Academic Anesthesiologist

[militarymd]

---

Members do not see this ad.

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.

You just have "sour grapes" because I dissed UCSF......

 

[advoxxx]

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.

I remember a certain post by a Dr. MilMD spouting off about being an "alpha male" who "fu kked the cheerleaders", accompanied by a very sad picture of his own bare chest posted here that has since been erased, probably when he looked at what a fool he was making of himself.
don't search for it. it's been removed.
i still have a copy of the picture though. it was hilarious.

tsk tsk.

oh well, back to my lurking on an otherwise informative board.

 

[militarymd]

I remember a certain post by a Dr. MilMD spouting off about being an "alpha male" who "fu kked the cheerleaders", accompanied by a very sad picture of his own bare chest posted here that has since been erased, probably when he looked at what a fool he was making of himself.
don't search for it. it's been removed.
i still have a copy of the picture though. it was hilarious.

tsk tsk.

oh well, back to my lurking on an otherwise informative board.

You save pictures of strange men's bare chests on your hard drive???😱

 

[Arch Guillotti]

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

"Funny?" That's a strange way of thinking about things. You sound angry.

 

[coprolalia]

"Funny?" That's a strange way of thinking about things. You sound angry.

Most pedi anesthesiologists I've met have an extreme supreriority complex. They see themselves as the penultimate anesthesiologist, a little bit better than their colleagues.

So, angry? No. Sense of irony? Yes. 😀

-copro

 

[jetproppilot]

Most pedi anesthesiologists I've met have an extreme supreriority complex. They see themselves as the penultimate anesthesiologist, a little bit better than their colleagues.


-copro

Not the case at all at the childrens hospital where I did 6 months as a resident.

2 of the attendings are still there.

Really laid back dudes.

 

[coprolalia]

Not the case at all at the childrens hospital where I did 6 months as a resident.

2 of the attendings are still there.

Really laid back dudes.

Fair enough. Speaking from personal experience here. Our pedi anesthesiologists, except for one of them, are definitely not "laid back". If anything, they are uptight, screechy, tense, "waiting for the stuff to hit the fan", over-vigilant, high-sphincter-tone, and generally unpleasant people to be around.

-copro

 

[toughlife]

We are nuts to be arguing about who is what and why in academic vs. PP anesthesiology. I have yet to see other specialties argue whether their PP or academic colleagues are better than the other.

Whatever we think of the other, we must realize that in order for our specialty to remain strong we need to have top-notch people in both camps.


Without academic programs to train the current generation of anesthesiologists and those of us currently training, we would not have the opportunity to look forward to a nice future. So all of you need to be thankful that someone care enough to stay there and make it possible for you to learn something.

MMD was in academia for a while and I am sure someone learned something from his teaching.

If there were no academic attendings (and programs) it would spell the end of anesthesiology since the pipeline would be shut off. The competition would love to see that and it is obvious they know this since they want to replace residency training programs with CRNA schools.

Let us not fall into that trap and instead of biting the hand that fed you at one point, you should take some of your fat paycheck (which you are getting because an academic anesthesiologist taught you something) and donate to the FAER (foundation for anesthesia and research education). That way you can contribute to improving the quality of academic anesthesiology if it bothers you so much.

 

[militarymd]

Fair enough. Speaking from personal experience here. Our pedi anesthesiologists, except for one of them, are definitely not "laid back". If anything, they are uptight, screechy, tense, "waiting for the stuff to hit the fan", over-vigilant, high-sphincter-tone, and generally unpleasant people to be around.

-copro

That is the same experience I have had...and they were from BIG name peds hospitals that I won't name.

 

[militarymd]

We are nuts to be arguing about who is what and why in academic vs. PP anesthesiology. I have yet to see other specialties argue whether their PP or academic colleagues are better than the other.

Whatever we think of the other, we must realize that in order for our specialty to remain strong we need to have top-notch people in both camps.


Without academic programs to train the current generation of anesthesiologists and those of us currently training, we would not have the opportunity to look forward to a nice future. So all of you need to be thankful that someone care enough to stay there and make it possible for you to learn something.

MMD was in academia for a while and I am sure someone learned something from his teaching.

If there were no academic attendings (and programs) it would spell the end of anesthesiology since the pipeline would be shut off. The competition would love to see that and it is obvious they know this since they want to replace residency training programs with CRNA schools.

Let us not fall into that trap and instead of biting the hand that fed you at one point, you should take some of your fat paycheck (which you are getting because an academic anesthesiologist taught you something) and donate to the FAER (foundation for anesthesia and research education). That way you can contribute to improving the quality of academic anesthesiology if it bothers you so much.

tough....you're right...

I don't know about Jet, but my feelings are that ACADEMIC folks are SUPPOSED to be a HIGHER caliber because they are supposed to train us....

HOWEVER, the system doesn't support that...rather it allows MANY to hide in it...MANY who aren't the HIGHEST Caliber....VERY similar to the military's way of promoting and retaining.

PP has its weak folks, but THERE is competition in PP...Per other thread where NedFlanders was calling me names.

IN PP, the fastest, strongest, smartest, most competive (both in clinical & interpersonal & business skills) win out....in my group, we are dropping the weak....they have to move on to less desirable practices.

I guess that's MY point....Issue with the Academic SYSTEM..more so than the TRUE ACADEMIC anesthesiologist.....if you read one of the other threads, I encouraged someone to take an academic position first BEFORE heading into PP, but with the condition of doing the academic job in a certain way.

 

[toughlife]

tough....you're right...

I don't know about Jet, but my feelings are that ACADEMIC folks are SUPPOSED to be a HIGHER caliber because they are supposed to train us....

HOWEVER, the system doesn't support that...rather it allows MANY to hide in it...MANY who aren't the HIGHEST Caliber....VERY similar to the military's way of promoting and retaining.

PP has its weak folks, but THERE is competition in PP...Per other thread where NedFlanders was calling me names.

IN PP, the fastest, strongest, smartest, most competive (both in clinical & interpersonal & business skills) win out....in my group, we are dropping the weak....they have to move on to less desirable practices.

I guess that's MY point....Issue with the Academic SYSTEM..more so than the TRUE ACADEMIC anesthesiologist.....if you read one of the other threads, I encouraged someone to take an academic position first BEFORE heading into PP, but with the condition of doing the academic job in a certain way.

I agree with your assessment and the reality is that as long as academic salaries continue to lag behind PP, there will always be an exodus to the PP world.

Anesthesiology departments are sorely lacking in research funds and the amount of NIH funding, except for the elite few, is non-existant. Most academic positions are really clinical instructor jobs since most academic attendings don't write grant proposals or publish in peer-reviewed journals. For academic anesthesiology to prosper we need strong deparments with all ranges of instructors and academicians from the clinical instructor to the super-star researcher.

Couple the above problem with a field that attracts people who are mainly lifestylers and only interested in a fat paycheck for as little work as possible and you have a stagnant field that is relegated to a technical job. As long as funding is not available to attract bright minds with a hefty salary to do research, the deterioration of academic anesthesia will only continue.

That is why we continue to hear the old argument of fighting to increase reimbursement for teaching anesthesiologists. For as long as we are shortchanged by medicare (by way of strong opposition lobbying), the caliber, quality and growth potential of anesthesiology won't be forthcoming. Granted, increased medicare reimbursements won't be the solution we all hope to see but it will be a huge step in the right direction.

1)

 

[fakin' the funk]

I agree with your assessment and the reality is that as long as academic salaries continue to lag behind PP, there will always be an exodus to the PP world.

Anesthesiology departments are sorely lacking in research funds and the amount of NIH funding, except for the elite few, is non-existant. Most academic positions are really clinical instructor jobs since most academic attendings don't write grant proposals or publish in peer-reviewed journals. For academic anesthesiology to prosper we need strong deparments with all ranges of instructors and academicians from the clinical instructor to the super-star researcher.

Couple the above problem with a field that attracts people who are mainly lifestylers and only interested in a fat paycheck for as little work as possible and you have a stagnant field that is relegated to a technical job. As long as funding is not available to attract bright minds with a hefty salary to do research, the deterioration of academic anesthesia will only continue.

That is why we continue to hear the old argument of fighting to increase reimbursement for teaching anesthesiologists. For as long as we are shortchanged by medicare (by way of strong opposition lobbying), the caliber, quality and growth potential of anesthesiology won't be forthcoming. Granted, increased medicare reimbursements won't be the solution we all hope to see but it will be a huge step in the right direction.

Great post 👍

 

[militarymd]

That is why we continue to hear the old argument of fighting to increase reimbursement for teaching anesthesiologists. For as long as we are shortchanged by medicare (by way of strong opposition lobbying), the caliber, quality and growth potential of anesthesiology won't be forthcoming. Granted, increased medicare reimbursements won't be the solution we all hope to see but it will be a huge step in the right direction.

1)

This is the one time where you'll see me type this: It's not about the money.

I was in the Navy...at 11 years of AD service, I was making about 120,000 per year as a doubled boarded anesthesiologist working 50 to 60 hours a week...usually 2 weekends a month....

I didn't leave because of the money.

I considered academics....I chose PP...NOT because of the money.

I have a partner who I recruited to be my partner from ACADEMICS....this person left ACADEMICS and joined me.....and the reason was NOT the money.

Tough...you're right about the reimbursement issue being an OLD DEAD HORSE....because it is.....

I'm willing to bet that the BEST academic types you're going to recruit and retain in ACADEMICA will NOT be there because of the money.

 

[GasEmDee]

We are nuts to be arguing about who is what and why in academic vs. PP anesthesiology. I have yet to see other specialties argue whether their PP or academic colleagues are better than the other.

Whatever we think of the other, we must realize that in order for our specialty to remain strong we need to have top-notch people in both camps.


Without academic programs to train the current generation of anesthesiologists and those of us currently training, we would not have the opportunity to look forward to a nice future. So all of you need to be thankful that someone care enough to stay there and make it possible for you to learn something.

MMD was in academia for a while and I am sure someone learned something from his teaching.

If there were no academic attendings (and programs) it would spell the end of anesthesiology since the pipeline would be shut off. The competition would love to see that and it is obvious they know this since they want to replace residency training programs with CRNA schools.

Let us not fall into that trap and instead of biting the hand that fed you at one point, you should take some of your fat paycheck (which you are getting because an academic anesthesiologist taught you something) and donate to the FAER (foundation for anesthesia and research education). That way you can contribute to improving the quality of academic anesthesiology if it bothers you so much.

Thanks toughlife, I agree 100%. No one has argued that academic anesthesiologists are better than anyone else. There is a spectrum of skill in both the pp and academic camps, and both are needed to fulfill different roles.

 

[jetproppilot]

Thanks toughlife, I agree 100%. No one has argued that academic anesthesiologists are better than anyone else. There is a spectrum of skill in both the pp and academic camps, and both are needed to fulfill different roles.

The bar needs to be raised in academics.

 

[GasEmDee]

The bar needs to be raised in academics.

Is it the same bar by which private practitioners are measured?

 

[goodoc]

This discussion is sort of apples to oranges, The goal of PP vs AA are the same in the respect that anesthesia is desired and delivered, the reasons are quite different. In PP you should have learned the basics by now zebras are rare,(send then to a university by god) and the goal is to maximize income by decreasing use of resources (OR time, Drugs, equipment, labs, etc).
In the academic world it is supposed to be about educating so you must point out all of the things that might screw you in the PP world, You look for the zebra, and you train for the worst. As time goes by and clinical skills improve fewer resources need to be spent to achieve the same outcome due to the increased proficiency of the clinician.
These are the big differences between the two groups IMHO.

 

[GasEmDee]

I'm willing to bet that the BEST academic types you're going to recruit and retain in ACADEMICA will NOT be there because of the money.

I appreciate that you are now focusing on safer bets. I guess its not just about the Benjamins after all. Have a good morning.

 

[GasEmDee]

In the academic world it is supposed to be about educating so you must point out all of the things that might screw you in the PP world, You look for the zebra, and you train for the worst. As time goes by and clinical skills improve fewer resources need to be spent to achieve the same outcome due to the increased proficiency of the clinician.
These are the big differences between the two groups IMHO.

Yes, and beyond education, its is obviously about expanding the frontiers of our knowledge base. This is a very real production pressure that is different from time pressure. No one cares about room turn-around when you doing a rare twin-splitting operation.

 

[jetproppilot]

Is it the same bar by which private practitioners are measured?

Read Mil's post #60.

That pretty much says it all.

 

[coprolalia]

One time not too long ago I said out loud, "this isn't the real world" in the OR. Man, did that get a reaction from everyone in the room.

What I meant is that the inefficiency just simply isn't tolerated. I know. I've seen it firsthand in PP land where people are actually generally helpful. It's ridiculous some of the extra crap that we do that's really unnecessary. I think a lot of residents are going to have a rude awakening in PP when they realize a lot of what they've been taught to do is superfluous.

-copro

 

[GasEmDee]

Read Mil's post #60.

That pretty much says it all.

Let me rephrase the question. What measures should be used to evaluate academic anesthesiologists, and what measures should be used to evaluate private practice anesthesiologists?

 

[militarymd]

Let me rephrase the question. What measures should be used to evaluate academic anesthesiologists, and what measures should be used to evaluate private practice anesthesiologists?

can I answer?

 

[GasEmDee]

can I answer?

Please do.

 

[jetproppilot]

Let me rephrase the question. What measures should be used to evaluate academic anesthesiologists, and what measures should be used to evaluate private practice anesthesiologists?

I feel as though you've missed my point. Which is OK. I don't know what else to write, other than that I feel academic anesthesia could do a much better job in preparing residents for the way they are most likely to practice, which is in private practice.

You've done alotta defending academia.

I respect that.

I just don't agree with your point of view.

How many residents, Gas, would you say are gonna stay in academia?

I'd say the vast majority are headed for private practice, where anesthesia is practiced vastly differently than at a university.

If a resident is probably gonna practice out here, why not train them like we practice out here?

I disagree with the post that made the analagy of "you must first walk before you can run.."

That doesnt apply. Learning the academic way of practicing isnt "walking" verses PP being "running".

No.

They are completely different.

Since probably nine outta ten residents head for the private world, my point is....why not train them like they are gonna practice so they don't hafta be "retrained" by their new private practice partners when they arrive at their new group?

And thats what happens.

A resident goes through a "retraining".....interpersonal, skill, and judgement.... when he/she hits the private practice world.

My points are aimed more at the system than anything else.

 

[militarymd]

Please do.

This is what I would propose:

- at most, any attending is allowed to "teach" residents only 50% of the time.

- the remaining 50% of the time, the attendings go into the scheduling pool just like everyone else...to do cases that everyone else has to do.

- In the time period that attendings have to do cases, there will some attendings out available to help attendings in rooms...to get cases started..do blocks ...give breaks & lunches...etc...the ratio will be similar to the attendings doing cases with residents.
so....they will experience what it feels like on a routine basis to HAVE breaks or NOT.

- the following times will be measured and posted in a public arena:

- turnover time
- time from in room to release from anesthesia (based on types of cases)
- time per procedure performed ( a lines, epidurals, etc.)
- complication rates...wet taps, block failures, etc.
- COST per anesthetic
- cancellation rate
- etc.

Compensation of attendings will be dependent on performance parameters.

Research related stuff to be done during teaching blocks when residents are stool sitting. .....and obviously some cases are resident/fellow cases.... ie your favorite conjoined twin splitting procedure.

I've obviously made this pretty simple here, but you get the point.

Getting to teach is a privilege...and only the BEST should be allowed...and we should have a system that DRIVES OUT any other.

 

[jetproppilot]

Mil is right.

Teaching residents is a privilege.

I'd love to experience that privilege.

But the benjamin delta, and the system is the reason I dont.

 

[VentdependenT]

Give that man a nickel!

 

[GasEmDee]

Jet, in response to your last post:

First, let me acknowledge explicitly that you are talking about the academic system, whereas MilMD appears to be focusing a bit more about individual academic practitioners, themselves. In reality, the two are obviously intertwined.

Second, let me state explicitly that I agree with much of what you say. In fact, some of your arguments have been made in other fields as well. Your point: we need to train people so that they hit the ground on their first job running. I hear that. We may disagree on how to achieve that, but that is a separate issue.

That is not what ignited this debate for me. Rather, I took issue with your sweeping opinion that academia harbors subpar clinicians because these are people that couldn't have made it elsewhere.

Residency serves at least two distinct educational purposes: 1) the "education" i.e., the teaching of the theoretical knowledge base of the field and 2) the "vocational training", i.e. the teaching of technical and personal skills required to function as a competent practitioner. Academic anesthesiologists address each of these, but to differing degrees, depending on their natural abilities -- and their interests.

On the one extreme, you might have the "nutty professor", who is intellectually brilliant and scientifically productive, but who is clinically inept in the OR. On the other hand, you might have the "slicks" who are technically outstanding, but who don't really contribute to the scientific foundations of the field.

The problem that I see with this discussion is that you consistently devalue the former. There is no debate that the overwhelming majority of residents go into private practice. There is no debate that residents need to learn the practical skills to survive in the real world. But learning from the individuals that are making scientific advancements to our field is equally important during residency.

Those academicians that rate highly on both scientific contributions and clinical skill are the "studs" and "rock stars" that you refer to, and I agree those are rare. But so what?

During my graduate school years, I had engineering professors that were intellectually brilliant. They are inventors and thought leaders. Numerous companies, publications, jobs, dollars, and advances have resulted from their work. I doubt they had much experience with practical skills relevant to industry, e.g., project management. But again, who cares? Their role in academia was obvious. And they weren't there because they had tried -- and failed -- jobs in industry. Arthur Kornberg, the nobelist whose work on elucidating DNA replication mechanisms gave birth to the field of molecular medicine, probably wouldnt have been so good at pipetting test tubes at Genentech corporation. Do you think he decided to become a professor because he couldn't hack it as an industry biologist? Was academia a harbor for him, who would have otherwise been a 3rd rate industrial employee?

One last time: I am not pro-academia. I am against the bashing of academia and academicians as a group. There is a difference.

 

[GasEmDee]

I've obviously made this pretty simple here, but you get the point.

Getting to teach is a privilege...and only the BEST should be allowed...and we should have a system that DRIVES OUT any other.

Yes, I hear you and I dont disagree.

As I wrote to Jet in the prior post, there are several roles within academia. Many academic institutions in the U.S. have recognized this explicitly, and have created distinct professorial lines:

A) The traditional tenure track - the researchers that are judged based on academic contributions, e.g., number and significance of publications

B) The educator track - individuals who are recognized and promoted for their teaching abilities (in a broad sense)

C) The clinical professoriate -- individuals who are recognized for their outstanding clinical skills. For example, a surgeon that does not publish but yet is reknowned for his technical skills would fit here.

Your metrics really apply best to the third group.

I agree with you that only the BEST be allowed to teach. My point is that there are multiple, valid, context-specific definitions of what is best. Therefore performance metrics need to be applied in the appropriate contexts. That, in a nutshell, is the bottom line of my entire argument.

 

[militarymd]

Yes, I hear you and I dont disagree.

As I wrote to Jet in the prior post, there are several roles within academia. Many academic institutions in the U.S. have recognized this explicitly, and have created distinct professorial lines:

A) The traditional tenure track - the researchers that are judged based on academic contributions, e.g., number and significance of publications

B) The educator track - individuals who are recognized and promoted for their teaching abilities (in a broad sense)

C) The clinical professoriate -- individuals who are recognized for their outstanding clinical skills. For example, a surgeon that does not publish but yet is reknowned for his technical skills would fit here.

Your metrics really apply best to the third group.

I agree with you that only the BEST be allowed to teach. My point is that there are multiple, valid, context-specific definitions of what is best. Therefore performance metrics need to be applied in the appropriate contexts. That, in a nutshell, is the bottom line of my entire argument.

Yes, Group A) needs to exist, but there is no need for them to ever interact with and torment residents except in a NON-clinical environment...like as mentors for research.....one day a week by themselves in the OR, the rest would be lab time for Group A)

My metrics can easily be applied to Groups B) and C).

Our current teaching system (which is also my beef...I actually raised the point first) treats A,B,&C the same.

The groups can work amongst themselves WITHOUT residents, and only certain ones of them should be allowed to work with residents....

However, in the current system, the truly gifted clinicians are usually the ones working by themselves while your Group A)s get paired with residents to keep them "out of trouble"👎

 

[core0]

Just to resurrect the thread. This is the type of position that is probably hard to get out of private practice.

http://www.cirm.ca.gov/press/pdf/2008/03-12-08.pdf

David Carpenter, PA-C

 

[coprolalia]

Yes, Group A) needs to exist, but there is no need for them to ever interact with and torment residents except in a NON-clinical environment...like as mentors for research.....one day a week by themselves in the OR, the rest would be lab time for Group A)

Man, oh, man I can think of one of my "mentors" who fits this bill nicely. This person publishes a lot of papers, but it is all theory and little actual common sense when it comes to patient care. "Torment" is an apt word to describe working in the OR with them.

-copro

 

[Pharm Life]

So what advice would you guys give to someone who wants to be a Dr. Perfect academic anesthesiologist besides just, be good at everything? What are some more specific things that those guys do right? I'm still a med student, so I don't know everything yet like the curmudgeon attendings.

 

[Gern Blansten]

So what advice would you guys give to someone who wants to be a Dr. Perfect academic anesthesiologist besides just, be good at everything? What are some more specific things that those guys do right? I'm still a med student, so I don't know everything yet like the curmudgeon attendings.

-Intraoperative teaching (if your resident does not finish the day with some significant new knowledge to take away, you have not done your job)
-Give breaks
-Stay in the room for discussion after the tube goes in or the block is placed
-Give upper level residents autonomy to make decisions and let them fly on their own when appropriate(note, this does not mean sit in the lounge and ignore them, it means let them do an induction without hovering)
-Don't be pompous or an a$$hole
-Be open to ways of doing things other than your own
-Don't steal the procedure before the resident has had a fair shot at it
-If you do step in to assist, hand it back over after you get past the problem(unless it is causing patient distress)
-Praise in public and reprimand in private

These are things I make a conscious effort to do.

 

[epidural man]

Best of luck with your lap choles and knee replacements.

Damn, private practice sounds great! I can't wait till I am part of it. What a dream....lap choles, knee scopes, and hernia repairs.

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

Nice description - luckily, I think most of my attendings were close to Dr. Perfect. I loved my residency.