IM vs Anesthesiology

[lost007]

M4 here...have interviewed for both fields and need to decide what to go into. Residents and attendings who may have been in my position and now have the added benefit of hindsight - please help me!

Internal Medicine
Pros: Lots of good fellowships to choose from, more laid back than anesthesia in terms of being vigilant all the time, probably more interesting.
Cons: Likely less pay, annoying patients, paperwork, social work.

Anesthesiology
Pros: Not dealing with annoying patients, one patient at a time, ability to specialize in pain, better pay, better lifestyle outside of work.
Cons: more intense (have to be vigilant all the time), earlier hours, taking orders from surgeons, higher risk.

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[rokshana]

M4 here...have interviewed for both fields and need to decide what to go into. Residents and attendings who may have been in my position and now have the added benefit of hindsight - please help me!

Internal Medicine
Pros: Lots of good fellowships to choose from, more laid back than anesthesia in terms of being vigilant all the time, probably more interesting.
Cons: Likely less pay, annoying patients, paperwork, social work.

Anesthesiology
Pros: Not dealing with annoying patients, one patient at a time, ability to specialize in pain, better pay, better lifestyle outside of work.
Cons: more intense (have to be vigilant all the time), earlier hours, taking orders from surgeons, higher risk.

doesn't that negate the annoying pts con in the IM column?

 

[lost007]

true but I'm talking about interventional pain, where a lot of the time would be dedicated towards doing procedures while someone else (maybe an NP) takes care of some of the other things.

 

[235009]

M4 here...have interviewed for both fields and need to decide what to go into. Residents and attendings who may have been in my position and now have the added benefit of hindsight - please help me!

Internal Medicine
Pros: Lots of good fellowships to choose from, more laid back than anesthesia in terms of being vigilant all the time, probably more interesting.
Cons: Likely less pay, annoying patients, paperwork, social work.

Anesthesiology
Pros: Not dealing with annoying patients, one patient at a time, ability to specialize in pain, better pay, better lifestyle outside of work.
Cons: more intense (have to be vigilant all the time), earlier hours, taking orders from surgeons, higher risk.

anesthesiologists are CONSTANTLY charting. i would say about 50% of their job is charting.

also the biggest con for anesthesia that you didn't even mention is that there is extreme uncertainty within the field about the future. i was told by an anesthesia attending who has been practicing for a couple of decades that 5 years ago he used to encourage med students to pursue anesthesia but no longer does. on the other hand in IM hospitalist medicine is a new and expanding field, you have a myriad of fellowship options open to you after 3 years of residency and primary care is never going to become obsolete and is a field where you can use midlevel providers to your advantage.

finally as for chronic pain, you can't avoid the patients. you're the one with the prescription pad and the DEA number so you're all that stands between (a whole bunch of) your patients and those sweet narcotics. i would take a patient with social problems and 5 objectively verifiable and potentially treatable medical problems over a patient with chronic pain any day.

 

[lost007]

I agree, charting is a big time consumer, although a lot of places where I've interviewed use electronic charting - this will eventually be everywhere....so charting time will decrease substantially.

 

[LovelyBRass]

M4 here...have interviewed for both fields and need to decide what to go into. Residents and attendings who may have been in my position and now have the added benefit of hindsight - please help me!

Internal Medicine
Pros: Lots of good fellowships to choose from, more laid back than anesthesia in terms of being vigilant all the time, probably more interesting.
Cons: Likely less pay, annoying patients, paperwork, social work.

Anesthesiology
Pros: Not dealing with annoying patients, one patient at a time, ability to specialize in pain, better pay, better lifestyle outside of work.
Cons: more intense (have to be vigilant all the time), earlier hours, taking orders from surgeons, higher risk.

i think it's helpful to consider what you picture the most amazing doctor version of yourself doing everyday. forget the bs about social work or taking orders from surgeons. on your best day are you calmly leading a code blue in the OR while everyone else panics, or are you putting together the pieces to nail the diagnosis that eluded 3 other specialists (granted these could be interchangeable, but you get my drift)? etc

 

[disorder]

I agree, charting is a big time consumer, although a lot of places where I've interviewed use electronic charting - this will eventually be everywhere....so charting time will decrease substantially.

i will have to say this is wrong from having read/listened to many attendings bitch and moan about how EMR's have multiplied their charting work. it seems that an EMR makes you chart MORE volume wise but maybe more efficiently (depending on the EMR). with EMR's it's obviously easier to track outcomes, and thus, charting becomes even more important and tedious.

 

[bronx43]

true but I'm talking about interventional pain, where a lot of the time would be dedicated towards doing procedures while someone else (maybe an NP) takes care of some of the other things.

You still have to deal with the pain seekers even if you're "interventional pain." There isn't a situation where all you do is sit in the procedure suite and knock out injections all day. Unless you live in the boondocks where there's literally no one else doing these procedures, you'll have to deal with all the difficult patients that PCPs and other physicians don't want to deal with (and hence send your way).

 

[lost007]

i think it's helpful to consider what you picture the most amazing doctor version of yourself doing everyday. forget the bs about social work or taking orders from surgeons. on your best day are you calmly leading a code blue in the OR while everyone else panics, or are you putting together the pieces to nail the diagnosis that eluded 3 other specialists (granted these could be interchangeable, but you get my drift)? etc

True...I think I enjoy a good patient workup leading to a diagnosis more than anything. I really find gratification from a thorough process like that. Also, I don't see myself really as the person to calmly lead a code blue, but that's what residency (IM and anesthesia) prepares you for...i guess that's a hallmark of a good anesthesiologist whereas in IM, if you don't want to run codes, you don't have to (in private practice after residency).

 

[Bostonredsox]

M4 here...have interviewed for both fields and need to decide what to go into. Residents and attendings who may have been in my position and now have the added benefit of hindsight - please help me!

Internal Medicine
Pros: Lots of good fellowships to choose from, more laid back than anesthesia in terms of being vigilant all the time, probably more interesting.
Cons: Likely less pay, annoying patients, paperwork, social work.

Anesthesiology
Pros: Not dealing with annoying patients, one patient at a time, ability to specialize in pain, better pay, better lifestyle outside of work.
Cons: more intense (have to be vigilant all the time), earlier hours, taking orders from surgeons, higher risk.

The Cards and Gi guys have a bone to pick on the money. IM money is tied to your specialty, the ceiling of which can be quite high compared with Gas. General IM outpt/hospitalist will be < gas though.

The endocrinologists and rheumatologists working 9-5 with 1/2 day friday no call no weekends and makign excellent pay would dispute the lifestyle claim.

Us in the MICU would also dispute the intensity and hours claims.

We all hear the surgeons yelling their orders....but are any of us really listening

that said, gas is a fabulous field. IM more versatile though.

 

[Blackcomb]

I agree, charting is a big time consumer, although a lot of places where I've interviewed use electronic charting - this will eventually be everywhere....so charting time will decrease substantially.

This is completely false. Switching from paper charts --> EMR at least doubled my charting time in clinic. Why?

It's not just because older attendings are poor typers. I can type 120 words/minute. There is so much information we have to input into EMRs (with the increased documenting rules per Medicare).

Now there are some attendings who template everything and probably document more than they actually did. They are vulnerable to being charged with Medicare billing fraud though..

Of course there are benefits to EMRs. I can catch up on a patient's chart far more efficiently and effective than with paper charts. It's a complete fallacy to say you will spend less time charting though.

 

[235009]

I can type 120 words/minute

from wiki: An average professional typist types usually in speeds of 50 to 80 wpm, while some positions can require 80 to 95 (usually the minimum required for dispatch positions and other time-sensitive typing jobs), and some advanced typists work at speeds above 120 wpm.


...totally off topic but had a feeling that was an exaggeration and had to look it up.

 

[C5toC9]

SDN billing fraud

 

[gasblaster]

This is completely false. Switching from paper charts --> EMR at least doubled my charting time in clinic. Why?

It's not just because older attendings are poor typers. I can type 120 words/minute. There is so much information we have to input into EMRs (with the increased documenting rules per Medicare).

Now there are some attendings who template everything and probably document more than they actually did. They are vulnerable to being charged with Medicare billing fraud though..

Of course there are benefits to EMRs. I can catch up on a patient's chart far more efficiently and effective than with paper charts. It's a complete fallacy to say you will spend less time charting though.

I think the OP was referring to anesthesia electronic charting which is a time saver in the long run. It's the beginning of the case that can be a pain because their are a lot of false readings as cases/patients are set up.

 

[gasblaster]

OP I would do a search through the anesthesiology forum as well. This question comes up every so often and there are quite a number of IM to anesthesia converts, who provide a great perspective. I've worked with 2 residents who had completed their IM residencies and then started anesthesiology.

 

[dozitgetchahi]

M4 here...have interviewed for both fields and need to decide what to go into. Residents and attendings who may have been in my position and now have the added benefit of hindsight - please help me!

Internal Medicine
Pros: Lots of good fellowships to choose from, more laid back than anesthesia in terms of being vigilant all the time, probably more interesting.
Cons: Likely less pay, annoying patients, paperwork, social work.

Anesthesiology
Pros: Not dealing with annoying patients, one patient at a time, ability to specialize in pain, better pay, better lifestyle outside of work.
Cons: more intense (have to be vigilant all the time), earlier hours, taking orders from surgeons, higher risk.

This part is also questionable when you look at the way many anesthesiologists are practicing nowadays (i.e, managing a fleet of CRNAs/AAs who administer most of the anesthesia).

 

[tallash]

M4 here...have interviewed for both fields and need to decide what to go into. Residents and attendings who may have been in my position and now have the added benefit of hindsight - please help me!

Internal Medicine
Pros: Lots of good fellowships to choose from, more laid back than anesthesia in terms of being vigilant all the time, probably more interesting.
Cons: Likely less pay, annoying patients, paperwork, social work.

Anesthesiology
Pros: Not dealing with annoying patients, one patient at a time, ability to specialize in pain, better pay, better lifestyle outside of work.
Cons: more intense (have to be vigilant all the time), earlier hours, taking orders from surgeons, higher risk.

Personally it sounds like you want gas.

But, that being said:

1) Dealing with annoying patients and dealing with surgeons can probably be considered one and the same.
2) One patient at a time is quickly moving to "one patient at a time IF you do a fellowship but manage a cluster of CRNAS/rant about your falling salary if you don't".
3) Pain looks good on paper when you're a med student (read: $$$) but that's changing, probably for the better, and why would you cite "not dealing with annoying patients" and "ability to specialize in pain" in the same sentence?!
4) Being more vigilant all the time = definitely not the case.

And I'll second what everyone says about EMRs leading to more scut charting. Gas has to chart so friggin' much, and they don't even pick out the music in the OR. No thanks.

 

[Blackcomb]

from wiki: An average professional typist types usually in speeds of 50 to 80 wpm, while some positions can require 80 to 95 (usually the minimum required for dispatch positions and other time-sensitive typing jobs), and some advanced typists work at speeds above 120 wpm.


...totally off topic but had a feeling that was an exaggeration and had to look it up.

FWIW, i temped for a year before med school and i had to take a typing exam. And yes, i did do 120/min. my old temp job (the very glamorous and lucrative position of data entry) told me to slow down or there wouldn't be any work left.

That wasn't my main point; skinmd- you seem to have a habit of being unnecessarily belligerent.

 

[Stellar Clouds]

Personally it sounds like you want gas.

But, that being said:

1) Dealing with annoying patients and dealing with surgeons can probably be considered one and the same.
2) One patient at a time is quickly moving to "one patient at a time IF you do a fellowship but manage a cluster of CRNAS/rant about your falling salary if you don't".
3) Pain looks good on paper when you're a med student (read: $$$) but that's changing, probably for the better, and why would you cite "not dealing with annoying patients" and "ability to specialize in pain" in the same sentence?!
4) Being more vigilant all the time = definitely not the case.

And I'll second what everyone says about EMRs leading to more scut charting. Gas has to chart so friggin' much, and they don't even pick out the music in the OR. No thanks.

Hold up, are you really trying to say that anesthesia charts more than IM?!?! Sure, anesthesia writes down vitals and meds administered constantly, but they sure as hell don't sit down for hours writing 12 page notes per patient per day.

 

[rokshana]

I agree, charting is a big time consumer, although a lot of places where I've interviewed use electronic charting - this will eventually be everywhere....so charting time will decrease substantially.

hahahahahahaha....no.

 

[Per4mer8]

M4 here...have interviewed for both fields and need to decide what to go into. Residents and attendings who may have been in my position and now have the added benefit of hindsight - please help me!

Internal Medicine
Pros: Lots of good fellowships to choose from, more laid back than anesthesia in terms of being vigilant all the time, probably more interesting.
Cons: Likely less pay, annoying patients, paperwork, social work.

Anesthesiology
Pros: Not dealing with annoying patients, one patient at a time, ability to specialize in pain, better pay, better lifestyle outside of work.
Cons: more intense (have to be vigilant all the time), earlier hours, taking orders from surgeons, higher risk.

I really can't believe there are people that are literally between these two fields. The only way I get thru the next H&P is with the thought that I'll be in the OR next year passing gas. But that's just me.

Based on your post I get the sense that you're leaning towards IM. Don't go into anything for the [expected] money. Period.

 

[Per4mer8]

I agree, charting is a big time consumer, although a lot of places where I've interviewed use electronic charting - this will eventually be everywhere....so charting time will decrease substantially.

I will also echo multiple posters sentiments regarding this naive pipe dream. EMRs do NOTHING to reduce amount of charting time, actually quite the opposite. Atleast in IM...... In Anesthesia however.....

 

[lost007]

I will also echo multiple posters sentiments regarding this naive pipe dream. EMRs do NOTHING to reduce amount of charting time, actually quite the opposite. Atleast in IM...... In Anesthesia however.....

In anesthesia, I think EMR saves time....instead of manually having to chart vitals every 5 minutes, the computer automatically logs it.

 

[235009]

FWIW, i temped for a year before med school and i had to take a typing exam. And yes, i did do 120/min. my old temp job (the very glamorous and lucrative position of data entry) told me to slow down or there wouldn't be any work left.

That wasn't my main point; skinmd- you seem to have a habit of being unnecessarily belligerent.

...sry i insulted your typing skillz


PS: i'm aware it wasn't your main point which is why I said "totally off topic"

 

[rokshana]

The Cards and Gi guys have a bone to pick on the money. IM money is tied to your specialty, the ceiling of which can be quite high compared with Gas. General IM outpt/hospitalist will be < gas though.

The endocrinologists and rheumatologists working 9-5 with 1/2 day friday no call no weekends and makign excellent pay would dispute the lifestyle claim.

Us in the MICU would also dispute the intensity and hours claims.

We all hear the surgeons yelling their orders....but are any of us really listening

that said, gas is a fabulous field. IM more versatile though.

I am looking forward to this...

 

[lost007]

Comeon guys I need help...I tried to post this on the anesthesia board but the thread got closed down because its was a duplicate.

 

[Impromptu]

I am followed this thread from the anesthesia forum. I love EMRs in the ORs. I believe that charting vitals by hand every 3-5 minutes for 10 hours is tedious and a waste of our time. IM docs chart a lot, too, but it is different charting, difficult to compare. Fortunately, most places where I have trained have had EMRs in the OR. They may add 5-15 minutes of devoted charting time looking away from your patient, which for a simple bilateral myringotomy tube insertion may last as long as the case, but they pay off in the longer cases. Paper charts are still in use at most private places I have interviewed, though they all conceded that EMRs will be coming soon. That advance is slow in coming because of the $1/2 million per OR price tag, as well as ongoing maintenance charges.

As iterated above, anesthesiologists may closely manage 1 patient if they are fortunate enough to do their own cases (which occurs more often in the west), but at most other places they will manage up to 4 patients at a time if medically directing CRNAs/AAs, and considerably more patients if medically supervising. Pre-ops, inductions, post-ops, nerve blocks, discharges from the PACU on multiple, multiple patients throughout the day. Imagine the turnover when running 4 GI suites or several ENT rooms.

I am very calm during codes and traumas. How many gunshots to the chest? Okay, bring him up. Let's get started. You may also notice from my avatar that I ride a motorcycle. I like adrenaline. I get that in the ORs, even while looking calm.

Every day I drove home during my IM floor months as an intern I would consider skipping my exit and continuing on for 15 hours to Mexico. IM floors were their own special misery. Sure it would probably get better with more experience, but I love the OR much more. I appreciate the IM people, but it was not the life for me.

Money! Anesthesiology pay may continue to decline, and this is in real dollars not adjusted for inflation, but it may also increase again. Currently it still pays better than most other fields, despite the declines. It will be nice to pay off my medical school loans within a few years. It will be nice to make more than the surgeons (of course they only operate a couple days a week while I am in there daily). It will be nice to make more in my first year as an attending than I had made during all my previous years on this earth. Money is important and helped me lean more toward anesthesiology from other fields, but it won't override your misery if anesthesiology cannot be your passion. It is my passion and I will still enjoy it if pay decreases more.

I don't worry too much about CRNAs, especially with the spread of Anesthesia Assistants. They are just as good and pretty much interchangable with CRNAs, except that they are more medically trained rather than nursing trained (They must take the MCAT and standard pre-med classes in undergrad). They just need continued legislative support to gain rights in a few states where the CRNA lobby is particularly strong.

 

[rokshana]

...but it won't override your misery if anesthesiology cannot be your passion. It is my passion and I will still enjoy it if pay decreases more.

i think this statement is key, whether it is anesthesia or IM (or the subspecialties you can do from IM)...

to the OP, an exercise for you (maybe silly and simplistic, but it could be telling)...what is the 1st emotion you have if you think about someone introducing you...

this is Dr. Lost007 and he is an...internist or cardiologist or hematologist/oncologist, etc...

or he is an anesthesiologist...

im not saying that this should be the litmus test for which you pick but it may give you some insight into where you may have some passion...

 

[lost007]

Every day I drove home during my IM floor months as an intern I would consider skipping my exit and continuing on for 15 hours to Mexico. IM floors were their own special misery. Sure it would probably get better with more experience, but I love the OR much more. I appreciate the IM people, but it was not the life for me.

What made you think IM was misery? Was it the rounds? Dealing with patients?

 

[Impromptu]

What made you think IM was misery? Was it the rounds? Dealing with patients?

Paging from nurses, pharmacists, and nutritionists for the cross coverage patients during overnight call on patients about things I didn't know the answer to. These were typically simple questions that could have had many different answers depending on what the primary team's ultimate plan was. At 3 AM I don't know if unknown patient X from the White Team should be advanced to a diet of soft mechanical from liquid diet. Couldn't they wait until the regular resident got there to answer that question? The patient cannot sleep, what drug should we give them? (My unspoken response was to tell the nurse to stop going into the patient's room, waking them, and asking if they were sleeping).

I honestly loved my own patients. I enjoyed caring for them. I enjoyed delving into their medical histories. I felt like I owned their care. I enjoyed learning how the how to write good sliding scale insulin orders and adjusting them. How to write appropriate orders for withdrawal syndromes. How to treat acute pancreatitis. I disliked cross coverage and 30 hour shifts. Worse, rounding in the MICU was also quite tedious compared to rounding in our surgical ICUs. Different patient populations, but still we could have cut to the chase more quickly.

All of my IM floor month complaints would likely have dissipated had I had more experience and could answer the nurses without doing lots of research.

 

[Aether]

Internal Medicine is more flexible and versatile than anesthesia in many ways especially after residency. The job market is soaring for internists everywhere. In anesthesia the job market and outlook are not that great and you can end up in a location that you are not 100 percent happy with. moreover the competition with CRNAs is vicious right now. The lifestyle of an internists is worlds better. And the pay for an anesthesiologists is not that much better when you consider the hours on call, cases that are late and just the claustrophobia of the Operatiing room. If you like also being handcuffed to the anesthesia machine for 8 hours a day with only getting to go to the bathroom somtimes when the surgeon finishes anesthesia might be for you. You have to have a strong bladder for anesthesia especially for late night cases because nobody is going to relieve you so you can go pee or something else during a case

 

[gasblaster]

Internal Medicine is more flexible and versatile than anesthesia in many ways especially after residency. The job market is soaring for internists everywhere. In anesthesia the job market and outlook are not that great and you can end up in a location that you are not 100 percent happy with. moreover the competition with CRNAs is vicious right now. The lifestyle of an internists is worlds better. And the pay for an anesthesiologists is not that much better when you consider the hours on call, cases that are late and just the claustrophobia of the Operatiing room. If you like also being handcuffed to the anesthesia machine for 8 hours a day with only getting to go to the bathroom somtimes when the surgeon finishes anesthesia might be for you. You have to have a strong bladder for anesthesia especially for late night cases because nobody is going to relieve you so you can go pee or something else during a case

I will give you that their is more versatility after an IM residency if you aren't sure exactly where within IM your interest lies. However, people going into anesthesia typically know where their interests lie and have made their decision. Subspecializing in anesthesia is different that in IM.

You're assessment of anesthesia is a little off. There's no problems with securing jobs but just like many other fields the ones in high demand areas (socal, nyc, etc) are tougher to get at the salary you really want. If you do go farther out, your salary noticeably improves.

Day to day operations vary depending on the group. Like others have mentioned one model is for anesthesiologist oversight of cRNAs, another you do your own cases but your picture is way off. The anesthesiologists takes breaks between cases at the very least and typically during cases, theres almost always someone to relieve you. I'm not sure where your idea of the normal day of an anesthesiologist is coming from but I have never heard that.

Personally, I think lifestyle is better in anesthesia than an internist although I'm not that familiar with what the norm is. I've only seen the academic setting and one large private practice group.

 

[gutonc]

Comeon guys I need help...I tried to post this on the anesthesia board but the thread got closed down because its was a duplicate.

So you asked a bunch of strangers on the intarwubs what you should do with your life and now you're upset that the discussion has gone sideways? Are you serious?

Out of curiosity, how did the discussions go that you had with your IM and Anesthesiology mentors at your school?

 

[Aether]

What made you think IM was misery? Was it the rounds? Dealing with patients?

Have you not done rotations?

Just rotate through and ask a lot of questions but just remember what you enjoy NOW may not be what you will enjoy at 50 years old.

Anesthesiology is in serious trouble now just know that.

 

[Bostonredsox]

Hold up, are you really trying to say that anesthesia charts more than IM?!?! Sure, anesthesia writes down vitals and meds administered constantly, but they sure as hell don't sit down for hours writing 12 page notes per patient per day.

takes me on average about 8 minutes to dictate each patients daily progress note...maybe 12 for an H and P, 6-7 for a discharge summary. multiply by 20 pts and my total "charting time including CPOE" is about 2 hours in a 12 hour shift where I see 20 patients.

 

[rokshana]

takes me on average about 8 minutes to dictate each patients daily progress note...maybe 12 for an H and P, 6-7 for a discharge summary. multiply by 20 pts and my total "charting time including CPOE" is about 2 hours in a 12 hour shift where I see 20 patients.

that because you get to dictate...when you have to input everything into the comp (say like EPIC-don't get me wrong I like EPIC the best), it does increase your charting time.

 

[lost007]

So you asked a bunch of strangers on the intarwubs what you should do with your life and now you're upset that the discussion has gone sideways? Are you serious?

Out of curiosity, how did the discussions go that you had with your IM and Anesthesiology mentors at your school?

I'm not upset lol, just seeing if I can get the thread back on topic. My mentors have been useless, basically they tell me to do what I want. Problem is - I never had that "aha" moment during rotations. There are parts of IM and anesthesia that I like and parts that I dislike.

And yes, I did a couple months of anesthesia rotations this year. Again, there were things I enjoyed and things I didn't.

 

[Aether]

If you want to spend your careere chained to the anesthesia machine for 8-10 hours a day charting vitals then pick anesthesia. If you want to spend your day figuring out whats wrong with people go into Internal Medicine,.

 

[rokshana]

If you want to spend your careere chained to the anesthesia machine for 8-10 hours a day charting vitals then pick anesthesia. If you want to spend your day figuring out whats wrong with people go into Internal Medicine,.

jeez...what did anesthesia do to you? SUCH a chip....

 

[LovelyBRass]

If you want to spend your careere chained to the anesthesia machine for 8-10 hours a day charting vitals then pick anesthesia. If you want to spend your day figuring out whats wrong with people go into Internal Medicine,.

hahahahaha in other words, "if you want to be a real doctor..."

(it's my favorite argument for picking a specialty ever)

 

[fyfanatic]

The endocrinologists and rheumatologists working 9-5 with 1/2 day friday no call no weekends and makign excellent pay would dispute the lifestyle claim.

I feel like in every field, including these, there has to be someone on call...what if there's a patient with thyroid storm or temporal arteritis over the weekend. There are emergencies in every field of medicine, including these.

 

[rokshana]

I feel like in every field, including these, there has to be someone on call...what if there's a patient with thyroid storm or temporal arteritis over the weekend. There are emergencies in every field of medicine, including these.

STEMI vs thyroid storm?

which do you think happens more often?

really?? how many times do you seen an endocrine or rheum fellow in the hospital at 2 am vs a cards or gi fellow?

 

[bronx43]

I feel like in every field, including these, there has to be someone on call...what if there's a patient with thyroid storm or temporal arteritis over the weekend. There are emergencies in every field of medicine, including these.

Besides thyroid storms being a rare occurrence, it's also something that is handled by the ICU. They'll definitely have endocrine on board, but the primary team who manages day to day complications will not be the endo guys. It's the same idea as TEN and derm. Technically, it's a dermatological problem, but it's not something that requires the derm folks to come to the hospital immediately.

Contrast this to STEMIs and GI bleeds. There's no one else to do PCIs and scopes besides GI and cards.

 

[Bostonredsox]

I feel like in every field, including these, there has to be someone on call...what if there's a patient with thyroid storm or temporal arteritis over the weekend. There are emergencies in every field of medicine, including these.

Read my thyroid storm post in the EM forum. That sucker was mine, no endocrinology involvement....as we dont have one in town except one 75 year old guy who work in his office 10-4 lol. Surprised the RRC thinks it is sufficient for our one required endocrine month lol.

 

[MPMD]

M4 here...have interviewed for both fields and need to decide what to go into. Residents and attendings who may have been in my position and now have the added benefit of hindsight - please help me!

Internal Medicine
Pros: Lots of good fellowships to choose from, more laid back than anesthesia in terms of being vigilant all the time, probably more interesting.
Cons: Likely less pay, annoying patients, paperwork, social work.

Anesthesiology
Pros: Not dealing with annoying patients, one patient at a time, ability to specialize in pain, better pay, better lifestyle outside of work.
Cons: more intense (have to be vigilant all the time), earlier hours, taking orders from surgeons, higher risk.

To the OP,

Something I have figured out during med school (more slowly than I am proud of) is to never listen to one specialty about the pro's or con's of another. The grass is always greener, and paradoxically also browner. If you are looking for the highlights and drawbacks of IM, this is a good place to find them. However, this forum is going to be biased against anesthesia. Try asking the anesthesia forum, just don't make the post an exact duplicate.

As to your dilema, the two fields are different, but I can see what you might find interesting about each one. I admit that I am biased against IM, I never really enjoyed my medicine rotations, mostly because of the rounding, clinic, notes, H&P's, social issues and repeated running of the list. What is great about medicine though is the breadth and continued learning -- there is always an interesting or mystery case that demands that you read up on possibilities. Plus you can go into a huge variety of specialties. For me though, the interesting bits didn't make up for the downsides. You have to like the day to day work, and I just didn't.

Anesthesia I think appeals to people who want to be in the OR rather than on the floor, want to be thinking quickly and deliberately, want a variety of cases (admittedly in charge of the same processes for each though), and want to work with their hands. You don't get the zebra mystery diagnoses that stump teams for weeks, but you do get some diagnostics. Is the ICP dropping? Why? How can I immediately correct it given this particular patient's condition and unique physiology? I was surprised to find that it can be very fun work if you have the right personality fit. The downsides are of course that you don't get to be the superhero in the case (but you also don't have to come back in from home in the middle of the night when the graft fails), and there is some question as to the role of nurses in the future. I think that even if nurses and/or automation obviate the need for a physician to run each case individually, there will always be a role for anesthesiologists in peri-operative care and in the ICU.

Hope that helps.

 

[LovelyBRass]

saw this in another thread. really amusing song re: anesthesia

[YOUTUBE]http://www.youtube.com/watch?v=xuZl9tRqjoQ[/YOUTUBE]

^LOL

 

[usermike8500]

Anesthesiology average annual income: $350,000
Internal medicine average annual income: $190,000

so...

$350,000 - $190,000 = $160,000

Do you love internal medicine so much that you would be willing to pay $160,000 per year for the privilege of practicing it?

 

[Bostonredsox]

Anesthesiology average annual income: $350,000
Internal medicine average annual income: $190,000

so...

$350,000 - $190,000 = $160,000

Do you love internal medicine so much that you would be willing to pay $160,000 per year for the privilege of practicing it?

You are looking at the average of internal medicine alone, not all of its subspecialties, which almost 50% of IM grads enter into. So add in the salaries for Cardio, GI, Nephro, Pulm/cc, etc. The number is much higher than 190k.

 

[LovelyBRass]

Anesthesiology average annual income: $350,000
Internal medicine average annual income: $190,000

so...

$350,000 - $190,000 = $160,000

Do you love internal medicine so much that you would be willing to pay $160,000 per year for the privilege of practicing it?

Neurosurgery average annual income: $775,000

Do you love anesthesia enough that you would be willing to pay $425,000 per year to settle for practicing it?

 

[meetingacross]

The money in internal medicine is not as difficult.

In anesthesia you will see your career flash in front of your eyes at least twice a month at a busy place covering multiple sites. I think that is worth 100k trade off thats for sure. Anesthesia is not easy money.