Academic Anesthesiologist

[MarketDoc]

Advertisement - Members don't see this ad

I'm quite confused about what an "Academic" Anesthesiologist actually do...., anyone with more info please post.., will be most appreciated.

 

[jetproppilot]

I'm quite confused about what an "Academic" Anesthesiorisesl togist actually do...., anyone with more info please post.., o tewill be most appreciated.

Academic anesthesiologists work at University centers and in addition to taking care of patients, they have "academic" duties as well, like teaching our resident colleagues our trade, and research if they are on a tenure track.

My opinion is that at least in the past, many academic doctors are (were) at the bottom tier when it comes to clinical prowess compared to private practice peers because, and call me cynical, its all about the benjamins.

Traditionally academic jobs paid alot less than private practice..like a third of a good private job..and since the cream rises to the top, benjamin top, most stud clinicians went into private practice for the big dollars.

Which left the slow, beyond conservative, needlessly case-cancelling, lab-test-ordering, technically-ungifted dudes to fill in the slots at the universities.

We all remember, of course, some great academic dudes.

But I'd say they were outnumbered by their average-to-below-average peers.

Hopefully this is changing.

 

[Gern Blansten]

Academic anesthesiologists work at University centers and in addition to taking care of patients, they have "academic" duties as well, like teaching our resident colleagues our trade, and research if they are on a tenure track.

My opinion is that at least in the past, many academic doctors are (were) at the bottom tier when it comes to clinical prowess compared to private practice peers because, and call me cynical, its all about the benjamins.

Traditionally academic jobs paid alot less than private practice..like a third of a good private job..and since the cream rises to the top, benjamin top, most stud clinicians went into private practice for the big dollars.

Which left the slow, beyond conservative, needlessly case-cancelling, lab-test-ordering, technically-ungifted dudes to fill in the slots at the universities.

We all remember, of course, some great academic dudes.

But I'd say they were outnumbered by their average-to-below-average peers.

Hopefully this is changing.

Wow, pretty broad brush you paint with.

 

[abords]

Today I did 3 whipples and 2 ruptured esophagus repairs (one thanks to a TEE probe placed by a highly skilled private practice guy) as well as covered the vascular lab. I wish I knew what I could have done if I wasn't such a below average, clinical skill-lacking piece of junk academic anesthesiologist. Best of luck with your lap choles and knee replacements.

 

[jetproppilot]

Wow, pretty broad brush you paint with.

Wow, such eloquent metaphors you reply with.

I'm a redneck from Florida, dude.

Try puttin' in a dippa Copenhagen, sinch up your tightie-whities, and

RESPONDE CON LOS CAJONES.

like...

"Jet, your post is way off, Dude."

"Jet, Dude, thattsa buncha B.S.."

"Jet, my mom could squat more than you on your best day."

i can take it, bro.....I've got a f u kk you account, remember?

I PAINT WITH A BROAD BRUSH??

Cummon, Steve Martin.

Speak your mind.

But deep inside you know its an overall accurate description of the stereotypical academic center.

 

[jetproppilot]

Today I did 3 whipples and 2 ruptured esophagus repairs (one thanks to a TEE probe placed by a highly skilled private practice guy) as well as covered the vascular lab. I wish I knew what I could have done if I wasn't such a below average, clinical skill-lacking piece of junk academic anesthesiologist. Best of luck with your lap choles and knee replacements.

So you are the stud I speak of.

Look at your twenty-eight peers.

How many are as good as you?

And why did you choose academia if you can make five-hundred-large with nine weeks vacation in PP?

I stick to my opinion, by the way.....the most important being alotta the resident education, or lack of, really, that occurs.

I'm a critic of many things done "the academic way".

Sorry it bothers you.

 

[abords]

I will not make 500 large but I do ok with my mid 300s. I enjoy crazy cases and teaching residents. I like having to think about how to take care of the quadraplegic with long QT and a HR of 25 or how to anesthetize the twins so that the surgeon can successfully separate them. The challenges excite me and make me want to wake up in the morning. I like having a lab and trying to make new discoveries to further the field. I could make a lot more money in private practice but I don't know that I would be much happier than I am right now. 500 large does sound good though.

 

[jetproppilot]

I will not make 500 large but I do ok with my mid 300s. I enjoy crazy cases and teaching residents. I like having to think about how to take care of the quadraplegic with long QT and a HR of 25 or how to anesthetize the twins so that the surgeon can successfully separate them. The challenges excite me and make me want to wake up in the morning. I like having a lab and trying to make new discoveries to further the field. I could make a lot more money in private practice but I don't know that I would be much happier than I am right now. 500 large does sound good though.

I admire your attitude.

But you still didnt tell me about your twenty-eight anesthesiologist colleagues.

 

[abords]

Most of my co-workers work pretty hard. There are exceptions to this and they clearly would sink in private practice. Sometimes I get nervous signing out to them and there is no way I would hand them over a sitting crani or and LVAD case. Doesn't mean I don't like working with them though - they are all great people.

 

[jetproppilot]

Most of my co-workers work pretty hard. There are exceptions to this and they clearly would sink in private practice. Sometimes I get nervous signing out to them and there is no way I would hand them over a sitting crani or and LVAD case. Doesn't mean I don't like working with them though - they are all great people.

I'm sure they are all great people.

But humor me here.

What percentage of your colleagues can, in their sleep, do the majority of the procedures of our specialty with a very high success rate, and do them quickly and efficiently without alotta fanfare?

How many cancellations or delays do you see because of labs that were (needlessly) ordered or workups that were (needlessly) ordered?

What percentage of your colleagues have great clinical knowledge, AND have the ability to apply it?

What percentage of your colleagues have great interpersonal skills?

What percentage can quell conflict with their interpersonal skills?

What percentage have the confidence to QUICKLY take charge when the unexpected happens and the surgeon is looking at the anesthesiologist for help?

What is the failure rate of labor epidurals, epidurals for total joints, thoracic epidurals for abdominal/chest cases, regional blocks like interscalenes, axillary?

How long does it take for your colleagues to do procedures? Would you say most of them are deft, average, or below average?

How many egomaniacs are in your group, not realizing we are consultants? BTW, for my resident colleagues, I know this is a sticky point, but you will thrive if you realize this early. It'll make you feel better that just about EVERYBODY is a consultant to someone....unless you are at the top of the consulting hierarchy, which are our primary care doctors.

Heart surgeons are consultants to cardiologists.

Surgeons are consultants to family practice, IM, OB/GYN.

Etc Etc

 

[urge]

Best of luck with your lap choles and knee replacements.

I wish I got to do some of those sometimes. Nowadays it seems I cannot start a case without an epi drip as everyone seems to have a foot on the grave.

Anyway, an academic anesthesiologist is usually someone involved in resident education and/or research. Doesn't always happen like this. Can be really skilled or not very skilled. Usually don't get paid as well as PP. Production pressure is usually lower. Harder/sicker cases are the norm. Being slow is not much of an issue. Decision making is. Academic guys get resident or new grad CRNA's who need a lot of supervision. There is no incentive to work long hours, so canceling cases is a great way to go home early.

PP guys survive by being fast, as production pressure is higher. They usually have good experienced CRNA's which make their lives easier. It's more "assembly line" work. They work very hard to please surgeons as they bring the money. I had an attending who had formed a pp group before entering academics tell me they would hand gifts to surgeons like baskets, wine,.... just to keep them happy. Surgeons would make fun of them saying "BTW my car is on the 3rd floor, please have it washed and waxed before I leave" He was sick of this and finally gave them the finger.

When you work in an academic center you will realize pp surgeons take the good cases and close the door to the bad ones. Where do you think they end up?- In the academic center with the not so fast guy.

 

[militarymd]

Today I did 3 whipples and 2 ruptured esophagus repairs (one thanks to a TEE probe placed by a highly skilled private practice guy) as well as covered the vascular lab. I wish I knew what I could have done if I wasn't such a below average, clinical skill-lacking piece of junk academic anesthesiologist. Best of luck with your lap choles and knee replacements.

did you have a resident do all your work and you sign the chart?

or did you actually do the cases?

I know a couple of attendings at Mayo.....so I know what you did today.

 

[urge]

Sometimes I get nervous signing out to them and there is no way I would hand them over a sitting crani or and LVAD case.

What kind of anesthesiologist separates twins, does sitting crani's, whipples and LVADs?? Dude, your department is short in fellowship trained people if you are doing that.

 

[militarymd]

I will not make 500 large but I do ok with my mid 300s. I enjoy crazy cases and teaching residents. I like having to think about how to take care of the quadraplegic with long QT and a HR of 25 or how to anesthetize the twins so that the surgeon can successfully separate them. The challenges excite me and make me want to wake up in the morning. I like having a lab and trying to make new discoveries to further the field. I could make a lot more money in private practice but I don't know that I would be much happier than I am right now. 500 large does sound good though.

Wait a minute....so youre' telling me/us that as a "clinical instructor" at Mayo clinic.....someone who HAS NOT even taken his oral boards yet.....you have your OWN fu cking lab????????

Someone who Sweated the writtens?????...less than a year later...and you have your OWN fu cking lab??????

 

[nociceptor]

I'm quite confused about what an "Academic" Anesthesiologist actually do...., anyone with more info please post.., will be most appreciated.

aren't "Academic" Anesthesiologist (AA) and Anesthesiologist "Assistants" (AA) the same thing?? Just a slightly different alliteration,right?


/couldn't resist

 

[Planktonmd]

Today I did 3 whipples and 2 ruptured esophagus repairs (one thanks to a TEE probe placed by a highly skilled private practice guy) as well as covered the vascular lab. I wish I knew what I could have done if I wasn't such a below average, clinical skill-lacking piece of junk academic anesthesiologist. Best of luck with your lap choles and knee replacements.

2 esophageal ruptures in one day!
You must work in a town where the private practice guys who insert TEE probes are very rough 🙂

 

[abords]

I know that my skills have serious limitations and that i have a lot to learn. I know that PP guys can do things more efficiently and with greater proficiency than I can, but I just wanted to get it into the forum that AA do difficult cases and work hard as well. I am not going to have to take a patient off pump or manage a TEF in a newborn because that is not in the patient's best interest as I have not done that in a while. Clinically I am not as adept at these things as I probably should be. At the same time I am not going to hand over a difficult case to one of my collegues who hasn't managed something like that in a while because that is not in the patient's best interest. We all have our strengths and weaknesses in an AA practice, I am no exception. Please accept my appology if there is any misunderstanding. AA is a great way to learn new things because of the wealth of knowledge that surrounds you and the support you get is tremendous.

 

[Gern Blansten]

Wow, such eloquent metaphors you reply with.

I'm a redneck from Florida, dude.

Try puttin' in a dippa Copenhagen, sinch up your tightie-whities, and

RESPONDE CON LOS CAJONES.

like...

"Jet, your post is way off, Dude."

"Jet, Dude, thattsa buncha B.S.."

"Jet, my mom could squat more than you on your best day."

i can take it, bro.....I've got a f u kk you account, remember?

I PAINT WITH A BROAD BRUSH??

Cummon, Steve Martin.

Speak your mind.

But deep inside you know its an overall accurate description of the stereotypical academic center.

Okay, I'll give it a try...here goes:

Cummon Jet, don't be such a douchebag!
Why you gots to be a hater, dude??
Why you gunna make me go all Milli Vanilli on yo ass? That's where I mess you up so bad you be wishin' you was somebody else.

That is the best I can come up with right now. How was that?
BTW, I am glad someone knows the Steve Martin connection.

 

[militarymd]

I know that my skills have serious limitations and that i have a lot to learn. I know that PP guys can do things more efficiently and with greater proficiency than I can, but I just wanted to get it into the forum that AA do difficult cases and work hard as well. I am not going to have to take a patient off pump or manage a TEF in a newborn because that is not in the patient's best interest as I have not done that in a while. Clinically I am not as adept at these things as I probably should be. At the same time I am not going to hand over a difficult case to one of my collegues who hasn't managed something like that in a while because that is not in the patient's best interest. We all have our strengths and weaknesses in an AA practice, I am no exception. Please accept my appology if there is any misunderstanding. AA is a great way to learn new things because of the wealth of knowledge that surrounds you and the support you get is tremendous.

I'm wondering about the answers to my questions.

 

[Gas]

Not to sound too idealistic, but we shouldn't be bashing each other. We are all anesthesiologists. The advances/discoveries that academic anesthesiologists have brought on have made the field what it is today, for all of us. I just finished residency at a large academic center, and I am in PP, so I see the differences. Certain things are valued in PP, certain other things are valued in academics. No one is better than the other, just different.

 

[Felix]

Not to sound too idealistic, but we shouldn't be bashing each other. We are all anesthesiologists. The advances/discoveries that academic anesthesiologists have brought on have made the field what it is today, for all of us. I just finished residency at a large academic center, and I am in PP, so I see the differences. Certain things are valued in PP, certain other things are valued in academics. No one is better than the other, just different.

Fact.

(Facts are boring.)

 

[xjohns1]

what a disappointing thread this is. there are lousy anesthesiologists in both private practice and academia. the skill set and attitudes and efficiency are undeniably different in private practice and academia. but where would the field be without academic anesthesiologists? is it really necessary that ted eger be slick at pumping out cases and placing epidurals? of course not, but without him our understanding and use of volatile agents would likely be very different, even in private practice. i'm pretty proud of our academic anesthesiologists who have made amazing advances in the field and have the freedom to say no to unreasonable surgeons when necessary, to be on the forefront of therapies and practice, and to care for the very sickest of the sick during the entire perioperative period: in the or during the most exotic of operations, in the icu, and on a comprehensive acute pain service. our faculty work in labs and publish studies, conduct clinical trials on drugs that will revolutionize the field, and write about possible future practice paradigms. they write textbooks that define the field and its subspecialties. they organize and teach at national conferences and meetings. they train generations of anesthesiologists, intensivists, and pain specialists. they teach every medical student that graduates from our medical school the value of anesthesiology to the profession of medicine. they do this despite living in one of the most expensive places in the country for substantially less than the area private practice salaries. it seems hard to argue it's entirely about 'the benjamins.' our system is weak in many areas compared to private practice, and certainly not everyone is a ted eger. but i'm glad (for patients' sake) that our faculty are doing the work they're doing and aren't in private practice.

 

[militarymd]

what a disappointing thread this is. there are lousy anesthesiologists in both private practice and academia. the skill set and attitudes and efficiency are undeniably different in private practice and academia. but where would the field be without academic anesthesiologists? is it really necessary that ted eger be slick at pumping out cases and placing epidurals? of course not, but without him our understanding and use of volatile agents would likely be very different, even in private practice. i'm pretty proud of our academic anesthesiologists who have made amazing advances in the field and have the freedom to say no to unreasonable surgeons when necessary, to be on the forefront of therapies and practice, and to care for the very sickest of the sick during the entire perioperative period in the or during the most exotic of operations, in the icu, and on a comprehensive acute pain service. our faculty work in labs and publish studies, conduct clinical trials on drugs that will revolutionize the field, and write about possible future practice paradigms. they write textbooks that define the field and its subspecialties. they organize and teach at national conferences and meetings. they train generations of anesthesiologists, intensivists, and pain specialists. they teach every medical student that graduates from our medical school the value of anesthesiology to the profession of medicine. they do this despite living in one of the most expensive places in the country for substantially less than the area private practice salaries. it seems hard to argue it's entirely about 'the benjamins.' our system is weak in many areas compared to private practice, and certainly not everyone is a ted eger. but i'm glad (for patients' sake) that our faculty are doing the work they're doing and aren't in private practice.

I think you've missed Jet's point......

How MANY academic anesthestiologists are like the ones you described.

One of my attendings trained at UCSF....Had GLOWING letters of recommendations from Dr. Miller....about how great this guy was...and how they would have liked to have kept him at UCSF if it was for the Navy oblligation...blah blah blah...

I wouldn't let him anesthetize my rabid dog.

 

[nociceptor]

I wouldn't let him anesthetize my rabid dog.

what about your rabid dog exhibiting aggressive behavior?

 

[Gern Blansten]

I wouldn't let him anesthetize my rabid dog.

You own a rabid dog? Well, that clears up a few inconsistencies.🙂

 

[militarymd]

what about your rabid dog exhibiting aggressive behavior?

NO.....I don't believe in cruelty to animals.....

 

[Planktonmd]

You own a rabid dog? Well, that clears up a few inconsistencies.🙂

​

 

[jetproppilot]

Okay, I'll give it a try...here goes:

Cummon Jet, don't be such a douchebag!
Why you gots to be a hater, dude??
Why you gunna make me go all Milli Vanilli on yo ass? That's where I mess you up so bad you be wishin' you was somebody else.

That is the best I can come up with right now. How was that?
BTW, I am glad someone knows the Steve Martin connection.

THAT WAS GREAT, STEVE.

Keep up the passion.

 

[GasEmDee]

I think you've missed Jet's point......

How MANY academic anesthestiologists are like the ones you described.

...and I think YOU'VE missed xjohn's point.

How many private practice anesthesiologists are like the ones you have described? There are plenty of lousy pp anesthesiologists, I am sure, as you have spent a significant amount of your time here putting down the anesthesiologists that you have come in contact with. Every population has a normal distribution. That applies to both academic and private practice anesthesiologists.

Don't bite the hand that fed you. Without academic anesthesia, you'd be anesthetizing your patient's with whiskey. I am curious what contributions you have made that entitle you to pass judgement on those how have contributed?

I agree with your viewpoint that we all should question basic dogma and assumptions taught in academia. But your the tone of your posts just reeks of sour grapes.

And BTW, not every person has the single-minded goal of making "benjamins".

 

[jetproppilot]

...and I think YOU'VE missed xjohn's point.

How many private practice anesthesiologists are like the ones you have described? There are plenty of lousy pp anesthesiologists, I am sure, as you have spent a significant amount of your time here putting down the anesthesiologists that you have come in contact with. Every population has a normal distribution. That applies to both academic and private practice anesthesiologists.

Don't bite the hand that fed you. Without academic anesthesia, you'd be anesthetizing your patient's with whiskey. I am curious what contributions you have made that entitle you to pass judgement on those how have contributed?

I agree with your viewpoint that we all should question basic dogma and assumptions taught in academia. But your the tone of your posts just reeks of sour grapes.

And BTW, not every person has the single-minded goal of making "benjamins".

I'm gonna answer your post very pragmatically.

Your post is filled with feel good stuff...

..."don't bite the hand that fed you"...

..."not every person has the ...goal of making benjamins"....

Residency is a symbiotic relationship, Gas.

I am thankful for my education.

But I know the residency program that trained me profitted from training me.

Did you know residency programs get paid for each resident, in addition to being able to bill the patient?

So my CA-1 year was a wash, yes.

But as a CA-2...CA-3, you churn out alotta benjamins for your program, since you are staffing a room at pauper's wage....less than half of what our CRNAs make...with not-alotta supervision with many cases you do...

So its a win-win.


The resident wins. The institution wins.

So back to your "don't bite the hand that feeds you" idea....

HUH?

They won too!

I am a product of a residency. Why do you see it as a crime to call out deficiency?

And by deficiency I'm referring to many university-based program issues.

Think outside the box for justa minute:

1)Why can't university programs be more efficient, and in the process of succeeding at this, in addition to making more benjamins for said institution, they teach residents to be more efficient? Cuz you're expected to be efficient out here, ladies and gentlemen. Even though your residency program didnt instill that in you.

2)Why can't university programs eliminate alotta drama involved in many scenerios that happen every day in our specialty (difficult airway, GA in a parturient, full stomach, LMA use in a non-symptomatic GERD pt, lab test orders, "clearances", etc etc), and in the process eliminate the unneeded fear instilled in residents when these situations arise?

3)There are many practices/habits/myths perpetuated in academia to residents that are, quite frankly, unneeded. Why can't we work to eliminate this?

I am not passing judgement on any individual, Slim.

I am passing judgement on the system.

It could be better.

Which means residents will be better educated at the end of their residency.

If noone questions the system, it will never change.

And, uhhhhhh, cummon, Gas. If you don't think academia is a safe haven for docs that can't cut the mustard, then you arent being honest with yourself.

Thats not to say there arent great academic docs, because there are.

But out here, where its all about benjamins, y'aint gonna be given a shot at the low-NFL-draft-pick dollars as a partner unless you can cut the mustard.

There aint no university system to hide under.

Which brings me to my next point:

You said "not every person has the single-minded goal of making benjamins."

I'll give you a pragmatic answer:

MOST PEOPLE DO.

Its self preservation.

After sacrificing your twentieth decade and accumulating a tonna debt while your business-major friends were lying by the pool on the weekends you spent cramming for that organic chem final, and getting laid on weekday evenings while you were stuck in the library keeping up with your eighteen-hour semester load needs, not to mention the insane sacrifices made during med school and residency,

Dude wants to get paid at the end of all this training.

So whaddya trying to say with your anti-benjamin statement? How many 31 year old CA-3 residents do you know, who sacrificed their twenties, who sacrificed the by-the-pool scene during college and med school and residency, who no-doubt have a tonna debt, arent gonna go for the benjamins?

And who are you to imply that somehow thats wrong?

Money brings options.

Lets you pay off the six-figure student loan debt you own.

Lets you send your son to college.

Lets you establish a f u kk you account.

Although I'd love to bite into your Sister Theresa statement,

philanthropists are few and far between.

So take your propeganda elsewhere, Slim.

Cuz it ain't the reality most people face.

 

[militarymd]

...and I think YOU'VE missed xjohn's point.

How many private practice anesthesiologists are like the ones you have described? There are plenty of lousy pp anesthesiologists, I am sure, as you have spent a significant amount of your time here putting down the anesthesiologists that you have come in contact with. Every population has a normal distribution. That applies to both academic and private practice anesthesiologists.

Don't bite the hand that fed you. Without academic anesthesia, you'd be anesthetizing your patient's with whiskey. I am curious what contributions you have made that entitle you to pass judgement on those how have contributed?

I agree with your viewpoint that we all should question basic dogma and assumptions taught in academia. But your the tone of your posts just reeks of sour grapes.

And BTW, not every person has the single-minded goal of making "benjamins".

I just call it like I see it ....in my very limited experience since I finished my residency in 1997.

 

[GasEmDee]

Nowhere did I argue that academic medicine is anywhere near perfect. In fact, I agree wholeheartedly with a lot of the deficiencies that you point out. That's not the point.

What I do take issue with, is that folks like you and MilMD take nearly the polar opposite stance:

And, uhhhhhh, cummon, Gas. If you don't think academia is a safe haven for docs that can't cut the mustard, then you arent being honest with yourself.

and...

But out here, where its all about benjamins, y'aint gonna be given a shot at the low-NFL-draft-pick dollars as a partner unless you can cut the mustard.

Really. So private practice is somehow exempt from lousy clinicians? Clearly not, since MilMD comes on this board at regular intervals to bash his colleagues. Why does academic anesthesia constantly need to be singled out as the sole resting place for lousy doctors?

Or do you believe, Jet, that there are no lousy private practice anesthesiologists? Do all lousy anesthesiologists exist in academia? Or are you saying that academic anesthesiologists no pressure to perform or produce?

2)Why can't university programs eliminate alotta drama involved in many scenerios that happen every day in our specialty (difficult airway, GA in a parturient, full stomach, LMA use in a non-symptomatic GERD pt, lab test orders, "clearances", etc etc), and in the process eliminate the unneeded fear instilled in residents when these situations arise?

Its VERY SIMPLE my friend. It has nothing to do with instilling fear. When you are first taught how to write, you are taught to create very stereotypical letters. Then when you become proficient, you develop your own style of handwriting. When I taught martial arts, I insisted that beginners learn the basics in stereotypical form. As they became more proficient, they were allowed to exercise more individual style.

Its similar with teaching anesthesia. When you have developed some decent clinical judgement, then you can be a little more free form with things. You start conservative until you are experienced enough to know when the "rigid rules" can be relaxed. Until then, you just don't know better. Academic anesthesiologists are not so dogmatic as you would have this board believe.

And finally.......

You said "not every person has the single-minded goal of making benjamins."

I'll give you a pragmatic answer:

MOST PEOPLE DO.

Its self preservation

And who are you to imply that somehow thats wrong?

Please quote me where I implied this. I said that not everyone is single-mindedly focused on money. I've endured the same financial hardships, so spare me the hardship lecture.

Had it occurred to you that there is a process of SELF SELECTION here? If you are single-mindedly interested in money, you dont take an academic job. DUH. If you are the type of person that isn't that is less interested in maximizing income, an academic career is a more feasible option. I won't even bother to address the fact that academia has roles other than just production. xjohn's post spelled that out as obviously as it can be put.

In other words, Slim, being a lousy anesthesiologist isnt the only reason one chooses to pursue an academic career. Why are these basic concepts so hard to understand? There is no propaganda here, man, just common freakin' sense.

I am not propping up academia, I am not putting down private practice. I only argue that there is a role for both, that neither are perfect, and that academia does not deserve unilateral bashing from the private sector.

 

[GasEmDee]

I just call it like I see it ....in my very limited experience since I finished my residency in 1997.

And there are plenty of academic anesthesiologists who finished their residencies in the 1970's. So I guess they have very limited experience too. 🙄

You need a lot more back up than "because I'm older than you" if you are gonna talk smack about an entire group of people. Until you produce it, you're just another self-aggrandizing internet a-hole.

I'm wondering about the answer to my question.

 

[militarymd]

And there are plenty of academic anesthesiologists who finished their residencies in the 1970's. So I guess they have very limited experience too. 🙄

You need a lot more back up than "because I'm older than you" if you are gonna talk smack about an entire group of people. Until you produce it, you're just another self-aggrandizing internet a-hole.

I'm wondering about the answer to my question.

Like I said....my experience is limited...

and, I never called anyone any bad names....

why is it that any opinion, other than one that is consistent with your own, is talking smack and being an a sshole?

why?

I'm still waiting for answers from the Mayo clincial instructor who sweated his written boards, waiting to talk his orals, but has his own lab at Mayo's answers to my questions.

 

[coprolalia]

TIME FOR COPRO TO WEIGH IN

As a n00b deep in the trenches who's also made a little extra coin in the PP environment (basically like an underpaid CRNA), here's my take...

When you come to a University to get your surgery, you essentially get 2-for-1 when you go to the OR. You get two pretty damn smart people looking at you, reviewing your data, doing the procedures, etc., etc. The attending is motivated by not looking like a jackass in front of the resident. The resident is motivated by not looking like a jackass in front of the attending. The result? You've got two people who are banging heads together and trying to get the job done correctly, at least during the critical parts of the case.

2-for-1. So, those complex cases that come to the University are not done by a solo anesthesiologist. Period. They are usually done by a senior resident who's had a little time to starting honing his/her craft and usually a senior academic anesthesiologist who has done quite a few of these tough cases (always with help from a resident, though) and basically knows what to expect.

Speaking from experience, here's the difference:

1) Efficiency. WAY more pressure to get cases done efficiently in PP land. Sure, the acuity may not be as high, but you take 25 minutes to wake someone up at the end of a case and you're going to hear about it. And, this is not during a quarterly evalution. This is right in the room. Hearing about it might be snide, passive-aggressive comments from the surgeon, dirty looks from the circulator, and even the OR aide pushing the mop bucket into the room on one occassion. I've learned really how to be efficient in that gig, something that clearly is not taught or emphasized in academia land. Time is money. A little pearl completely missed at Anesthesiology U.

2) Luxury of extra hands. You don't have a slew of people there to help your butt in PP land. You may have a tech in the room who, depending on their attitude, may or may not be helpful. You're often on your own. And, quite frankly, a lot of the anesthesiologists who are teaching me at Anesthesiology U. just couldn't hack having to do that much on their own. There are anesthesiologists who, aside from signing their name at the bottom, haven't touch the anesthesiology record in years.

3) Attitude. I don't know if that speaks to laziness or just being in an environment for so long where they've been pampered and have a bunch of residents to boss around. But, we have some pretty damn arrogant anesthesiologists in Anesthesiology U. that try to boss everyone around and even talk smack to the surgeons. They pop in and out of the room basically to "tell 'em how it is" and can always leave whenever they want because the resident will be there. This just doesn't happen at my other gig. It is much more cordial in PP land. Smack talk only happens if something really, REALLY bad is about to happen. And, if they're already tenured, no one can touch them. We have one prof who'd last about five minutes in PP land if he acted the way he does at Anesthesiology U. Why does he act that way? Because he can. Period.

4) Lack of creativity. There's only one solution to the problem in Anesthesiology U.: Do what the book says, or worse, "do what I say". And, that book could be Miller or the three 6"-thick volumes of "Policy and Procedure" written by someone who spends probably 5 days in the OR per year. I hear this over and over again. "You will do this because this is policy." For example, "reversing" a patient who got 50mg of rocuronium four hours ago and has been spontaneously breathing for the past three hours during the case with more-than-adequate tidal volumes because, I dunno, somehow residual neuromuscular paralysis is going to occur suddenly when you pull the tube and take them to the PACU. Forget about adding additional risks of the reversal agent. You will do this because it's policy. People are so afraid to go outside the box in Academia. It's quite ironic, actually, because that's the place that is supposed to put intellect and understanding of physiology and pharmacology on a pedestal.

5) Downward drift. Academia has the ability to "suck you in" and create an environment where you're not really accountable for your actions. There is always someone else to blame. Result? You get "accountability diffusion" and there is never really one person to point the finger out. "Why is that bad?" you might ask. Well, because it further engenders laziness in all shapes and forms. You can blame any host of people or (as stated above) policies that dictated or interfered with what you wanted to do. You don't really have any power of independent medical judgment, so you don't really have any accountability. Someone else always has their hands in what you do, so you're not really ever directly accountable for something (unless you miss an airway or something). What this has the net effect of doing is creating an environment where no real growth occurs. Cynical? Perhaps. But, I don't really see our top clinicians getting any better or daring to try new techniques because they have used and teach the "standard of care" for so long. Again, the real irony is that anesthetics become "cookie cutter" because everyone has to "teach to the mean" and is so fearful of thinking outside the box.

So, I think residency in this day and age - and I've talked to a lot of the oldies who did their training in the '60's and '70's - is totally different, whitewashed, standardized type of experience where the academicians are not really getting any better or being incentivized to be creative (because it's all risk and no reward to them). Plus, they don't want to buck the already established system. Why would they? There's already layers of accountability that will protect them. Who would want to stick their neck out in that kind of environment?

Lastly, here are the four types of academic anesthesiologists:

1) Gray-haired curmudgeon: This one knows everything. You know nothing. They pop into the room to scream at you for 20 minutes in front of the entire surgical team. They don't really do anything themselves, except yell. You are stupid. They are brilliant. And, everyone knows it. They have not touched a chart in twenty years. They haven't intubated someone or placed a line in at least ten. They've produced a long list of papers on the effects of enflurane on the hair follicles of capabaras in New Guinea, which proves how much smarter they are than you. They are essentially worthless, except for churning out meaningless papers and making the department look more "academic".

2) Nervous Nelly: This one tries to do everything. You wind up with massive bruises on your flanks from the number of times they've bowed you out of the way. They often make a lot of motion and noise like a flock of flamingos getting ready to take flight. But, their skills are never as great as they themselves think they are. They rob procedures from the residents. They push needless drugs at the slightest hint that some minor hemodynamic parameter is changing. They generally sabotage your anesthetic, although they think that the patient surely would've died had they not saved your ***. You learn more about what not to do from them, which I suppose is meaningful in some small way.

3) Billy Benchwarmer: This one does nothing. It's 3:00 PM and you've just turned your fourth case. The only thing that hurts worse than your aching bladder, which is about to rupture, is that pit in your stomach because you've been NPO longer than your patient. When Billy finally walks in, you detect that whiff of nicotine even through the surgical mask. Usually you get, "I'll be back in a few minutes to give you a break." Two hours later, Billy gets you out but then pages you back to the room ten minutes later after you're only three bites into the hospital gruel (which tastes like filet mignon you're so damn hungry). You can't learn anything meaningful from Billy. Your attitude, after working with him a few times, rapidly becomes an expectation that he'll show-up, sign your chart, and just basically stay out of your way while you do the anesthetic. But, you will definitely learn a lot by working with Billy... by doing everything on your own.

4) Dr. Perfect: A rare breed. A true do-gooder. Wants to be in academics because, like a grade school teacher, has felt a mission to teach. Not in it for the money. There are usually only one or two of these in an entire department. They balance the right amount of letting you do it on your own with stepping in when necessary. They never criticize you in front of other people, and when they do it is always professional and courteous. They are pretty competent, but just like the slower pace of academia. You're not going to learn to be super efficient from them, but you're going to learn how to be a good human being.

-copro

 

[2ndyear]

Copro,
So so true on many points regarding the styles of academic types. Academia is sooo subspecialiezed that we hardly get to see a true generalist. AAA- the vascular/thoracic guy is your attending. 5 year old healthy kid comes in at night, call the pedi person. Transplant? Call the transplant person. Ambulatory? Hey, there's even a fellowship for that. Definately gives a skewed view as to who can do what. We all should be able to do most things. My favorite attendings are the hands off ones at this point in my CA-3 year. If I'm fumbling with a procedure, knowing what your backup plan is is essential. Yesterday I couldn't get a thoracic epidural. Old lady, 81 years old, crooked nasty spine. Attending had me throw in some intrathecal morphine. Never took a shot, and I respect that.

 

[coprolalia]

Academia is sooo subspecialiezed that we hardly get to see a true generalist.

Yeah, it's funny trying to watch an academic pedi anesthesiologist try to put a labor epidural in a 350-lb beached whale when they pull "general" call. Can anyone say "high likelihood of wet tap"?

I wanted to say (one time when this actually happened), "Hey, why don't you giver her a GA, roll her on her side, and put in a caudal?"

-copro

 

[GasEmDee]

Copro,
So so true on many points regarding the styles of academic types. Academia is sooo subspecialiezed that we hardly get to see a true generalist. AAA- the vascular/thoracic guy is your attending. 5 year old healthy kid comes in at night, call the pedi person. Transplant? Call the transplant person. Ambulatory? Hey, there's even a fellowship for that. Definately gives a skewed view as to who can do what. We all should be able to do most things.

That's fair. Partly it is due to extreme subspecialization, and partly it is simply a division of labor. One anesthesthesiologist can't be on call for all the aortic dissections, the liver transplants, OB emergencies, trauma, and pedi. University medical centers are just too large for that.

Furthermore, tertiary and quarternary referral cases are just too complex for a person who doesnt do them every day. That is why there are specialties and subspecialties of medicine. I dont expect the cardiologists to be good at colonoscopies, eventhough both are medicine trained.

Isn't the reason for extreme subspecialization in academia obvious? And from an educational standpoint, wouldn't you rather have learned a subspecialty from the guy who eats, breathes, and sleeps it? I'm glad I was introduced to TEE from the guy who does it every day, rather than the generalist. I'm glad I had fellowship-trained attendings to teach me how to take care of a sick neonate.

Most large academic residencies have their residents rotate to private practice sites. There you get to see attendings who are excellent generalists! Yes they do adult and pedi and OB. But they don't do Fontans, arterial switches, fetal EXIT procedures, liver transplants, heart transplants, etc. So you ought to have been opposed to the range of anesthesia practices, if you are in a decent residency program.


Honestly, this whole topic comes up from time to time, and I think its a useless discussion, as we are comparing apples and oranges. Usually, its the PP guy who bashes academia as a haven for slow, dogmatic, mediocre clinicians. And yet, these guys generally dont do cases remotely as complex as the ones I have listed. In contrast, you generally don't see a super-specialized academic type coming onto this board criticizing private practitioners for not knowing how to do a pedi heart. That would be ridiculous. The objectives are just different. We need both, and there is a spectrum of skill in both groups.

 

[GasEmDee]

why is it that any opinion, other than one that is consistent with your own, is talking smack and being an a sshole?

why?

Its the historical tone of your posts over the years. It reeks of arrogance and condescension. And who are you anyway? If either you or I disappeared off the face of the planet, the state of anesthesia wouldn't change an iota.

I'm still waiting for answers from the Mayo clincial instructor who sweated his written boards, waiting to talk his orals, but has his own lab at Mayo's answers to my questions.

That is irrelevant to my own question to you, for which I am still awaiting an answer.

 

[Planktonmd]

Copro,
There is allot of reality in what you mentioned but I am surprised that as a resident you have such negative view of all of your attendings without exception.
I remember when I was in training that I could at least identify 4 or 5 attendings that I respected and did not consider dysfunctional.
It is sad if you go through your training without having any mentors.

 

[militarymd]

Its the historical tone of your posts over the years. It reeks of arrogance and condescension. And who are you anyway? If either you or I disappeared off the face of the planet, the state of anesthesia wouldn't change an iota.




That is irrelevant to my own question to you, for which I am still awaiting an answer.

I'm no one...and you don't know me....The arrogance and condescension is you projecting yourself into my posts.....most people see qualities in others that they have themselves.

I simply have a point of view that is different from yours. I can only suppose that you are an arrogant and condescending sort of guy....so you see it in my posts.

I didn't get to my position in life by being an a-hole...doesn't work that way in private practice....private practice values hard workers who know how to work with a variety of personalities and get them to work efficiently in a production pressure filled environment.

I'm waiting for an answer from another poster about his Mayo experience...not you.

And as for your question to me....I believe I answered it...if you bother to read what I wrote and not project your own thoughts and feelings into them.

I said that based on my limited experience since I finished my residency in 1997, I see a certain trend.....

To which you started babbling about people who finished training in the 70's....What's that got to do with my experience ...which I already conceded was limited.

Anyways....go ahead continue with your name calling and arrogance ...it's ok with me....I'm quite used to folks like you.

 

[GasEmDee]

I'm no one...and you don't know me....The arrogance and condescension is you projecting yourself into my posts.....most people see qualities in others that they have themselves.

Haha. Man that is rich. You know you are digging for a comeback when you have to resort to pseudo psychology. Your next response will be "I know you are, but what am I".

Perhaps I am the only one with that opinion then. For anyone that doesn't know you or know me, a simple search through forum posts allow them to settle that opinion for themselves.

I said that based on my limited experience since I finished my residency in 1997, I see a certain trend.....

My question is, what have you contributed to anesthesia that allows you to pass judgement on those who have? Your answer is a non-sequitur.

I'm no one...

Damn straight. and neither am I.

What's that got to do with my experience ...which I already conceded was limited.

Fair enough. I accept your concession.

 

[militarymd]

Haha. Man that is rich. You know you are digging for a comeback when you have to resort to pseudo psychology. Your next response will be "I know you are, but what am I".

Perhaps I am the only one with that opinion then. For anyone that doesn't know you or know me, a simple search through forum posts allow them to settle that opinion for themselves.


.

Pseudo psychology or not.....the truth can sting sometime.

And go ahead and search and post up....what you'll find is a history of me posting my point of view....followed by folks like you calling me names.

as a matter of fact....I challenge to dig up some posts that don't go that way.

 

[militarymd]

My question is, what have you contributed to anesthesia that allows you to pass judgement on those who have? Your answer is a non-sequitur.


.

Do movie critics have to have made movies before they are allowed to critique them?

It's a free country....anyone can pass judgement on anyone else for no reason other than because they want to......just like you passing judgement on me.

 

[GasEmDee]

.....the truth can sting sometime.

Haha. OK, well that was not quite "I know you are but what am I", but the cliche was just as close...

And go ahead and search and post up....what you'll find is a history of me posting my point of view....followed by folks like you calling me names.

Why have you had this problem with so many other people? Is everyone arrogant but you?

as a matter of fact....I challenge to dig up some posts that don't go that way.

http://forums.studentdoctor.net/showthread.php?t=348682

Post 8 is the first post that has anything derogatory in it, and its yours. Look at your reference to "ACADEMIC" types. He responded in kind, calling you a "dope". Then conversation degenerated into one of your typical threads.

And regarding passing judgement, I agree with you. You are free to give your opinion, just as I am free to give mine.

 

[coprolalia]

It is sad if you go through your training without having any mentors.

Like I said, there are a few "Dr. Perfects" in my program. But, I can only surmise that, due to the extremely lucrative private practice environment right now, most of the real talent is out there getting paid.

It takes a certain personality to make it in academia. Most of us (meaning my fellow residents) are going into PP when we're done. We share our frustrations. The few that are staying in academia seem to emulate and personify exactly what I'm talking about in the other personalities. It's strange. Academia seems to self-select those who either think they are smarter and brighter than their colleagues, or somehow have something to prove to the world.

I do have a few that I think are Jedi masters in my program. Sadly, I can count them on one hand. And, there are others who are truly great clinicians, but have major personality defects. Just the way it is. They're not going to get the boot, 'cuz it's too hard to recruit.

-copro

 

[militarymd]

Haha. OK, well that was not quite "I know you are but what am I", but it was close...




So you have had this problem with other people before huh? I guess everyone else is arrogant but you.

And regarding passing judgement, I agree with you. You are free to give your opinion, just as I am free to give mine. No one here has asked for your posts to be deleted or your account to be banned.

Yes...many people call me various different names...assign various different characteristics to me......because I offer an opinion or point of view that is different than theirs.

bigot, racist, crook, arrogant, incompetent .......all different....if you believe the various denizens of sdn, I embody all that is EVIL in mankind....

I've managed and been managed by enough people in my career (both military and civilian) to know how most think.....especially someone at your stage of life.

 

[GasEmDee]

Yes...many people call me various different names...assign various different characteristics to me......because I offer an opinion or point of view that is different than theirs.

Nope. There are many other opinions that I disagree with here. It is merely your delivery style. And your sour grapes. And your self assuredness that everyone is wrong but you. Just look at that old thread I posted, at your request.

I've managed and been managed by enough people in my career (both military and civilian) to know how most think.....especially someone at your stage of life.

I have managed and been managed too. Mostly in the software industry. I have never been in the military. To this day, I still do not presume to know how most people think.

I also do not understand why you love to pull the age/experience argument, all while criticizing those who are older and more experienced and more productive than you. 😕

BTW, what did you think of that post that I found? Surprisingly, it wasn't too hard to dig one up despite your 4000 posts here.

 

[militarymd]

I also do not understand why you love to pull the age/experience argument, all while criticizing those who are older and more experienced and more productive than you. 😕

BTW, what did you think of that post that I found? Surprisingly, it wasn't too hard to dig one up despite your 4000 posts here.

I'm glad you picked that thread....look who started calling names first...wasn't me.

I said nothing derogatory ..... until I was called a "dope" first..... I swear....don't you read....or do you just "read into" things.

I didn't pull any age/experience arguement....once again...you are "reading into" things.

Who said that I had "limited" experience...it was me...not you....

Are you not a resident?...

Do residents NOT have a different perspective than someone whose finished with training and moved on?????

I would hope so.

 

[GasEmDee]

I'm glad you picked that thread....look who started calling names first...wasn't me.

I said nothing derogatory ..... until I was called a "dope" first..... I swear....don't you read....or do you just "read into" things.

LOL. I wasn't involved in most of that conversation, so I guess EVERYONE else that responded negatively to you "read into" it as well? Well gosh, then maybe you read into the word "dope"

Anywho, I'm tired man...The thread is there for everyone to see. People can judge as they please. There seems to be a schizm that I cannot bridge here. There are lots of people here who offer opinions, and yet no one seems to get the reactions that you do.

Everyone else is wrong, everyone else is arrogant, everyone else reads into things. And you are just the innocent little flower, just offering an opinion and minding your own business. 👎

I'm going to go enjoy my Saturday.