Thursday, March 12, 2009

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.)

12 comments:

Baal Habos said...

Very interesting! Thanks for sharing.

zdub said...

Have a few radiologist friends ad they love their specialty. Regular hours, good pay, directly involved in diagnoses, plus there is always new technology to learn and play with. The downside seems to be that its also a specialty that can be outsourced since readings can be done remotely (Australia & India in particular.)

Orthoprax said...

Z,

The great thing about medicine is that it's broad enough to satisfy the personalities and interests of almost anyone who goes into it (which is ironic since on paper med-school applicants tend to look like carbon copies). I think diagnostic radiology is a great specialty but I personally find it extremely boring. I didn't go into medicine to sit in front of a computer screen.

But that's me - it takes all types.

Baal Habos said...

> didn't go into medicine to sit in front of a computer screen.

What's wrong with that? Then you can blog in-between patients ;)

Nice Jewish Guy said...

They say that anesthesiology (very much like being an airline pilot, I suppose) is hours of sheer boredom punctuated by (potentially) moments of sheer terror. I suppose for those moments, you need to be calm, on the ball, and know your s*it.

Orthoprax said...

Baal,

"What's wrong with that? Then you can blog in-between patients"

You think I'd still have the time to keep to my busy schedule of one post a month?


NJG,

Sure, there's a lot of truth to that and I've seen that analogy many times. There's a lot of stress at takeoff and landing but most of the flight is a matter of cruising - and once in awhile you need to be the guy who can land safely in the Hudson.

Miri said...

I can't exactly say that I have any context or experience from which I am capable of giving you advice. But I did choose a career which is long hours, practically no pay, and infringes on home life (though certainly not to the extent of a surgeon on call) not to mention the fact that it is essentially a long uphill battle against beuraucracy, stupidity, and futility. But despite the fact that I know exactly what I'm getting into, I'm still doing it because I also know I love it, and I know that it's what I really ought to be doing. My point is, if you think you feel that way about surgery, it might be worth all the insanity. If you don't necessarily feel that way about surgery, it definitely isn't worth it.

Jeff said...

If you're set on cutting, some surgical subspecialties have at least fair lifestyles and reasonable residencies such as opthy, derm, uro, ortho and ENT. If needles are enough, interventional spine is great.

Orthoprax said...

Miri,

Thanks for dropping by. The key issue is really do I feel that strongly about surgery? I like it and all, and I do think the work is cool - but do I have the sheer passion for it to slog through the residency and marry myself to the specialty?


Jeff,

I just finished an elective week in ophtho. It's not terrible, and sure it's a lifestyle specialty, but it just doesn't excite me. I had once said to one of the residents I was working with that I like the 'coelomic' specialties - think chest and abdomen - the ones where you can go inside and manipulate them big organs.

This is the same reason why I really don't have interest in either ENT or Ortho (besides for the point that my grades are probably not stellar enough to catch a spot in those fields). Derm is only remotely a surgical field.

Urology happens to be something on my short list.

Anonymous said...

Be very careful to hedge your bets in the match if you go for something competitive like urology or even radiology. Urology wasn't that much less competitive than ENT when I was a medical student just a few years ago. Derm was perhaps the most competitive field and even harder to get than ENT and ortho.

Ben Avuyah said...

I usually feel bad for the anesthesiologist, who is usually flipping through a people magazine to pass the time. That is, until a surgery gets dicey...then I wish I where in his seat.
It is nice shift work though... I don't really think there are any "on call" issues...you are either at work or not.

you know my opinion...surgical subspecialties ! The only way to fly ;-)

Orthoprax said...

Ben,

Anesthesiology and surgery pull me in different ways. One of the strong points for anes is indeed lifestyle considerations. For surgery it is plainly for the coolness of the work.

So which is more important to me? Do I live for my work or work to support a lifestyle? The wrong choice could potentially leave me deeply dissatisfied.

Do I really like surgery enough for this kind of commitment? Maybe.