M4 deciding between ophtho and anesthesia

[premedeq]

Hey all,

I'm an M4 deciding whether to pursue anesthesia or ophtho. I'm pretty confident I would be able to match well in either specialty (T30 med school, honors on all rotations, AOA, step1 in 260s, step 2 in 270s, no red flags). I feel like I owe it to myself to apply to a competitive specialty (ophtho) to guarantee my future self job security but from my experience as a medical student, I really prefer anesthesia. I would love to hear some perspectives. Here are some pros and cons to organize my thoughts:

Ophtho Pros:
-surgical specialty without much scope creep from midlevels. Plus, residency positions have been pretty stable so not a lot of saturation within the field either.
-continuity with patients- not something that I value a ton now, but maybe someday I will

Ophtho Cons:
- lots of clinic, somehow a 12-hour day in the OR seems much shorter than an 8-hour day in clinic. And from what I've seen, most attendings spend 3-4 days in clinic (academic med center)
- Repetitive surgeries- again, my perspective from just observing in an academic med center, but it seems like the attendings I've worked with only do one type of surgery (cataracts, blephs), over and over again. I'm sure a lot of my perspective here is due to shadowing vs doing (much more shadowing on ophtho, much more doing on anesthesia rotations)

Anesthesia Pros:
- mix of medicine (pulm and cardio are both really interesting to me) and procedures
- the ability to do locums, pick up and move around the country without having to build up a patient base
- shift work
- I really enjoyed my time on anesthesia

Anesthesia Cons:
- uncertainty in the feild, with increasing numbers of residency positions, CNRA's and AAs every year, five years from now if I graduate from anesthesiology residency are the jobs still going to be around or will the field be saturated like EM?

I know that picking a specialty based on step score isn't a great strategy, but I can't help but worry that picking the specialty I'm most interested in is just going to lead to lots of financial stress and regret in the future- I would really appreciate your thoughts!
- overall more enjoyable for me thus far

TiA!

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[VA Hopeful Dr]

I think Optometry might have something to say about that scope creep.

If you don't like clinic, long term patients, or doing the same handful of procedures, ophthalmology isn't likely to be a satisfying specialty for you.

Also, trying to predict the future of the job market/reimbursement more than 1-2 years in the future is almost never going to be accurate.

 

[Captain_Falcon]

Sounds like you should do anesthesia

 

[Drrrrrr. Celty]

Clinic as a student / learner is a significantly different experience than clinic as an established and knowledgeable practioner who has written a note about the patient before and has established what they're treating. Also know your population base, resident clinics are far more difficult to manage than regular outpatient clinics.

 

[operaman]

I think anesthesia sounds like the right call for you and they seem to have an excellent quality of life. The docs I work with all seem very happy and have very active lives outside the hospital.

As noted above, plenty of scope creep in Ophtho too. I think anesthesia scope creep is going to be slowed/halted by the rise of AAs - basically just a like a crna but no nursing background and less expensive. I’ve seen some supervised practice models where it’s MDs and AAs - we had that in fellowship and I didn’t even realize those people weren’t CRNAs until 6 months in. So I’m pretty bullish on anesthesia’s ability to manage scope creep - mainly by using more scope creep against the creepers!

 

[Oso]

If you prefer anesthesia, then do anesthesia (and it really does sound like you like it more than optho).

Applying for a super competitive specialty just because you have the stats for it sounds like a recipe for long term dissatisfaction and unhappiness.

Great job in medical school, now apply to top anesthesia programs and go have a great career.

 

[Captain_Falcon]

Applying for a super competitive specialty just because you have the stats for it sounds like a recipe for long term dissatisfaction and unhappiness.

Agree 100%. I have excellent scores and I'm applying to an arguably bottom 4 competitive field

 

[voxveritatisetlucis]

i would go optho

Wisconsin Hospital Replaces All Anesthesiologists with CRNAs.

https://www.beckershospitalreview.com/hospital-ph… Don't know how I feel about this.

www.wallstreetoasis.com

 

[srirachamayonnaise]

don’t apply to a competitive specialty just because you have the stats (ophthalmology is like dentistry….. so boring in the OR. You basically just do one thing only as an attending in academic or private setting. The reason why it pays well is because you can do 30 cateracts in a day without scrubbing out. It sounds so boring to me.) You seem to enjoy gas a lot more and you will find a job certainly from a top residency program no matter what the job market is like.

 

[srirachamayonnaise]

i would go optho

Wisconsin Hospital Replaces All Anesthesiologists with CRNAs.

https://www.beckershospitalreview.com/hospital-ph… Don't know how I feel about this.

www.wallstreetoasis.com

I really don’t think you could advise without spending some time in the ophtho clinic. The OP is absolutely right about the repetitive nature of ophtho. You basically repeat all the stuff over and over in the clinic and OR. Slit lamp, eye drops, not working, OR (cataracts, glaucoma, bleph, or retina). I think the only sub specialty in ophtho that can offer some varieties in your practice is oculoplastics, which is super super competitive to get into for a fellowship. Then why don’t you just go for plastics or ENT then…

 

[mistafab]

...from my experience as a medical student, I really prefer anesthesia.

Then go anesthesia bro. Money will come. If you love your job your work is less like work and more like play.