Decision-Making II

I also looked at this from the perspective of what I'd lose if I went into a particular field. If I went into medicine, I might lose the procedures; certainly, I'd lose intubation, and if I didn't go into cardiology, I'd lose most of the hands-on interventions. I'd lose the operating room, which surprisingly, makes me more sad than the prospect of losing clinic. I'd lose the one-on-one intense patient focus while someone is under anesthesia. I may lose some of the emergency situations. I'd lose the immediacy and satisfaction of pushing meds myself and seeing the physiologic response.

If I went into anesthesia, I'd lose long-term patient relationships and a patient cohort. That's a big difference; that's what many people picture when they think of medicine or a doctor. I'd lose the differential diagnosis and evaluation of a new patient, but I'm not sure how much of that attendings do (especially if I stick to the inpatient setting). I'd lose the well-honed history and physical exam; that skill belongs to the internist. I'd lose the outpatient side. And on the inpatient side, I'd lose the camaraderie of a large team.

Looking at those two paragraphs, it's also a funny way of putting what I'd "gain" in each specialty. But there are also things that come with each specialty that I wouldn't necessarily want. If I went into medicine, I'd be afraid of the paperwork, the coordination of care, the nitty gritty details of modern day practice that I've blogged previously about. The truth is, I'd also be afraid of "difficult" patients; I don't finesse those situations as well as others.

If I went into anesthesia, I'd worry a little about having to work day-to-day with surgeons; most are fine, but some are a little abrasive. I'd be wary that routine cases would bore me, but I think I have the personality to deal with "hours of boredom punctuated by moments of sheer terror." The hours would be worse; I might have to take in-house call depending on where I worked.

Practice settings may impact what I choose. I don't know too much about different practice settings, but if I were to pick one, I'd go for academics. I like teaching. I like research. I like the complexity of a tertiary care center. Flexibility is nice. I don't like having to deal with the "business" end of things. Academia may suit me well. I think in academia, a clinician's influence goes far beyond the direct care of the patient; attendings model good behavior for students, sculpt residents into better doctors, and investigate questions that may have a long-lasting impact on clinical care.

The downsides of academia are clear. The environment can be "sink-or-swim," based on publications. It is hard to compete with others, especially pure PhD's who have a more research-focused background and no clinical responsibilities. Grants ebb and flow. Research is a frustrating long-term endeavor that may not ultimately pay out. The salary is worse. The hours can be longer. All of these slightly favor anesthesia where I don't have a patient base and a set clinical schedule, where my life is more flexible to accommodate my other responsibilities. The salary in anesthesia is higher than general internal medicine and comparable to a subspecialist, giving me a buffer if I choose to work in academics.