Anesthesiologists treated like second rate physicians.

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marshall21

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After four years of anesthesiology residency, I still have my day ruined by some jerk surgeon, nurse, scrub tech, circulating nurse, PACU nurse treating me like crap compared to non-anesthesiologist physicians. I've tried to watch closely how other residents are treated and I swear anesthesia attendings and residents are treated like second rate physicians. Is it just this hospital or is it nationwide? Is it because we do some "nursing" functions like start IVs, empty foley bags, push gurneys, and administer medications that we're viewed less as physicians and more as subordinates to the surgeons? Even on the whiteboard in the ORs they will have written "Attending: Dr. X, Resident: Dr. Y, Anesthsesia Attending/Resident: John/Jane." Did we not go to medical school like everybody else? Have I not been in school for the past 13 years? I know its small stuff to worry about, but it wears on a person when its every day, every case. It causes much bitterness to have one's pride trampled on every day and not be able to do anything about it.

As a resident, I don't feel very empowered to "talk back" to attendings or even the nurses really. Any words of advice? Anybody else feel this way? How do you handle the micromanaging and rude surgeon or the jerk scrub tech or b***ch circulating nurse? Real world suggestions are apprecitated, not things like, "ketamine dart them when they're not looking."
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Trust me, it's not just at your place. In between the small number of places where I've worked fulltime, plus moonlight gigs, plus multitudes of military hospitals, I've seen a lot of places. At first I was annoyed and irritated; later I just learned to ignore them. It's a real skill to maintain a completely neutral, expressionless exterior demeanor, while on the inside you're thumbing your nose at the offender. Don't let it get to you when other people exhibit their inadequacies at your expense, in pitiful service of trying to buttress their weak ego. You're better than they are, stay above the fray, and let your peaceful demeanor mystify (and annoy) the offenders.

Oh, it only took me about a decade to fully develop that skill. The come-to-Jesus moment, when I realized I needed to get a grip on my emotions and develop coping mechanisms, was when my big red button got pushed one time too many in the OR ... watching a quad-channel IV pump explode into 1,001 pieces when I smashed it against the floor in anger provided me with a flash of insight, that "something" needed to change. Other people obviously weren't going to change, so I would make myself stronger than anything they could dish out. Now I go placidly amidst the turmoil with an inner smile on my face.

PS. I had sent that same IV pump to biomed maintenance three times previously, and each time they returned it "fixed." BS. Trying to prime it when an emergency CABG bring-back is coming through the OR doors, and all you get is "error" codes because the damned thing wasn't fixed (again), does tend to push one's button.
 
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I don't have any good advice...I mean I do, but I think it is all personality driven. I handle it a certain way, but it fits my personality.

I think it doesn't happen in private practice. It probably doesn't happen with long standing relationships between surgeons/anesthesiologists.

I will say this as words of comfort - just remember the surgeons LONG to be in your shoes. The nurses and techs are envious of your job. I guess you could cut them a little slack since you do have the best job in hospital (except maybe the Rad ONC guys).
 
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Just worry about taking care of the patient and collecting the Benjamins.
Life is too short to worry about miserable coworkers.

I call everyone by their first name including the surgeons and hospital CEO. Puts everyone on the same level.

Everyone is there to work and be a servant to the patient. That's it.
 
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Private practice is different. I was called Dr X for 3 months by everyone, then I told them they could call me by my first name if they prefer. Some still don't like to. In front of patients it is always Dr., just as I always refer to surgeons as Dr in front of patients. I call the surgeons by either first name or last name without Dr. if patients aren't around.

Nurses get me whatever I ask for whenever I ask for it, because it is their job, and more importantly, they trust my judgement.

This doesn't mean that we don't get treated to a different standard than surgeons when it comes to start times, or that there aren't exceptions, but on the whole, private practice is better.

PS trinity, at my place they set up those four channel pumps for us, we just have to check them.
 
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ProRealDoc said:
I call everyone by their first name including the surgeons and hospital CEO. Puts everyone on the same level.

Everyone is there to work and be a servant to the patient. That's it.
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Ditto - well said.
 
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Definitely depends on your department and hospital. Where I did residency was drastically different from where I am now. The surgery and anesthesia departments were very collegial and the senior anesthesia faculty are on the tenure committees for all of the tenured track surgeons so the dynamics were very good. Probably also helped that the president of the hospital system was an anesthesiologist.
 
marshall21 said:
After four years of anesthesiology residency, I still have my day ruined by some jerk surgeon, nurse, scrub tech, circulating nurse, PACU nurse treating me like crap compared to non-anesthesiologist physicians. I've tried to watch closely how other residents are treated and I swear anesthesia attendings and residents are treated like second rate physicians. Is it just this hospital or is it nationwide? Is it because we do some "nursing" functions like start IVs, empty foley bags, push gurneys, and administer medications that we're viewed less as physicians and more as subordinates to the surgeons? Even on the whiteboard in the ORs they will have written "Attending: Dr. X, Resident: Dr. Y, Anesthsesia Attending/Resident: John/Jane." Did we not go to medical school like everybody else? Have I not been in school for the past 13 years? I know its small stuff to worry about, but it wears on a person when its every day, every case. It causes much bitterness to have one's pride trampled on every day and not be able to do anything about it.

As a resident, I don't feel very empowered to "talk back" to attendings or even the nurses really. Any words of advice? Anybody else feel this way? How do you handle the micromanaging and rude surgeon or the jerk scrub tech or b***ch circulating nurse? Real world suggestions are apprecitated, not things like, "ketamine dart them when they're not looking."
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Get used to it, pal. You'll be dealing with this your ENTIRE career.
 
You can gain respect on a personal level but don't expect it to be handed to you the way it's handed to other physicians.
It's a direct result of having nurses claiming to do the exact job you do.
 
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Planktonmd said:
You can gain respect on a personal level but don't expect it to handed to you the way it's handed to other physicians.
It's a direct result of having nurses claiming to do the exact job you do.
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Do you think all MD practices command more respect? That is the only model I have not practiced in. All other models I have found a bit demoralizing and quite frustrating. I agree that in the care team model we are seen as nurse equivalents.
 
Depends on your rapport.

People call me "Dr." when they don't know me well. Invariably they always call me "Buzz" when they get to know me. Some nurses will still call me "Dr." after I tell them it's okay to call me "Buzz". The perception that you are laid back goes a long way to their comfort level. If you don't want them to have a comfort level, then act that way. The respect you command is up to you.

For what it's worth, the grayhairs I work with (anesthesiologists) are always referred to as "Dr.". If you are younger and seem cool, they'll feel more comfortable calling you by your first name. If you're single and looking to put it out there, trust me, this will work to your advantage. One of my partners has developed quite a reputation as a babe slayer. Respect is secondary to him. Getting laid is primary. Do I agree with that? I can't do anything about it. So I don't worry about it. He's a good anesthesiologist.

The only thing I won't tolerate is being called "anesthesia". That gets an instant on-the-spot correction. This only happened when I was new. I'd say, "It's Dr. Phreed. Anesthesia is what we give to the patient." I say this loudly and sarcastically so the whole room can hear it. You look like a dick. But they get the message.
 
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Where I am, wenget treated as well as the surgeons except from administration as in they don't check the surgeons on their start times, just anesthesiologists. Where I trained we where treated like you are, crappy and the attendings were doormats. so hopefully it gets better for you. It was such a welcome change coming here compared to the crap of residency.
 
Another thing to keep in mind is that after a while, the OR nurses and techs know the score. They know the value of a good anesthesiologist for sick/complex patients or when a crisis hits. They know the value of a good surgeon, too.

One thing that gets lost or ignored in these boo-hoo threads about respect is that the OR staff also talk plenty of smack about slow surgeons and bad surgeons. They play their passive-aggressive games with the weak surgeons too.

I'm just sayin' ... if you're routinely the target of periop nurse and scrub tech abuse, maybe you're not the rock star you think you are. Maybe you're the anesthesia equivalent of a surgeon who can't take out a gall bladder in less than 90 minutes. Give them a reason to respect you, other than the degree printed on your ID badge.
 
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chudat said:
Jesus christ this is super frustrating for those of us who matched into anesthesia
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Haha, maybe you should have done a little research before making a life-changing decision like matching in your chosen specialty. I have spoken with piles of med students with plans to enter into fields like anesthesia, radiology, emergency med, etc who have done no research into the specialty, including things as important as, job market, clinical environment/day to day work, reimbursement, mid level encroachment... You are a big boy/girl now. It's time to take responsibility for your choices.


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risnwb said:
Haha, maybe you should have done a little research before making a life-changing decision like matching in your chosen specialty. I have spoken with piles of med students with plans to enter into fields like anesthesia, radiology, emergency med, etc who have done no research into the specialty, including things as important as, job market, clinical environment/day to day work, reimbursement, mid level encroachment... You are a big boy/girl now. It's time to take responsibility for your choices.
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:thumbup::thumbup::thumbup:

I've known people who specifically chose Anesthesia bc they felt like they could get into the other letters of the ROAD. Not smart at all.
 
risnwb said:
Haha, maybe you should have done a little research before making a life-changing decision like matching in your chosen specialty. I have spoken with piles of med students with plans to enter into fields like anesthesia, radiology, emergency med, etc who have done no research into the specialty, including things as important as, job market, clinical environment/day to day work, reimbursement, mid level encroachment... You are a big boy/girl now. It's time to take responsibility for your choices.


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Probably because grown ass men and women, even on this sub-forum, spit out bull**** platitudes like "do what you like and the rest will work out."
 
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epidural man said:
I don't have any good advice...I mean I do, but I think it is all personality driven. I handle it a certain way, but it fits my personality.

I think it doesn't happen in private practice. It probably doesn't happen with long standing relationships between surgeons/anesthesiologists.

I will say this as words of comfort - just remember the surgeons LONG to be in your shoes. The nurses and techs are envious of your job. I guess you could cut them a little slack since you do have the best job in hospital (except maybe the Rad ONC guys).
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After 18 years of private practice, I still feel this way!
Nicely said, Sir.
 
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Thankfully, in 10 years of practice, I haven't worked anywhere that I felt disrespected as a physician. I would probably quit if I did. Even if the job paid a little more, you can't put a price on respect. You have to go there every day, so it is worth giving up a little bit of money in order to not be miserable with your life. I remember when I went on residency interviews, one of the hospitals had the anesthesiologists wear pink scrubs, while everybody else wore green. They looked like nurses. I didn't even bother to stay for the interview. You will only be treated the way you allow yourself to be treated. The more anesthesiologists that allow themselves to be treated like 2nd rate doctors, the worse it is for all of us.
 
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gasdoc1 said:
Thankfully, in 10 years of practice, I haven't worked anywhere that I felt disrespected as a physician. I would probably quit if I did. Even if the job paid a little more, you can't put a price on respect. You have to go there every day, so it is worth giving up a little bit of money in order to not be miserable with your life. I remember when I went on residency interviews, one of the hospitals had the anesthesiologists wear pink scrubs, while everybody else wore green. They looked like nurses. I didn't even bother to stay for the interview. You will only be treated the way you allow yourself to be treated. The more anesthesiologists that allow themselves to be treated like 2nd rate doctors, the worse it is for all of us.
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I did quit. The job actually paid less. Sometimes taking a step backwards to make a few steps forward is just... a step backwards. Recognize that. Leave.

And I agree that the **** you take equals the **** you'll get, which is basically what you said in your last sentence. Although we all have to cater and facilitate on some level in our specialty, doesn't mean you have to be a doormat. Ever.
 
I am a rising MS4 who will apply to anesthesia this year despite reading this forum for years. I can't lie- at times what I read here made me deeply uncomfortable. But in my three short years in medical school, there are two things I've yet to find (despite my best efforts): 1) any specialty I liked better, or even half as much and 2) an unhappy anesthesiologist.
 
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Nivens said:
I am a rising MS4 who will apply to anesthesia this year despite reading this forum for years. I can't lie- at times what I read here made me deeply uncomfortable. But in my three short years in medical school, there are two things I've yet to find (despite my best efforts): 1) any specialty I liked better, or even half as much and 2) an unhappy anesthesiologist.
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Dude, no attending will tell that to a medical student rotating through his service. Plus s/he won't bitch about the job except to other attendings. You will get a much better idea about the field reading this forum, where people think they are relatively anonymous.

Do yourself a favor and find a surgical specialty you like. Your generation is doomed in anesthesia.
 
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FFP said:
Do yourself a favor and find a surgical specialty you like. Your generation is doomed in anesthesia.
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All the surgeons I've talked to have told me to do anesthesia. All the anesthesiologists I've talked to have told me to do anesthesia. I like anesthesia. I'm going to do anesthesia.


I may never make 500k, but absolute worst case scenario, I think I'm still looking at a pretty good life.
 
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Nivens said:
I may never make 500k, but absolute worst case scenario, I think I'm still looking at a pretty good life.
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I wouldn't be so sure about that. Just my 2 cents.

Do it if you are crazy about it. Don't do it just because you think it's a good life. It's not a lifestyle specialty, and it's sinking fast. It's a valet, I mean "service" specialty; you have almost zero clout as a doctor in your hospital (or department). Nurse administrators love CRNAs (more), bean counters love CRNAs (more); you will be there to clean up their ****.

Do it if you (also) want to do critical care. Do it if you have a great CV that will get you into great programs that will get you into a pain fellowship. Don't do it for anesthesia proper; 10 years from now you'll regret it.
 
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FFP said:
Dude, no attending will tell that to a medical student rotating through his service. Plus s/he won't bitch about the job except to other attendings. You will get a much better idea about the field reading this forum, where people think they are relatively anonymous.

Do yourself a favor and find a surgical specialty you like. Your generation is doomed in anesthesia.
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How is surgery any better? They work longer hours than anesthesiologists and the pay isn't that much better (if at all) unless you're an orthopedic surgeon or a neurosurgeon.
 
circulus vitios said:
How is surgery any better? They work longer hours than anesthesiologists and the pay isn't that much better (if at all) unless you're an orthopedic surgeon or a neurosurgeon.
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Until our current system changes the surgeons bring the business to the hospital and are catered to. Anesthesiologists are not. That's the difference. It is not "shift" work like in the ED either. You have no real control over your daily life. Surgeons book cases and you are expected to cover them. Not enough cases at your hospital (for whatever reason from new hospital/surg center opening up down the street where you don't have the contract to perception of crappy care) and you may be out of a job anyway.

As an anesthesiologist you are totally at the whim of administration and forces beyond your control. If you are down with that then fire away.
 
BuzzPhreed said:
Until our current system changes the surgeons bring the business to the hospital and are catered to. Anesthesiologists are not. That's the difference. It is not "shift" work like in the ED either. You have no real control over your daily life. Surgeons book cases and you are expected to cover them. Not enough cases at your hospital (for whatever reason from new hospital/surg center opening up down the street where you don't have the contract to perception of crappy care) and you may be out of a job anyway.

As an anesthesiologist you are totally at the whim of administration and forces beyond your control. If you are down with that then fire away.
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Isn't that the point of a service specialty? No different than a radiologist being expected to read a CT scan, or a pathologist and a microscope slide. All specialties are the whim of an administrator. If surgeons screw around -- habitually late to the OR and/or throwing **** fits that delay the case -- then they're going to get their ass chewed by administrators because time is money, especially when a very expensive and in-demand OR isn't be utilized.

As far as controllable lifestyle goes, anesthesiology does seem ****ty but it's a hell of a lot better than surgery. As far as I know, you guys aren't taking weekend call/steady weekday call/doing weekend rounds as an attending?
 
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circulus vitios said:
How is surgery any better? They work longer hours than anesthesiologists and the pay isn't that much better (if at all) unless you're an orthopedic surgeon or a neurosurgeon.
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They don't work longer hours but they do spend most of their time in clinic :eek:
 
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circulus vitios said:
As far as controllable lifestyle goes, anesthesiology does seem ****** but it's a hell of a lot better than surgery. As far as I know, you guys aren't taking weekend call/steady weekday call/doing weekend rounds as an attending?
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??? We have anesthesiologists in house 24/7/365.
 
jwk said:
??? We have anesthesiologists in house 24/7/365.
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Ditto that. I work 24 hour calls approximately q7 and I work 17 weekends a year, as well as 2-3 holidays a year (all in-house). And I think I have a pretty good job.
 
After four years of _____, I still have my day ruined by some jerk ____ treating me like crap compared to ______
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So lets remove all things specific to anesthesia and I think there are two things here that are perhaps the issue.
1. This expectation that a person's profession/training dictates how one should be treated/respected
2. You allowing your day to be ruined by a triviality/comparison with someone else

I would expect that you'd be upset by something regardless of what you did if those things were always a factor
 
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Orin said:
I would expect that you'd be upset by something regardless of what you did if those things were always a factor
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No, it's about having and maintaining control of a particular situation. It used to be that when the doctor spoke, there weren't ten layers of bullsh*t he/she had to talk through. That's changed. Now it's only the people who bring $$$ to the hospital who have less of this to deal with.

I briefly was in a practice where I had to negotiate care, regardless as to whether or not I was ultimately correct (usually I was although some of it didn't matter ultimately, I admit), and often agree to an inferior plan. This was simply so as to not rock the boat and keep the machine running.

This is part-and-parcel to the service industry, and it is still different than what radiologists and ED physicians have to deal with. There's no radiology tech telling them that they're not going to do something because they disagree with it. That was a regular part of my day. Until I realized that I didn't have to put up with that B.S. and I went back to my old job. I'm only wondering how long I will be able to ride the current system until more and more people who actually don't touch the patient, or don't really know how to touch the patient, continue to encroach on telling me what I can and can't do. That's the difference.
 
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circulus vitios said:
Isn't that the point of a service specialty? No different than a radiologist being expected to read a CT scan, or a pathologist and a microscope slide. All specialties are the whim of an administrator. If surgeons screw around -- habitually late to the OR and/or throwing **** fits that delay the case -- then they're going to get their ass chewed by administrators because time is money, especially when a very expensive and in-demand OR isn't be utilized.

As far as controllable lifestyle goes, anesthesiology does seem ****** but it's a hell of a lot better than surgery. As far as I know, you guys aren't taking weekend call/steady weekday call/doing weekend rounds as an attending?
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You seem to defend anesthesiology like you're trying to justify a mistake in going into it. Please don't take this as an insult, it's not. It's just what I perceive from most of your posts regarding anesthesiology.
 
BuzzPhreed said:
No, it's about having and maintaining control of a particular situation. It used to be that when the doctor spoke, there weren't ten layers of bullsh*t he/she had to talk through. That's changed. Now it's only the people who bring $$$ to the hospital who have less of this to deal with.

I briefly was in a practice where I had to negotiate care, regardless as to whether or not I was ultimately correct (usually I was although some of it didn't matter ultimately, I admit), and often agree to an inferior plan. This was simply so as to not rock the boat and keep the machine running.

This is part-and-parcel to the service industry, and it is still different than what radiologists and ED physicians have to deal with. There's no radiology tech telling them that they're not going to do something because they disagree with it. That was a regular part of my day. Until I realized that I didn't have to put up with that B.S. and I went back to my old job. I'm only wondering how long I will be able to ride the current system until more and more people who actually don't touch the patient, or don't really know how to touch the patient, continue to encroach on telling me what I can and can't do. That's the difference.
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Surgeons aren't indispensable. You're crazy if you think penny pinching administrators view surgeons as anything more than a figure on a spread sheet.
 
Baller MD said:
You seem to defend anesthesiology like you're trying to justify a mistake in going into it. Please don't take this as an insult, it's not. It's just what I perceive from most of your posts regarding anesthesiology.
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Maybe, but I think calling surgery a better field than anesthesiology with regard to money and lifestyle is ridiculous.
 
Pride and respect are close cousins of money. Once you start looking for them, you never get enough.
 
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This respect thing is all in your head.. if you went to med school and residency in order to have your butt kissed by some hourly hospital employee you will be sorely disappointed. My best friend is an orthopod.. if he waits to finish pinching a loaf before call back a primary physician the consult and patient go to someone else. He does 10-12 hours on his operating days and sees 40+ patients a day on his office days. If you think the 2 hours you spent caring for that "self pay" patient were bad, he has to deal with that same guy for weeks after you've already forgotten him. I watch him get the the tagalog "YES DOCTOOOOOR" of death over and over and then get laughed at the moment he leaves the room while his preference cards have the same wrong sutures for the past 5 years. It almost seems like the nurses / scrub techs / sterile processing people are intentionally screwing with his instruments, pretending to not know how to answer his phone when he is operating on call, holding up his cases for BS chart problems, contaminating entire trays of implants in middle of a procedure, screwing up counts and oh yes.. watching my colleagues cancel his cases for questionable reasons so they can make it to juniors soccer game.

The kicker is that he is a nice guy.. a "respected" surgeon and someone who brings an inordinate amount of cash into the hospital and surgery center. He has operated on several of the nurses we work with and takes care of many of their family members. I estimate that on a given day I deal with 5% of the BS he deals with and work 1/3 as many hours over the course an average month. I also know how much he makes and it sure as heck isn't triple what I make.. not even close.

None of the "disrespect" mentioned in this thread impairs my ability to care for a patient to the best of my abilities while earning a generous salary and maintaining a very good lifestyle. Do your job, collect your paycheck and buy yourself something nice.

/rant
 
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Gasworks said:
This respect thing is all in your head.. if you went to med school and residency in order to have your butt kissed by some hourly hospital employee you will be sorely disappointed. My best friend is an orthopod.. if he waits to finish pinching a loaf before call back a primary physician the consult and patient go to someone else. He does 10-12 hours on his operating days and sees 40+ patients a day on his office days. If you think the 2 hours you spent caring for that "self pay" patient were bad, he has to deal with that same guy for weeks after you've already forgotten him. I watch him get the the tagalog "YES DOCTOOOOOR" of death over and over and then get laughed at the moment he leaves the room while his preference cards have the same wrong sutures for the past 5 years. It almost seems like the nurses / scrub techs / sterile processing people are intentionally screwing with his instruments, pretending to not know how to answer his phone when he is operating on call, holding up his cases for BS chart problems, contaminating entire trays of implants in middle of a procedure, screwing up counts and oh yes.. watching my colleagues cancel his cases for questionable reasons so they can make it to juniors soccer game.

The kicker is that he is a nice guy.. a "respected" surgeon and someone who brings an inordinate amount of cash into the hospital and surgery center. He has operated on several of the nurses we work with and takes care of many of their family members. I estimate that on a given day I deal with 5% of the BS he deals with and work 1/3 as many hours over the course an average month. I also know how much he makes and it sure as heck isn't triple what I make.. not even close.

None of the "disrespect" mentioned in this thread impairs my ability to care for a patient to the best of my abilities while earning a generous salary and maintaining a very good lifestyle. Do your job, collect your paycheck and buy yourself something nice.

/rant
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I call bullshit on this story. If he's a "nice guy" and "respected" surgeon no one is going to do this to him. Only the assholes get treated like this. Something in your anecdote isn't adding up.
 
I agree with the OP that there seems to be a lack of respect for anesthesiologists that surprised me when I started residency. But to be honest I feel there is a sort of lack of respect for physicians in general that I didn't expect. I feel this may be because its seems currently "fashionable" for docs to seem like regular people-joking with nurses and staff, going out for drinks on occasion. When I was a kid my pediatrician had such strict old school bedside manner and professionalism that commanded respect. Now it seems this kind of doc is going extinct.
 
BuzzPhreed said:
I call bullshit on this story. If he's a "nice guy" and "respected" surgeon no one is going to do this to him. Only the assholes get treated like this. Something in your anecdote isn't adding up.
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What is happening in this anecdote would also likely affect the bottom line. Contaminating implants and trays? Not cheap, and not tolerated pretty much anywhere.
 
You'll realize after a few years of making 420K to do a fairly easy job that it doesn't really matter - at least I did. It says more about the surgeon than it does about you if they treat anyone as a "second class physician". Just get along and be happy. Life has a way of sorting out the douche bags...
 
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