If not Anesthesiology, what do you recommend students to go into?

[Nivens]

I feel like there’s a “wrong” answer for specialty choice based on personality and interests.

This is definitely true. We have a few residents that I wish would explore some other more...cerebral specialties.

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[deleted162650]

The clinic I hear from urologists friends can be a bit of a pain.

True. You gotta deal with a lot of dicks in Urology clinic.

Ba-Dum Tss
Don’t forget to tip your circulator. I’ll be here all week.

 

[deleted162650]

If I was gonna do anything else (I still think I have the best job in the hospital) it would be ENT. Good mix of medicine/surgery. Lucrative office based procedures. Plenty of different head holes to pick if you wanna sub-specialize, segway into facial plastics, etc.

 

[CidHighwind]

This is definitely true. We have a few residents that I wish would explore some other more...cerebral specialties.

Now when you say this, is this because they argue all the time, are too slow in acting, or are you saying that anesthesia doesn’t require a lot of thinking? Be honest.

 

[Nivens]

Now when you say this, is this because they argue all the time, are too slow in acting, or are you saying that anesthesia doesn’t require a lot of thinking? Be honest.

Haha OK, this is going to seem like I set you up- I swear I didn't. But, since you asked: the people I've seen that struggle the most in anesthesia are those that cannot make a decision under pressure with incomplete information. Those that want to discuss the problem from every angle, run it by a few friends, consider the most recent literature... it's not infrequent in anesthesia that we just don't have that kind of time. You need to gather what information you have, make a decision, and act, or the patient is going to die (or worse), all the while trusting that you can manage any side effects and if it doesn't work you've got 5 more arrows in your quiver you can still shoot. I've had junior residents that just stand there and squawk, which is no bueno. They're often the nicest, most caring people, too...

What I like to see- as the late, great, Anthony Bourdain put it in "Kitchen Confidential" when talking about ideal line-cook candidates- are people with moves. It's hard to explain, but there's an economy of movement thing that some people just naturally have in to OR. Doesn't mean you can't learn to dance, but some new residents definitely take to things faster than others.

 

[BLADEMDA]

Med students are excellent at picking out the better specialties. They aren't perfect at it but overall the STEP score correlates with the specialty. Prestige, Lifestyle and Money are the major factors. If there are a lot of midlevels in the "field" then the prestige factor is lower so that leaves lifestyle and money.

I'd rather earn $500k as a Physician who is at the top of the food chain than $500K being at the bottom. If you aren't at the table then you are on the menu. Anesthesiology is viewed as low prestige and a non money maker. CMS views it as a nursing level duty based on reimbursement levels.

Eventually, Medicare for all or a Medicare Option will pass. Those specialties that can weather that storm will be at the top of the food chain. Anesthesiology and EM will be lucky to survive "Medicare for all" vs Ortho which gets paid 80% of a typical HMO rate.

Deciding upon a specialty is a huge choice almost as big as deciding who to marry. In some ways it may be a bigger decision because most rarely get a second bite at the apple with specialty choice post residency.

 

[CidHighwind]

Med students are excellent at picking out the better specialties. They aren't perfect at it but overall the STEP score correlates with the specialty. Prestige, Lifestyle and Money are the major factors. If there are a lot of midlevels in the "field" then the prestige factor is lower so that leaves lifestyle and money.

I'd rather earn $500k as a Physician who is at the top of the food chain than $500K being at the bottom. If you aren't at the table then you are on the menu. Anesthesiology is viewed as low prestige and a non money maker. CMS views it as a nursing level duty based on reimbursement levels.

Eventually, Medicare for all or a Medicare Option will pass. Those specialties that can weather that storm will be at the top of the food chain. Anesthesiology and EM will be lucky to survive "Medicare for all" vs Ortho which gets paid 80% of a typical HMO rate.

Deciding upon a specialty is a huge choice almost as big as deciding who to marry. In some ways it may be a bigger decision because most rarely get a second bite at the apple with specialty choice post residency.

One could argue that EM has tons of lay person prestige, and many would say Anesthesiology is prestigious as well. In contrast, many lay people consider dermatologists “not real doctors”. One thing I would say is that a lot of what is competitive or not deals with the job market. Look at how uncompetitive RadOnc got once word got out that there’s no jobs. What you say does make sense, and the issue will only be compounded further with crna degrees being a doctorate, and them making patients and staff refer to them as “doctor”.

 

[epidural man]

Now when you say this, is this because they argue all the time, are too slow in acting, or are you saying that anesthesia doesn’t require a lot of thinking? Be honest.

No job is a thinking job. Every physician even when taking care of very complex situations - after a few years - is just using pattern recognition.

People always want to be “challenged” with their job. My opinion is that your job will become a routine job no matter what you do. Your challenges in life should then come from reading a good book, talking to the cute nurses about the latest “against the rules” podcast by Michael Lewis, or discussion why Trump isn’t a racist...stuff like that. And then getting your pilot’s license or learning to sail, or become the cities best pickle ball player.

Having an interesting job is different from a challanging job. Find something you find interesting over and over.

 

[dhb]

Urologist. Good lifestyle. Good Pay. Respected as a surgeon. The clinic I hear from urologists friends can be a bit of a pain.

It has to be in your D&A (dicks and asses).
Too many emergencies for a great lifestyle. Prostate surgery might not be needed in the near future too.

 

[Monterosso]

No one has given you the right answer.

Ready for it?

Reproductive medicine.

Cash pay. (And a lot of it). Patients (that are all young) all love you...even with poor results.

My guess is that liability issues are low.

4 years of OB-GYN residency, and then another 3 year fellowship though (and may not match REI). Additionally, when you look at pay (from surveys like MGMA) it's less than that for Anesthesia..

 

[deleted171991]

4 years of OB-GYN residency, and then another 3 year fellowship though (and may not match REI). Additionally, when you look at pay (from surveys like MGMA) it's less than that for Anesthesia..

Especially with that in-house call schedule.

 

[chocomorsel]

IM, then allergy/immunology, rheumatology, nephrology. Great lifestyle, and I hear good money. Honestly IM, with sub-specialization with something outpatient would be great.

 

[Nivens]

I think the nicest thing about something like REI would be getting to participate in someones life in a "happy" way. Obviously reproductive issues suck (speaking from experience), but my SO and I are so tremendously grateful to our REI doc. I feel like at best I can take someone who's really sick and return them "not dead" on the other side of a big surgery that probably didn't fix them. It's got to feel good to have people sending you thank you cards and photos of their children they wouldn't have without you.

 

[narcotics999]

4 years of OB-GYN residency, and then another 3 year fellowship though (and may not match REI). Additionally, when you look at pay (from surveys like MGMA) it's less than that for Anesthesia..

What? REI does not make more than anesthesia? Most of them pay cash.

 

[chocomorsel]

What? REI does not make more than anesthesia? Most of them pay cash.

No way. I bet those docs make millions. Let me ask my friend.

 

[epidural man]

4 years of OB-GYN residency, and then another 3 year fellowship though (and may not match REI). Additionally, when you look at pay (from surveys like MGMA) it's less than that for Anesthesia..

It's wrong then. Because the busy and good ones kill it.

 

[narcotics999]

No way. I bet those docs make millions. Let me ask my friend.

Each cycle of IVF costs around 8K-12K. Busy clinic does 2000-4000 cycles. You figure the revenue.

They do work hard, often including both weekends.

 

[chocomorsel]

Each cycle of IVF costs around 8K-12K. Busy clinic does 2000-4000 cycles. You figure the revenue.

They do work hard, often including both weekends.

Apparently you have to have your own lab to make the dough. But either way, you can have a good lifestyle.

 

[dhb]

I think the nicest thing about something like REI would be getting to participate in someones life in a "happy" way. Obviously reproductive issues suck (speaking from experience), but my SO and I are so tremendously grateful to our REI doc. I feel like at best I can take someone who's really sick and return them "not dead" on the other side of a big surgery that probably didn't fix them. It's got to feel good to have people sending you thank you cards and photos of their children they wouldn't have without you.

 

[deleted162650]

Each cycle of IVF costs around 8K-12K. Busy clinic does 2000-4000 cycles. You figure the revenue.

They do work hard, often including both weekends.

Lotta overhead though.

 

[Consigliere]

Do addiction medicine.

 

[CidHighwind]

Do addiction medicine.

Why do you say that? Opioid epidemic? Also you were one of the main people I identified as saying anesthesia is dead.

 

[LebronManning]

I think Interventional Cardiology is the move going into the future for a field that will always be among the highest paid and respected and needed but for that you sacrifice lifestyle

 

[PieOHmy]

I think Interventional Cardiology is the move going into the future for a field that will always be among the highest paid and respected and needed but for that you sacrifice lifestyle

The lifestyle of a cardiologist must be HELL.
At some pt. the money wont make up for it.

Derm. Physiatry, allergy and immunology, plastic surgery.

 

[epidural man]

Why do you say that? Opioid epidemic? Also you were one of the main people I identified as saying anesthesia is dead.

The percutaneous valve replacements are game changing - and those are scheduled cases.

 

[PieOHmy]

The percutaneous valve replacements are game changing - and those are scheduled cases.

game changing for whom? not for us.

 

[Consigliere]

Why do you say that? Opioid epidemic? Also you were one of the main people I identified as saying anesthesia is dead.

It is. Ergo the recommendation for addiction medicine.

 

[deleted171991]

It is. Ergo the recommendation for addiction medicine.

Sounds like OP wants to be the patient, not the doctor.

 

[CidHighwind]

Sounds like OP wants to be the patient, not the doctor.

.
Let me ask you guys this, I’m considering radiology, would you say to go for that over anesthesia? Why or why not?

 

[GlowInTheDark]

.
Let me ask you guys this, I’m considering radiology, would you say to go for that over anesthesia? Why or why not?

Because I’d rather stab myself in the eye than sit at the screens all day with a never-ending list of studies to read.

 

[deleted171991]

This is easy: when in doubt, do NOT choose anesthesia.

 

[PieOHmy]

Because I’d rather stab myself in the eye than sit at the screens all day with a never-ending list of studies to read.

At least you can get up and use the restroom whenever you want when you are reading studies.
SItting in the OR with a never ending surgery.... you just may have to S**t yourself or P**s yourself right there in the room in addition to stabbing yourself in the eye.

 

[deleted50478]

At least you can get up and use the restroom whenever you want when you are reading studies.
SItting in the OR with a never ending surgery.... you just may have to S**t yourself or P**s yourself right there in the room in addition to stabbing yourself in the eye.

I can go to the restroom whenever I want!

I’d be nice to avoid the negatives of anesthesia, but I’d choose anesthesia again. I just couldn’t stand doing clinic for 25 years.

 

[PieOHmy]

I can go to the restroom whenever I want!

you S**t in the room?
Pi** in the room?

 

[GlowInTheDark]

At least you can get up and use the restroom whenever you want when you are reading studies.
SItting in the OR with a never ending surgery.... you just may have to S**t yourself or P**s yourself right there in the room in addition to stabbing yourself in the eye.

I don’t have bowel/bladder issues, has never been a problem.

 

[PieOHmy]

I don’t have bowel/bladder issues, has never been a problem.

anyone who drinks coffee in the morning knows what im talking about

 

[pgg]

This obsession with peeing and pooping is weird. For normal people it's just ... not an issue.

 

[CidHighwind]

This is easy: when in doubt, do NOT choose anesthesia.

Why? Some of my advisors told me that it’s a good backup to apply for and can be a lot of fun. Also don’t you guys get breaks during the case where you can go to the restroom? You’re not like EM guys that may literally go the whole 8-12 hour shift without going to the restroom.

 

[deleted171991]

Why? Some of my advisors told me that it’s a good backup to apply for and can be a lot of fun. Also don’t you guys get breaks during the case where you can go to the restroom? You’re not like EM guys that may literally go the whole 8-12 hour shift without going to the restroom.

Because it's an underappreciated specialty being taken over by midlevels. Do it if you know you like it, not the idea of it.

 

[epidural man]

.
Let me ask you guys this, I’m considering radiology, would you say to go for that over anesthesia? Why or why not?

Even if you don’t like Andrew Yang, what he says is true - that is another industrial revolution is inevitable but this time it will displace about 10x the number of jobs the first one did (have you seen those robots from Boston Dynamics?) In medicine, radiology will be the first replaced by AI. Anesthesia is in that list also but probably further down.

 

[Nivens]

Some of my advisors told me that it’s a good backup to apply for

Are these advisors anesthesiologists?

Regardless, do us all favor: don't use us as your "backup".

 

[CidHighwind]

Are these advisors anesthesiologists?

Regardless, do us all favor: don't use us as your "backup".

One of them was actually. Said a lot of people applying for competitive surgical subspecialties apply Anesthesiology as a backup. Said it makes sense since the job has lots of procedures, critical care, and is a fun/rewarding job. Didn’t mean to offend you guys.

Even if you don’t like Andrew Yang, what he says is true - that is another industrial revolution is inevitable but this time it will displace about 10x the number of jobs the first one did (have you seen those robots from Boston Dynamics?) In medicine, radiology will be the first replaced by AI. Anesthesia is in that list also but probably further down.

Will it replace it or just make their jobs easier? I doubt that they’ll just blindly trust the computer’s read without someone double-checking it.

 

[Silo004]

If you land in a town with 3 urologists = q3 weekends but better pay.

Not many urologic emergencies though right?

Torsion. Really bad priapism. Fournier's if it gets to that point. Urology is a good move.

 

[AdmiralChz]

Not many urologic emergencies though right?

Torsion. Really bad priapism. Fournier's if it gets to that point. Urology is a good move.

Much more common than either of those is severe bladder bleeding from chemo/XRT. We do several cases a month in the middle of the night.

Also the anatomy just doesn’t do it for me, personally. Do something you LIKE not because of some perceived lifestyle.

 

[vector2]

Not many urologic emergencies though right?

Torsion. Really bad priapism. Fournier's if it gets to that point. Urology is a good move.

Uro has managed to dump a bunch of obstructive stone stuff on IR in the last few years, but historically urgent/emergent cysto/perc nephro was like a once a day occurence. Also if you're at a trauma center you'll be coming in for all sorts of uro injuries.

 

[PieOHmy]

allergy/immunology, derm, occ med, some parts of physiatry, plastic surgery. ENT (only surgery center kind) facial plastics,

anesthesia (lots of badness)

 

[deleted500612]

Not many urologic emergencies though right?

Torsion. Really bad priapism. Fournier's if it gets to that point. Urology is a good move.

Acute urinary retention is the most common urological emergency, ED can often handle it though

 

[deleted171991]

Even if you don’t like Andrew Yang, what he says is true - that is another industrial revolution is inevitable but this time it will displace about 10x the number of jobs the first one did (have you seen those robots from Boston Dynamics?) In medicine, radiology will be the first replaced by AI. Anesthesia is in that list also but probably further down.

We already have robots. They are called CRNAs.

 

[VA Hopeful Dr]

Each cycle of IVF costs around 8K-12K. Busy clinic does 2000-4000 cycles. You figure the revenue.

They do work hard, often including both weekends.

Ha, I wish.

Try 25k, and that's just the retrieval and fertilization. Putting the embryos back is another 2k/attempt.

 

[appalachian_man]

Ha, I wish.

Try 25k, and that's just the retrieval and fertilization. Putting the embryos back is another 2k/attempt.

I think this is dependent on location/institution. I know our REI guys charge like 15-18k per cycle. Still making bank