Anesthesia vs other specialites

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Propofol_Pusher

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10+ Year Member
MS3 here considering anesthesia but concerned about issues such as CRNAs and boredom.

The science of medicine and pathology in med school is really cool. Do you guys feel like you still make use of it in your day-to-day work?

Thanks
 
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Propofol_Pusher said:
MS3 here considering anesthesia but concerned about issues such as CRNAs and boredom.

I wouldn't want to lose my medical school knowledge by replacing it with the skills that a highly trained nurse could possess.

The science of medicine and pathology is really cool. Do you guys feel like you still make use of it in your day-to-day work?

Thanks
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Depends on practice environment and patient population. If you work at a surgicenter doing ASA1 and 2s you aren't going to reach deep into your medical knowledge background to get through the day. If you work in a higher acuity hospital taking care of patients with all sorts of underlying medical issues and surgeries, you will have to.

For instance, I don't need to know every freaking detail about hemochromatosis or multiple sclerosis, but I do need to know how specific anesthetic considerations when taking care of them. e.g. for hemochromatosis the possibility of limited neck ROM from joint involvement, endocrine abnormalities "bronze diabetics", heart failure and conduction abnormalities, liver failure, etc; for MS the concerns relating to using suxx if weak, the theoretical concerns relating to regional and neuraxial anesthesia, the effect of hyperthermia.

So you should know a fair amount about a lot of different disease processes, and a fair amount about a lot of different surgeries. It will help you formulate a more tailored and safe anesthetic plan for the patient, and perhaps anticipate things before they happen.. The more you know the more versatile you will be as a physician and consultant anesthesiologist.
 
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It is my opinion that an anesthesiologist should be the “intensivist” of the OR. We should know a lot of medicine and especially how anesthetic may exacerbate conditions, how we can acutely manage exacerbation. Because at the end of the day, surgery is an iatrogenic trauma and stress to a patient like no other. Everyday I ask myself how can I best optimize this patient for surgery, do they have medications I need to be worried about, medical conditions that would be suitable for stressful surgery, are their heart/lungs okay and what kind of comorbities that may interact. And then through the surgery I’m thinking how can I can I safely induce and intubate this patient given the medical issues, what access do I need, what drips/drugs do I need for hemodynamics, can I do regional anesthesia for post op pain, can I safely extubate, if there is an unforeseen emergency (arrhythmia most commonly), larger cases have acid/base issues, coagulation management. Then I think Pacu care. So just listing all that you can see there’s TONS of medicine involved. Having said that, anesthesia has become very “safe”. In that we have a lot of tools to keep a patient alive and in general, patients have a lot more resilience than you’d think. So nurses have learned meds that bring up or down the BP, airway skills oxygenation ventilation, vascular access, pain control, etc. But anesthesiologist are physicians for a reason where we use medical knowledge to best take care of our patients. We hopefully know a lot but also know what our limitations are through our medical training.
 
Propofol_Pusher said:
What can cause this difference, other than personal interests? Does it depend on the specific job?
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I have met a lot of physicians during my career. Some of the smartest and most well read were Critical Care Trained. If you want knowledge and want to use that daily then Anesthesia + CCM is a good fit. I can assure you there will be few other physicians in any specialty better informed and better trained than you. But, that pathway comes at a price few are willing to pay.
 
BLADEMDA said:
I have met a lot of physicians during my career. Some of the smartest and most well read were Critical Care Trained. If you want knowledge and want to use that daily then Anesthesia + CCM is a good fit. I can assure you there will be few other physicians in any specialty better informed and better trained than you. But, that pathway comes at a price few are willing to pay.
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Can you elaborate? Are you talking financials, specifically?
 
Also somewhat interested in this discussion as I am a MS4 considering dual applying IM/Anesthesia. Really enjoyed both of my rotations, thinking about critical care fellowship.
 
I usually suggest those students to think about whether they would rather be in the OR or doing pulm consults/pulm clinic when not doing critical care. The inpatient floor, clinic and OR are obviously very different.
 
Propofol_Pusher said:
I wouldn't want to lose my medical school knowledge by replacing it with the skills that a highly trained nurse could possess.
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I wouldn't worry so much about CRNA (or DNP in nonanesthesia fields) bravado. We don't do cookbook healthcare. Medicine is complex and requires training and critical thinking, despite what midlevel nurse propaganda would have you think. When you or your family member needs medical care they want a physician with 10,000 hours of clinical training, not an independent nurse with less training than entry level dog groomer or whose claim of experience involve watching an anesthesiologist do something while standing in the corner
 
coffeebythelake said:
I wouldn't worry so much about CRNA (or DNP in nonanesthesia fields) bravado. We don't do cookbook healthcare. Medicine is complex and requires training and critical thinking, despite what midlevel nurse propaganda would have you think. When you or your family member needs medical care they want a physician with 10,000 hours of clinical training, not an independent nurse with less training than entry level dog groomer or whose claim of experience involve watching an anesthesiologist do something while standing in the corner
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It matters not what “you and your family want”. So long as it’s cheaper with a “reasonable” safety profile, it will win every time.
 
Sometimes I don’t worry at all about CRNA encroachment. I’ve practiced for 9 years now… solo jobs and supervision jobs…. I’ve seen crnas kill people, cause aspiration, negative pressure pulmonary edema, anoxic injury, miss airways and consistently, fundamentally not understand wtf they are doing. Many of the new grads lack the icu rn depth of knowledge some of the older ones do. Most of them have a devil may care it’s someone else’s problem and want to go home promptly at the end of their shift… even if that means signing out the last 10 minutes of the case.
I think you need to decide if you like the OR, ICU or the clinic environment. I like the OR, my bud chocomorsel hates it and likes the icu better. Anesthesia is very useful that it can go in many different ways -
Choco and I started our careers at the same time… it’s taken awhile for us to get to the place they are. She’s found balance w locums and a mix of anes and ccm. That would never work for me.
I put in the time in the partner track and made partner, something she would never have wanted to do. Now my days are trauma and plastics lol…. Now some Seniority has landed me the Cush plastics solo days in between my crazed trauma and safari anesthesia days.
I have another friend who makes way less than choco and me but has a cushy asa 1-2 type gig. Another friend runs her own pain practice, another mommy tracks ans still does better than medicine people. Anesthesia, at least for now is very customizable to what’s a good fit for you…
 
BLADEMDA said:
I have met a lot of physicians during my career. Some of the smartest and most well read were Critical Care Trained. If you want knowledge and want to use that daily then Anesthesia + CCM is a good fit. I can assure you there will be few other physicians in any specialty better informed and better trained than you. But, that pathway comes at a price few are willing to pay.
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Maybe ICU trained anesthesiologist will become a hotter commodity post pandemic now
 
teacher2md said:
I know more cardiology than anyone besides a cardiologist. I know more about neurosurgery than anyone besides a neurosurgeon. I know more pediatrics than anyone besides a pediatrician. I know more obstetrics than anyone besides an OB...
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Hey, that's my line (FM)
 
ToKingdomCome said:
Maybe ICU trained anesthesiologist will become a hotter commodity post pandemic now
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Riiiight. After all the clapping and free food stopped, the "heroes" are the ones who got bent over the hardest. Emergency medicine physicians are such heroes! Here take care of a slightly lower number of patients but with half the staff thanks!
 
Propofol_Pusher said:
MS3 here considering anesthesia but concerned about issues such as CRNAs and boredom.

I wouldn't want to lose my medical school knowledge by replacing it with the skills that a highly trained nurse could possess.

The science of medicine and pathology is really cool. Do you guys feel like you still make use of it in your day-to-day work?

Thanks
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Kinda insulting to ask such a dumb question.

Would you ask an ED physician how much medicine they know since you wouldnt want to lose your medical school knowledge by replacing it with the skills that a highly trained PA/NP could possess?

Same as FM and Family practice NPs
Intensivists and ICU NP/PAs
Derm and ‘dermatologist’ NP/PA
IM and NP/PA hospitalists

Pick up an anesthesia textbook and see for yourself
 
dannyboy1 said:
It matters not what “you and your family want”. So long as it’s cheaper with a “reasonable” safety profile, it will win every time.
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Even you fall into the CRNA propaganda talking points. Let's be clear.. it is not any cheaper to patients. They pay exactly the same for lesser care. The only ones who actually benefit are hospital admins bonuses and militqnt CRNA diptards who stoke their ego by playing doctor because they can treat hypotension with phenylephrine and tachycardia with esmolol.
 
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coffeebythelake said:
Even you fall into the CRNA propaganda talking points. Let's be clear.. it is not any cheaper to patients. They pay exactly the same for lesser care. The only ones who actually benefit are hospital admins bonuses and militqnt CRNA diptards who stoke their ego by playing doctor because they can treat hypotension with phenylephrine and tachycardia with esmolol.
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Hmmm I also treat hypotension with phenylephrine and tachycardia with esmolol...
 
GassYous said:
Hmmm I also treat hypotension with phenylephrine and tachycardia with esmolol...
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That's my point. They think they can do everything you do because of simple one step, essentially reflex maneuvers. But when I'm treating hypotension and tachycardia I'm doing so to temporize while also thinking about whether it is purely due to vasodilation from the anesthetic or something else. My experience watching so many CRNAs is that only a few would do the same. Doing something you "always do" might work most of the time until it doesn't. My CRNA the other day basically tried to kill the patient from one of these non thinking reflex moves.
 
coffeebythelake said:
Even you fall into the CRNA propaganda talking points. Let's be clear.. it is not any cheaper to patients. They pay exactly the same for lesser care. The only ones who actually benefit are hospital admins bonuses and militqnt CRNA diptards who stoke their ego by playing doctor because they can treat hypotension with phenylephrine and tachycardia with esmolol.
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Of course. The ones who benefit are employers. You can see how this is a problem for us. The bottom line is that nobody who is paying cares about “good”or “bad” anesthesia. They only care about anesthetic disasters which are very rare regardless of who is in the room….
 
dabears505 said:
The only bit of medicine I know is to call in a z pack when a family member tells me they are coughing. Other than that, a 12 year old could easily do my job and not an ounce of medical knowledge is required. Please do us all a favor and not enter anesthesia
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Truth. I needed a personal day last Friday because I was having the blues so I called out “sick” 😉and the charge nurse was like don’t worry doc we got u covered…the PACU is over staffed today so we will have one of the PACU Nurse RN, BSN, AORN specialists care for your patients in the OR too. It actually worked out better for the patients to have more continuity of care rather than suffering through a handoff to a different medical professional after the surgery was over.
 
Propofol_Pusher said:
MS3 here considering anesthesia but concerned about issues such as CRNAs and boredom.

I wouldn't want to lose my medical school knowledge by replacing it with the skills that a highly trained nurse could possess (don’t mean this to sound rude - just trying to figure out how much medicine’s in anesthesia and why CRNAs believe they can forgo medical school and do the same job)

The science of medicine and pathology is really cool. Do you guys feel like you still make use of it in your day-to-day work?

Thanks
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Depends… but quite a bit.
 
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sevoflurane said:
Depends… but quite a bit. My wife managed a severely hyperkalemic patient yesterday, managed the patients renal failure and hyperglycemia, then placed a dialysis catheter and arranged for dialysis…. btw cases. This patient never made it to the OR. Just doing a favor for a vascular surgeon and a nephrologist. Not normal for us to do, but we can do it.
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I'd rather be home with my family and not dealing with the hospitalist's problems
 
sevoflurane said:
Depends… but quite a bit. My wife managed a severely hyperkalemic patient yesterday, managed the patients renal failure and hyperglycemia, then placed a dialysis catheter and arranged for dialysis…. btw cases. This patient never made it to the OR. Just doing a favor for a vascular surgeon and a nephrologist. Not normal for us to do, but we can do it.
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How does this happen ? Patient on the floor in renal failure and they page … Anestheia?
Was the patient going for a procedure and labs showed severe hyperkalemia? Kudos to your wife but most of us just cancel and turf to nephrology.
 
Enough medicine to know when I need to look up something that may make an impact with my anesthetic. For example, a lot of things can cause a multiple sclerosis exacerbation, so a quick google to make sure I don’t forget sometime obvious, like avoidance of hyperthermia, or they may be on steroids, etc.
 
dannyboy1 said:
How does this happen ? Patient on the floor in renal failure and they page … Anestheia?
Was the patient going for a procedure and labs showed severe hyperkalemia? Kudos to your wife but most of us just cancel and turf to nephrology.
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Simply put, they don't pay attention to patients on the floor. When the hospitalist is rounding on 30 patients they don't realize the morning K suddenly jumps up to 6.5 when they send the parient for whatever mundane procedure they had booked the day before.

I had a patient whose K was 2.0 or 2.2 or something ridiculously low. Cancelled. Same explanation. Pt refused KCl IV and PO for several days, progressively worsening. Floor nurse just decided it was okay to send down for procedure. I called and asked her not-so-politely why she thought that was a smart idea.
 
dannyboy1 said:
How does this happen ? Patient on the floor in renal failure and they page … Anestheia?
Was the patient going for a procedure and labs showed severe hyperkalemia? Kudos to your wife but most of us just cancel and turf to nephrology.
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Case was cancelled. Peaked T waves. Worsening renal failure. Vascular surgeon busy. She just did what was right in the middle of the night. As I said, this doesn’t happen hardly ever… but yeah we can handle the medicine and procedure stuff when push comes to a shove.
 
sevoflurane said:
Case was cancelled. Peaked T waves. Worsening renal failure. Vascular surgeon busy. She just did what was right in the middle of the night. As I said, this doesn’t happen hardly ever… but yeah we can handle the medicine and procedure stuff when push comes to a shove.
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I am always amazed just how much we can do off hours, nights and on weekends. I always tell the med students we are physicians first then proceduralists/anesthesia second. This means our job is to think through the problems and make the right decisions.
 
NicMouse64 said:
Also somewhat interested in this discussion as I am a MS4 considering dual applying IM/Anesthesia. Really enjoyed both of my rotations, thinking about critical care fellowship.
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I love medicine. It's the reason I am doing a CCM fellowship. I came into anesthesiology always wanting to do CCM. Anesthesia is truly medicine in action. ICU is medicine in action. Sure we miss the long term management of things or nitty details of certain disease processes but all in all, we get to actually practice what we learned pharm/physio in medical school nistead of worrying about dispo/most social issues/etc. Having said all that, like a poster said, IM and anesthesia are separate fields unless you only want to do CCM. Really think if you'd be willing to do clinic vs OR. I sometimes think that I regretted not doing the IM/Anes 5 yr track but I just didn't see myself doing IM residency after I had finished my prelim medicine year. However, if you pick only Anesthesia residency route, please keep brushing up on your general medical knowledge because it's so easy to fall into that trap of just get the patient through the surgery (Prop/roc/tube mentality). Also, do a prelim medicine year with plenty of MICU if you're so inclined. There are also combined Anesthesia/CCM programs which if you don't mind staying at one place is actually good since you can have more ICU time and elective time through your residency. I honestly donn't know much about those but it sounds good.
 
Katheudontas parateroumen said:
I love medicine. It's the reason I am doing a CCM fellowship. I came into anesthesiology always wanting to do CCM. Anesthesia is truly medicine in action. ICU is medicine in action. Sure we miss the long term management of things or nitty details of certain disease processes but all in all, we get to actually practice what we learned pharm/physio in medical school nistead of worrying about dispo/most social issues/etc. Having said all that, like a poster said, IM and anesthesia are separate fields unless you only want to do CCM. Really think if you'd be willing to do clinic vs OR. I sometimes think that I regretted not doing the IM/Anes 5 yr track but I just didn't see myself doing IM residency after I had finished my prelim medicine year. However, if you pick only Anesthesia residency route, please keep brushing up on your general medical knowledge because it's so easy to fall into that trap of just get the patient through the surgery (Prop/roc/tube mentality). Also, do a prelim medicine year with plenty of MICU if you're so inclined. There are also combined Anesthesia/CCM programs which if you don't mind staying at one place is actually good since you can have more ICU time and elective time through your residency. I honestly donn't know much about those but it sounds good.
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you don't regret not having just done IM->Pulm/CC?
 
NicMouse64 said:
you don't regret not having just done IM->Pulm/CC?
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Not really other than I enjoy micu pathology vs cv/neuro/sicu. However if I really would have done it again I would have done maybe another IM subspecialty all together. IM overall just gives you more leeway to do something else. I’m happy with ccm whether it be through anesthesia or IM. But if you have any thoughts of IM is okay then I’d go with IM.
 
coffeebythelake said:
Simply put, they don't pay attention to patients on the floor. When the hospitalist is rounding on 30 patients they don't realize the morning K suddenly jumps up to 6.5 when they send the parient for whatever mundane procedure they had booked the day before.

I had a patient whose K was 2.0 or 2.2 or something ridiculously low. Cancelled. Same explanation. Pt refused KCl IV and PO for several days, progressively worsening. Floor nurse just decided it was okay to send down for procedure. I called and asked her not-so-politely why she thought that was a smart idea.
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Very interested to hear what she had to say. 👀
 
sevoflurane said:
Depends… but quite a bit. My wife managed a severely hyperkalemic patient yesterday, managed the patients renal failure and hyperglycemia, then placed a dialysis catheter and arranged for dialysis…. btw cases. This patient never made it to the OR. Just doing a favor for a vascular surgeon and a nephrologist. Not normal for us to do, but we can do it.
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sounds like a nice work environment. All the nephros I've worked with would have thrown a fit if some other specialty dared to order HD
 
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