Specialty Choice: Anesthesia or Surgery?

[studentsurgeon]

Even before I started medical school, I was hoping and dreaming of becoming a surgeon. I worked with surgeons and anesthesiologists in a level 1 trauma center for a year before I started school, and I loved the stressful situations, the communication skills you develop, the general "type of person" that tends to be in these roles.

This past year I was diagnosed with a chronic illness which, by all accounts that I can dig up, means that I very likely should not be a surgeon (based on the speculation of what could possibly go wrong). I am trying to lean more into anesthesiology now, as a more hands-off approach while still being in the OR, which seems like a good compromise, but I can't help wanting to be on the other side of the drape, performing the actual work that is going on.

My question, ultimately, is how did people choose between surgery and anesthesia, did anyone switch suddenly (and why), and lastly does it make sense for me to try and force my way into a surgical specialty if others truly feel that I should not be there with the diagnosis I have (side note: my specialist for that illness says she is fine with me doing a surgical specialty).

Thanks!!!!

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[i-doctor]

Hmm. I don’t know the answer either, but is it possible that being on the other side of the drape could actually make things worse for you? Having to constantly be reminded every day that you are on the other or “wrong” side could be tough. Perhaps consider a different field altogether? Maybe something like IR (interventional radiology), where you are doing interesting procedures but not exactly on the “other side of the drape”.

 

[Dr. Anonymouss]

I was interested in orthopedic surgery when I first started medical school. I busted my ass doing research and getting lots of publications and connections, but 3rd year showed me that I didn’t want that lifestyle. I suppose that’s when I realized I didn’t want to be just a doctor. I also couldn’t imagine putting my wife through the 5 year surgical residency which has much much longer hours than a lot of other specialties. Anesthesia on the other hand has a terrific lifestyle where you can decide how much you want to work and how much call you want to take. I also found it to be very fascinating between the pharmacology and physiology. It’s very hands on with lots of little procedures as well so that was sufficient enough to stimulate my surgical side. I’d say may more than anything it was lifestyle that pushed me away from surgery and towards anesthesia.

 

[operaman]

I think a lot depends on the details. Without knowing specifics, I would caution you about thinking the surgical subs are any less physically demanding than gen surg. That’s a common perception, but may not be completely accurate. Even if parts of a field are less physically demanding, there may be other parts that are and you would likely need to complete them to graduate residency.

Medicine is sadly 30-40 years behind in terms of dealing with disabled trainees. In ent, I’ve seen it go two ways: I’ve seen someone forced switch to anesthesia after PGY3 because they couldn’t use the microscope and thus couldn’t perform many of the key cases needed to graduate, and I’ve seen a similar situation where they were graduated but with restrictions that made it much harder to find a job afterwards. You’re really at the mercy of your program in these situations.

Anesthesia is definitely the field I’ve seen most surgery-bound people change to, especially people who switched during residency. Currently it’s one of the best paid and best lifestyle fields out there, with many fellowship options that offer variety.

I don’t think there’s much across the drape envy once you leave training. Eventually everything is pretty boring and routine. Even my favorite cases to do are fairly routine and I’m only in my third year out of fellowship. I would get money the attending you’ve worked with in what were exciting situations for you likely felt much the same way. It’s a great job, but like anything you get used to it and the excitement part fades even if you still enjoy the work.

If you enjoy the actual day to day work of anesthesia, it’s a nice option to consider.

One other thing a bit off topic but worth considering: now that you carry this new diagnosis, you will probably never be able to get disability insurance. The only exception would be if you go to a residency program that offers a guaranteed issue private policy to their trainees and not every hospital offers this. This is NOT the hospital paid disability insurance that every program offers and only covers you during training (and usually only pays a max 3 years of benefits if you need to use it), I’m talking about a policy you pay yourself and can take with you into attendinghood. These policies truly don’t require any medical check and usually the only thing that can disqualify you is if you’ve ever applied for and been denied disability coverage in the past. So don’t apply for anything ever until you’ve first secured a guaranteed issue policy. Depending on your diagnosis, having a disability policy you can carry with you may be the most valuable thing you can get from training and is important enough that I would consider ranking only programs that offer it, in any field, if you can.

 

[studentsurgeon]

Hmm. I don’t know the answer either, but is it possible that being on the other side of the drape could actually make things worse for you? Having to constantly be reminded every day that you are on the other or “wrong” side could be tough. Perhaps consider a different field altogether? Maybe something like IR (interventional radiology), where you are doing interesting procedures but not exactly on the “other side of the drape”.

That is definitely something I've been thinking about a lot. I shadowed EM docs a few times and was hoping I would love it... but I didn't. I probably should look into IR more, thank you for the idea!

 

[studentsurgeon]

I was interested in orthopedic surgery when I first started medical school. I busted my ass doing research and getting lots of publications and connections, but 3rd year showed me that I didn’t want that lifestyle. I suppose that’s when I realized I didn’t want to be just a doctor. I also couldn’t imagine putting my wife through the 5 year surgical residency which has much much longer hours than a lot of other specialties. Anesthesia on the other hand has a terrific lifestyle where you can decide how much you want to work and how much call you want to take. I also found it to be very fascinating between the pharmacology and physiology. It’s very hands on with lots of little procedures as well so that was sufficient enough to stimulate my surgical side. I’d say may more than anything it was lifestyle that pushed me away from surgery and towards anesthesia.

I think this part in particular is where I am not sure what to do - I really like the all-in, crazy lifestyle of surgery. I have always pictured myself staying up all hours of the day and night, and my friends and family know this has been my plan all along so luckily they're along for whatever path I end up choosing. I could also have night call etc with anesthesia and get the trauma cases and all of that, so I am trying to convince myself it will be a similar vibe but I am not sure that's true...

 

[i-doctor]

You’ve got to do an anesthesia elective. It’s one of those electives where you will know the answer in likely only 3 days. It’s either a strong yes or a strong no.

 

[studentsurgeon]

I think a lot depends on the details. Without knowing specifics, I would caution you about thinking the surgical subs are any less physically demanding than gen surg. That’s a common perception, but may not be completely accurate. Even if parts of a field are less physically demanding, there may be other parts that are and you would likely need to complete them to graduate residency.

Medicine is sadly 30-40 years behind in terms of dealing with disabled trainees. In ent, I’ve seen it go two ways: I’ve seen someone forced switch to anesthesia after PGY3 because they couldn’t use the microscope and thus couldn’t perform many of the key cases needed to graduate, and I’ve seen a similar situation where they were graduated but with restrictions that made it much harder to find a job afterwards. You’re really at the mercy of your program in these situations.

Anesthesia is definitely the field I’ve seen most surgery-bound people change to, especially people who switched during residency. Currently it’s one of the best paid and best lifestyle fields out there, with many fellowship options that offer variety.

I don’t think there’s much across the drape envy once you leave training. Eventually everything is pretty boring and routine. Even my favorite cases to do are fairly routine and I’m only in my third year out of fellowship. I would get money the attending you’ve worked with in what were exciting situations for you likely felt much the same way. It’s a great job, but like anything you get used to it and the excitement part fades even if you still enjoy the work.

If you enjoy the actual day to day work of anesthesia, it’s a nice option to consider.

One other thing a bit off topic but worth considering: now that you carry this new diagnosis, you will probably never be able to get disability insurance. The only exception would be if you go to a residency program that offers a guaranteed issue private policy to their trainees and not every hospital offers this. This is NOT the hospital paid disability insurance that every program offers and only covers you during training (and usually only pays a max 3 years of benefits if you need to use it), I’m talking about a policy you pay yourself and can take with you into attendinghood. These policies truly don’t require any medical check and usually the only thing that can disqualify you is if you’ve ever applied for and been denied disability coverage in the past. So don’t apply for anything ever until you’ve first secured a guaranteed issue policy. Depending on your diagnosis, having a disability policy you can carry with you may be the most valuable thing you can get from training and is important enough that I would consider ranking only programs that offer it, in any field, if you can.

Thank you for the reply! I don't even know what surgical field I would go into at this point (I love ortho but I can also see myself in gen surg). I have seen some lectures and spoken with doctors studying disabilities in medicine, and it looks like things are changing, but as you know, not rapidly in any way. It is actually relieving to hear you talk about how the days become "boring and routine" for all specialties - I think I need to hear that because everything seems boring to be EXCEPT surgery right now.

I have been told a few times now about the disability insurance situation - from my specialist doctor as well. I think this is definitely something I will have to consider no matter what field I go into, but based on the chronic illness I have and the VERY minimal symptoms/episodes I have had, I am hoping it will not be an issue.. but good to think about for the future.

 

[studentsurgeon]

You’ve got to do an anesthesia elective. It’s one of those electives where you will know the answer in likely only 3 days. It’s either a strong yes or a strong no.

I hope I will figure it out soon! I have shadowed many anesthesiologists at this point (cardiac, pediatric, general), done anesthesia research, worked alongside them in the O.R. before medical school, and I still feel like I am unsure. Perhaps because I am trying to force myself to like it, I am not sure.

 

[Lem0nz]

There are surgeons on this forums (myself included) who can give you an honest and direct answer if you share the underlying problem. It is exceedingly unlikely that someone is going to hunt you down from SDN and figure out who you are in real life to impact your ability at all to progress through medical school, apply to residency, etc. But its your call.

I choose surgery because I quite literally couldn't tolerate anything else exactly as you have described. I regret nothing. If I had to do something besides surgery I would not be in medicine.

I will say that as an actual functioning adult member of society and attending surgeon now you will grow to hate, HATE, excitement in this field and literally any sub-specialty branch of surgery. But that's whatever - it gets beaten out of you.

I have friends and colleagues with metastatic cancer still operating, hepatitis on chronic medication, narcolepsy, tons of people with carpal tunnel, MS... it depends on the problem.

 

[operaman]

There are surgeons on this forums (myself included) who can give you an honest and direct answer if you share the underlying problem. It is exceedingly unlikely that someone is going to hunt you down from SDN and figure out who you are in real life to impact your ability at all to progress through medical school, apply to residency, etc. But its your call.

I choose surgery because I quite literally couldn't tolerate anything else exactly as you have described. I regret nothing. If I had to do something besides surgery I would not be in medicine.

I will say that as an actual functioning adult member of society and attending surgeon now you will grow to hate, HATE, excitement in this field and literally any sub-specialty branch of surgery. But that's whatever - it gets beaten out of you.

I have friends and colleagues with metastatic cancer still operating, hepatitis on chronic medication, narcolepsy, tons of people with carpal tunnel, MS... it depends on the problem.

I hear you on the excitement thing. Give me boring predictable days any time! Boring days end with me leaving a bit early, having a nice swim, and grabbing a cocktail.

The excitement is less fun when you’re the one responsible for the outcome.

 

[AnonymousDoctorGuyPerson]

performing the actual work that is going on.

If it's any consolation, anesthesiologists are performing some of the crucial actual work that is going on


Also as others have stressed, time and time again the folks looking for excitement wind up looking forward to the boring days. I'm in the same boat as you, I have the idea "I want excitement, and I'm not like these other folks I'll never be bored of it" but who am I to ignore the wisdom of all my seniors?

 

[ACSurgeon]

I hear you on the excitement thing. Give me boring predictable days any time! Boring days end with me leaving a bit early, having a nice swim, and grabbing a cocktail.

The excitement is less fun when you’re the one responsible for the outcome.

Yes but a boring surgery is like playing a fun game. Everything else is like reading a book that could range from a really interesting book to a really tedious one.

 

[LucidSplash]

As someone that just got out of bed at 3am today because I was on call and there was a trauma vascular emergency, I would definitely disclose, either in the forum or by PM to some of us surgeons, what the nature of your chronic illness is to give you complete advice.

I thought I was going to do trauma surgery but decided in residency that I liked vascular better (not because I thought it was a better lifestyle, it is the same or sometimes arguably worse depending on the hospital except I don’t take any inhouse call so at least I’m home in my own bed for call). While I really value my anesthesia colleagues (who are frequently busier than they’d like in my cases because almost all vascular patients are not exactly ASA I), I didn’t like the chemistry/physiology interface enough as a med student. I did like critical care, hence my interest in trauma initially, and some anesthesiology do some critical care, but I just did not enjoy being responsible for the airway. Which seems silly when you consider I’m the one who gets called to stop bleeding, but 🤷🏼‍♀️.

I still love what I do but I do curse my life choices sometimes when overnight emergencies come in or especially 5pm emergencies when I was otherwise gonna leave the hospital. And the postcall days are harder at 42 than they were in my 20s. And yeah, the “excitement” factor is not really a thing when you are medicolegally responsible for a really terrible disaster. There is still professional interest and satisfaction, but not excitement. Trauma surgeons mostly still like trauma but there are definitely some that leave it to do just general surgery after awhile, just as an example.

I do get some professional satisfaction out of fixing stuff that makes some other types of surgeons nervous, but that is offset by having to fix other specialty complications (also usually at 5pm) while the specialist just heads out the door.

As far as disability insurance, if you are an employed surgeon and get your DI through the hospital, it won’t be an issue, as those big group policies usually spread the risk and don’t require specific info from you most of the time. But if you are looking to get your own separate policy, like if you are PP or 1099, it will be an issue. I have stable IgA nephropathy with no evidence of progression of disease since diagnosis going on 7 years ago now and stage 3a CKD only since then. I’m doing 1099 work and the only policy I could get has an exclusion rider for ANYTHING renal related, which could be any serious illness honestly. And I had to find a particular broker who was willing to help me find a company that would do that. Which shouldn’t stop you from being a surgeon if you want to, but you should take it into account if you had a specific practice pattern in mind.

 

[operaman]

As someone that just got out of bed at 3am today because I was on call and there was a trauma vascular emergency, I would definitely disclose, either in the forum or by PM to some of us surgeons, what the nature of your chronic illness is to give you complete advice.

I thought I was going to do trauma surgery but decided in residency that I liked vascular better (not because I thought it was a better lifestyle, it is the same or sometimes arguably worse depending on the hospital except I don’t take any inhouse call so at least I’m home in my own bed for call). While I really value my anesthesia colleagues (who are frequently busier than they’d like in my cases because almost all vascular patients are not exactly ASA I), I didn’t like the chemistry/physiology interface enough as a med student. I did like critical care, hence my interest in trauma initially, and some anesthesiology do some critical care, but I just did not enjoy being responsible for the airway. Which seems silly when you consider I’m the one who gets called to stop bleeding, but 🤷🏼‍♀️.

I still love what I do but I do curse my life choices sometimes when overnight emergencies come in or especially 5pm emergencies when I was otherwise gonna leave the hospital. And the postcall days are harder at 42 than they were in my 20s. And yeah, the “excitement” factor is not really a thing when you are medicolegally responsible for a really terrible disaster. There is still professional interest and satisfaction, but not excitement. Trauma surgeons mostly still like trauma but there are definitely some that leave it to do just general surgery after awhile, just as an example.

I do get some professional satisfaction out of fixing stuff that makes some other types of surgeons nervous, but that is offset by having to fix other specialty complications (also usually at 5pm) while the specialist just heads out the door.

As far as disability insurance, if you are an employed surgeon and get your DI through the hospital, it won’t be an issue, as those big group policies usually spread the risk and don’t require specific info from you most of the time. But if you are looking to get your own separate policy, like if you are PP or 1099, it will be an issue. I have stable IgA nephropathy with no evidence of progression of disease since diagnosis going on 7 years ago now and stage 3a CKD only since then. I’m doing 1099 work and the only policy I could get has an exclusion rider for ANYTHING renal related, which could be any serious illness honestly. And I had to find a particular broker who was willing to help me find a company that would do that. Which shouldn’t stop you from being a surgeon if you want to, but you should take it into account if you had a specific practice pattern in mind.

Well said.

I’d add that many of the group disability policies through the hospital or large group have a limit on how long they pay. My hospital DI policy only pays out for 3 years, so I’d be SOL if something bad happened that knocked me out for the rest of my career.

The holy grail for OP is a guaranteed issue private policy, usually only something you can get through a big hospital residency program, if at all. That’s something they can keep with them out of training in addition to any other group policies and most private policies pay benefits until you hit 60 or 65 years old. I feel like many employers put the max length of payouts down in the fine print.

 

[LucidSplash]

Well said.

I’d add that many of the group disability policies through the hospital or large group have a limit on how long they pay. My hospital DI policy only pays out for 3 years, so I’d be SOL if something bad happened that knocked me out for the rest of my career.

The holy grail for OP is a guaranteed issue private policy, usually only something you can get through a big hospital residency program, if at all. That’s something they can keep with them out of training in addition to any other group policies and most private policies pay benefits until you hit 60 or 65 years old. I feel like many employers put the max length of payouts down in the fine print.

Yes I should mention that I did port my residency policy. I pay $80/month for ~$4000/month potential benefit with that policy, which ain’t bad. It is not own occupation though. But still cheapest I will ever pay and no exclusion rider. So definitely look into if your training policy is can be ported when you finish.