Thinking About Quitting Anesthesia Residency

[UnhappycGas]

I am a current CA-1, and since July things have not been going that well.

First, the environment that I work in is full of political tension. At one site, spinals and regionals are not done out of fear of upsetting the surgeons who want to start the case immediately. Resident work hours have increased as surgeons demand to do what they want when they want because 'they are the ones that bring in the money'.

A good number of the anesthetists seem to be very political, and talk openly about how they do everything on their own and the MD's are just there to push drugs at the beginning of the case and rubber stamp the chart. Some claim that they are being 'raped' and that the anesthesia care team model is "bull****". Others very publicly state that there is no practical difference between an MD and CRNA/AA and that all of the MD's detailed knowledge about how this stuff works and complementary medical knowledge is irrelevant.

Alarmingly, it seems to me that they are right in about 95% of the cases- which are completely straightforward and amenable to protocolization. The attending pushes drugs, leaves, and then signs the patient out of PACU. Beyond that, "see this, do that" carries the day.

Everyone from the anesthetists to the surgeons and nurses and even some attendings seem to look down their nose at anesthesia residents. I am constantly getting snapped at, talked down to, and occasionally even publicly humiliated. We have one especially notorious attending who has lost jobs in the past for his temperment flip out on me (over nothing) to the point where I questioned my physical safety. I have had surgery residents in the OR and PACU turn to me and express disbelief that I get treated like this. Anesthesia appealed to me in part because I thought the people were friendly and laid back. BOY was I WRONG!

The nurses and anesthetists (who are beloved by the attendings because they are potentially there forever, need to be retained, and can make their lives easier) are quick to complain about the residents and the department will take their side. I have learned to successfully avoid confrontation by putting on a fake smile and kissing up to them all, but I can't take it much longer. My stress level is up to 11/10 and I fell like I'm in that old Simpsons Halloween episode where Bart had the power to put a magical curse on anyone who said, did, or thought anything 'unhappy'.

On top of all that, the teaching is mediocre. While there are some exceptions, most attendings are around for induction and then walk out of the room never to return. If I call with a question, I sometimes get an annoyed response or am told something along the lines of "its physiology" or "I'm not here to read you a textbook".

The workload is heavy (close to 70hr weeks as an overall average), and calls are frequent and brutal. I usually run around like a headless chicken all night don't feel normal for a couple days afterwards. I'm sure a lot of people reading this have or had much worse, but my current workload is a lot to stomach in the context of everything else going on... another straw on the camel's back. The 3-4 ICU months ahead of me will be even worse.

If I was sure that it was all going to lead to a good end, I would probably stomach it and endure. But I'm not. It really seems to me that most operations don't need an anesthesiologist, and those who have recently graduated tell me that most anesthetists out there are very adamant about doing it their way. In the best case scenario, do I really want to be someone who basically organizes anesthetists all day and rubber stamps charts? With the number of new CRNA schools opening and the volume of new graduates getting pumped out I doubt the remaining MD only models will last much longer in the face of the constant cost pressure.

In the worst case scenario, do I want to have to retrain in the future after going through all this? Right now, MD's have been able to maintain their grip on supervision because of slightly lower across the board mortality (in addition to a mountain of lucrative campaign contributions and expensive lobbyists). Once insurance companies and medicare figure out WHICH cases benefit from MD anesthesia (which will probably be a minority) it could all be over- especially in light of cost pressures which are going to get high enough to turn coal into diamonds once the baby boomers hit the medicare payroll and healthcare shoots past 20% of the US GDP. Either that or they could decide that the overall 30 day mortality benefit of one in 400 cases for physician supervision isn't worth the greatly increased expense.

On the other hand, I truly enjoy the physiology and pharmacology, and like the procedures. I am generally happy when I am in the OR if there aren't peripheral issues making my life miserable. My wife is in the city she wants to be in and has a job that she loves. We own a home, and in this economy would have a heck of a time selling it. Beyond that, If I were to quit I'd be trading a devil I know for a devil I don't. Who knows what kind of unforseen problems might arise in another field and city or if I'd be even more unhappy? Radiology is calling me, but finding an outside the match spot would probably be impossible and it would be a bear to wait a year to match who knows where and then wait another year and a half to start.

Any thoughts would be appreciated,
-Unhappy

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[Nuriko]

I am a current CA-1, and since July things have not been going that well.

First, the environment that I work in is full of political tension. At one site, spinals and regionals are not done out of fear of upsetting the surgeons who want to start the case immediately. Resident work hours have increased as surgeons demand to do what they want when they want because 'they are the ones that bring in the money'.

A good number of the anesthetists seem to be very political, and talk openly about how they do everything on their own and the MD's are just there to push drugs at the beginning of the case and rubber stamp the chart. Some claim that they are being 'raped' and that the anesthesia care team model is "bull****". Others very publicly state that there is no practical difference between an MD and CRNA/AA and that all of the MD's detailed knowledge about how this stuff works and complementary medical knowledge is irrelevant.

Alarmingly, it seems to me that they are right in about 95% of the cases- which are completely straightforward and amenable to protocolization. The attending pushes drugs, leaves, and then signs the patient out of PACU. Beyond that, "see this, do that" carries the day.

Everyone from the anesthetists to the surgeons and nurses and even some attendings seem to look down their nose at anesthesia residents. I am constantly getting snapped at, talked down to, and occasionally even publicly humiliated. We have one especially notorious attending who has lost jobs in the past for his temperment flip out on me (over nothing) to the point where I questioned my physical safety. I have had surgery residents in the OR and PACU turn to me and express disbelief that I get treated like this. Anesthesia appealed to me in part because I thought the people were friendly and laid back. BOY was I WRONG!

The nurses and anesthetists (who are beloved by the attendings because they are potentially there forever, need to be retained, and can make their lives easier) are quick to complain about the residents and the department will take their side. I have learned to successfully avoid confrontation by putting on a fake smile and kissing up to them all, but I can't take it much longer. My stress level is up to 11/10 and I fell like I'm in that old Simpsons Halloween episode where Bart had the power to put a magical curse on anyone who said, did, or thought anything 'unhappy'.

On top of all that, the teaching is mediocre. While there are some exceptions, most attendings are around for induction and then walk out of the room never to return. If I call with a question, I sometimes get an annoyed response or am told something along the lines of "its physiology" or "I'm not here to read you a textbook".

The workload is heavy (close to 70hr weeks as an overall average), and calls are frequent and brutal. I usually run around like a headless chicken all night don't feel normal for a couple days afterwards. I'm sure a lot of people reading this have or had much worse, but my current workload is a lot to stomach in the context of everything else going on... another straw on the camel's back. The 3-4 ICU months ahead of me will be even worse.

If I was sure that it was all going to lead to a good end, I would probably stomach it and endure. But I'm not. It really seems to me that most operations don't need an anesthesiologist, and those who have recently graduated tell me that most anesthetists out there are very adamant about doing it their way. In the best case scenario, do I really want to be someone who basically organizes anesthetists all day and rubber stamps charts? With the number of new CRNA schools opening and the volume of new graduates getting pumped out I doubt the remaining MD only models will last much longer in the face of the constant cost pressure.

In the worst case scenario, do I want to have to retrain in the future after going through all this? Right now, MD's have been able to maintain their grip on supervision because of slightly lower across the board mortality (in addition to a mountain of lucrative campaign contributions and expensive lobbyists). Once insurance companies and medicare figure out WHICH cases benefit from MD anesthesia (which will probably be a minority) it could all be over- especially in light of cost pressures which are going to get high enough to turn coal into diamonds once the baby boomers hit the medicare payroll and healthcare shoots past 20% of the US GDP. Either that or they could decide that the overall 30 day mortality benefit of one in 400 cases for physician supervision isn't worth the greatly increased expense.

On the other hand, I truly enjoy the physiology and pharmacology, and like the procedures. I am generally happy when I am in the OR if there aren't peripheral issues making my life miserable. My wife is in the city she wants to be in and has a job that she loves. We own a home, and in this economy would have a heck of a time selling it. Beyond that, If I were to quit I'd be trading a devil I know for a devil I don't. Who knows what kind of unforseen problems might arise in another field and city or if I'd be even more unhappy? Radiology is calling me, but finding an outside the match spot would probably be impossible and it would be a bear to wait a year to match who knows where and then wait another year and a half to start.

Any thoughts would be appreciated,
-Unhappy

It sounds to me like your unhappiness stems not from the field of anesthesia, but rather from the setting you happen to be in. It sounds like a malignant program, with excessive hours, poor teaching, and very pissy and political people, both within and outside of your field. If you really enjoy the field otherwise, then deal with it for the next 3 yrs and then go someplace where you will fit in better.

 

[RxBoy]

In the worst case scenario, do I want to have to retrain in the future after going through all this? Right now, MD's have been able to maintain their grip on supervision because of slightly lower across the board mortality (in addition to a mountain of lucrative campaign contributions and expensive lobbyists). Once insurance companies and medicare figure out WHICH cases benefit from MD anesthesia (which will probably be a minority) it could all be over- especially in light of cost pressures which are going to get high enough to turn coal into diamonds once the baby boomers hit the medicare payroll and healthcare shoots past 20% of the US GDP. Either that or they could decide that the overall 30 day mortality benefit of one in 400 cases for physician supervision isn't worth the greatly increased expense.

Funny, this was always my attending's argument why we always NEED anesthesiologists. He claimed no matter how many CRNAs and Anesthesiologists get trained, the demand (especially with the baby boomers) will always outpace the supply.

This however visits a very scary alternative. If the demand is outpaced faster than insurance can pay, we'll be starring at new legislation. Anesthesiologists may have the upper hand when it comes to "Patient comes first". But if it becomes a monatary issue (especially with this ongoing economic collapse), CRNA's will have the upper hand.

 

[Jeff05]

when you're THE ONE that has to make real clinical decisions (not how much prop to push in a healthy 24 year old for an LMA) and take full responsibility for them, you'll see how "algorithmic" it is. the reason you don't actually know how much you don't know or how much responsibility you will have is because you are a ca1. you may get a feel of what it's like to be an attending sometime in your ca3 year.

the attending doesn't just push drugs and signs charts - he actually approves and monitors the complete scope of a midlevel's practice. CRNAs are so used to this that they think they are practicing without supervision. right. as soon as **** hits the fan, or there is an upper level management question (a patient with a T3 cord lesion and and morbid obesity with difficult airway comes for a cystoscopy...) the attending is the one who is there to BACK THEM UP. she is the LAST LINE OF DEFENSE.

i wouldn't call a NURSE getting 150k/yr for 36 hour workweeks (while many MDs make substantially less) as "getting raped" either.

as far as being "sure that this will lead to a good end" - you can't be sure of ANYTHING IN LIFE. yea, there is a chance that gas salaries will get hit and you'll be making 150k/yr. yep, has happened before. there is a chance that you may have a difficulty finding a job, because the entire country has converted to ONLY nursing anesthesia. or maybe a version of the McGill anesthesia machine that just does everything electronically. once the cuts hit, trust me rads is not going to make 500k/yr for suggesting to clinically correlate. \


what is more likely however, is that:
1. you will always have a job, regardless of economy or country of residence
2. you will always make enough money to lead at least a middle class life
3. residency sucks more than most things and once you're an attending you will develop relationships with surgeons, as well as mutual respect
4. CRNAs will not get completely independent practice in states that believe in evolution/have populations >5 million and put all MDs out of business.
5. this is one specialty i which you can do a 1 year fellowship in:
a. peds - nurses will NEVER be allowed to touch kids in most of US
b. ICU - nurses will NEVER supervise an ICU
c. cardiac - nurses will NEVER get TEE
d. pain - nurses will NE...well, i hope not.
e. OBs will never let a CRNA manage anesthesia on their floors

 

[Planktonmd]

I have to start by saying that the specialty of anesthesiology is not disappearing and what you are being told by your CRNA "colleagues" is simply their political rhetoric that they use to advertise their silly agenda.
Anesthesiology is the practice of perioperative medicine and no nurse is qualified to do that.
You are right on one thing, a nurse can administer anesthesia but that's not what you are being trained to do, you my friend are going to be a consultant physician in the specialty of anesthesiology.
I am not saying that it's going to be easy or that there are no worries about the future, I am saying that if you like this specialty enough and you are willing to take the pain (which does not seem to be the case), then it is worth it.
Residency is not a vacation, you will work hard and you will not be appreciated most of the time, but that's OK, you are not there to be appreciated, you are there to learn anesthesiology, politics, how to avoid conflicts and how to survive.
The more they hurt you right now the more strength you will have in the future.
If you feel that the place where you are is absolutely terrible and you are unable to continue then go somewhere else, don't switch specialties.
But again, if you went to anesthesia because you wanted an easy ride and for the "life style" then by all means go become a radiologist.

 

[cfdavid]

Plank, very insightful response.

Perhaps I'll elaborate later, and maybe I've just had good experiences (the residents at my home program are (and at all levels), as an almost universal rule, quite happy), but I'm not concerned about the future of this profession. Again, if this arguement heats up, I'll elaborate why, as an MS3, I feel the future is quite intact.

Sure, there will always be challenges. Hell, my NP aunt just opened up a very classy psychiatric clinic. She's the owner and there's an MD that is "medical director" whom I can guarantee will never set foot in that place.
So, many fields in medicine face challenges, by no means just anesthesiology.

 

[SleepIsGood]

To the OP

Hey man, I hear your pain. Many have followed in your footsteps and were in similar positions during their CA1. It is not appealing at times to be treated in the manner you describe.

Here's my suggestion. Suck it up and start your CA2 year up. A lot of the 'anxiety' you feel now is external, but may also be because you are not completely comfortable with everything yet. The more comfortable you become with the Bread and Butter procedures, the more your confidence will increase.

You got here and made it this far. Barring some physical threat to you, I say try to work it out.

 

[sevo85288]

Sorry to hear about your situation. Anesthesiology is not going anywhere. At my institution pt's are getting sicker and older. A CRNA would not be able to do most of the cases here. We just got rid our last CRNA in our ASC (we didn't use them in the hosptial) Bottom line, we provide good, safe service and pt's do great. Kaiser N. CA is a large employer of CRNAs and they have gone from 1:2 to a 2:1 ratio of MDs to CRNAs. They are all about the bottom line. Why do you think they have had a change of heart? More complications, sicker patients and scheduling difficulties and no $$ savings.

 

[Noyac]

When I read your post, I can't help but think that you are trying to convince yourself that you don't like anesthesia.
I also know that one side of the story is not the whole story but thats not important here. My gut tells me you should get out of anesthesia.

 

[ProRealDoc]

I am a current CA-1, and since July things have not been going that well.

First, the environment that I work in is full of political tension. At one site, spinals and regionals are not done out of fear of upsetting the surgeons who want to start the case immediately. Resident work hours have increased as surgeons demand to do what they want when they want because 'they are the ones that bring in the money'.

A good number of the anesthetists seem to be very political, and talk openly about how they do everything on their own and the MD's are just there to push drugs at the beginning of the case and rubber stamp the chart. Some claim that they are being 'raped' and that the anesthesia care team model is "bull****". Others very publicly state that there is no practical difference between an MD and CRNA/AA and that all of the MD's detailed knowledge about how this stuff works and complementary medical knowledge is irrelevant.

Alarmingly, it seems to me that they are right in about 95% of the cases- which are completely straightforward and amenable to protocolization. The attending pushes drugs, leaves, and then signs the patient out of PACU. Beyond that, "see this, do that" carries the day.

Everyone from the anesthetists to the surgeons and nurses and even some attendings seem to look down their nose at anesthesia residents. I am constantly getting snapped at, talked down to, and occasionally even publicly humiliated. We have one especially notorious attending who has lost jobs in the past for his temperment flip out on me (over nothing) to the point where I questioned my physical safety. I have had surgery residents in the OR and PACU turn to me and express disbelief that I get treated like this. Anesthesia appealed to me in part because I thought the people were friendly and laid back. BOY was I WRONG!

The nurses and anesthetists (who are beloved by the attendings because they are potentially there forever, need to be retained, and can make their lives easier) are quick to complain about the residents and the department will take their side. I have learned to successfully avoid confrontation by putting on a fake smile and kissing up to them all, but I can't take it much longer. My stress level is up to 11/10 and I fell like I'm in that old Simpsons Halloween episode where Bart had the power to put a magical curse on anyone who said, did, or thought anything 'unhappy'.

On top of all that, the teaching is mediocre. While there are some exceptions, most attendings are around for induction and then walk out of the room never to return. If I call with a question, I sometimes get an annoyed response or am told something along the lines of "its physiology" or "I'm not here to read you a textbook".

The workload is heavy (close to 70hr weeks as an overall average), and calls are frequent and brutal. I usually run around like a headless chicken all night don't feel normal for a couple days afterwards. I'm sure a lot of people reading this have or had much worse, but my current workload is a lot to stomach in the context of everything else going on... another straw on the camel's back. The 3-4 ICU months ahead of me will be even worse.

If I was sure that it was all going to lead to a good end, I would probably stomach it and endure. But I'm not. It really seems to me that most operations don't need an anesthesiologist, and those who have recently graduated tell me that most anesthetists out there are very adamant about doing it their way. In the best case scenario, do I really want to be someone who basically organizes anesthetists all day and rubber stamps charts? With the number of new CRNA schools opening and the volume of new graduates getting pumped out I doubt the remaining MD only models will last much longer in the face of the constant cost pressure.

In the worst case scenario, do I want to have to retrain in the future after going through all this? Right now, MD's have been able to maintain their grip on supervision because of slightly lower across the board mortality (in addition to a mountain of lucrative campaign contributions and expensive lobbyists). Once insurance companies and medicare figure out WHICH cases benefit from MD anesthesia (which will probably be a minority) it could all be over- especially in light of cost pressures which are going to get high enough to turn coal into diamonds once the baby boomers hit the medicare payroll and healthcare shoots past 20% of the US GDP. Either that or they could decide that the overall 30 day mortality benefit of one in 400 cases for physician supervision isn't worth the greatly increased expense.

On the other hand, I truly enjoy the physiology and pharmacology, and like the procedures. I am generally happy when I am in the OR if there aren't peripheral issues making my life miserable. My wife is in the city she wants to be in and has a job that she loves. We own a home, and in this economy would have a heck of a time selling it. Beyond that, If I were to quit I'd be trading a devil I know for a devil I don't. Who knows what kind of unforseen problems might arise in another field and city or if I'd be even more unhappy? Radiology is calling me, but finding an outside the match spot would probably be impossible and it would be a bear to wait a year to match who knows where and then wait another year and a half to start.

Any thoughts would be appreciated,
-Unhappy

In summary, what makes anesthesia residency stink are the never-ending, annoying, day-to-day dealing with CRNAs and spineless, weak, lame attendings.

 

[UnhappycGas]

double post

 

[UnhappycGas]

when you're THE ONE that has to make real clinical decisions (not how much prop to push in a healthy 24 year old for an LMA) and take full responsibility for them, you'll see how "algorithmic" it is. the reason you don't actually know how much you don't know or how much responsibility you will have is because you are a ca1. you may get a feel of what it's like to be an attending sometime in your ca3 year.

the attending doesn't just push drugs and signs charts - he actually approves and monitors the complete scope of a midlevel's practice. CRNAs are so used to this that they think they are practicing without supervision. right. as soon as **** hits the fan, or there is an upper level management question (a patient with a T3 cord lesion and and morbid obesity with difficult airway comes for a cystoscopy...) the attending is the one who is there to BACK THEM UP. she is the LAST LINE OF DEFENSE.

i wouldn't call a NURSE getting 150k/yr for 36 hour workweeks (while many MDs make substantially less) as "getting raped" either.

as far as being "sure that this will lead to a good end" - you can't be sure of ANYTHING IN LIFE. yea, there is a chance that gas salaries will get hit and you'll be making 150k/yr. yep, has happened before. there is a chance that you may have a difficulty finding a job, because the entire country has converted to ONLY nursing anesthesia. or maybe a version of the McGill anesthesia machine that just does everything electronically. once the cuts hit, trust me rads is not going to make 500k/yr for suggesting to clinically correlate. \


what is more likely however, is that:
1. you will always have a job, regardless of economy or country of residence
2. you will always make enough money to lead at least a middle class life
3. residency sucks more than most things and once you're an attending you will develop relationships with surgeons, as well as mutual respect
4. CRNAs will not get completely independent practice in states that believe in evolution/have populations >5 million and put all MDs out of business.
5. this is one specialty i which you can do a 1 year fellowship in:
a. peds - nurses will NEVER be allowed to touch kids in most of US
b. ICU - nurses will NEVER supervise an ICU
c. cardiac - nurses will NEVER get TEE
d. pain - nurses will NE...well, i hope not.
e. OBs will never let a CRNA manage anesthesia on their floors

I completely agree that attending anesthesiologists are far better suited to make complex clinical decisions. I have tremendous respect for the knowledge bases of my attendings, and am in no way, shape, or form trying to knock it. I also completely agree that the vast majority of anesthetists are abjectly lost when it comes to understanding the details of what they are doing. My points are:

1) Complex clinical decision making does not come to play in a significant majority of cases. I may not be doing the big neuro, cards, liver transplants, etc, (which certainly are the exception) but I sit in a room all day every day doing just about every low and medium risk procedure you can imagine. Seldom does anything really complex ever come up. A little hypotension here, a high peak pressure there... But rarely is there anything to really sink your teeth into- even in the ASA 3's.

2) Despite the gaping knowledge gap, nurse anesthetists handle themselves fairly well without MD backup. The UPENN study that MD's primarily use to justify supervision requirements shows an excess 30 day mortality of only one death for every four hundred cases when the CRNA is THE ONE making the decisions. If the appropriate subgroup analysis and follow up studies were ever completed I suspect that we would see some very large subgroups where there was little to no difference at all. In those cases, the additional cost might even lead to higher global mortality because of higher cost being a barrier to access.

The idea of switching to radiology is not about money. I never expected the current salary levels to stay anywhere near where they currently are in either field. Rather, the reward I am concerned with is being happy in the future. Will I like who I am working with? Will I dread the political ramifications of every word out of my mouth? Will I be proud of what I do?

My number one complaint about anesthesiology is its highly political nature. You have the surgeons who think you are their dog, the midlevels who think you are a parasite on their back, and the nurses who think you're their orderly. I see the attendings at my program getting zero respect from anyone, not standing up for the department or for the residents, and apparently very unhappy. When I was a medicine intern, I had one real problem with a nurse all year. And that one time my attending stood up for me and let them have it. Nobody gave me grief as an *intern*, but as a resident I'm constantly heaped under dung and expected to just roll over and take it. Its not just about residency stinking; I worked significantly longer hours as an intern but still felt like a human being through it all. Now, I often am made to feel less than human. In order to be successful in the future of anesthesiology I think you'll need to be a great people manager and politician. You also have to be ready to turn the other cheek back and forth day after day as they are incessantly slapped. I am not.

What attracts me to radiology (or pathology) is that you still have the thought process, the interpretation, and the analysis but with much less of the political bull. I think I could interpret images/slides for 50 hours a week at 130K per year and still be very happy as long as I was able to focus on my work in peace and not have to worry about being utterly displaced. Some people say they couldnt sit in a dark room all day, but I say it beats sitting there while some surgeon spits venom from across the curtain and your midlevels are trying to knife you in the back.

I also think the worst case scenario is far more bleak than a lot of people recongize. Some neglect to consider that CRNA salaries are tied to their value in extending or replacing a physician. If we go to a system in which CRNA's have independent practice, (a decision that could be made at a national level in an upcoming 'non-exclusive but extremely large government payer setup' like the one Obama proposes) the next step is for the government and insurance companies to bring their salaries more in line with other mid levels. "If you dont need to be a doctor to do this, then you don't need to get paid that much". Supply and demand will surely buffer this for a time but as more and more CRNA schools open and pump out more and more CRNA's, salaries will come down. In the coming "pay for service" rather than a "pay for degree" environment, that would leave MD anesthesiologists up the proverbial creek. In a nightmare scenario, 150K would be a pipe dream.

Around here the anesthetists are doing hearts and peds too. In fact, they say that the MD's don't give them any more input there than anywhere else. There are already plenty of hospitals in this country where OB is CRNA only, and there's not good evidence to say they're any worse off. The CRNA's are also fighting hard to have pain management recognized as being 'within the scope of nursing'. Soon, I'm sure the DNP's will be doing their "residencies" in hearts, peds, pain, etc. etc. as well.

When I applied to anesthesiology, I could HONESTLY say that this is what I wanted to do regardless of salary or anything else and that's why I chose it. I was under no illusion that I was going into derm, psych, or occupational medicine and expected to work 60+ hours a week and take call. At the same time I expected to be able to hold my head up at the end of the day. The physiology, pharmacology, immediate results, and procedures appealed to me a lot and still do. In a vacuum, I still enjoy it. I'm just not sure I want to deal with the bickering, politics, and the perennial threat of losing my livelihood for the rest of my career.

I'm clearly very upset now, yet I don't know what I'm going to do. One part of me says suck it up a while and see if things get better CA-2 year, but the other part of me says get out now and start preparing for the 2010 match.

 

[Jeff05]

OP,
you're having a classic anesthesia ego problem. usually it doesn't hit till ca2 year though. and granted your program seems to be pretty crappy and therefore amplify all the negative issues.

so you're either gonna get over it and learn how to deal in your own way. do not quit if you're concerned about midlevels. trust me, we will still be around for a long time.

but, if your ego can't accept your role in the scheme of things (you're not the boss), then do something else.

 

[Bertelman]

OP, if you don't like politics, get out of medicine. Radiology has its own set of problems. I know it sounds fun to Dx strange abd CTs, but you will be more likely to stare at 150 CXR a day.

There is no field of medicine immune from greed, jealousy and power struggles.

Sounds to me like you enjoy certain aspects of anesthesiology, but don't like the attitude. From what you describe, it;s one of the worst programs I can imagine. That means it will *most* likely improve when you graduate.

PP surgeons won't treat you like shat.

 

[InductionAgent]

I also think the worst case scenario is far more bleak than a lot of people recongize. Some neglect to consider that CRNA salaries are tied to their value in extending or replacing a physician. If we go to a system in which CRNA's have independent practice, (a decision that could be made at a national level in an upcoming 'non-exclusive but extremely large government payer setup' like the one Obama proposes) the next step is for the government and insurance companies to bring their salaries more in line with other mid levels. "If you dont need to be a doctor to do this, then you don't need to get paid that much". Supply and demand will surely buffer this for a time but as more and more CRNA schools open and pump out more and more CRNA's, salaries will come down. In the coming "pay for service" rather than a "pay for degree" environment, that would leave MD anesthesiologists up the proverbial creek. In a nightmare scenario, 150K would be a pipe dream.

The worst-case scenario in my mind (which I don't think will happen) is that our income and practice opportunity becomes equal with CRNAs. And like many posters have indicated, CRNAs don't have a bad deal. It's unrealistically pessimistic to think that even if CRNAs do get full, unsupervised, unrestricted practice rights in every state that anesthesiologists couldn't continue to at least do the same work as them for the same pay.

 

[FBIprofiler]

I completely agree that attending anesthesiologists are far better suited to make complex clinical decisions. I have tremendous respect for the knowledge bases of my attendings, and am in no way, shape, or form trying to knock it. I also completely agree that the vast majority of anesthetists are abjectly lost when it comes to understanding the details of what they are doing. My points are:

1) Complex clinical decision making does not come to play in a significant majority of cases. I may not be doing the big neuro, cards, liver transplants, etc, (which certainly are the exception) but I sit in a room all day every day doing just about every low and medium risk procedure you can imagine. Seldom does anything really complex ever come up. A little hypotension here, a high peak pressure there... But rarely is there anything to really sink your teeth into- even in the ASA 3's.

2) Despite the gaping knowledge gap, nurse anesthetists handle themselves fairly well without MD backup. The UPENN study that MD's primarily use to justify supervision requirements shows an excess 30 day mortality of only one death for every four hundred cases when the CRNA is THE ONE making the decisions. If the appropriate subgroup analysis and follow up studies were ever completed I suspect that we would see some very large subgroups where there was little to no difference at all. In those cases, the additional cost might even lead to higher global mortality because of higher cost being a barrier to access.

The idea of switching to radiology is not about money. I never expected the current salary levels to stay anywhere near where they currently are in either field. Rather, the reward I am concerned with is being happy in the future. Will I like who I am working with? Will I dread the political ramifications of every word out of my mouth? Will I be proud of what I do?

My number one complaint about anesthesiology is its highly political nature. You have the surgeons who think you are their dog, the midlevels who think you are a parasite on their back, and the nurses who think you're their orderly. I see the attendings at my program getting zero respect from anyone, not standing up for the department or for the residents, and apparently very unhappy. When I was a medicine intern, I had one real problem with a nurse all year. And that one time my attending stood up for me and let them have it. Nobody gave me grief as an *intern*, but as a resident I'm constantly heaped under dung and expected to just roll over and take it. Its not just about residency stinking; I worked significantly longer hours as an intern but still felt like a human being through it all. Now, I often am made to feel less than human. In order to be successful in the future of anesthesiology I think you'll need to be a great people manager and politician. You also have to be ready to turn the other cheek back and forth day after day as they are incessantly slapped. I am not.

What attracts me to radiology (or pathology) is that you still have the thought process, the interpretation, and the analysis but with much less of the political bull. I think I could interpret images/slides for 50 hours a week at 130K per year and still be very happy as long as I was able to focus on my work in peace and not have to worry about being utterly displaced. Some people say they couldnt sit in a dark room all day, but I say it beats sitting there while some surgeon spits venom from across the curtain and your midlevels are trying to knife you in the back.

I also think the worst case scenario is far more bleak than a lot of people recongize. Some neglect to consider that CRNA salaries are tied to their value in extending or replacing a physician. If we go to a system in which CRNA's have independent practice, (a decision that could be made at a national level in an upcoming 'non-exclusive but extremely large government payer setup' like the one Obama proposes) the next step is for the government and insurance companies to bring their salaries more in line with other mid levels. "If you dont need to be a doctor to do this, then you don't need to get paid that much". Supply and demand will surely buffer this for a time but as more and more CRNA schools open and pump out more and more CRNA's, salaries will come down. In the coming "pay for service" rather than a "pay for degree" environment, that would leave MD anesthesiologists up the proverbial creek. In a nightmare scenario, 150K would be a pipe dream.

Around here the anesthetists are doing hearts and peds too. In fact, they say that the MD's don't give them any more input there than anywhere else. There are already plenty of hospitals in this country where OB is CRNA only, and there's not good evidence to say they're any worse off. The CRNA's are also fighting hard to have pain management recognized as being 'within the scope of nursing'. Soon, I'm sure the DNP's will be doing their "residencies" in hearts, peds, pain, etc. etc. as well.

When I applied to anesthesiology, I could HONESTLY say that this is what I wanted to do regardless of salary or anything else and that's why I chose it. I was under no illusion that I was going into derm, psych, or occupational medicine and expected to work 60+ hours a week and take call. At the same time I expected to be able to hold my head up at the end of the day. The physiology, pharmacology, immediate results, and procedures appealed to me a lot and still do. In a vacuum, I still enjoy it. I'm just not sure I want to deal with the bickering, politics, and the perennial threat of losing my livelihood for the rest of my career.

I'm clearly very upset now, yet I don't know what I'm going to do. One part of me says suck it up a while and see if things get better CA-2 year, but the other part of me says get out now and start preparing for the 2010 match.

Zwerling is that you again?

 

[maceo]

In summary, what makes anesthesia residency stink are the never-ending, annoying, day-to-day dealing with CRNAs and spineless, weak, lame attendings.

what makes being an anesthesiologist stink is the day to day dealings with all of the above and , nurses, pacu nurses, techs, other attendings surgeons .. its just a pain in the ass daily. You have to tune them out and think of something else 99 percent of the time.

 

[maceo]

I completely agree that attending anesthesiologists are far better suited to make complex clinical decisions. I have tremendous respect for the knowledge bases of my attendings, and am in no way, shape, or form trying to knock it. I also completely agree that the vast majority of anesthetists are abjectly lost when it comes to understanding the details of what they are doing. My points are:

1) Complex clinical decision making does not come to play in a significant majority of cases. I may not be doing the big neuro, cards, liver transplants, etc, (which certainly are the exception) but I sit in a room all day every day doing just about every low and medium risk procedure you can imagine. Seldom does anything really complex ever come up. A little hypotension here, a high peak pressure there... But rarely is there anything to really sink your teeth into- even in the ASA 3's.

2) Despite the gaping knowledge gap, nurse anesthetists handle themselves fairly well without MD backup. The UPENN study that MD's primarily use to justify supervision requirements shows an excess 30 day mortality of only one death for every four hundred cases when the CRNA is THE ONE making the decisions. If the appropriate subgroup analysis and follow up studies were ever completed I suspect that we would see some very large subgroups where there was little to no difference at all. In those cases, the additional cost might even lead to higher global mortality because of higher cost being a barrier to access.

The idea of switching to radiology is not about money. I never expected the current salary levels to stay anywhere near where they currently are in either field. Rather, the reward I am concerned with is being happy in the future. Will I like who I am working with? Will I dread the political ramifications of every word out of my mouth? Will I be proud of what I do?

My number one complaint about anesthesiology is its highly political nature. You have the surgeons who think you are their dog, the midlevels who think you are a parasite on their back, and the nurses who think you're their orderly. I see the attendings at my program getting zero respect from anyone, not standing up for the department or for the residents, and apparently very unhappy. When I was a medicine intern, I had one real problem with a nurse all year. And that one time my attending stood up for me and let them have it. Nobody gave me grief as an *intern*, but as a resident I'm constantly heaped under dung and expected to just roll over and take it. Its not just about residency stinking; I worked significantly longer hours as an intern but still felt like a human being through it all. Now, I often am made to feel less than human. In order to be successful in the future of anesthesiology I think you'll need to be a great people manager and politician. You also have to be ready to turn the other cheek back and forth day after day as they are incessantly slapped. I am not.

What attracts me to radiology (or pathology) is that you still have the thought process, the interpretation, and the analysis but with much less of the political bull. I think I could interpret images/slides for 50 hours a week at 130K per year and still be very happy as long as I was able to focus on my work in peace and not have to worry about being utterly displaced. Some people say they couldnt sit in a dark room all day, but I say it beats sitting there while some surgeon spits venom from across the curtain and your midlevels are trying to knife you in the back.

I also think the worst case scenario is far more bleak than a lot of people recongize. Some neglect to consider that CRNA salaries are tied to their value in extending or replacing a physician. If we go to a system in which CRNA's have independent practice, (a decision that could be made at a national level in an upcoming 'non-exclusive but extremely large government payer setup' like the one Obama proposes) the next step is for the government and insurance companies to bring their salaries more in line with other mid levels. "If you dont need to be a doctor to do this, then you don't need to get paid that much". Supply and demand will surely buffer this for a time but as more and more CRNA schools open and pump out more and more CRNA's, salaries will come down. In the coming "pay for service" rather than a "pay for degree" environment, that would leave MD anesthesiologists up the proverbial creek. In a nightmare scenario, 150K would be a pipe dream.

Around here the anesthetists are doing hearts and peds too. In fact, they say that the MD's don't give them any more input there than anywhere else. There are already plenty of hospitals in this country where OB is CRNA only, and there's not good evidence to say they're any worse off. The CRNA's are also fighting hard to have pain management recognized as being 'within the scope of nursing'. Soon, I'm sure the DNP's will be doing their "residencies" in hearts, peds, pain, etc. etc. as well.

When I applied to anesthesiology, I could HONESTLY say that this is what I wanted to do regardless of salary or anything else and that's why I chose it. I was under no illusion that I was going into derm, psych, or occupational medicine and expected to work 60+ hours a week and take call. At the same time I expected to be able to hold my head up at the end of the day. The physiology, pharmacology, immediate results, and procedures appealed to me a lot and still do. In a vacuum, I still enjoy it. I'm just not sure I want to deal with the bickering, politics, and the perennial threat of losing my livelihood for the rest of my career.

I'm clearly very upset now, yet I don't know what I'm going to do. One part of me says suck it up a while and see if things get better CA-2 year, but the other part of me says get out now and start preparing for the 2010 match.

Go into radiology if you hate anestheisa that bad. I think radiology is a great field I almost went into it. you are right radiologists dont really have constant interruptions and external distractions to make you question what you do on a daily basis.
All you need is one complication to have anyone question independent crna practice. i think we have more than a few on the books that gained national attention in recent years. There needs to be a physician to guide the patient medically. **** anyone can turn the dials in anesthesia. the patient needs somebody who knows something about whats going on. A good anesthesiologist always looks like he is not doing anything, but in reality he is doing a lot.

 

[Gern Blansten]

Zwerling is that you again?

I was thinking the same thing. It seems too easy to just get on here and whine about how bad the state of the field is to discourage med students. And to think that radiology is the answer? How cheap is it to digitally send the studies to India for interpretation. As someone else said, every field of medicine has its own issues, and they are all pretty major.
Ortho-podiatrists want to operate all the way up to the knee
Psych-psychologists want prescribing rights
FP-nurse practitioners
OB-nurse midwives
radiology-digital images sent to foreign countries
EM-triage nurses
general surgery-disappearing field; GI docs want to do appys through scopes; if you're not a surgical subspecialist, what will you do? Hernias and gall bladders?
neurosurgery-Interventional radiology do most aneurysms
neurology-nobody ever gets better
cardiac surgery-interventional cards doing much more less invasive techniques
anesthesiology-militant CRNAs and DNPs
pediatrician-you have to deal with the moms

No specialty is perfect. You gotta find one you enjoy and would be happy doing even if the pay sucked.

 

[UnhappycGas]

The worst-case scenario in my mind (which I don't think will happen) is that our income and practice opportunity becomes equal with CRNAs. And like many posters have indicated, CRNAs don't have a bad deal. It's unrealistically pessimistic to think that even if CRNAs do get full, unsupervised, unrestricted practice rights in every state that anesthesiologists couldn't continue to at least do the same work as them for the same pay.

That's exactly the problem. As soon as it is decided that you don't need an MD to do anesthesia, the government and insurance companies will start pushing compensation rates to be more along the lines of other mid-levels. That means if you're an MD doing anesthesia, you might end up with a true midlevel provider salary because it would be reasoned that that is all it takes to perform your service. Of course, I'm sure there will be some consideration for sick patients and high risk cases. But will there be enough of those around for all of us? And do you really want to work as a consultant for the CRNA group in "difficult cases?"

 

[UnhappycGas]

I was thinking the same thing. It seems too easy to just get on here and whine about how bad the state of the field is to discourage med students. And to think that radiology is the answer? How cheap is it to digitally send the studies to India for interpretation. As someone else said, every field of medicine has its own issues, and they are all pretty major.
Ortho-podiatrists want to operate all the way up to the knee
Psych-psychologists want prescribing rights
FP-nurse practitioners
OB-nurse midwives
radiology-digital images sent to foreign countries
EM-triage nurses
general surgery-disappearing field; GI docs want to do appys through scopes; if you're not a surgical subspecialist, what will you do? Hernias and gall bladders?
neurosurgery-Interventional radiology do most aneurysms
neurology-nobody ever gets better
cardiac surgery-interventional cards doing much more less invasive techniques
anesthesiology-militant CRNAs and DNPs
pediatrician-you have to deal with the moms

No specialty is perfect. You gotta find one you enjoy and would be happy doing even if the pay sucked.

There isn't an army of adequately trained radiologists in India waiting to take away the jobs of US radiologists. Nor are there CRNradiologist schools opening up over there and pumping out new graduates at record rates. Could there be? Sure, and that goes for any field of medicine. But anesthesia is one of the few fields where its a reality, and people in other fields are aware of what has transpired.

 

[Planktonmd]

There isn't an army of adequately trained radiologists in India waiting to take away the jobs of US radiologists. Nor are there CRNradiologist schools opening up over there and pumping out new graduates at record rates. Could there be? Sure, and that goes for any field of medicine. But anesthesia is one of the few fields where its a reality, and people in other fields are aware of what has transpired.

If you truly believe that a nurse can do your job then you really need to move on to another field.
I am a little bit confused by your attitude though, and there are some parts of your posts that don't sound like something a resident would say.
When you mention the silly comparison of outcome between physicians and nurses you actually sound like a nurse because you seem to advertise that anesthesiology is about outcome, and as long the patient does not die then you are doing a good job! This is how the nurses think and this is the logic they try to sell to the lay public, but we here are educated people and we know that there is more to our work than simply surviving the anesthetic.

 

[bigpharmD]

Not an MD here but was recently walking through the ICU and one of the attendings asked me to drop a note about antibiotics on a patient because the hospital was going to be sued. I asked what was going on and he told me the patient was an OB patient who somehow aspirated in the OR and the CRNA kept bagging the patient instead of intubating. Blew gut bugs all through her lungs now on the vent. This was the short story, but scary. I will request you guys from now on...

 

[ozzie20]

I also think the worst case scenario is far more bleak than a lot of people recongize. Some neglect to consider that CRNA salaries are tied to their value in extending or replacing a physician. If we go to a system in which CRNA's have independent practice, (a decision that could be made at a national level in an upcoming 'non-exclusive but extremely large government payer setup' like the one Obama proposes) the next step is for the government and insurance companies to bring their salaries more in line with other mid levels. "If you dont need to be a doctor to do this, then you don't need to get paid that much". Supply and demand will surely buffer this for a time but as more and more CRNA schools open and pump out more and more CRNA's, salaries will come down. In the coming "pay for service" rather than a "pay for degree" environment, that would leave MD anesthesiologists up the proverbial creek. In a nightmare scenario, 150K would be a pipe dream.

1. you sound like you're a cheerleader for CRNAs.
2. If these salaries go down, then less people will want to go and be a CRNA/AA, not just MDs.
3. People make this argument all the time, "that the vast majority of the time, you don't need an MD for this stuff". My argument is that you DO. NP's can practice and diagnose a runny nose just like anyone who hasn't even gone to med school, and there still are FP's in business. The physician can differentiate between a runny nose and a new onset Leukemia, an NP typically cannot. The same thing goes in the OR. Its proven that the team approach model works, if CRNA's don't wanna play that game for money's sake, they're SOL, and they're gonna be even more SOL if MD's go away, because they won't be paid the same anymore, and they're gonna go broke.

 

[thegasman]

Zwerling is that you again?

I agree - something is fishy here.

 

[cfdavid]

That's exactly the problem. As soon as it is decided that you don't need an MD to do anesthesia, the government and insurance companies will start pushing compensation rates to be more along the lines of other mid-levels. That means if you're an MD doing anesthesia, you might end up with a true midlevel provider salary because it would be reasoned that that is all it takes to perform your service. Of course, I'm sure there will be some consideration for sick patients and high risk cases. But will there be enough of those around for all of us? And do you really want to work as a consultant for the CRNA group in "difficult cases?"

I think you're underestimating the power of having MD/DO behind your name. That said, we DO need to protect this priviledge through active participation in PACs as well as becoming much more vigilant, as has been discussed in the private forum and here.

 

[maceo]

There isn't an army of adequately trained radiologists in India waiting to take away the jobs of US radiologists. Nor are there CRNradiologist schools opening up over there and pumping out new graduates at record rates. Could there be? Sure, and that goes for any field of medicine. But anesthesia is one of the few fields where its a reality, and people in other fields are aware of what has transpired.

Look radiology will not go oversees because you still need a board certified radiologist BY US standards to read the films. WHy would an american board cert radiologist be living in south east asia??? maybe a few.. but not a whole lot of them to take away the field of radiology.


What we do as anesthesiologists is a vital job. We medical evaluate the patients, pre op and post op provide medical direction to nurses and PAs who administer anesthesia,we are available throughout the course of the anesthetic for any issues that arise, provide medical direction in the post anesthesia care unit, be consultants for the surgeons and the ICU among many many other things. and there are a lot of places including places where i work where we are the sole anesthesia provider. My last job was a total supervision job. I cant tell you how many horror stories i have with providing medical direction. I used to shake my head a lot with how many subtle mistakes were being made. and all the other attendings on this board can probably say the same thing. Just pure errors in judgement that only nurses can make. even the ones who have 20 years experience i was redirecting often . So if you wanna leave anesthesia, leave. thats fine. It is a tough tough job that many people do not understand. Leave because you dont like it, not because you think its going to be taken over by anesthetists. Because it sure as **** wont because the patients need our expertise. IF it actually does happen, we seriously should consider leaving the country.

 

[ProRealDoc]

Look radiology will not go oversees because you still need a board certified radiologist BY US standards to read the films. WHy would an american board cert radiologist be living in south east asia??? maybe a few.. but not a whole lot of them to take away the field of radiology.


What we do as anesthesiologists is a vital job. We medical evaluate the patients, pre op and post op provide medical direction to nurses and PAs who administer anesthesia,we are available throughout the course of the anesthetic for any issues that arise, provide medical direction in the post anesthesia care unit, be consultants for the surgeons and the ICU among many many other things. and there are a lot of places including places where i work where we are the sole anesthesia provider. My last job was a total supervision job. I cant tell you how many horror stories i have with providing medical direction. I used to shake my head a lot with how many subtle mistakes were being made. and all the other attendings on this board can probably say the same thing. Just pure errors in judgement that only nurses can make. even the ones who have 20 years experience i was redirecting often . So if you wanna leave anesthesia, leave. thats fine. It is a tough tough job that many people do not understand. Leave because you dont like it, not because you think its going to be taken over by anesthetists. Because it sure as **** wont because the patients need our expertise. IF it actually does happen, we seriously should consider leaving the country.

the OP is probably a troll CRNA under the disguise of a resident. God knows we get our fair share of those here.

 

[Taurus]

Not an MD here but was recently walking through the ICU and one of the attendings asked me to drop a note about antibiotics on a patient because the hospital was going to be sued. I asked what was going on and he told me the patient was an OB patient who somehow aspirated in the OR and the CRNA kept bagging the patient instead of intubating. Blew gut bugs all through her lungs now on the vent. This was the short story, but scary. I will request you guys from now on...

Yep, it is these types of cases that keep hospital admins up at night and why you won't see CRNA's make much headway. 1 bad outcome = $20 million lawsuit.

 

[Taurus]

Don't feed the troll.

If you're not, don't let the door hit you on the way out. If you can't take it, switch to another specialty.

 

[jetproppilot]

the OP is probably a troll CRNA under the disguise of a resident. God knows we get our fair share of those here.

I was thinking the same thing and am certain you're right.

 

[ozzie20]

I was thinking the same thing and am certain you're right.

agreed.

 

[lfesiam]

I was thinking the same thing and am certain you're right.

second that

 

[Gimlet]

I was thinking the same thing and am certain you're right.

agreed.

second that

So are we gonna bust out the banstick, or what?

 

[Arch Guillotti]

Close, but not yet. I would like to give the OP a chance to respond just to see what happens. Till then I wouldn't feed the troll. At least burp it afterwards.

So are we gonna bust out the banstick, or what?

 

[jetproppilot]

Jet the FBI Profiler stands at the periphery of the interrogation room, arms across his chest, leaning against the wall, eyes keened on the suspect who is seated at the table in the middle of the room.

"Hmmm. So Unhappy, I know where you are. Can't by the life of me see that place the way you describe....matter of fact I've got a colleague who's been there since the Halothane days."

Jet walks up to the table and leans on it with both hands, arms straight, directly in front of the suspect. His stare has not left the man's face.

"Looks like you're a fraud, right Unhappy? There's one anesthesia residency where you are. And you don't work there, do ya Slim?"

 

[CambieMD]

On the other hand, I truly enjoy the physiology and pharmacology, and like the procedures. I am generally happy when I am in the OR if there aren't peripheral issues making my life miserable.

-Unhappy[/QUOTE]

Switching specialties may not be the answer for you.
You have to find a healthy way in which to deal with your stress. We have CRNAs at my hospital. The issues that you stated are no issues in my mind. The team approach works well here.

Do not let politics and social issues drive you out of a specialty that you are well suited for.

Find attendings who will mentor you and will hold your confidence. Try not to be too vocal about your unhappiness. I understand that you may need to vent.

No specialty is completely problem free.

I do not worry about the MD/CRNA issue. My goal every day is to have fun and learn as much as I can.

Cambie

 

[panetrain]

Troll or no Troll, this thread brought out some interesting discussions. But what is new here? When I was a pre-med, I had an anesthesiologist tell me that this field will be dead (midlevel devastation) by the time I hit residency.
The struggle contines...

On another note, the OR is a toxic environment in most academic institutions. I have had to deal with my own issues with having an inferiority complex in the OR. Anesthesia residents for whatever reason are typically not treated with the respect given to surgery residents by OR ancillary staff. This was vary apparent in my CA 1 year. I can say with confidence now that I am treated with respect in the OR, but I had to earn every bit of it. If your good, eventually you will receive the respect that you earn (you don't deserve anything on day 1 and you are certainly not entitled to having respect unless you earn it as well as reciprocate it!). The OR is not the wards. The OR is the battle front. The ancillary staff have to deal with constant criticism, humiliation, being talked down too like a child. They are not going to let you just walk in their world as a CA1 and run the show. You must earn everything you get in that OR. My suggestion would be to stick it out, work harder, become involved in the department/field more so than just pushing drugs in the OR and recording vitals. It's like anything else, it's what you make of it.

 

[FBIprofiler]

FBI profiles comes back positive. Moderator terminate troll with prejudice.

 

[dhb]

Everyone from the anesthetists to the surgeons and nurses and even some attendings seem to look down their nose at anesthesia residents. I am constantly getting snapped at, talked down to, and occasionally even publicly humiliated.

Can you elaborate on this?

 

[outfitter]

regardless of what everyone comments the poster is the only true judge of how bad his program is. we sacrifice alot to be physicians and deserve not to be treated like crap. there anest. programs out there that are malignant and worse then surgery programs. not every resident is compatible with every program. yes residency sucks but you should not be miserable and if you are something is wrong

 

[panetrain]

The workload is heavy especially as a CA 1. You are expected in most institutions to do all the non heads and heart cases when on call and reserve the use of the upper levels for these more complex cases. Otherwise the upper levels read/sleep/Halo/TV etc...Don't for one second think that anesthesiology is a chill laid-back residency. It's not a residency for a candy ass, that would be IM/FP/neuro/derm/path/rads etc... We have a board certified general surgeon as a resident in our program who can testify to what I just stated. I hear this all the time from MS's "I wanted to do surgery, but the residents work too hard so I'm applying for anesthesia instead" this makes me wand to vomit and I immediately draw the attention of our admission's committee to these students. We don't want you, you will not work hard enough.thumbdown If you want to do anesthesia be prepared to bust balls for 3 years. Then see what happens after that. Just know what your getting into.

I am a current CA-1, and since July things have not been going that well.
The workload is heavy (close to 70hr weeks as an overall average), and calls are frequent and brutal. I usually run around like a headless chicken all night don't feel normal for a couple days afterwards. I'm sure a lot of people reading this have or had much worse, but my current workload is a lot to stomach in the context of everything else going on... another straw on the camel's back. The 3-4 ICU months ahead of me will be even worse.

 

[ProRealDoc]

I was thinking the same thing and am certain you're right.

Oh wait, maybe the OP is a RESIDENT SRNA. Ain't that what they call themselves nowadays?


Prorealdoc, MD, LMFAO

 

[huktonfonix]

The workload is heavy especially as a CA 1. Don't for one second think that anesthesiology is a chill laid-back residency. It's not a residency for a candy ass, that would be IM/FP/neuro/derm/path/rads etc... We have a board certified general surgeon as a resident in our program who can testify to what I just stated. I hear this all the time from MS's "I wanted to do surgery, but the residents work too hard so I'm applying for anesthesia instead" this makes me wand to vomit and I immediately draw the attention of our admission's committee to these students. We don't want you, you will not work hard enough.thumbdown If you want to do anesthesia be prepared to bust balls for 3 years. Then see what happens after that. Just know what your getting into.

I am a current CA-1, and since July things have not been going that well.
The workload is heavy (close to 70hr weeks as an overall average), and calls are frequent and brutal. I usually run around like a headless chicken all night don't feel normal for a couple days afterwards. I'm sure a lot of people reading this have or had much worse, but my current workload is a lot to stomach in the context of everything else going on... another straw on the camel's back. The 3-4 ICU months ahead of me will be even worse.

 

[huktonfonix]

The workload is heavy especially as a CA 1. Don't for one second think that anesthesiology is a chill laid-back residency. It's not a residency for a candy ass, that would be IM/FP/neuro/derm/path/rads etc... We have a board certified general surgeon as a resident in our program who can testify to what I just stated. I hear this all the time from MS's "I wanted to do surgery, but the residents work too hard so I'm applying for anesthesia instead" this makes me wand to vomit and I immediately draw the attention of our admission's committee to these students. We don't want you, you will not work hard enough.thumbdown If you want to do anesthesia be prepared to bust balls for 3 years. Then see what happens after that. Just know what your getting into.

Dunno how it was in your program bro, but the calls got harder as you got more senior for us. Usually, if anyone was sleeping it was the CA1. The CA3s sure as hell didnt sleep, and maybe the CA2 got some sleep.

 

[panetrain]

At my institution the CRNA's introduce themselves to the patients as "I'm your anesthesia provider" As well as refer to the attendings as "MDA's". This frequently confuses the patients into thinking the "MDA" is the nurse/tech and the CRNA "anesthesia provider" is the physician/decision maker. The term "anesthesiologist" or "physician/doctor" is never uttered from their mouth. This contributes to the widely misunderstood notion that anesthesiologist are not doctors but some form of a technician/OR ancillary staff. I make it a point to refer to the CRNA's as "NURSE anesthetists" to the patients rather than using deceivingly confusing acronyms.

Oh wait, maybe the OP is a RESIDENT SRNA. Ain't that what they call themselves nowadays?


Prorealdoc, MD, LMFAO

 

[UnhappycGas]

I'm no CRNA or troll, although thinking so might comfort some. I appreciate many of the comments people have made, and sincerely thank you all. I have thought a lot about this predicament over the last couple days, and I think most of it boils down to feeling like I'm treated like scum. It is one thing to have to 'earn' respect as a doctor. I don't expect to be afforded the same respect as the attendings or even have the honor of eating lunch in the same room as them. I know what the attendings had to go through to get where they are, and I DO respect their knowledge base. Rather, I just expect to be treated with the same basic human dignity that I try to afford everyone from the chair of the surgery department to the guy who cleans the rooms.

I would easily be able to handle the work if I felt good about myself, and I would probably even thrive off of it. As I said, I worked harder as an intern and had no problems. The issue is that I don't feel that I'm getting any psychological 'reward'. I feel looked down upon, and honestly wonder whether the skillset I am trying to acquire will lead to a fulfilling career. Still mulling it over...

 

[foxtrot]

In summary, what makes anesthesia residency stink are the never-ending, annoying, day-to-day dealing with CRNAs and spineless, weak, lame attendings.

Amen to that. And this is from someone who actually did transfer anesthesia residencies and graduated without losing any time. If things are really bad try to transfer into another program if you truly like anesthesia and cannot see yourself doing anything else. There are some really crappy programs out there and it is not worth being tortured to the point where you are clinically depressed and suicidal. Look at USF, they are no more because they were corrupt and treated their residents like **** (yes, I am sure there were other factors too). Bottom line, try to transfer if you really like anesthesia, graduate, and then when you get done be politically active against the CRNA bull****. Keep your chin up

 

[UnhappycGas]

I have gotten a lot of PM's asking if I'm a troll or what program I'm at.

Part of what I'm doing is venting (because I really have nowhere else to turn and would be very afraid to say anything), and part of what I'm doing is asking for advice. That said, I really do not want to name names. Alex Rodriguez's court sealed steroid test results just leaked, and nothing I say to anyone (especially over the internet) is 100% secure. It would come back to haunt me. I'm venting and looking for anonymous advice anonymously.

After reading a few more PM's and reflecting further, I think a big part of it is just needing to feel good about what I'm doing and knowing that everything I've gone through and am going through is going to make a difference. Surgeons put in 90 hour weeks, but they also get an incredible sense of accomplishment and seem to have great camaraderie (not that I want to be a surgeon). I feel like my co-residents and I get looked down upon, and that the team is dysfunctional and malignant. I can't stomach it to think that the 8 years, the mountains of loans, the frequent personal debasement, and all these lost evenings and weekends with my family that I will never get back are going to amount to nothing more than some guy who worked 40 hours a week for two years and skated along.

If you know of any data that anesthesiologists have significantly better outcomes (whether mortality or otherwise), it would make me feel a whole lot better. And we can all trade anecdotes; I can even give a few where MD anesthesiologists royally screwed up and led to the deaths of young people that never should have died.

I do enjoy what I'm doing and really don't *WANT* to quit. I just fear that switching might be in the best interest of my marriage and sanity in the short run and sense of purpose and pride in the long run. I worry sometimes that MD anesthesiology is kind of like a phD in english lit. Elegant, scholarly, and admirable... just not very applicable in the real world and probably not worth it if the cost is astronomically high. Someone convince me I'm wrong!

 

[2ndyear]

CA1 year can really suck. You go from being good at something (rounding, managing floor patients) to being totally new and trying to learn on the job. The OR never really slows down to let you learn procedures. Everything that you do is watched by everyone in the room. It sounds like you've gotten over that hurdle though. Bigger cases will come your way soon. Challenges.

Perhaps you'll fall in love with cardiac anesthesia, the TEE, daily line placement, the mystery and wonderment of the perfusion machine. Every day I did cardiac I stopped to think how darn amazing it is that we can stop someones heart completely, go on bypass, and then come off. Still boggles my mind a bit. Same could be said for your pedi/pain/ICU rotations and their respective challenges.

I will also say that things are a LOT different when YOU are the one in charge. I got killed on call this weekend, bad. But I'm glad my training prepared me for the challenges I faced. It's easy to lose sight of this in residency, the fact that in 3 short years you may be in a hospital all by yourself, in the middle of the night with a critically ill patient in the OR. There is no backup. The buck stops and ends with you. Suck the most out of your training every single day to prepare yourself for this scenario.

My favorite case of this weekend was an obese lady with no neck and poor mouth opening who fell and had an open radius and ulnar fracture. MI 2 weeks ago. Case has to go, preferably within 6 hours. Probably not a big deal for most of us, but I'm glad I was adequately trained in regional anesthesia, I really didn't want to put her to sleep. Not at night, not by myself, not without anyone to help if things went south. Quick supraclavicular block with ultrasound. Great surgical block. I know it sounds easy, but when your anesthetic relies on your skills you learned in residency then you better come to the table prepared.