Surgery vs anesthesiology

[Suranest]

may sound stupid, but why is anesthesiology considered a lifestyle specialty but not surgery?

I mean, they both need to be present during surgery right? 

And will I ever be able to see the sunlight again if I become a surgeon? Is the lifestyle that bad?

[offmychestplease]

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[Suranest]

8 minutes ago, offmychestplease said:

If anything like lifestyle + job opportunities are even remotely important to you , stay far far away with from anything surgery 

How bout anesthesiology?

[offmychestplease]

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[rmorelan]

2 hours ago, Suranest said:

may sound stupid, but why is anesthesiology considered a lifestyle specialty but not surgery?

I mean, they both need to be present during surgery right? 

And will I ever be able to see the sunlight again if I become a surgeon? Is the lifestyle that bad?

a bunch of reasons - but lifestyle specialities are about control in many ways - the ability to have a schedule that is predictable and you can stick to. Sure they both have to be there for the OR time but that is just one part of things - anaesthesia has a lot going for it beyond that (less call, shorter shifts, predictable end times to shifts....). No 6 am (or earlier) rounds. The OR ends and can go home. Surgery has a lot still to do. 

 

[MasterDoc]

2 hours ago, offmychestplease said:

job opportunities

What if you are willing to relocate to the US, then is Surgery viable?

[robclem21]

11 hours ago, Suranest said:

may sound stupid, but why is anesthesiology considered a lifestyle specialty but not surgery?

I mean, they both need to be present during surgery right? 

And will I ever be able to see the sunlight again if I become a surgeon? Is the lifestyle that bad?

As mentioned above, performing surgery is only a single part of being a surgeon. There are still clinics to run (to assess referrals, consent for surgery, follow-up post-op, disease surveillance, etc.) and a ward to manage (early morning rounding before the OR starts, rounding at the end of the day after OR ends to deal with any issues from the day).

Typically with anesthesia, unless you are on call, your day starts about 20 minutes before the OR and ends when your last patient is in PACU. There is no list of patients to round on or follow-up with. When your day is done, you get to go home and not worry about anything in the hospital. Because the service is usually bigger (some places may have 15-20 anesthesiologists depending on how big the site is) who are capable of taking call (vs. 2-3 urologists, 4-5 general surgeons, 1 neurosurgeon), the call is spaced out more and less frequent. That being said, anesthesia call can be very very busy, especially if you are at a site with obstetrics.

Anesthesia may still be considered a bit of a "lifestyle" speciality, but certainly is not a lifestyle residency so keep that in mind as well that you will have a tough training before enjoying some of the specialty benefits.

[cotecc]

On 10/4/2020 at 6:02 AM, robclem21 said:

As mentioned above, performing surgery is only a single part of being a surgeon. There are still clinics to run (to assess referrals, consent for surgery, follow-up post-op, disease surveillance, etc.) and a ward to manage (early morning rounding before the OR starts, rounding at the end of the day after OR ends to deal with any issues from the day).

Typically with anesthesia, unless you are on call, your day starts about 20 minutes before the OR and ends when your last patient is in PACU. There is no list of patients to round on or follow-up with. When your day is done, you get to go home and not worry about anything in the hospital. Because the service is usually bigger (some places may have 15-20 anesthesiologists depending on how big the site is) who are capable of taking call (vs. 2-3 urologists, 4-5 general surgeons, 1 neurosurgeon), the call is spaced out more and less frequent. That being said, anesthesia call can be very very busy, especially if you are at a site with obstetrics.

Anesthesia may still be considered a bit of a "lifestyle" speciality, but certainly is not a lifestyle residency so keep that in mind as well that you will have a tough training before enjoying some of the specialty benefits.

Are most anesthesist only working in the OR or do they have other roles to?

[DrOtter]

23 hours ago, cotecc said:

Are most anesthesist only working in the OR or do they have other roles to?

 

 

Some subspecialists such as pain docs can work in clinic as well. But most are peri-operative, I think.

Edit: also some anesthesiologists also sub-specialize in critical care!

[robclem21]

18 hours ago, DrOtter said:

Some subspecialists such as pain docs can work in clinic as well. But most are peri-operative, I think.

Too add, if they do, it would be by their choice in an area they are personally interested in. Not part of the general scope of practice. Even then its still majority in the OR and it would not be OR, followed by clinic or vice versa. Clinic would be in lieu of the OR on those days.

[premed72]

Interesting discussion. On the CARMS stats it says that the ratio between first choice discipline to number of spots available in anesthesia is 0.82-ish. Would this be considered a moderately competitive speciality? Also, if you check out individual program descriptions, for example at uOttawa, there's approx 600 applicants for like 8 positions.. am I reading that right??? Seems super competitive haha

[robclem21]

On 10/10/2020 at 12:04 PM, premed72 said:

Interesting discussion. On the CARMS stats it says that the ratio between first choice discipline to number of spots available in anesthesia is 0.82-ish. Would this be considered a moderately competitive speciality? Also, if you check out individual program descriptions, for example at uOttawa, there's approx 600 applicants for like 8 positions.. am I reading that right??? Seems super competitive haha

I would say anesthesia fits into the "moderately competitive" group of specialties. It is not insanely competitive, but you have to be fairly committed to be successful in matching. Applications to spots at a single school are often misleading since many applicants apply broadly, but have no intention on going to many of the schools they apply to. (even though they may rank them). Students are often competing against each other for spots across many institutions, not for spots at a single institution. 

I don't agree with the number stated on CaRMS website. I think that is misleading. There are approximately 100 spots for english-speaking anesthesia programs across the country so you can expect about 130ish people to rank anesthesia first to get your ratio. Most schools interview between 40-60 and students for 5-10 spots, which means they interview about one third to half the candidates that apply in any given year.

[jnuts]

On 10/3/2020 at 9:46 PM, MasterDoc said:

What if you are willing to relocate to the US, then is Surgery viable?

Viability of this option will depend on your specialty and specific personal factors.  It is possible in some circumstances. Relocation should not be considered as an 'easy out' to surgical employment difficulties after Canadian surgical training.  The number of people who are successful at it would be about 5% of all graduating Canadian surgeons (rough estimate based on observations of my peer group).

[MasterDoc]

3 hours ago, jnuts said:

Viability of this option will depend on your specialty and specific personal factors.  It is possible in some circumstances. Relocation should not be considered as an 'easy out' to surgical employment difficulties after Canadian surgical training.  The number of people who are successful at it would be about 5% of all graduating Canadian surgeons (rough estimate based on observations of my peer group).

Hmmm... From some of the digging I did, I talked to an ortho who didn't have a US green card but was able to find a job where they sponsored an H1B visa. Though this was job was located in a small population area. Found out about a cardiologist who got her green card sponsored through her work and a Canadian trained radiologist working down south suggested as long as you do the USMLEs, you have the option of going down south. Also said visas are not usually an issue for Canadians. 

Don't know how much merit this holds as it is all anecdotal. 

[jnuts]

On 10/20/2020 at 12:12 PM, MasterDoc said:

Hmmm... From some of the digging I did, I talked to an ortho who didn't have a US green card but was able to find a job where they sponsored an H1B visa. Though this was job was located in a small population area. Found out about a cardiologist who got her green card sponsored through her work and a Canadian trained radiologist working down south suggested as long as you do the USMLEs, you have the option of going down south. Also said visas are not usually an issue for Canadians. 

Don't know how much merit this holds as it is all anecdotal. 

 

Happy to discuss more; but the bottom line is that it's much more complicated than 'not usually an issue' and worse in the current climate.  The number of employers willing to go for the H1B has dropped dramatically recently (and the J-1 is basically indentureship) 

Here's some info on that path from one of the locum companies (https://comphealth.com/resources/foreign-physicians-residency-advantages-disadvantages-h-1b-visa/#:~:text=Disadvantages%20for%20the%20physician%20%E2%80%94%20An,granted%20in%20three%20year%20increments.):

Disadvantages of the H-1B Visa

Disadvantages for the medical facility — In order to petition for the H-1B on behalf of the physician, the medical facility must first file a labor condition application (LCA) with the U.S. Department of Labor (DOL). The LCA is supposed to ensure that the admission of the physician to work in the U.S. will not adversely affect the job opportunities, wages and working conditions of U.S. workers. Medical Facilities are subject to attestations made in the LCA, which include the obligation to pay the prevailing wage and maintenance of certain public access records. Many medical facilities prefer the J-1 option, as they may find the obligations (and the extremely high filing fees) imposed on the H-1B employer to be onerous.

Disadvantages for the physician — An H-1B worker is only permitted to remain in the U.S. in H-1B status for a total of six years. H-1B status is granted in three year increments. At the end of the sixth year, the H-1B worker must find a new status or must return to his home country for at least one year before being allowed to return to the U.S. in H-1B status.

Completion of certain residency programs will often cause some physicians to exceed the six-year period allotted by the H-1B. In 2000, Congress enacted the American Competitiveness in the 21st Century Act, which included provisions allowing flexibility of the six-year cap. Generally, an individual is permitted to remain in the U.S. in one year increments beyond the sixth year if her labor certification has been pending for more than 365 days.

It is also allowed if an I-140 immigrant petition for alien worker has been approved on the physician’s behalf, but she is not able to file an adjustment of status application solely because her priority date is not yet current, or if an adjustment of status application is pending based on an approved I-140.  In order for the physician to take advantage of these provisions, she must develop an early strategy for taking the necessary steps leading to lawful permanent residence.

[MasterDoc]

On 10/26/2020 at 3:13 PM, jnuts said:

 

Happy to discuss more; but the bottom line is that it's much more complicated than 'not usually an issue' and worse in the current climate.  The number of employers willing to go for the H1B has dropped dramatically recently (and the J-1 is basically indentureship) 

Here's some info on that path from one of the locum companies (https://comphealth.com/resources/foreign-physicians-residency-advantages-disadvantages-h-1b-visa/#:~:text=Disadvantages%20for%20the%20physician%20%E2%80%94%20An,granted%20in%20three%20year%20increments.):

Disadvantages of the H-1B Visa

Disadvantages for the medical facility — In order to petition for the H-1B on behalf of the physician, the medical facility must first file a labor condition application (LCA) with the U.S. Department of Labor (DOL). The LCA is supposed to ensure that the admission of the physician to work in the U.S. will not adversely affect the job opportunities, wages and working conditions of U.S. workers. Medical Facilities are subject to attestations made in the LCA, which include the obligation to pay the prevailing wage and maintenance of certain public access records. Many medical facilities prefer the J-1 option, as they may find the obligations (and the extremely high filing fees) imposed on the H-1B employer to be onerous.

Disadvantages for the physician — An H-1B worker is only permitted to remain in the U.S. in H-1B status for a total of six years. H-1B status is granted in three year increments. At the end of the sixth year, the H-1B worker must find a new status or must return to his home country for at least one year before being allowed to return to the U.S. in H-1B status.

Completion of certain residency programs will often cause some physicians to exceed the six-year period allotted by the H-1B. In 2000, Congress enacted the American Competitiveness in the 21st Century Act, which included provisions allowing flexibility of the six-year cap. Generally, an individual is permitted to remain in the U.S. in one year increments beyond the sixth year if her labor certification has been pending for more than 365 days.

It is also allowed if an I-140 immigrant petition for alien worker has been approved on the physician’s behalf, but she is not able to file an adjustment of status application solely because her priority date is not yet current, or if an adjustment of status application is pending based on an approved I-140.  In order for the physician to take advantage of these provisions, she must develop an early strategy for taking the necessary steps leading to lawful permanent residence.

That is unfortunate. So when going through Carms, I guess you should select a residency that is employable in Canada and moving to the US is not an easy out.

[jnuts]

On 10/28/2020 at 5:09 PM, MasterDoc said:

That is unfortunate. So when going through Carms, I guess you should select a residency that is employable in Canada and moving to the US is not an easy out.

Possible in some cases, but not easy.  Echoing what's been said many times on here: don't do surgery if you can see yourself doing anything else.