The Other Side of the Curtain

So I'm now three quarters through my surgery third-year clerkship [and what, 15 months until my MD? Yikes!] and I'm thinking maybe it isn't the field for me. Not that I don't think the surgeries aren't cool, they really are for the most part, but there's a lot of baggage that comes with a surgery practice that I'm less keen on. There's the time spent in clinic, the time rounding on patients, the notes, the forms, the dictation on the phone, the frequent (and frequently busy) nights on call, the fact that my days run easily 14, 15, 16.....27 hours long, blah blah blah. And this isn't just residency, it's pretty typical of what an attending needs to do in general surgery too. I'm not letting all that cloud the coolness of doing surgery itself, but is it worth it? The money would be decent, but the lifestyle sucks and the practice is only a shining prize under a pile of detritus. I really don't know if that prize is worth the substantial cost.

I sense in myself the perspective that I wouldn't want to live this way my whole life and I would easily end up in a sub-specialty like colon/rectal (which sounds bad, but is actually cool because I have a fondness for the digestive system - don't know why), but once there I'd have to still do plenty of clinic/office time just so I could perform my half-dozen specialty procedures which I fear would eventually bore me. How awful.

So now I'm peeking over the curtain and considering another field: Anesthesiology. It's chock full of procedures (which are my favorite), they get to play with some of the most powerful drugs known to man, virtually no clinic, call is generally more limited and when called it isn't to consult but to do a procedure (intubate/epidural/general anesthesia/what have you). Anesthesiologists can also have a much more varied practice where they can be in the OR, on the labor floor, and in the ER or ICU securing a difficult airway all in one day. People tend to not realize this, but anesthesiologists are critical care specialists (as would make sense since they put people into a state of respiratory arrest multiple times daily) and often run the codes at the bedside. Plus, an anesthesiologist's day is defined by shift parameters so that when a case in the OR is running late, the anesthesiologist is relieved by the night shift at six or seven pm and goes home to eat dinner with his/her family while the surgeons go on working late into the night. And to top it all off, the compensation for anesthesiology is great - typically even better than a general surgeon.

In addition, there's virtually no overhead for an anesthesiologist's practice (which equates into significant freedom of where to live and where to work), they also get to wear pajamas (scrubs) to work all day, and they get to potentially participate in the full range of surgical procedures - pediatrics, plastics, brains, hearts, trauma, etc. - without being pigeonholed in a given specialty. The residency is also shorter, the people tend to be more personable, and the training is far less malignant.

Sounds pretty good, eh?

Some concerns: Would I get bored sitting in the 'cockpit' watching vital signs during those long cases? Will I be jealous of the surgeons and down the line regret my decision? (I have the same worry mirrored that if I'm a surgeon would I regret not choosing anesthesia? Though general surgery residencies have a 20% attrition rate, with most residents leaving for anesthesia. Comparatively, leaving anesthesia for another field is rare.)

Do CRNAs pose a real threat to the practice of anesthesia as we know it? (I doubt it.) Will socialized medicine reign in America to the point that I'd have to fill out more red tape and work longer hours for less compensation? (Same concern I have for most of medicine.)