Specialties List I

I realized it would be cool to list the specialties I'm considering and watch how they change over time (unfortunately I didn't do it last year, and I have a feeling that my preferences have changed since then). With rotations coming up in a few months, it would be both interesting and important to document how I feel regarding different specialties and to see which stereotypes are reinforced or refuted. So here is my list right now.

1. Anesthesia -> Critical Care. I think I'd like to end up in critical care medicine because of the complexity of the cases and the emphasis on multiple organ systems and whole body physiology. That stuff excites me. I'm not entirely sure right now, but I may prefer intensive care of a patient for a limited period of time rather than a more longitudinal experience. I am okay with very sick patients who may die. I am interested in end-of-life ethics. So what about anesthesia? I think that anesthesia complements critical care well. They are both team-oriented hospital-based fields with vast possibilities of research. The procedures are similar, including hemodynamic monitoring and airway support. I like how anesthesia takes care of one person at a time, and the culture of anesthesiologists fits me well. It is an exportable specialty. Anesthesiologists work with adults, kids, pregnant women, and people in pain; it's a diverse field.

2. Internal Medicine -> Critical Care +/- Infectious Disease, Cardiology, or Pulmonary. While most people opt for a Pulmonary/Critical Care fellowship, I'm not certain that's what I'd want to do. Pulmonology doesn't excite me that much. I could consider doing infectious diseases or cardiology first. These aren't ideal pathways. ID might make sense if I'm interested in ID research or infection control (big problem in ICUs). I think it'd be a useful but not essential background. Cardiology is an iffy proposition; there was the advent of coronary care units (CCUs) but it remains to be seen whether cardiology-trained intensivists are required to run those (it may just be sufficient to have either cardiology or critical care, not both). Furthermore, I would enjoy doing a further fellowship in interventional cardiology, and to do critical care after interventional cardiology would be a significant loss in compensation (it's unlikely that I'd really care though).

The thing about critical care is that you need something else to balance it out; it's too easy to burn out doing 100% ICU medicine (if I wanted to do that, I would consider being a hospitalist). Anesthesia (well-controlled environments, one patient at a time), cardiac caths (procedural, fun, high reimbursement), pulmonary clinic (straightforward, longitudinal continuity), ID consults or infection control all provide a venue to destress. It remains to be seen what I end up choosing.