Thursday, December 4, 2014

MiM Mail: Anesthesiology or psychiatry?

Hi everyone!

As many others have shared, MiM has been such a valuable resource to me since embarking on the path to a career in medicine. Now, I have a more direct question for you all. I have been considering specialties, and while I still have plenty of time to decide, the pressure to make arrangements for research this summer and beyond is weighing on me, especially because I'm interested in two very different fields for obviously different reasons: anesthesiology and psychiatry. 

Anyway, some background first… I am a first year medical student and my partner is a fourth year, currently interviewing for residency. He is pursuing ENT and has mentioned interest in the possibility of pursuing a head and neck fellowship eventually… We have no children yet but starting a family is a huge priority and we both envision a timeline within the next 5 years (i.e., during medical school or residency for me). 

Because family life is extremely important to both of us, and it’s already becoming clear to me that his field will be a lot less flexible in this regard, I’m seeking any advice on deciding between the two specialties above. I know that balancing family life in a two-physician family is going to be extremely difficult regardless and so I am willing to make some career decisions to account for that. It seems that both anesthesiology and psychiatry can make for good lifestyles eventually (though with drastically different levels of compensation) but is there more I should know? Are the residencies drastically different? Is the difference in salaries going to be too stark if pursuing manageable hours (or even “part time”)? I know both can be flexible, but are those lower hour positions more realistic in one field? Anything else I’m missing?

I should also note that because we’re both from, and hope to remain in, a relatively undesirable area near what is considered a highly underserved area, I would seriously consider the NHSC scholarship if I chose to pursue psychiatry. I could also earn an MPH in one year at no cost through my medical school’s MD-MPH program which is something I have also considered (my pre-medical school studies were based in the social sciences).

Thanks so much!



  1. This isn't go to be a popular answer, but here it is:
    It is too early in your career and in your family life to begin making sacrifices. No one should know what specialty they're going into as a first year medical student. Learn; try things you like; meet mentors and advisers in many fields; figure out your interests and what ignites your passion.
    Once you've done that, you can start figuring out how to fit a family into it. You're very lucky -- you're an in underserved area, so they need you and they need your husband. That means the two of you get to call the shots: if your area needs a doctor, anything is better than 0, so the two of you are in a great position to bargain for part-time, or flexibility, or lots of vacation time, or whatever, no matter what specialties you're in.

  2. I agree that you shouldn't be planning for a certain specialty as a first year medical student.

    I can't speak to psychiatry as a specialty as I'm an anesthesiologist, and it's not necessarily a family-friendly specialty. I'm sure the residencies are drastically different. The hours CAN be ok in anesthesia but it depends if you can find that type of job. I'm working per diem right now while my husband is a fellow and this has worked really well for us because I dictate when I work. It means I don't have benefits or a salary but I get paid for when I work.

    For now, focus on figuring out what you like to do and then go from there!

  3. I'll second what the other comments have said. It's too early to make that choice. If you want to have children soon, that's fine (because there is never going to be a good/easy time to start your family.)

    You can make any specialty work (with some being a little easier that others.) I know moms in all fields who are great moms and great physicians. So it's much more important to know that you'll make a choice based on what you actually like that just what the life style is. If you make a choice purely based on a life style expectation, you won't be happy.

    I'm an anesthesiologist, and I love my work, but it's not as family friendly as people try to sell it. If that had been the only reason I chose it, I would be miserable.

  4. Larval Doctor's advise was more popular than he/she anticipated. I echo that. I have noted many talented female physicians who launched their careers with the understanding that they would take a backseat to their husband. That's certainly not the worst thing in the world. We all have priorities and that's fine. … But I hate to see young women like yourself take that on very early. I have a female ENT colleague who did two very hard-driving fellowships, has a daughter and home-life, and her husband also has a time-intensive field. These things can be managed. But one thing that makes it possible for both partners to pursue their passions (rather than start their by drastically narrowing possibilities) is communication. If you assume you will take a backseat, is that coming from your husband? Have you broadcast that to him? He may not assume that at all. He may assume you will pursue your passions as much as he has - and down the road there may be room for both of you to make allowances for family (once that happens). Have those conversations with him now. And first do some soul-searching about why you are so willing to begin this journey in the backseat.

  5. The question in your post that stuck out to me (as an anesthesiogist) is whether the residencies of anesthesiology and psychiatry are that different. YES! They are very different! They are very different fields! I cannot speak for all anesthesia programs, but my program was quite rigorous. It is very procedure-oriented and in a completely different environment than psychiatry (the OR, trauma bay, ICU, etc. vs clinic and wards).

    The only way you would know the difference is by spending more time in med school and seeing the differences for yourself. Only then will you know the right field for you. And as others have said, I would caution against choosing a field solely for its reputation as a "lifestyle field". There is a huge continuum of jobs in every specialty. Enjoy med school for now!

  6. A psychiatrist chiming in here to say (shrink-like) that as hard as it may be to sit with the feeling of being undecided, it may nevertheless be the right thing to do for now. I agree that the 1st year of medical school is too early for most students to decide on a specialty -- it really takes experiencing your clinical rotations to know what "pulls" you the most. Anesthesiology and psychiatry are indeed different in many ways; I don't think I personally know anyone who was deciding between those two specialties (whereas I know a lot of people who were deciding between psych and internal medicine or peds, and I even know a few psychiatrists who said the other specialty they loved was surgery). I suspect that once you get to your rotations, you'll discover that one of those specialties fits you much better than the other. You may also discover that an entirely different field "calls" to you the most.

    This doesn't mean you have to simply sit back and wait. There are many ways you could try to get exposure to these fields in advance -- interest groups, research projects, summer rotations, etc. (And if you don't mind me saying so, I think your background in social studies and interest in public health suggest that psychiatry could indeed be a great fit. (-: )

    That said, I agree with the previous commenters who were worried that you were deciding early to put your career choice second to your partner's. Whatever you do, you're going to have to love it enough to put up with several grueling years of residency and perhaps fellowship, and then a lifetime of doing that work. You definitely don't want to discover halfway through residency that you want to change fields and need to reinterview -- you could wind up resenting your partner.

    And just to address a couple of other mentioned applying for a National Health Service Corps scholarship if you went into psychiatry. I don't know if this still the case, but at the time that I finished residency, almost all of the psych positions available to my co-resident with an NHSC scholarship were in the correctional system, and it took a lot of work for her to set up a position with a homeless services team. But in general, there's a shortage of psychiatrists, with the number declining every year, so I can't imagine it being hard to get a decent job in the field.

    For now, enjoy the ride, and good luck!

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  8. I thought I wanted to do primary care my first year of med school. HAHAHAHAHA. Agreeing with everyone else that it is way to early to decide. Also seconding the idea that you should pick the field you want before deciding on something because it's lifestyle friendly. I would far prefer to work long hours at a job I loved with my kids safe at home than 8 hours per day at a job I hate even if it did buy me more time with my family.

  9. I agree with the other posters, that it is too early to make a decision now. As a psychiatry resident, I can tell you that my hours are manageable (for the most part) and I do get more time with my baby than say, my husband (who is also in medicine in another field). However, psychiatry is tough in different ways and you really have to love it to do it. Our patients really need that sort of dedication. Do your rotations first--you may hate both of these fields or love one much more than another. For now, study study study!

  10. Just my thoughts:

    1. I'd agree with what everyone else has been saying. Of course, it's good to keep these two specialties in the back of your mind as you go through med school. But at the same time there's just so much to explore and enjoy in med school as well.

    Of course, there's a lot of %$#@! to put up with too!

    2. Sure, it's possible to work part-time in anesthesiology or psychiatry. But yes, it could come at a sacrifice to salary and/or other things. However, this is also true of many other specialties. I suppose if lifestyle is the top priority, and assuming you have an interest in it, then why not reach for the stars and go for something like dermatology?

    3. All specialties have their pros and cons. But let's take anesthesiology since you mentioned an interest in it.

    Anesthesiology is great if you like the OR environment, physiology, pathophysiology, pharmacology, minimal patient interaction, acute care, doing procedures, don't want to deal with social issues in patients (which by the way is almost the opposite of psychiatry), it has a good starting salary, etc.

    But disadvantages include respect issues (which may or may not bother you depending on your personality) like often being treated as second fiddle to surgeons, patients sometimes confuse you with nurses, CRNAs are generally nice people but every so often you may have to deal with a militant CRNA who thinks they can easily do your job, anesthesiologists don't bring patients to hospitals so hospitals may not give you a certain amount of respect as they give to other doctors who do bring in patients, etc. Other cons are possibly working long hours (~60hrs on average as an attending in private practice), the Anesthesia Care Team model is here to stay so it's possible you'll have to manage CRNAs in your career (which could be good or bad depending on your perspective), anesthesiologists face the ever looming threat of AMCs buying out private practices, as well as CRNAs taking over in many locales, reimbursements under Medicare are horrible for anesthesiologists, etc.

    Likewise it might helpful to consider subspecialties in a field. For instance, anesthesiology has pediatric and cardiac anethesiology as subspecialties which keep you in the OR and are sometimes valuable to private practices (though if you subspecialize realize it may ironically be harder to work part-time). I believe the only two subspecialies in anesthesiology which get you out of the OR are pain and ICU. These come with their own advantages and disadvantages (e.g. dealing with pain patients isn't exactly easy, you have to wear a lead vest a lot of the time, but pain medicine can have derm-like hours).

    Anyway, here is an article about the advantages and disadvantages of anesthesiology from a good anesthesiologist.

    4. Also, keep your personality in mind. Your personality may or may not suit a particular specialty, and you may not know this until you try the specialty. For example, anesthesiology may look great on paper to you, so to speak, but when you actually do it, you may not actually enjoy it. In other words, just as you learn about the specialty, make sure to also learn about yourself (e.g. are you an introvert or extrovert, are you the sort of person who is able to function on 4-6 hrs of sleep per night for a long period of time or do you need more sleep each night, how do you deal with irregular or uncontrolled schedules, do you mind working with surgeons, do you like to interact with patients).

    Hope all this helps somewhat!

  11. What is written above is excellent advice. The best piece of advice I ever received in regards to choosing a specialty is this: Choose a specialty that you will enjoy working in every day, regardless of what is happening in your personal life. So much may change in your personal life over the course of your career--death of family members, divorce, sick child, etc. You need a job that you love so that you will keep yourself going when the world is crashing around you.

    That being said, if you are still considering anesthesiology, I wouldn't choose it for lifestyle reasons. Anesthesiologists work hard. I sometimes go 2-3 days without seeing my son because I am at work before he awakes and after he goes to bed. But I love my work and showing my son that I am fulfilled by my job is incredibly important to me, and that the time I have with him is even more treasured because it is limited.


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