It’s been a dilemma 9 months in the making: Anesthesia versus Emergency Medicine. Wow, that’s the amount of time for a full-term baby to pop out! Am I ready to be “born,” to take the first baby steps towards being a doctor in the real world?
Since January, I have been straddling the fence between Anesthesiology and Emergency Medicine. I did both mini-clerkships back-to-back in the middle of 3rd year, and loved both equally. I was that eager medical student, chasing down blood draws and IV placements, clearing the rack of charts, driving the stretcher into the OR (albeit haphazardly, like your stereotypical Asian female driver) and jumping to intubate!
In the past 9 months, I ended up picking anesthesiology and just running with it. No looking back, no tripping and no regretting. I even did an international trip to China with one an anesthesiology team from across America to raise awareness about epidural analgesia during delivery, a method of pain management so prevalent in the United States, but lacking in China. A great trip to top off the end of 3rd year and solidify my path towards anesthesiology as the centerpiece of my personal statement. Or so I thought…
Now, the BIG however… Call it a 6th sense or the devil versus angel sitting upon my shoulders. I still felt fidgety about my choice, a constant nagging sensation in the deep cortices of my brain. Why was I asking dozens of residents and anesthesiologists why and how they chose the field? What are their career plans? What does the future look like, as if a magic crystal ball exists in every operating room?
I had misgivings about the field, particularly with the uncertainties of Obamacare. For instance, Obamacare calls for increased use of midlevel providers, such as physician assistants and nurse practitioners, to fulfill the need for primary care providers. In essence, they are cheaper labor for less time (in terms of education and training). Now, translate that to anesthesiology… certified nurse anesthetists (cRNAs) are infiltrating the field, citing they are as equally qualified as MD anesthesiologists to perform procedures, administer powerful medications and work independently. In roughly a dozen states, cRNAs can practice in the OR without physician supervision. With all the head butting and increased competition, there is a growing expectation of physicians to pursue fellowship training in areas such as pain management, cardiothoracic surgery, pediatrics, obstetrics and regional anesthesia, to have that extra level of expertise, particularly in saturated areas of the country (think urban hubs, from East Coast to the West Coast).
From my experience and extensive research sifting through blogs and articles, the future as an anesthesiologist is looking murky and potentially on the downslope. People have tried dodging this question, but I have a good idea of the answer. Reimbursements are going down. MD anesthesiologists may be moving towards perioperative care, working in the clinic and optimizing patients for surgery. They are also falling into a supervising role, where one physician oversees 4-5 rooms of residents (at an academic center) or nurse anesthetists (community or academic hospitals). The physician in charge pops into the room when 1) it’s time to intubate, 2) it’s time to extubate or 3) when complications arise. Of course, more complicated patients will require a physician from beginning to end, attentive to the vital signs, medications, fluid input/output and actual surgery.
And I believe that’s what struck me the most: potentially less patient contact and feeling less like a doctor. Your interaction with the patient is 75% in the OR, when he or she is heavily medicated and asleep. True, leading up to anesthetizing a patient, you are the person alleviating any anxiety and concerns, which is a powerful role anesthesiologists play. At the same time, you are a floating manager, instead of the hands-on doctor who cares for the patient from beginning to end. I need to talk, touch and think. I need to be remembered, be the doctor.
Here is my top 5 list of reasons why I switched last minute… 1-2-3… Breathe!!!
1. I’m not a clinic person: I shadowed for a morning in the perioperative clinic… and hated it. When I was in the pain clinic… it was utterly painful. Yes, it’s lucrative, procedure-heavy and regular. But hells-to-the-no when days drag on and you have to deal with potential opioid addicts and chronic pain patients who are only temporarily treated with steroid injections and never really cured. There’s a belief floating out there that people who go into anesthesiology, but hate the operating room and love the moolah, end up in the pain clinic. One of the basic foundations of anesthesia is analgesia, achieving pain relief. If I could barely deal with the acute pain service and chronic pain clinic, how could I survive becoming an anesthesiologist for the rest of my life, without paining myself?
2. I’m a cold person: The operating room is always too cold. Not even donning a scrub hat and mask helps me stay warm. Or sitting at the head of the table, playing word games and occasionally peeping over the curtain at the surgeon’s stage, trying to stay warm beside the patient’s bear hugger-heater.
4. I’m a world traveler: In my personal statement, I wrote about my trip to China and newfound motivation to become an anesthesiologist. When the chairman of medicine critiqued it, he stated, “… I don’t see how global health fits in with your career choice in anesthesiology… there just aren’t many opportunities out there for you… and it’ll confuse your readers.” And it clicked. No matter how much I force it, anesthesiology was not meant to be.
5. I’m a fashionista: When you’re wearing hospital scrubs all day, hiding and suffocating behind a mask and stuffing your long black locks into a scrub cap, it’s hard to become a fabulous trendsetter.
September rolls around, I start my sub-internship in Emergency Medicine. I chose it because 1) my school requires every 4th year to complete a 4-week sub-internship to graduate and 2) I was potentially ruling it out. Except… I ruled it in. About 4 days into my sub-internship, I was a changed medical student. Any bit of doubt and confusion dissipated and my mind was as clear as a fine spring day. It took 4 weeks of anesthesiology to realize it was not for me and 4 days of emergency medicine to see how happy, excited and awake I was, no matter what hour or how nutritionally deprived my mind and body were. Best diet regimen: caffeine, water, adrenaline and some food. I would bring in a homemade meal, Chinese veggies/chicken over rice or a simple sandwich, and it would take me hours to eat, one meal chunked into bite-sized portions over 2-4 hours. Multitasking at my best. Discipline made effortless.
So I flipped my future with a snap of my fingers. In 2 short, but busy, weeks I had to start on a clean slate, shotgun and select programs, write a new personal statement exploring why I love emergency medicine, obtain new letters of recommendations and honor my current sub-internship with flying colors and comments. Luckily, it only took me 1 solid day to draft a personal statement (versus a whole summer to get a single paragraph down for my anesthesiology essay). The only thing I failed at was securing an away rotation this late in the game. I threw my arms up in despair and crossed my fingers for the best.
And what a fine month it has been, as I have never been this motivated and energetic about medicine and work thus far in life. To be at the front lines as the “medical detective,” not knowing what surprises will come ramming through the door, is truly rewarding and exhilarating. In a fun little series, called “Adventures in the ER,” I will have anecdotes from my month as a sub-intern and how learning from patients is the best medicine for any doctor.