New CA1 having issues adjusting to anesthesia

[Dasani water]

Hey everyone, I was hoping I could get some advice. I ended up going into anesthesia because it was the one specialty I thought was cool but was insulated from a lot of the things I found frustrating about general surgery. Physiology and pharmacology, thinking fast about patients as their conditions change in the OR, ICU, procedural stuff in pain and regional, I thought all of these things made it super appealing. My categorical intern year was split with medicine and surgery. I loved my intern year. I was pushing 80 hours a week if not more especially on the surgical rotations, but working with patients and with teams was incredible. I loved managing patients on the floor. I loved that the surgeons let us in the OR for some smaller cases, and surgery was fun. I felt like work was no longer work and had a bit of regret that I didn't do surgery. I remembered that I struggled overall at first with adjusting, but things worked themselves out.

I started CA1 year this year, and I'm struggling like i did last year with adjusting. My faculty members have told me I am doing a good job but I don't have that same spark that I did last year. I don't enjoy going to work. I get this pit in my stomach every morning I go into work and can't wait to go home because I don't feel well in the OR. I hate how I have to rush patients into the OR and don't get to actually chat with them anymore. The type of medical management in the OR for anesthesia is not as fun to me as the management that I got to do on the wards. Quite frankly I feel like I made a mistake in terms of picking a specialty. Even though I've been reading much more this year than last year, I don't get as excited as I did reading about anesthesia as compared to medicine/surgery. I know that this is an adjustment phase. I really want to love this field, or at least I want to feel like it will get better. Unfortunately, there are days where I just go home and lie down and do nothing because I feel so emotionally drained. I don't know why this is because clearly something drew me to it, otherwise I wouldn't have picked it. But I find it hard to go on day by day and I'm scared it won't get better and I'll be like this for the rest of my life.

I'm sure what I'm experiencing is an extreme case of difficulty adjusting to something new, and needing to get a new knowledge base and skill set. I was wondering if anyone else had any experiences remotely similar and how they dealt with it.

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[Planktonmd]

Hey everyone, I was hoping I could get some advice. I ended up going into anesthesia because it was the one specialty I thought was cool but was insulated from a lot of the things I found frustrating about general surgery. Physiology and pharmacology, thinking fast about patients as their conditions change in the OR, ICU, procedural stuff in pain and regional, I thought all of these things made it super appealing. My categorical intern year was split with medicine and surgery. I loved my intern year. I was pushing 80 hours a week if not more especially on the surgical rotations, but working with patients and with teams was incredible. I loved managing patients on the floor. I loved that the surgeons let us in the OR for some smaller cases, and surgery was fun. I felt like work was no longer work and had a bit of regret that I didn't do surgery. I remembered that I struggled overall at first with adjusting, but things worked themselves out.

I started CA1 year this year, and I'm struggling like i did last year with adjusting. My faculty members have told me I am doing a good job but I don't have that same spark that I did last year. I don't enjoy going to work. I get this pit in my stomach every morning I go into work and can't wait to go home because I don't feel well in the OR. I hate how I have to rush patients into the OR and don't get to actually chat with them anymore. The type of medical management in the OR for anesthesia is not as fun to me as the management that I got to do on the wards. Quite frankly I feel like I made a mistake in terms of picking a specialty. Even though I've been reading much more this year than last year, I don't get as excited as I did reading about anesthesia as compared to medicine/surgery. I know that this is an adjustment phase. I really want to love this field, or at least I want to feel like it will get better. Unfortunately, there are days where I just go home and lie down and do nothing because I feel so emotionally drained. I don't know why this is because clearly something drew me to it, otherwise I wouldn't have picked it. But I find it hard to go on day by day and I'm scared it won't get better and I'll be like this for the rest of my life.

I'm sure what I'm experiencing is an extreme case of difficulty adjusting to something new, and needing to get a new knowledge base and skill set. I was wondering if anyone else had any experiences remotely similar and how they dealt with it.

It seems to me that you want to be a surgeon not an anesthesiologist.
If that's the case you will never be happy in this field.
Anesthesia is 90% boring repetitive non glorious work and that will not change.

 

[deleted171991]

Hey everyone, I was hoping I could get some advice. I ended up going into anesthesia because it was the one specialty I thought was cool but was insulated from a lot of the things I found frustrating about general surgery. Physiology and pharmacology, thinking fast about patients as their conditions change in the OR, ICU, procedural stuff in pain and regional, I thought all of these things made it super appealing. My categorical intern year was split with medicine and surgery. I loved my intern year. I was pushing 80 hours a week if not more especially on the surgical rotations, but working with patients and with teams was incredible. I loved managing patients on the floor. I loved that the surgeons let us in the OR for some smaller cases, and surgery was fun. I felt like work was no longer work and had a bit of regret that I didn't do surgery. I remembered that I struggled overall at first with adjusting, but things worked themselves out.

I started CA1 year this year, and I'm struggling like i did last year with adjusting. My faculty members have told me I am doing a good job but I don't have that same spark that I did last year. I don't enjoy going to work. I get this pit in my stomach every morning I go into work and can't wait to go home because I don't feel well in the OR. I hate how I have to rush patients into the OR and don't get to actually chat with them anymore. The type of medical management in the OR for anesthesia is not as fun to me as the management that I got to do on the wards. Quite frankly I feel like I made a mistake in terms of picking a specialty. Even though I've been reading much more this year than last year, I don't get as excited as I did reading about anesthesia as compared to medicine/surgery. I know that this is an adjustment phase. I really want to love this field, or at least I want to feel like it will get better. Unfortunately, there are days where I just go home and lie down and do nothing because I feel so emotionally drained. I don't know why this is because clearly something drew me to it, otherwise I wouldn't have picked it. But I find it hard to go on day by day and I'm scared it won't get better and I'll be like this for the rest of my life.

I'm sure what I'm experiencing is an extreme case of difficulty adjusting to something new, and needing to get a new knowledge base and skill set. I was wondering if anyone else had any experiences remotely similar and how they dealt with it.

Sounds like surgery would make you happier. Give internal medicine a thought, too.

There is one mistake bigger than choosing the wrong residency/career path: persisting in the mistake.

 

[MoMoGesiologist]

Do you enjoy any parts of your day in the OR? Doing a smooth induction and intubation, pushing meds to fix vitals, adjusting the vent, an elegant wake up?

The start of CA1 year is a steep learning curve and you feel uncomfortable and incompetent making it hard to enjoy. I know I felt so drained I thought I made a mistake. Once you get the routine maybe you'll start enjoying it.

However, if you enjoy floor medicine and doing surgery, and look across the drape and wish you were on the surgery side, maybe anesthesia isn't for you. Or maybe you'll want to consider a pain or ICU fellowship where you have more patient ownership and get more follow up. I would say give it six months until you've settled into your role as a CA1 and if you still feel the same, consider going into surgery. You'll spend a third of your life at your job and you want to be happy and not have regrets. Though recognize there's a reason a lot of surgery residents switch into anesthesia and it's very rare to go the other direction.

 

[Dexmetaketapropofol]

Maybe regain focus on the things that you found initially interesting? As a CA-1 you may (or may not) have been shielded from highly complex cases. For me, I felt a lull in the mundane approach to outpatient high speed B&B cases/anesthesia. I found in doing liver tx, cardiac cases, TEE, ICU management, VADs, etc more appealing.

Maybe you've been exposed to some of this and still dont enjoy? All I know is that the information to do this job "perfectly" is endless. Maintaining humility and finding challenges in the field is what will make you an exceptional anesthesiologist.

As a reminder, even though you may be reading more, you still may not have grasped the weight of the information in clinical practice yet. At some point you will need to commit to anesthesia or an alternative to gain early confidence and success.

I hope you find your answers!

 

[deleted50478]

Switch to surgery.

 

[deleted171991]

Let's clear this up once and forever: there is no patient "ownership" in critical care. There may be more meaningful patient interaction, but, at least in the SICU, you are "co-owning" those patients with the surgeons. Meaning you don't own them at all, because everybody in the darn hospital cares more about the surgeons than about you, beginning with the patients. And anesthesiologists have small chances of working in MICUs.

Anybody who wants to be THE hero, THE doctor, THE captain, had better run as far away from anesthesia as they can. This specialty is for people who feel OK shining the shoes of the aforementioned. The main reason many people are still relatively happy in this specialty is that it's still relatively well-paid (even CRNAs make more than some doctors in other specialties).

OP, don't believe the BS about excellence in anesthesia either. People rarely care how great you are at your job (it's very hard for a non-anesthesiologist to judge the performance of an anesthesiologist); it's all about smoke and mirrors. You have to be just good enough at anesthesia, and great at surgical/managerial ass-kissing. It's a service specialty, so acting the part is a must.

 

[MoMoGesiologist]

Let's clear this up once and forever: there is no patient "ownership" in critical care. There may be more meaningful patient interaction, but, at least in the SICU, you are "co-owning" those patients with the surgeons. Meaning you don't own them at all, because everybody in the darn hospital cares more about the surgeons than about you, beginning with the patients. And anesthesiologists have small chances of working in MICUs.

Anybody who wants to be THE hero, THE doctor, THE captain, had better run as far away from anesthesia as they can. This specialty is for people who feel OK shining the shoes of the aforementioned. The main reason many people are still relatively happy in this specialty is that it's still relatively well-paid (even CRNAs make more than some doctors in other specialties).

OP, don't believe the BS about excellence in anesthesia either. People rarely care how great you are at your job (it's very hard for a non-anesthesiologist to judge the performance of an anesthesiologist); it's all about smoke and mirrors. You have to be just good enough at anesthesia, and great at surgical/managerial ass-kissing. It's a service specialty, so acting the part is a must.

From my understanding, there are some SICUs, usually community, where the surgeons are happy to drop off their patients and let the ICU manage things with minimal intervention. The SICU in my residency I felt had a pretty good relationship with the primary team depending on the service. Except transplant. They just thought they knew everything.

I do agree with you on the part about excellence in anesthesia. You could be the best or worst anesthesiologist, as long as the patient comes out of the OR alive, no one notices or cares what you do. Titrating meds, vents, doing things to optimize outcomes... none of it matters once you reach PACU!

 

[Twiggidy]

Switch to medicine

You'll have options at the end of residency if you want more procedures (GI and interventional cards) vs a job where you still get to round and "be a doctor" (hospitalist, fill in the blank medicine specialty)

You got sucked in like the most where you see only "the glory" of anesthesia which is like maybe 10% of the field and didn't really get schooled on the 90% of the field which is plain boredom and the rub is, when you've done anesthesia long enough you SEEK boredom.

 

[Cryc_to_the_point]

So the SICU "mother-may-I" and "co-ownership," is everywhere?

 

[Twiggidy]

So the SICU "mother-may-I" and "co-ownership," is everywhere?

For the most part, yes.

 

[Cryc_to_the_point]

I'm disappointed...

 

[Dasani water]

I guess I meant having a consistent group of patients you see when I meant patient ownership. It is kind of nice to just not do OR things and round on patients, work them up, and get them out of the unit/hospital. It breaks up the monotony. I just feel claustrophobic in the same OR all day for months on end and wish there was something else at work to get me out of there save a break. People calling me "anesthesia" or not being "the guy" does get to me though, and I recognize this is an ego issue. I just wish it didn't bug me much and that it would get better.

I have been talking with a friend about this, and they said that my mood has changed a lot with regards to other aspects of my life and recommended i talk to a counselor or therapist to make sure I'm not feeling this way because of something else. Clearly it isn't right for me to have these visceral responses to the thought of going to work, and maybe its a lot of underlying anxiety or something. I recognize I'm basically an anesthesia intern in the sense that I am doing only the most basic of things and need to learn so much about a very complex field, and maybe I'm having manifestations of bad nervousness or feeling frightened. I think they are right though in that I am not being myself when I sit back and think about it. I don't see any downside to talking about it with a professional, unless it kills my chances for a decent career in the future.

 

[Ronin786]

My usual response to CA1 blues is that it's a steep learning curve and it'll get better, but you don't seem to have a problem with doing anesthesia, especially if you're hearing compliments from your attendings. You DO sound like you have fundamental problems with the general idea of anesthesia and its workflow. Definitely consider switching into medicine or surgery. Given how much fun you had as an intern, trend more towards IM than surgery (and you may get credit for your intern year).

 

[deleted171991]

So the SICU "mother-may-I" and "co-ownership," is everywhere?

Four out of 4 I have seen (3 academic, one community). One simply cannot BEGIN to compare SICU with the independence of the medical intensivists. Maybe in the few closed SICUs that exist in the country. Maybe...

 

[MoMoGesiologist]

Four out of 4 I have seen (3 academic, one community). One simply cannot BEGIN to compare SICU with the independence of the medical intensivists.

The moment I find a decent job in a community MICU, I'm done with anesthesia and SICU.

To be fair, did any of us go into anesthesia because we WANTED to own the patients?

 

[deleted171991]

To be fair, did any of us go into anesthesia because we WANTED to own the patients?

No. But I also didn't expect the level of disrespect for our work and expertise. Those are tolerable as long as one has a good lifestyle and/or pay.

Many surgeons treat the anesthesiologists as underlings, and let their residents do the same. And not only surgeons. I have repeatedly been called to intubate in MICUs without the attending even bothering to pick up the phone or come to the bedside and tell me about the patient (our airway pager is always carried by an attending anesthesiologist). Let's not mention the cases when the patient should have benefited more from being left unintubated. You are not a doctor; you are a tech.

 

[Twiggidy]

No. But I also didn't expect the level of disrespect for our work and expertise. Those are tolerable as long as one has a good lifestyle and/or pay.

Many surgeons treat the anesthesiologists as underlings, and let their residents do the same. And not only surgeons. I have repeatedly been called to intubate in MICUs without the attending even bothering to pick up the phone or come to the bedside and tell me about the patient. Let's not mention the cases when the patient should have benefited more from being left unintubated.

This all day. Anesthesiology is wildly false advertised as a med student and even as a resident and I feel that’s because if given the reality of the field no one would do it. I really think all of the “Should I do *blank* vs anesthesia” threads are just people coming here to confirm they really don’t want to do this. As said above, good pay and the fact we DONT own patients. Those are the two main reasons people chose anesthesiology. We have to know a lot to do our jobs but all anyone in the hospital cares about is “Is the patient asleep?” or “Does the block work?”

 

[Cryc_to_the_point]

This all day. Anesthesiology is wildly false advertised as a med student and even as a resident and I feel that’s because if given the reality of the field no one would do it. I really think all of the “Should I do *blank* vs anesthesia” threads are just people coming here to confirm they really don’t want to do this. As said above, good pay and the fact we DONT own patients. Those are the two main reasons people chose anesthesiology. We have to know a lot to do our jobs but all anyone in the hospital cares about is “Is the patient asleep?” or “Does the block work?”

Why isn't this the case elsewhere? I've seen what looks like a lot nicer situation in regards to respect/variety of work in other countries. Why not here?

 

[deleted171991]

Why isn't this the case elsewhere? I've seen what looks like a lot nicer situation in regards to respect/variety of work in other countries. Why not here?

One simple reason: in most other countries, anesthesiologists control all ICUs, which are closed (whether surgical or medical). Hence the surgeons behave, because, in the ICU, it can be their turn to be the "underlings".

Also, for the same reason, anesthesiologist-intensivists are much more valuable for the hospital. Plus, in other countries, the ICU is not the same money pit as in the US, because people who have low chances of surviving are NOT admitted to the ICU, regardless how sick. One can die on the floor; it's much cheaper. While we admit 90+% of ICU requests, European intensivists admit just 60%, for example.

Another big reason is what @Twiggidy says below: supply/demand issues. We simply graduate a ton of anesthesia providers, including CRNAs, hence we are seen as easily replaceable. Good luck replacing an anesthesiologist-intensivist with 7 years of GME, and no CRNA threat, as in other countries.

 

[Twiggidy]

Why isn't this the case elsewhere? I've seen what looks like a lot nicer situation in regards to respect/variety of work in other countries. Why not here?

The U.S. is a "what have you done for me lately" country. Anesthesiologist don't bring any money to the hospital so the mindset of many in the hospital is "Be happy I'm putting food on your table 'anesthesia' by bring you patients to put to sleep FOR ME." We also graduate an insane amount of residents to keep the wheels of the OR in motion in many hospitals so the supply demand curve is not in the anesthesiologists favor, ie, you're expendable. Play nice, put the patients to sleep, and get paid. The mantra in this gig is "Don't be disruptive"

 

[Orin]

Two or three thoughts here:

- Do talk to a counsellor/psychologist. Your physiologic/somatic response to things sound like anxiety/depression/adjustment disorder which can be a part of being a resident in some programs. Do check your vitals to make sure there isn't a medical issue. Do assess your overall health and mental well being.

- You're not anywhere near good at this yet and so give it time. Later on when you're able to flip a room in seconds rather than minutes, you'll have time to do more of the "doctoring" that you're looking to do with patient interactions. Later on, you'll be able to see patients coming in repeatedly or follow up with them in the PACU/ICU/floor. You'll get that if you need it. It'll be different than the wards, will take more time, won't pay you extra, but may be worth it to you. For residents, stuff like pre-op-ing your own inpatients or rounding on them post-op can really help you feel like you're still a "doctor" in that intern/ward sense, even though that's more work.

- I do think that down the road you may find pain or ICU work is more for you. You don't have to stay in anesthesia to do those. You do have to survive residency though.

There's no bad time to admit you made a mistake, but I still don't see anything that tells me you've done that. If I'm reading in between the lines here, you're just not happy with how different it is, got good at something as an intern and are having a harder time acclimating to the OR/sucking, and miss being able to use your communication/connecting skills since you're too stressed with the other stuff to do that. It'll get better, but talk to some of your older residents/faculty about it and see what they think.

 

[Ezekiel2517]

Don't panic and overreact and certainly don't listen to some of the people on here. You have no idea who these people are. You know yourself better than anyone. Many residents start out feeling exactly how you do. It's too early. Things change. Understand that when you are feeling like this, the grass is always perceived to be greener on the other side. It's not. Always keep the bigger picture in mind. Your career isn't gonna last 5-10 years. Those 80 hr weeks and all that floor work and daily nonstop rounding may seem doable now but it gets old fast. It's not sustainable. Stay the course.

 

[Twiggidy]

I guess I meant having a consistent group of patients you see when I meant patient ownership. It is kind of nice to just not do OR things and round on patients, work them up, and get them out of the unit/hospital. It breaks up the monotony. I just feel claustrophobic in the same OR all day for months on end and wish there was something else at work to get me out of there save a break. People calling me "anesthesia" or not being "the guy" does get to me though, and I recognize this is an ego issue. I just wish it didn't bug me much and that it would get better.

I have been talking with a friend about this, and they said that my mood has changed a lot with regards to other aspects of my life and recommended i talk to a counselor or therapist to make sure I'm not feeling this way because of something else. Clearly it isn't right for me to have these visceral responses to the thought of going to work, and maybe its a lot of underlying anxiety or something. I recognize I'm basically an anesthesia intern in the sense that I am doing only the most basic of things and need to learn so much about a very complex field, and maybe I'm having manifestations of bad nervousness or feeling frightened. I think they are right though in that I am not being myself when I sit back and think about it. I don't see any downside to talking about it with a professional, unless it kills my chances for a decent career in the future.

Also do social things with the other residents in your program. Realizing that you're all struggling together can be helpful and ease the stress of residency, especially in a field where you're "alone" in the OR.

 

[anbuitachi]

Hey everyone, I was hoping I could get some advice. I ended up going into anesthesia because it was the one specialty I thought was cool but was insulated from a lot of the things I found frustrating about general surgery. Physiology and pharmacology, thinking fast about patients as their conditions change in the OR, ICU, procedural stuff in pain and regional, I thought all of these things made it super appealing. My categorical intern year was split with medicine and surgery. I loved my intern year. I was pushing 80 hours a week if not more especially on the surgical rotations, but working with patients and with teams was incredible. I loved managing patients on the floor. I loved that the surgeons let us in the OR for some smaller cases, and surgery was fun. I felt like work was no longer work and had a bit of regret that I didn't do surgery. I remembered that I struggled overall at first with adjusting, but things worked themselves out.

I started CA1 year this year, and I'm struggling like i did last year with adjusting. My faculty members have told me I am doing a good job but I don't have that same spark that I did last year. I don't enjoy going to work. I get this pit in my stomach every morning I go into work and can't wait to go home because I don't feel well in the OR. I hate how I have to rush patients into the OR and don't get to actually chat with them anymore. The type of medical management in the OR for anesthesia is not as fun to me as the management that I got to do on the wards. Quite frankly I feel like I made a mistake in terms of picking a specialty. Even though I've been reading much more this year than last year, I don't get as excited as I did reading about anesthesia as compared to medicine/surgery. I know that this is an adjustment phase. I really want to love this field, or at least I want to feel like it will get better. Unfortunately, there are days where I just go home and lie down and do nothing because I feel so emotionally drained. I don't know why this is because clearly something drew me to it, otherwise I wouldn't have picked it. But I find it hard to go on day by day and I'm scared it won't get better and I'll be like this for the rest of my life.

I'm sure what I'm experiencing is an extreme case of difficulty adjusting to something new, and needing to get a new knowledge base and skill set. I was wondering if anyone else had any experiences remotely similar and how they dealt with it.

It sounds like you need to switch to medicine. Anesthesiology is a stressful field, it's much tougher than people think. it's not the chill ABC field that many people say it is, jokingly or not. A lot of times you have to do well under pressure, kind of like in the ED, you have limited time to do XYZ , and be expected to do well anyway.

 

[sniderwes]

No. But I also didn't expect the level of disrespect for our work and expertise. Those are tolerable as long as one has a good lifestyle and/or pay.

Many surgeons treat the anesthesiologists as underlings, and let their residents do the same. And not only surgeons. I have repeatedly been called to intubate in MICUs without the attending even bothering to pick up the phone or come to the bedside and tell me about the patient (our airway pager is always carried by an attending anesthesiologist). Let's not mention the cases when the patient should have benefited more from being left unintubated. You are not a doctor; you are a tech.

This sounds more like a personality issue to me. Sure, there's an innate level of respect that comes from what field you're in. But it can quickly be gained or lost based on how people see you interact with others, and how you let others talk to you. If someone is being disrespectful, check them.

 

[deleted171991]

This sounds more like a personality issue to me. Sure, there's an innate level of respect that comes from what field you're in. But it can quickly be gained or lost based on how people see you interact with others, and how you let others talk to you. If someone is being disrespectful, check them.

As somebody with two board certifications and 10+ years of extra experience, I am truly grateful for the valuable insight an MS-4 can offer. I hope you can feel my deep respect. If not, maybe it's your personality.

 

[sniderwes]

As somebody with two board certifications and 10+ years of extra experience, I am truly grateful for the valuable insight an MS-4 can offer. I hope you can feel my deep respect. If not, maybe it's your personality.

I didn't realize your board experience tested you on interpersonal relationships and standing up for yourself. You said it yourself, you let residents walk all over you, despite the extra experience I presume you hold. Congrats on standing up to the MS4. That's a good start.

 

[Dasani water]

I think at the end of the day I want to love what I do, or at least find it tolerable. I don't feel like I have that yet and some of my peers seem to have found it. I still feel kind of terrified by the OR even though I know I am learning and have handled myself well in difficult cases in the past only because I am reading more and more and quickly figuring out that there is so much more for me to learn. It just sucks when you feel like you get into a rhythm after 1 year doing something totally different than your intended career path and then you get into what you are supposed to be doing and you are starting over from square 1 in terms of feeling dumb and not adequate even though I know it comes with time.

 

[deleted171991]

I didn't realize your board experience tested you on interpersonal relationships and standing up for yourself. You said it yourself, you let residents walk all over you, despite the extra experience I presume you hold. Congrats on standing up to the MS4. That's a good start.

I don't let residents walk all over me. I don't know where you got the idea. What I said was that many surgeons allowed even their residents to be disrespectful towards anesthesiologists. Where I am now, that usually applies only to trainees (especially fellows) in their last years (senioritis, I guess). And it's typically not what they say (they know better), but HOW they say it (tone matters), and usually in the ICU not in the OR.

When you get out in the real world, and have to fight THE SYSTEM on a daily basis, mostly alone, you'll learn to pick your battles, too, or you'll be out of a job before you can say "microaggression". If the system says that anesthesiologists are lower on the totem pole, that's where you'll be.

 

[sniderwes]

I don't let residents walk all over me. I don't know where you got the idea. What I said was that many surgeons allowed even their residents to be disrespectful towards anesthesiologists. Where I am now, that usually applies only to trainees (especially fellows) in their last years (senioritis, I guess). And it's typically not what they say (they know better), but HOW they say it (tone matters), and usually in the ICU not in the OR.

When you get out in the real world, and have to fight THE SYSTEM on a daily basis, mostly alone, you'll learn to pick your battles, too, or you'll be out of a job before you can say "microaggression". If the system says that anesthesiologists are lower on the totem pole, that's where you'll be.

In a medical and political climate that preaches the idea that doctors, NPs, RNs, and even janitors are to be treated equally and fairly (regardless of whether or not I/you think that's right or wrong), it's pretty angering to think about doctors treating the own colleagues without any respect. Maybe you're right and I'm still naive, but that doesn't sound like the type of practice environment I would want to work in. I'm 100% OK with working behind the scenes. But not with a trainee talking to me like I'm some med student. After keeping our heads down all these years from med school to residency, shouldn't there we at least be allowed to fight for our own respect as attendings?

 

[Southpaw]

In a medical and political climate that preaches the idea that doctors, NPs, RNs, and even janitors are to be treated equally and fairly (regardless of whether or not I/you think that's right or wrong), it's pretty angering to think about doctors treating the own colleagues without any respect. Maybe you're right and I'm still naive, but that doesn't sound like the type of practice environment I would want to work in. I'm 100% OK with working behind the scenes. But not with a trainee talking to me like I'm some med student. After keeping our heads down all these years from med school to residency, shouldn't there we at least be allowed to fight for our own respect as attendings?

If you don’t think doctors treat their own colleagues without respect then you’re just not paying attention. Oftentimes the ONLY people doctors mistreat are their own colleagues. Not every physician of course, but we often hold each other to an expectation that can never be met. And yes, I imagine the physicians that do this (not all, like I said) do have some semblance of personality issues that lead to trouble in other aspects of their life.

 

[woopedazz]

In a medical and political climate that preaches the idea that doctors, NPs, RNs, and even janitors are to be treated equally and fairly (regardless of whether or not I/you think that's right or wrong), it's pretty angering to think about doctors treating the own colleagues without any respect. Maybe you're right and I'm still naive, but that doesn't sound like the type of practice environment I would want to work in. I'm 100% OK with working behind the scenes. But not with a trainee talking to me like I'm some med student. After keeping our heads down all these years from med school to residency, shouldn't there we at least be allowed to fight for our own respect as attendings?

People are dinguses mate. Doctors are people. You're being very naive.

That said, I really like where I work and everyone is super nice to me; even when I'm slow as slow can be while I learn the ropes. It's very rare anyone talks down to me, and I've never seen it happen to my seniors.

If anyone ever loses their cool with me they always apologise and try to make it right. Except for those rare true dinguses... Not much you can do about them. Kill em with kindness to their face without actually going out of your way for them and make them feel stupid.

 

[Twiggidy]

I think at the end of the day I want to love what I do, or at least find it tolerable. I don't feel like I have that yet and some of my peers seem to have found it. I still feel kind of terrified by the OR even though I know I am learning and have handled myself well in difficult cases in the past only because I am reading more and more and quickly figuring out that there is so much more for me to learn. It just sucks when you feel like you get into a rhythm after 1 year doing something totally different than your intended career path and then you get into what you are supposed to be doing and you are starting over from square 1 in terms of feeling dumb and not adequate even though I know it comes with time.

The thing is you’re not alone. The PGY2 in other specialties are in the same boat. No second year resident knows what they’re doing. But if some of the aspects of other fields is what you miss, like continuity of care and rounding, then you may want to look at something else

 

[Twiggidy]

In a medical and political climate that preaches the idea that doctors, NPs, RNs, and even janitors are to be treated equally and fairly (regardless of whether or not I/you think that's right or wrong), it's pretty angering to think about doctors treating the own colleagues without any respect. Maybe you're right and I'm still naive, but that doesn't sound like the type of practice environment I would want to work in. I'm 100% OK with working behind the scenes. But not with a trainee talking to me like I'm some med student. After keeping our heads down all these years from med school to residency, shouldn't there we at least be allowed to fight for our own respect as attendings?

You have to really read what he’s telling you. Absolutely it’s ok to stand up for yourself when being disrespected but you’ll also have to learn to pick your battles because even in cases where you may be correct about an issue, it doesn’t take much for a surgeon to say “Don’t put him in my room because he’s combative”. Now at that point “standing up” will effect your bank account

 

[Consigliere]

Get out now, kid. Trust me when I tell you, based on what you're saying NOW, you will be in for a lifetime of misery if you continue down this path. Cut your losses, enter another speciality, or suffer the consequences.

 

[Dasani water]

Is this remotely normal? I’m just wondering if this is adjustment blues and just a sense of “I felt comfortable doing something and now I’m not comfortable and looking through Rose colored glasses” sort of deal. I want to give this a legit shot and stuff but I’d be lying if I said my transition was easy

 

[Twiggidy]

That's one of the real problems of the "residency" system. You make a choice which could really be uninformed and then you're stuck. @Dasani water you could just be having "the blues" from a big change in comfort zone, but if something doesn't change over the next couple of months I'd seriously consider a change. It's only October so it's perfectly normal to still be a bit shell shocked, but by December you should start to feel more comfortable and if you don't, I'd say that's a serious sign that you need to do something else. I saw it when I was a senior resident. We had a first year who just clearly couldn't get a hold on what it meant to be an anesthesiology resident. People noticed it and she switched to medicine at the end of the year. It was probably a good choice for all parties.

 

[Section31]

I would passionately advocate for you sticking it out.

You know what sucks (and I mean SUCKS) really bad?

Residency.

Any residency in any field.

No one likes it. If you liked it, you’d have to be certifiably insane. It’s a grueling process by which you learn unfamiliar skills which you must master, on pain of insurmountable debt.

Switching residencies is a very bad idea. You’re application would be mired by the presumption that you were being kicked out. Why? Because people who are kicked out say they just didn’t like it. Some of those people are better liars than you are at telling the truth. So everyone will assume something bad happened. And you’ll have to prove your innocence. And you can’t.

If you later want to be a surgeon, I’d actually recommend finishing anesthesia and THEN applying to residency in Surgery. Graduating from a residency program looks infinitely better than leaving one.

But, once you finish, wouldn’t you be interested in earning 300-400k a year? The last thing you’ll want to do is go back to residency. That’s like going back to prison. I actually think I’d rather go to prison.

 

[Section31]

So the SICU "mother-may-I" and "co-ownership," is everywhere?

This IS NOT true at a great very many places. Where I trained and where I work, anesthesia had either a closed or semi-open (shared) SICU. In many cases, however, your surgeons are more than happy to let you take care of their sick-as-**** patients.

And it’s not “mother may I” even if it’s shared. It’s more like “Hey, Bill, guy I’ve known for years, would you mind if I did this?”

 

[Twiggidy]

I would passionately advocate for you sticking it out.

You know what sucks (and I mean SUCKS) really bad?

Residency.

Any residency in any field.

No one likes it. If you liked it, you’d have to be certifiably insane. It’s a grueling process by which you learn unfamiliar skills which you must master, on pain of insurmountable debt.

Switching residencies is a very bad idea. You’re application would be mired by the presumption that you were being kicked out. Why? Because people who are kicked out say they just didn’t like it. Some of those people are better liars than you are at telling the truth. So everyone will assume something bad happened. And you’ll have to prove your innocence. And you can’t.

If you later want to be a surgeon, I’d actually recommend finishing anesthesia and THEN applying to residency in Surgery. Graduating from a residency program looks infinitely better than leaving one.

But, once you finish, wouldn’t you be interested in earning 300-400k a year? The last thing you’ll want to do is go back to residency. That’s like going back to prison. I actually think I’d rather go to prison.

I would respectfully disagree. There's an issue with getting a residency after completing another residency which is that there are funding issues. From what I know, residents are paid via Medicare and if you do a second residency of the same length you won't be able to be paid. If it's longer, they can pay for the later years. It's a tricky situation. It's much easier to switch, per se, while you're still a resident.

 

[Section31]

I would respectfully disagree. There's an issue with getting a residency after completing another residency which is that there are funding issues. From what I know, residents are paid via Medicare and if you do a second residency of the same length you won't be able to be paid. If it's longer, they can pay for the later years. It's a tricky situation. It's much easier to switch, per se, while you're still a resident.

You have limited years of Medicare resident years, true. But Medicare only pays a part of your salary as a resident (60%). I know plenty of smart people who did two residencies. My friend finished training in peds and then did anesthesia. One of my old attendings, a young guy, did neurology then anesthesiology. A guy a met on the interview trail was a practicing fertility doctor.

 

[IMGASMD]

I would stick it out for a few more months. In the mean time you need to start thinking long and hard about what you want to do. This is it, not many people can switch residency more than once. You can like others have suggested finish one residency then do another.

It’s also very very rare to have someone switch from anesthesia into surgery..... surgery to anesthesia, met plenty.
Anesthesia to medicine, anesthesia to radiology.

Good luck.

 

[Cryc_to_the_point]

This IS NOT true at a great very many places. Where I trained and where I work, anesthesia had either a closed or semi-open (shared) SICU. In many cases, however, your surgeons are more than happy to let you take care of their sick-as-**** patients.

And it’s not “mother may I” even if it’s shared. It’s more like “Hey, Bill, guy I’ve known for years, would you mind if I did this?”

If that "guy I've known for years," can tell me "No." then it's mother-may-I in my book. Chances of working MICU? It's been discussed elsewhere but I can't find a single Anesthesia/CCM guy listed in my area working in a community center or academic MICU.

 

[Twiggidy]

If that "guy I've known for years," can tell me "No." then it's mother-may-I in my book. Chances of working MICU? It's been discussed elsewhere but I can't find a single Anesthesia/CCM guy listed in my area working in a community center or academic MICU.

It’s because for the most part the plum/cc people staff the MICU. Anesthesia/CC is mostly SICU with you sometimes sharing duties with surgical intensivists

 

[chocomorsel]

If that "guy I've known for years," can tell me "No." then it's mother-may-I in my book. Chances of working MICU? It's been discussed elsewhere but I can't find a single Anesthesia/CCM guy listed in my area working in a community center or academic MICU.

They are around. Getting interviews for both SICU and MICU. The world is changing for the better in Anesthesia CCM.

 

[chocomorsel]

I would passionately advocate for you sticking it out.

You know what sucks (and I mean SUCKS) really bad?

Residency.

Any residency in any field.

No one likes it. If you liked it, you’d have to be certifiably insane. It’s a grueling process by which you learn unfamiliar skills which you must master, on pain of insurmountable debt.

Switching residencies is a very bad idea. You’re application would be mired by the presumption that you were being kicked out. Why? Because people who are kicked out say they just didn’t like it. Some of those people are better liars than you are at telling the truth. So everyone will assume something bad happened. And you’ll have to prove your innocence. And you can’t.

If you later want to be a surgeon, I’d actually recommend finishing anesthesia and THEN applying to residency in Surgery. Graduating from a residency program looks infinitely better than leaving one.

But, once you finish, wouldn’t you be interested in earning 300-400k a year? The last thing you’ll want to do is go back to residency. That’s like going back to prison. I actually think I’d rather go to prison.

Switching residencies happens all the time. In fact many anesthesia residencies have extra CA1 spots for this exact scenario. And no, it doesn't necessarily look like one got fired.
PD's all talk to each other and get the real scoop of why a person left. Or rather, the "real scoop" as explained by the PD, which could be quite biased.
OP, if you want to be on the other side of the drapes, and develop long term relationships, and own patients, then switch.

 

[deleted171991]

Is this remotely normal? I’m just wondering if this is adjustment blues and just a sense of “I felt comfortable doing something and now I’m not comfortable and looking through Rose colored glasses” sort of deal. I want to give this a legit shot and stuff but I’d be lying if I said my transition was easy

There are real adjustment issues for the first 6 months or so, but they are mostly related to technical skills (especially if one was a good intern). Things do get more interesting in the last 2 years, but you still won't be much of a doctor (at least not in the eyes of most non-anesthesiologists... and patients).

 

[Dasani water]

I talked with someone I think I have some more clarity about it. Basically it was nice for someone to say that my life is worth more than medicine and I’m more than Dr. Dasani Water. I had more time at work last year and now that I’m free this year part of my identity is gone. It was beat in me by med school that you live for medicine and that’s all you should eat sleep and breathe and I ate it up. Now that I have some free time and flexibility I feel like I lost a part of myself. The sexy part that was in the spot light for everyone to see. It’s hard to let go of that when there isn’t much else you have going for you. At the end of the day, I’m gonna finish this out. If at the end of 4 years I want to reapply then so be it. But I’ll give this a college try and not count myself out. I just need to work harder on changing my attitude towards myself.

 

[MetaPhysicianBlog]

A guy a met on the interview trail was a practicing fertility doctor.

That's what I tell all my dates on a Friday night.