Relationship between anesthesia and surgery

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Which programs are generally good, which are notoriously bad, which are so-so?

I'll start:

Good
Hopkins
Mayo

Bad
Duke
WashU (?)

So-so
Brigham
 
good-to-excellent relationship:
MGH
 
Depends on the personality of the surgeon.
 
Lonestar said:
Depends on the personality of the surgeon.
Click to expand...

well besides the obvious individual personalites. . .departments can foster a general culture. At certain hospitals, surgeons have a lot of respect for anesthesia (besides the few individuals who prefer not to be), and at others, the disrespect can be pretty general. I'm just trying to get a feel for whch programs are known for a collegial relationship, and which aren't. . . .that's why i said "generally". I meant beyond just the individual personality variation.

Any opinions would be valuable.

Thanks.


p.s. also, please correct my categorizations above if inaccurate. Those were just my impressions from interviews/electives, and a couple, from word of mouth, so as such, could be wrong.
 
It varies by department, and often by surgeon at Columbia. Neuro universally gets along well with anesthesia. Ortho is so-so to bad, with one or two surgeons that are great to work with. ENT is about 1/2 good, 1/2 awful, same with GYN. General is a mixed bag. Overall I would give Columbia surgeons a 5/10 for relationships with anesthesiology. One thing that bugs me is the surgical residents. Many are decent human beings, but a good number treat anesthesiology residents with little respect, and it's (obviously) unjustified. You can frequently hear surgeons (residents and attendings) muttering their frustration with us for so-called anesthesia delays that are beyond our control. It's annoying, but it doesn't happen every day, so it's tolerable.
 
since we're pseudo generalizing here...here's my take on the subj from doing my surgery rotations/interviews, etc

I think it's suffice to say that in private hospitals (I guess that means for the more 'community based' and non-univ programs) the relationship b/w surgery and anesthesiology is great. The objective is usually to get the pt in and out ASAP. Get residents/attendings out on time. PERSONALLY, I think it makes for an excellent environment for education. You usually get lots of time to read and interact w/ attendings (since they're not out trying to publish X # of papers on something).

my 2 cents.
 
powermd said:
It varies by department, and often by surgeon at Columbia. Neuro universally gets along well with anesthesia. Ortho is so-so to bad, with one or two surgeons that are great to work with. ENT is about 1/2 good, 1/2 awful, same with GYN. General is a mixed bag. Overall I would give Columbia surgeons a 5/10 for relationships with anesthesiology. One thing that bugs me is the surgical residents. Many are decent human beings, but a good number treat anesthesiology residents with little respect, and it's (obviously) unjustified. You can frequently hear surgeons (residents and attendings) muttering their frustration with us for so-called anesthesia delays that are beyond our control. It's annoying, but it doesn't happen every day, so it's tolerable.
Click to expand...

When you hear that stuff and there isn't really an anesthesia delay, speak up and put them back in their place. I had that happen with a ton of the ortho and general residents who thought we were delaying cases for blocks, access, etc. when in fact, the patients weren't being allowed back into the rooms because the OR nurses wanted a break and more time to set up. I would take that resident and drag them to the preop area and flex, bend, or poke the affected appendage to show that the block was ready and the patient was just waiting to be moved back. I would then tell them to go apologize to my junior resident, half jokingly, but with enough of an edge to let them know that I was keeping score and would delay a case for my resident to get a 30 minute break if they kept up with the smack.
 
UTSouthwestern said:
I would then tell them to go apologize to my junior resident, half jokingly, but with enough of an edge to let them know that I was keeping score and would delay a case for my resident to get a 30 minute break if they kept up with the smack.
Click to expand...
😀
Did everyone else love this as much as I did?
 
powermd said:
It varies by department, and often by surgeon at Columbia. Neuro universally gets along well with anesthesia. Ortho is so-so to bad, with one or two surgeons that are great to work with. ENT is about 1/2 good, 1/2 awful, same with GYN. General is a mixed bag. Overall I would give Columbia surgeons a 5/10 for relationships with anesthesiology. One thing that bugs me is the surgical residents. Many are decent human beings, but a good number treat anesthesiology residents with little respect, and it's (obviously) unjustified. You can frequently hear surgeons (residents and attendings) muttering their frustration with us for so-called anesthesia delays that are beyond our control. It's annoying, but it doesn't happen every day, so it's tolerable.
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thanks powermd, this is very helpful.

Any other such reviews on some more programs (by current/past residents)?

and thanks to UTSW for the awesome advice (and yes i did like the joke 😀 )
 
All in all, surgeons & surgical-larvae are simple critters. :laugh: In dealing with them, you must realize (not necessarily participate in) that they are highly hierarchy driven folks. And, that they are very alpha-male/-female who are all about establishing a pecking order. Their favorite game is to piss on your shoes & see how you will react - this is true for the preponderance of them from intern all the way up to Dept. Chair. So, to establish yourself credibly & solidly w/i their delusional hierarchy, you must piss back on their shoes - with all the respect & professionalism due their rank, of course.

Seriously, the silly metaphor above is based in reality. If you allow them to walk on you, they will continue to do so - forever. Medicine is filled with driven, competitive people who consciously or unconsciously will seek to establish their dominion over you. You can either allow this or you can stand your ground - professionally, of course - and not become a doormat.

I am a very laid-back, easy-going anesthesia dude in our ORs. However, I do not & will not back down from a challenge...in fact, in a perverse manner, I sorta enjoy the mental chess involved 😍 . This affords me the luxury of not being constantly challenged...I have firmly established myself. I guess this propensity harkens back to my days as a bouncer - in my wild & wooley days!

:scared:
 
OldManDave said:
All in all, surgeons & surgical-larvae are simple critters. :laugh: In dealing with them, you must realize (not necessarily participate in) that they are highly hierarchy driven folks. And, that they are very alpha-male/-female who are all about establishing a pecking order. Their favorite game is to piss on your shoes & see how you will react - this is true for the preponderance of them from intern all the way up to Dept. Chair. So, to establish yourself credibly & solidly w/i their delusional hierarchy, you must piss back on their shoes - with all the respect & professionalism due their rank, of course.

Seriously, the silly metaphor above is based in reality. If you allow them to walk on you, they will continue to do so - forever. Medicine is filled with driven, competitive people who consciously or unconsciously will seek to establish their dominion over you. You can either allow this or you can stand your ground - professionally, of course - and not become a doormat.

I am a very laid-back, easy-going anesthesia dude in our ORs. However, I do not & will not back down from a challenge...in fact, in a perverse manner, I sorta enjoy the mental chess involved 😍 . This affords me the luxury of not being constantly challenged...I have firmly established myself. I guess this propensity harkens back to my days as a bouncer - in my wild & wooley days!

:scared:
Click to expand...

Very well said.

One can take their alpha male stuff and turn it around. Our premier ortho dude and I enjoy cutting each other down to the point where the OR personnel have a 😱 look on their faces:

Rick the ortho dude: "HEY BILL, your orange clogs are the epitomy of a gay dude! My buddy told me he saw you parking in front of The Oz (a french quarter gay bar) the other night!"

Jet: "MANNNN!!! You caught me, dude. I'm a queen! By the way, did you ever get off those child molesting charges?"

and it goes on and on and on....

makes my day go faster when I'm having fun at work!
 
It's an interesting dilemma that anesthesiology residents face every day: take it or fight it. My opinion is that when you're right, you're right and the patient's interests come first and foremost. That being said, I would sometimes piss on the sand to make sure the surgeons knew that A. I knew what I was doing and talking about and B. I am the gatekeeper of the OR.

What's ironic is that I am now working with some of those ex-residents and they can see that what I said was in fact true: The number of times a delay is truly an anesthesia delay is remarkably small. This was the case on Friday night when I was called in to cover three trauma cases for an ex-resident who couldn't get his normal anesthesia group to cover him and the sucker used the ER anesthesia call list. He immediately recognized me and I him and we started off terse with each other, but rapidly warmed up when he saw his first patient go back within five minutes of my arrival, waited all of seven minutes to have his patient blocked, asleep, and prepped and subsequently had only 5-10 minute turnover time between cases.

We started at 10:30 pm and finished three ortho trauma cases by 2 am and he couldn't stop complimenting me and the nurses for our speed, efficiency, and safety (he marked the wrong shoulder on the second patient).
 
UTSouthwestern said:
It's an interesting dilemma that anesthesiology residents face every day: take it or fight it. My opinion is that when you're right, you're right and the patient's interests come first and foremost. That being said, I would sometimes piss on the sand to make sure the surgeons knew that A. I knew what I was doing and talking about and B. I am the gatekeeper of the OR.

What's ironic is that I am now working with some of those ex-residents and they can see that what I said was in fact true: The number of times a delay is truly an anesthesia delay is remarkably small. This was the case on Friday night when I was called in to cover three trauma cases for an ex-resident who couldn't get his normal anesthesia group to cover him and the sucker used the ER anesthesia call list. He immediately recognized me and I him and we started off terse with each other, but rapidly warmed up when he saw his first patient go back within five minutes of my arrival, waited all of seven minutes to have his patient blocked, asleep, and prepped and subsequently had only 5-10 minute turnover time between cases.

We started at 10:30 pm and finished three ortho trauma cases by 2 am and he couldn't stop complimenting me and the nurses for our speed, efficiency, and safety (he marked the wrong shoulder on the second patient).
Click to expand...

Very important issue well covered by UT.

Your job as an anesthesiologist, put in very simple terms, is not unlike the owner of an Ace Hardware store.

Take care of your customers....the patients and surgeons....and you'll prosper.

That being said, that doesnt mean you have to become a whipping horse. You are a consultant physician, yes. But there are times where you have to draw a line in the sand, like UT said.

Even in private practice.

Got a problem surgeon who incessantly rises above the playful banter with alpha-male tactics?

Pull him into the office with you and your partners, tell him you're ready, willing, and able to take care of him and his patients in an optimum fashion, but his antics are over the top , and won't be tolerated. And if he continues said antics, well, you need to take your cases elsewhere, cuz we're ready to not cover your cases. Find your own anesthesiologist. Oh, by the way, we've got an exclusive contract here.

I've done it.

Rare, but happens.

And in my experience the surgeons that display errant antics typically aren't superstars you want in your OR anyway.

Franchise player surgeons rarely move beyond the friendly banter. They want premium patient care and fast turnover. Thats all they care about.

Don't be afraid to read the riot act to the out-of-control bottom-feeder surgeon.
 
Okay. So you guys seem to recommend picking your battles, which, with all due respect, is a healthy dose of common sense. And the patient comes first; gotcha on that, too. But when MUST you defend yourself? HOW do you do it? And what does that hierarchy mean when it's a world-famous Dept. of Surgery Chair and you're a CA1?

dc
 
Sounds like a good time to talk with your PD or chair and see whether or not they have a backbone. Definitely tough being a resident and getting into it with an attending, particular a surgery type with some variant of 'roid rage. We have varying success with taking issues to our PD. One of our attendings is a "name" in anesthesia and a great resident advocate. He will approach us individually if hears that a surgeon has "abused" us and ask if he needs to take care of it. I tend to prefer to fight my own battles, within reason, but that's just me. There are occasional perks to being 6'5" 😀

If nobody in your department picks up the ball then you're screwed and may have to bend over and take it for the time being.

PMMD
 
bigdan said:
Okay. So you guys seem to recommend picking your battles, which, with all due respect, is a healthy dose of common sense. And the patient comes first; gotcha on that, too. But when MUST you defend yourself? HOW do you do it? And what does that hierarchy mean when it's a world-famous Dept. of Surgery Chair and you're a CA1?

dc
Click to expand...


Dan,

Sorry - there is no recipe for success. This is where you must rely on your interpersonal relationship skills - those thing we gas-passers are accused of not having/needing. Needless to say, as a resident, you must be much more careful; however, that does not mandate being the whipping boy or the "bitch" for some arrogant cutter.

As pointed out above, if your staff for the day - or even better, your PD - has a sack & is a resident advocate, you're in a better spot. Our PD, Marc Bertrand, is an awesome guy, loads of fun & is a massive resident advocate...as well as our Chair, David Glass. For both of them, if you were to abused by a cutter - rarely happens at Dartmouth - and you were not inappropriate...let's just say I would not want to be that surgeon, because these guys take no prisoners. Of course, they are immensely popular with we residents.

As Jet points out - we are an exclusively consultative/referral-based specialists & the patients, OR staff & surgeons all represent our client base. That said, quality & courteous service are essential to being a successful business operator - after all, that is what "private practice" is. So, you have to pick your battles wisely. Furthermore, if a cutter, or for that matter, another gas-passer is acting like a turd, you will most likely find allegience for your confrontation from his/her colleagues as well as from your own. no one likes to work w/ a human phallus!
 
jetproppilot said:
Got a problem surgeon who incessantly rises above the playful banter with alpha-male tactics?

Pull him into the office with you and your partners, tell him you're ready, willing, and able to take care of him and his patients in an optimum fashion, but his antics are over the top , and won't be tolerated. And if he continues said antics, well, you need to take your cases elsewhere, cuz we're ready to not cover your cases. Find your own anesthesiologist. Oh, by the way, we've got an exclusive contract here.

I've done it.
Click to expand...


You have great ideas jetpropilot but I think the administration will sooner get rid of you then a orthopedic surgeon regardless of your exclusive contract which can become not exclusive come negotiation time. If you say (they need us). they can get any number of (employment agency type groups.. napa et al ) to staff their hospital. These groups have endless cash and they can afford to pay premium dollar to get staff going. Albeit probably not as good as you are but its coverage none the less. This specialty tolerates mediocre clinicians very well.
 
davvid2700 said:
You have great ideas jetpropilot but I think the administration will sooner get rid of you then a orthopedic surgeon regardless of your exclusive contract which can become not exclusive come negotiation time. If you say (they need us). they can get any number of (employment agency type groups.. napa et al ) to staff their hospital. These groups have endless cash and they can afford to pay premium dollar to get staff going. Albeit probably not as good as you are but its coverage none the less. This specialty tolerates mediocre clinicians very well.
Click to expand...

Not so fast. In the many hospitals I am practicing in, there have been recounts of surgeons that have been asked to leave because if their personalities are that abrasive, they are likely to rub everyone the wrong way including patients and administrators. Very hard for a jerk to just be a jerk to you. Their jerkdom has to extend to all that surround them and that can be career suicide regardless of your status.

An example I have is of an orthopedic surgeon who one of our competitors used to cover who has high volume but the personality of a wailing banshee. The hospital does tolerate him due to his volume, but gives him the worst staff to work with or forces him to post cases in the evening, and the anesthesia group dumped him. He now uses an independent who had previously been let go by two other groups and has had 3 major complications (MI, CVA, AUA) in just over two months. He approached me for coverage one day and I told him unless his personality has done a 180, no thanks. On call one weekend, a month ago, he couldn't find his independent for coverage and used the ER anesthesia call list at a remote facility I have priveleges at and of course it was me. He was remarkably polite, considerate, and respectful.

We still won't cover him, but the point is that everyone has to play nice to make the day fast and productive.
 
davvid2700 said:
You have great ideas jetpropilot but I think the administration will sooner get rid of you then a orthopedic surgeon regardless of your exclusive contract which can become not exclusive come negotiation time. If you say (they need us). they can get any number of (employment agency type groups.. napa et al ) to staff their hospital. These groups have endless cash and they can afford to pay premium dollar to get staff going. Albeit probably not as good as you are but its coverage none the less. This specialty tolerates mediocre clinicians very well.
Click to expand...
Anesthesia departments are not scut monkeys and are not a division of surgery as they used to be. A good anesthesia department, large or small, can ATTRACT surgeons to their facility. Surgeons want familiarity - they don't want some rotating-door locums group with a different face every week or month that's not used to working with them.

Also gone are the days that a hospital can afford to tolerate an abusive work environment from a primadonna surgeon (or any physician). Employees can and will sue the hospital if the hospital administration, by it's inaction, tolerates any type of abusive behavior. We've actually had surgeons required to attend anger management programs as a condition of maintaining their privileges.
 
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