutral people. I originally wanted to do general surgery, and didn't match because I didn't apply to enough places. I was super selective and then screwed myself over. Now I'm in a general surgery prelim and I don't feel like myself anymore. I don't eat regularly. I don't go to the gym. I barely read since I'm so tired from work. My upper levels give me a lot of sass and have been passive aggressive cause I'm a prelim resident. I am tired of doing this already and I'm only a month in. I originally thought I couldn't live doing anything other than surgery but now I feel like I have different goals for myself. I know I don't have the same passion for surgery that I once had, and I have been told if I could do surgery and something else and it wouldn't matter, I should pick the something else.

I am mostly concerned with my inability to focus on multiple patients. I find it extremely difficult to pay attention to the details in surgery. It is hard for me to say which patients are which postop day or what antibiotics they are on if someone asks me unless I have my rounding sheet in front of me. I don't know why its so hard for me to remember these things and it frustrates me to no end. I feel like I'm just super slow. I have always enjoyed ICU type rotations becaues you can actually sit down and talk about problems and think through them. And because they're such long term players, I know them really well with time. My memory seems to have gotten worse in residency and I'm wondering if my skillset is better suited to knowing a lot about one person at a time instead of knowing a lot about many. I loved physio and it just made a lot of sense to me, and quite frankly, it is nice to not have a list to round on.

Maybe part my frustration of that is intern year and maybe part of that is the program I am at. I spoke with graduates and fellows from this program and they said that it is miserable and a few fellows even told me that if they went here for residency they would probably quit too.

Brutal honesty is nice. I'd appreciate any input anyone has.

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[Iso4ane]

One of us. One of us. One of us.

You will not be the first nor the last one to go from surgery to anesthesia. In fact it's somewhat a right of passage, I'd think many people who go into anesthesia at least at one point considered going into surgery (myself included). But, make sure you are going in for the right reasons. Intern year is very rough and can be a grind at prelim surgery spots. So think carefully before you move on.

Also, one think I bring up is if you think internal medicine is full of mental masturbation, wait till you get into anesthesia, we play the 'what if' or 'why...' game all the time.

 

[sing robert]

How correct in my thought that with anesthesia, you focus on one patient at a time? I hate having my mind split a million ways cause someone asks me the urine output on mr Garcia, and I don't know that off the top of my head, and then they ask me what good ole Mrs. Smith got on her incentive spirometry, and I gotta flip through my rounding sheet while everyone is staring at me just muttering under their breath that I need to know my patients better. I just like the idea of having this one person in front of me, and I know what I'm giving them and whats coming out, and how much blood they've lost, and how much I need to give etc. I don't want to have an incorrect understanding and switch because my preconceived notions of the specialty are actually not based in truth

I give a lot of flak to my medicine friends about the whole mental masturbation thing, but I actually enjoy it too. The surgical fields that I gravitated to were ones where the teams talked a lot about how to manage patients and there was a lot of thinking and knob turning involved cause of how medicine-y the rotations were (surgical ICU, burns, vascular). I am not a big fan of the generic general surgery patient, and my whole purpose was to do gen surg for vascular given integrated vascular is too damn hard to get into.

 

[AdmiralChz]

I'm more than a little concerned about your description of Anesthesiology as a specialty...

How correct in my thought that with anesthesia, you focus on one patient at a time? I hate having my mind split a million ways cause someone asks me the urine output on mr Garcia, and I don't know that off the top of my head, and then they ask me what good ole Mrs. Smith got on her incentive spirometry, and I gotta flip through my rounding sheet while everyone is staring at me just muttering under their breath that I need to know my patients better. I just like the idea of having this one person in front of me, and I know what I'm giving them and whats coming out, and how much blood they've lost, and how much I need to give etc. I don't want to have an incorrect understanding and switch because my preconceived notions of the specialty are actually not based in truth

I give a lot of flak to my medicine friends about the whole mental masturbation thing, but I actually enjoy it too. The surgical fields that I gravitated to were ones where the teams talked a lot about how to manage patients and there was a lot of thinking and knob turning involved cause of how medicine-y the rotations were (surgical ICU, burns, vascular). I am not a big fan of the generic general surgery patient, and my whole purpose was to do gen surg for vascular given integrated vascular is too damn hard to get into.

During residency you typically focus on one patient at a time but it often isn't this slow, systematic approach where you can take your time and weigh your options. Things can change on a dime and patients can come crashing through the OR door at all times (traumas, post-op bleeds, subarachnoid hemorrhages)... you'll need to have a mastery of pharmacology and physiology and be able to act very quickly when seconds count for a patient. You'll also need to have some understanding about the procedures themselves to anticipate changes in the case.

Out in practice, you may be supervising 2 to 4 rooms (residents, CRNA/AAs) and you'd better be comfortable doing patients while thinking about the steps ahead and what needs to be done.

Even in the ICU, things can change quickly and new admits come out of nowhere (especially in surgical ICUs, where postop patients can deteriorate on the floor or traumas come up).

Basically, if you are interested in the field then chat up the anesthesiologist in the room with you. Listing your primary reason to switch specialties because you only have to concentrate on one patient at a time reeks of laziness and complete lack of understanding of the specialty itself. Sorry to be blunt but it sounds like you need to investigate your mental health first if you are having all the troubles with memory/sleep/recall that you describe.

 

[sing robert]

I don't mean to trivialize anesthesia. After talking to some of my classmates that did anesthesia, they gave off the impression that you focus on patients in a different way than people do on the floor. Things like fluid shifts and clot times and managing vitals/the vent seem interesting to me, and that gets addressed in the ICU and in the OR by anesthesia. I enjoyed my physio and pharm classes in med school, and I've enjoyed the ICU rotations that i've done because some of the patients are intubated and sedated and you have to focus on the hard data signs to make a decision. I have been drawn to sick patients/the high risk side of surgery and figured by applying to surgery, I could work with sick patients that way while being able to do procedures. I never really thought about the medicine or anesthesia to CC path, which is why i'm trying to explore my options.

I think a lot of my frustrations are institution dependent. I haven't gone to the OR yet aside from updating the upper levels, and all I feel like I'm doing is writing notes and discharge summaries while changing orders for glucose checks at 3 am. I wish I had the time to learn things. I understand if I come off as lazy, and maybe my idea of intern year is different than what it actually is, but I figured I'd have more guidance and teaching than what is going on now. I know I'm not a student anymore and this isn't the time for people to focus on my education since patient care comes first, but damn, I just miss having some degree of formal education. My institution is more about learning on the job than I thought.

And as far as mental health is concerned, I'm going to see the resident wellness people institution. I feel like I am not in the best place mentally and I think getting seen would be helpful. I do appreciate the input though.

 

[rokshana]

sounds like you may want to consider a less patient oriented specialty like pathology or a specialty with less critical patients like PMR...

 

[anbuitachi]

I also have no memory and i hated taking care of an entire list of patients cause i dont remember anything. The problem obviously doens't go away in anesthesiology but it makes it easier cause there are few random patient stuff to remember. It's like when i was on medicine night float and the teams hand off patients to you, and you are covering 60+ patients overnight and one codes, and they ask whos the one covering this patient and ask for the history... i'm like i got to read it off my patient lists. Even know when people do time outs and introduce oneself, i literally forget their names in like 2 seconds. I guess old age has caught up to me. Oh and when you cover the PACU, thats a list of about 25-30 patients

However, anesthesiology has a ton of downsides as well and you really need to look at those before switching, or otherwise you probably may find yourself hating one aspect of anesthesiology and start thinking of switching again. For example, if you want a life, you really need to pay attention to which program is a chill program and which programs aren't and how it impacts your education. I find myself pretty exhausted now even with shorter hours than general surgery, due to the hours we work (70s) + the constant shift changes (about 7 overnight 18-24 hour calls a month, which completely kills your sleep cycle; and ~6 non overnight calls which is about 630am to leave sometime before midnight (average 10pm or so).

 

[Winged Scapula]

I also have no memory and i hated taking care of an entire list of patients cause i dont remember anything. The problem obviously doens't go away in anesthesiology but it makes it easier cause there are few random patient stuff to remember. It's like when i was on medicine night float and the teams hand off patients to you, and you are covering 60+ patients overnight and one codes, and they ask whos the one covering this patient and ask for the history... i'm like i got to read it off my patient lists. Even know when people do time outs and introduce oneself, i literally forget their names in like 2 seconds. I guess old age has caught up to me. Oh and when you cover the PACU, thats a list of about 25-30 patients

However, anesthesiology has a ton of downsides as well and you really need to look at those before switching, or otherwise you probably may find yourself hating one aspect of anesthesiology and start thinking of switching again. For example, if you want a life, you really need to pay attention to which program is a chill program and which programs aren't and how it impacts your education. I find myself pretty exhausted now even with shorter hours than general surgery, due to the hours we work (70s) + the constant shift changes (about 7 overnight 18-24 hour calls a month, which completely kills your sleep cycle; and ~6 non overnight calls which is about 630am to leave sometime before midnight (average 10pm or so).

If you're an Anesthesiologist then why does your status say Podiatrist?

Please change it.

 

[SouthernSurgeon]

IMHO:

It's the beginning of August. You've been through the wringer the past year, not matching/scrambling/etc.

It doesn't surprise me at all to hear you expressing doubt given just the emotional experience of not matching in your chosen field.

I would hesitate though to make decisions based on your 5 weeks or so of intern year experience. Your descriptions of difficulty focusing, remembering various details, etc, are all natural struggles that interns go through in every field.

You do need to make some decisions, and quickly, about how to move forward for this year's application season. To do that, I would try to take a step back and look more globally at what drew you to surgery and why in the first place. Try to objectively assess whether those still hold true. Talk to some mentors - from med school if possible. Try to meet with people who can advise you who don't have a stake in the game (i.e. While the anesthesia PD at your hospital may be helpful, he/she may also have a vested interest in recruiting you).

 

[jthedestroyr]

One of us. One of us. One of us.

You will not be the first nor the last one to go from surgery to anesthesia. In fact it's somewhat a right of passage, I'd think many people who go into anesthesia at least at one point considered going into surgery (myself included). But, make sure you are going in for the right reasons. Intern year is very rough and can be a grind at prelim surgery spots. So think carefully before you move on.

Also, one think I bring up is if you think internal medicine is full of mental masturbation, wait till you get into anesthesia, we play the 'what if' or 'why...' game all the time.

We often have plans a b c d e for just an air or prepare for a situation to not use it( id rather not have to use back up plans as that means something isnt going as smooth as we want). I like that about anesthesia, the planning. I think of us as doom day prep type of people.

 

[Planes2Doc]

Do you know what the best thing is about intern year?

It ends.

 

[deleted497653]

Intern year is hard for most people. I used to rely on a list to remind me of patient details but as an ER attending now, I don't need a list but can remember patients easily. This comes with time. These are just growing pains as far as memory and sleep issues. As far as surgery vs anesthesia, think carefully before leaping. All fields are drought with issues, just have to decide which field has the least cons for you.

 

[Ruminahui]

Hello, I’m an img prelim Surgery resident. My scores are step 1 239 ck 255 cs pass in second attempt. I applied for categorical Surgery this year, but have not had any interviews as of late November. I’m interested in changing lanes to anesthesia, do you think there are soap alternatives to make the move or would it be a better idea to apply in 2018 general match? If so, what options would you consider to fill the gap year?

 

[anbuitachi]

Hello, I’m an img prelim Surgery resident. My scores are step 1 239 ck 255 cs pass in second attempt. I applied for categorical Surgery this year, but have not had any interviews as of late November. I’m interested in changing lanes to anesthesia, do you think there are soap alternatives to make the move or would it be a better idea to apply in 2018 general match? If so, what options would you consider to fill the gap year?

I would just do SOAP, if no luck try again next year. If you had 0 interviews in surgery, it's going to be just as difficult going to anesthesiology in general match