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Anesthesia Vs. Internal Medicine


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I was wondering if people could help me with the pros/cons of these two specialties versus each other, so when I say it's a con or pro, I mean relative to each other. This is what I have so far: 

 

1. IM is more diverse practice (hospital, clinic, etc.) and day-to-day work while Anesthesia is typically OR based with some clinic work (eg. PAC, CNCP)

2. Both have significant cerebral aspects and hands-on, but anesthesia has more of latter and IM is a lot of former 

3. IM can be very long-term focused while Anesthesia is more acute/immediate 

4. Develop a patient base of your own so good for connections with people whereas "see you never" in anesthesia most of the time - that also means easier time taking vacation (?) but no long term relationship with patients 

5. Income - similar (?) - although IM has overhead where anesthesia has very little, if any (?) 

 

Does anyone have any tips on how to approach a decision on this? I have shadowed both (CTU for IM and OR) and have enjoyed both so far. 

 

 

 

 

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Seems like you have good points/arguments for both sides. I am not in med school yet, nor do I personally have any experience in/with either specialty but a family member of mine is an anesthesiologist. He actually says he is able to develop patient/doctor relationships, maybe not as much as IM but some nonetheless. It also very much depends on your subspecialty within anesthesia. For example if you're working in palliative care or pain medicine, I'd argue your patient relationships could be just as strong or stronger than that of an internist.

 

Consider comparing the specialties on what you like the least... they're both amazing and exciting, comparing what you like the best would be never-ending, in my opinion.

 

Once again, I have 0 validity and am purely passing along what I have heard.

 

Sounds like you're in a pretty exciting time! I wish you all the best.... Make a post about what you decide choosing/what you match with down the road!

 

Take care.

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"Less desirable" aspects of anesthesia - preop clinic, preop consults, OB epidurals, acute pain service

These are in quotes because people often have special interests in these areas (I.e. Perioperative medicine, obstetrics, pain) such that many people do fellowship training in these areas, so they aren't unilaterally disliked aspects of the profession.

Overall, Very little scut work as a resident.

As staff, as long as the centre you work in has an OB service, you have to be in house for call (in case of crash sections). Therefore, the only two staff guaranteed to be present and awake for call and must be in hospital are OB and anesthesia.

More "cerebral" areas of anesthesia includes critical care (in some centres, including academic and community centres, anesthesiologists routinely cover ICU shifts), peri operative medicine, cardiac, vascular, and thoracic anesthesia.

Areas that tend to have longer patient interactions include chronic pain, palliative care, ICU.

The lists are by no means exhaustive. I'm still learning new things about the specialty everyday!

The specialty as a whole deals with more acute problems, and tend to have an element of having to do something when crap hits the fan royally, which is usually the reason for the FRCP part.

 

I can't really speak to Internal medicine since I ruled it out pretty early on and therefore didn't do much research about it. Bonus: as staff, at least in academic centres, no need to come in while on call unless very very bad things are happening.

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Another Anes downside: Terrible surgeon jokes in OR. At least my OR.

Are anes and surgeons friendly to each other? All the ORs I've seen, they don't really talk to each other...the surgeons just tell the anes to raise the bed once in a while or ask for more muscle relaxant. 

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More so if they see you all the time

In my centre no, and they do see each other ALL THE TIME.

It could be explained by the complexity of the surgeries, and how the surgeons' personalities could be.

And yes, the surgeons won`t bother to talk to anesth beside telling them a: the patient is bleeding, do something B) raise the bed please lol

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OP has a very good understanding, here is what I understand about the two specialties.

 

Procedure:cerebralness ratio

Anesthesia is probably 80:20 to 90:10

IM is anywhere from 0:100 to 100:0 depending on what you do (e.g. GI doing scope centres vs endo doing clinic)

 

Patient contact

Anesthesia: brief contact pre-op. Post-op is usually groggy, coming out of gas so not much

IM: lots. H&P, treatment discussions, consents etc

 

Work setting

Anesthesia tends to be 90% intraoperative. People talk about pain etc, but realize only so many people do pain and most anesthetists do intra-op anesthesia full time with some pre-op clinics.

IM again is more diverse depending on what you do with clinic-based specialties (Allergy, Endo, Rheum) vs hospital-based specialties (Cardio, GI, Nephro, ICU)

 

Practice style

IM is heavily evidence-based, and a lot of decisions making surrounding the evidence behind which diagnostic test is most reliable, which physical exam finding is most reliable, which treatment is most evidence-based.

Anesthesia tends to be more art (at least intraop) than science

 

In terms of $$,

Anesthesia billings depend quite a bit on on-call, OB, ASA3-4 cases that have higher $/hr. If you're in group practice (which is the usual environment since you work in a hospital setting), there tends to be a relatively fair split in cases. It could be both a good and a bad thing. Most anesthetists aren't there to be the highest billers anyways. Going through the BC blue book anywhere from $350-450 but no overhead.

 

IM billing depends purely on demand, procedure load, efficiency, and how long you work. Cardio/GI can end up billing more than $1mil a year from a number of reasons (procedure time, workload etc), whereas endo/rheum/allergy tend to bill less (complex patients, lack of lucrative procedures). That said, jobs are hard to come by with the high-paying subspecialties due to lack of hospital resources, whereas you can open up an office anywhere you want as an allergist and your consult list will be full in a week. Going through the BC blue book, anywhere from $300k to $1mill but with overhead

 

In terms of hours worked,

Anesthesia is pretty predictable. Show up at ~7:30-8:00, prep for first OR. Leave hospital by 3:30-4 unless on-call. Most of the time during the day spent sitting around charting etc

IM tends to be faster paced but again depends. Clinic hours can be set to whatever is preferred. Most people work 8-5 with an hour of break. Call is heavy for certain specialties like GIM and Cardiology due to the # of consults from ER and you're up most of the night even at the staff level (if you don't have residents). Other specialties less so (since they can be seen in the AM). # of hours worked relatively correlate with how much you bill so it's pretty variable.

 

Paperwork

Anesthesia certainly has less paperwork, once you're off work you're done work. 

IM has definitely more paperwork, dictations/MoT forms, referral letters, progress notes etc. But they tend to get shorter and brief as you move up the ladder.

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^you may have touched on this a bit already, but how does the job market compare for anesthesia vs the hospital based IM specialties?

 

Both aren't good because there are limited hospital resources these days, and more and more cuts in certain areas (i.e. ON)

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  • 4 weeks later...

All the major centers across the country, they are hard for either specialties. Last time I heard for academic centers, anesthesia needed a fellowship and/or master's. IM is certainly fellowship and some research capabilities. You can almost say for certain that you will never be able to find a job in academic centers as a pure 'clinician'

 

In the community, again you have to look for places with ORs for anesthesia (And daily ORs, not just few days a week or else you won't be working much). Hospital-based IM specialties are certainly hard and you'd have to go far from major centers (in Ontario, Thunder Bay and Sudbury are always looking for locums/permanent spots) or have to locum around for a few years before landing a permanent one. GI/Cardio/Nephro/ICU are probably the hardest to find in terms of jobs.

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  • 2 months later...

Hi all,

 

I'm a senior resident in Anesthesia and absolutely loving my specialty. I truly believe Anesthesiology is the hidden gem of Medicine and wouldn't change it for the world. For me, the choice between Anesthesia and IM isn't even close...but I'm a bit biased. ;) I know other personality types would disagree. I've been in residency for a while now and rotated through GIM as a resident as well as several IM specialties in my more senior years (pulmonary, cards, nephro, etc) so here is my two cents. I do have to disagree with some of the conclusions drawn in this thread...

 

Anesth does not require a Master's after the residency. Personally I don't know anyone who's gone for one. Fellowships are a different story; I'd estimate that about 1/3 of graduating residents in my area are going for one after to increase their marketability. Some centres and cities do require one it's true...but definitely not all. I know for a fact there are currently some sweet trauma centres in big cities hiring new grads straight out of residency. The job market waxes and wanes, and in some cities it's very tight whereas in others (still big cities) you can get a job without any extra training. IM specialties all vary, and I'm not an expert there, but I've heard from friends that Nephro is pretty ridiculous to get a job in right now, and ICU is insane (now there's a specialty demanding a lot! The extra 2 years of an ICU fellowship, plus extra work such as a Master's or some serious research usually to qualify for a job - bleh). 

 

IM is definitely the most "cerebral", to the point where it seems just overkill oftentimes - at least to outsiders. The culture has always struck me as much more serious, less apt to laugh at themselves, more nerdy for sure (friendly jab! love my internist friends!) and much more focused on research & evidence-based medicine. Anesth is actually very cerebral as well; definitely more than 80:20 procedure:cerebralness ratio, it's just cerebral in a very different way. We are VERY focused on acute physiology, especially of the cardiovascular and pulmonary systems. We think about & manage serious physiology on a daily basis, especially when caring for comorbid patients or doing big surgeries. The difference is, we operate solo, not in a big team like internists, and so it's not obvious to others what we're considering when we plan an anesthetic or manage intraoperative problems. I once heard someone say, all an outsider sees is the anesthetist frowning at the monitor, when there's a ton of medicine going through his or her head. The cerebral nature of our specialty is very acute, and I would compare it to most to Critical Care.

 

The residency is actually 5 years long not just because we have to learn how to respond when crap hits the fan (although that's certainly part of it), but more because we have to learn how to give a safe anesthetic for a huge variety of surgeries, to people with all different types of comorbidities. There are long lists of anesthetic considerations for different medical conditions AND for all the different surgeries that exist (eg. an anesthetic for a pre-eclamptic pregnant patient having an emergent c-section is not the same as an anesthetic for a trauma patient having a laparotomy is not the same as an anesthetic for a COPD patient having a lung resection for cancer is not the same as an anesthetic for a patient with increased ICP for a craniotomy... This is something that is absolutely huge in our specialty, but greatly under-appreciated by other healthcare workers. IM also spends a lot of mental effort on differentials, diagnosis and treatment of long-term conditions, while in Anesthesia this is done for acute problems we face in the moment (and perhaps more long-term in the pre-admission clinic, but even then it's still confined to the perioperative period). 

 

Our procedural skills are excellent when it comes to lifesaving skills - the "things that matter the most" such as maintaining an airway and invasive vascular access. These things are very fun too, and you get to do them every day! Then there's the other great stuff like epidurals, spinals, peripheral nerve blocks under ultrasound guidance, advanced airway techniques like fiberoptic intubation...it's all fun, fun stuff. At the end of every day I feel fulfilled I think in part because I get to use my hands to physically DO something...along with my mind. And there's something extremely rewarding about that. 

 

Anesthesia predictability - well actually, most of the time we don't know exactly what time we'll be finishing. It just depends how long the cases go, sometimes you're off early and other times you're unpredictably off much later than you anticipated. It's a downside of the specialty. I also must emphasize that Anesthesia is way more "fast-paced" than IM, at least the way I'm looking at it. Anesth is an acute-care specialty, IM is not so much unless you're looking at ICU/CCU. Certainly at a busy tertiary care centre, Anesth would be described as fast-paced. But yes, on the other hand there can be lots of downtime as well. Some people find this boring, I personally do not (...as long as it's not a 15 hour case, let's be real here).

 

Downsides of the specialty are probably the most important to consider, as many have said. Some in Anesthesia include working with difficult people - although they don't tend to come in the form of patients like in other specialties, they more often take the form of operating room personnel, such as the occasional angry surgeon or belittling nurse, early start times to your day, unpredictable end times, in-house call for your whole career, and generally being underappreciated by many (but certainly not all) other healthcare professionals and the public...because it's hard to get a good understanding of what we do. 

 

But overall - I love Anesthesia with a passion. Hope this helped.

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