Thursday, April 7, 2016

Anesthesiology-EM Residency. For Doctors Who Can't Make Up Their Minds

Okay this is rather unexpected. The American Board of Anesthesiology and the American Board of Emergency Medicine have announced a joint Anesthesiology-EM residency program. It's not April Fool's Day anymore, right? The new training program will last anywhere from 5-6 years depending on if the resident goes through a complete four year EM residency. So the ABA is saying that a resident really needs only two years of training to become an anesthesiologist but needs four to be an emergency physician? According to the ABA secretary Dr. James P. Rathmell, M.D., the new training program, "addresses a demand from residents interested in both emergency medicine and anesthesiology." The ABA and ABEM are currently accepting applications from residency programs who want to start up this new hybrid.

I didn't even know there was a huge demand from medical students who just absolutely can't make up their minds and want to do both anesthesiology and EM. This isn't like a Med-Peds program where the training is similar to Family Medicine minus the OB/GYN portion. I would think that an anesthesiology-cardiology or anesthesiology-pulmonary-critical care combined program would be a more natural fit.

When I was trying to decide what I wanted to do after medical school, EM was clearly near the top of my list of career choices, as it is for many med students. However I had good reasons for not choosing EM and to me those circumstances makes this combined residency all the more puzzling.

First of all, the work of anesthesiologists and EM couldn't be any more different. Anesthesiologists are responsible for studiously managing one patient at a time, carrying them through a difficult operation successfully with minimal complications. EM docs are frequently involved with a dozen or more patients simultaneously. Within minutes to hours, they have to decide whether a patient is safe for discharge or need to be admitted for higher levels of care. How does one juggle these two completely different mentalities in patient care?

I would think that an EM physician will be completely bored with sitting in the operating room. If one is used to the adrenaline rush of seeing multiple patients and being at the ready for whatever comes through the door, how are they going to feel being inside a small confined area of a cold OR watching one monitor on the same patient for hours at a time? Likewise if an anesthesiologist is used to the cerebral pace of managing patients during surgery, the move to the emergency room will come as a huge shock to their mental and physical capacities. Not that EM is harder than anesthesiology--it's just different.

When will this Anes-EM physician find time to use both of their board certificates? I suppose since most EM doctors work three days a week, they can use the other days to work in the operating rooms. But most EM docs I know treasure their days off. They can go on long weekends at least twice a month or string together a whole bunch of off days to take weeklong vacations without ever having to lose any shifts. Or many of them moonlight elsewhere to make even more money. I can't imagine they are eager to head to the operating rooms after several days of frenzied 12 hour shifts.

The only upside I see for an Anes-EM doctor is that this will alleviate one of my main concerns about going into EM. Because being in the ER is so stressful and carries a high risk of burnout, EM is not a field that one can grow old into. Now with an anesthesiology board certificate as backup, one can switch careers anytime they want without needing further training. I don't see a possibility that an anesthesiologist will become so weary of being in the OR's that they will want to switch into EM. Somebody like that should probably have done an EM residency instead of a combined program.

Despite all these reasons, I predict that an Anes-EM program will be in high demand. I see many medical students who love both fields but have a hard time deciding which one to make as a career. I just can't imagine how one juggles the different work styles of these two very different disciplines. But if they don't mind doing an extra two years of residency training, now they don't have to fear about going into the wrong field.

No comments:

Post a Comment