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People say I'm crazy.
In this day and age of "primary-care physicians" it would seem odd for a board-certified internist to leave a hefty salary and return to pursue a residency in another specialty. It would seem even more outrageous if that residency were in anesthesiology - a field plagued by dropping resident numbers and declining job opportunities.
Well, I beg to differ. Three years seems a small price to pay for happiness.
I have always enjoyed internal medicine for its emphasis on complete patient care and systematic approach to diagnosis and therapy of illness. However, I must admit that I never liked my outpatient clinical experience. It was very frustrating to me to have little time to really spend with my patients (routine appointments were only 15 minutes long). Furthermore, It was clear to me that psychosocial and behavioral issues beyond my control were at the root of the majority of my patients' medical problems. I felt that I spent more time trying to deal with those issues (without any formal training) than with the medical issues themselves. I saw myself becoming more and more of a pill-pusher -- Have a headache? Here's some Motrin. Guts hurt? Take this Tagamet. Resting glucose too high? take this glyburide. Come back in a few weeks and we'll check it again.
What I really wanted was to use my energies in the provision of medical care alone. Furthermore, I wanted to possess skills which would set me apart from the vast field of "allied health professional" - PA's, Nurse Practitioners and the like, that are, in my humble opinion, posing a real threat to the livelihood of qualified and dedicated primary care physicians. Finally - and I hate to admit this part - I found it too hard to be a primary care provider. I wanted to focus on a field where I would be more comfortable with my breadth of knowledge.
I found what I was looking for in anesthesiology. With my first year of residency almost completely behind me, it has become crystal clear that I have made the right choice. Although the transition from real-world to residency has been difficult, I now enjoy what I do and how I spend my time far more. Sure, it's difficult to be making 25% of my previous salary and to be working twice as much. It's difficult not to have the time to spend with my wife and daughter. It's difficult to return to the role of novice after achieving a degree of mastery in another field. Finally, it is most difficult to lose control of one's schedule (and hence one's "life"). However, now I spend my days taking care of one patient at a time - from the preoperative period through the stresses of surgery and then into the postoperative recovery period, no matter how long it takes. Alas, I actually have fun!
So, If there was one piece of advice that I could give to medical students trying to decide on a career, it would be to do what makes you happiest. Do not listen to hype about "fields for the future" or "the changing landscape of medicine". Expose yourself to a variety of rotations in medical school and then choose the one that seems most interesting and appealing to you - whether it be Family Practice or Pediatric Cardiac Surgery. And don't let anyone talk you out of it.
- Mo
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[ T o n y | M a r c u
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