Anyone else feel this way?--CA-1 woes

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Honeeplz3 said:
:kiss:Thank you everyone so much for all the encouragement. I was a little unsure about going to an anonymous forum because forums can attract some pretty negative people. I was looking for some positive enouragement and I'm truly touched by all the responses from anonymous people giving guidance through their experiences. You don't have to take time out of your day to help some random person on the intenet and your words and honestly were very appreciated. It has really shaped how I'm going to approach this week and next few months.

I'm realizing too this has got to be the biggest first world problem ever. When I turn on the news and see nothing but hurt, not loving my job at this moment isn't the worst thing in the world. I'm lucky that my co-residents and faculty are so amazing because if they weren't my situation would be 1,000,000x worse.

Any more experiences/thoughts, good and bad are appreciated. :kiss:
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Totally understand, I am at a large (> 20/year) residency program and we definitely have some attrition (around 1-2 or 5-10% per year, which coincides with national trends for Anesthesiology [side note, overall attrition rate for all residencies is 15-20%]) for a variety of reasons. About half aren't able to handle the clinical work for one reason or another (a stress management thing, usually), and then the other half have transitioned to a variety of other specialties they were always more interested in and afraid to admit to it before 🙂
 
Honeeplz3 said:
I'm concerned I smell like medicine too! Which I why I'm contemplating if it's worth 3 years of something I don't enjoy to do a year more of fellowship, or if I'd be happy doing IM for 2 years, and probably doing outpatient medicine. I realize the money in anesthesia is much higher...
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Perioperative surgical home might be the thing for you.
 
As my attending would say, "Anesthesiologists are doctors who should have been nurses, but made the mistake of going to med school."

Starting to agree since VA care is now totally CRNA controlled.
 
Honeeplz3 said:
I would take fulfilling, yet not life-consuming career >>>>>>> money
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Lock down the SO by getting married, then have kids and be a stay-at-home parent. Much easier solution than changing specialties or career, or finding a fulfilling unicorn at this point in life that pays 1.1-1.5%er income.

BLADEMDA said:
This generation sure has a lot of whiners/cry babies.
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I'm at the oldest end of the millennial generation, and I agree.
 
otis86 said:
As my attending would say, "Anesthesiologists are doctors who should have been nurses, but made the mistake of going to med school."

Starting to agree since VA care is now totally CRNA controlled.
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Actually anesthesiologists are mostly good doctors who thought anesthesiology was physiology, pharmacology, and all these other good things that the average outsider might imagine anesthesiology to be.
They usually realize later that those cool things are nothing but 10% of anesthesiology practice and the rest is pure nursing crap!
 
Some individuals (maybe many?) are clearly not too thrilled with their career choice. I really do feel the opposite and am excited for my future in the field.

Planktonmd said:
Actually anesthesiologists are mostly good doctors who thought anesthesiology was physiology, pharmacology, and all these other good things that the average outsider might imagine anesthesiology to be.
They usually realize later that those cool things are nothing but 10% of anesthesiology practice and the rest is pure nursing crap!
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Could the same not be said for almost every other medical specialty, in particular Emergency Medicine?
 
So those of you saying this is a nurses profession....are you saying that you'd go in for surgery or send your loved ones to the OR and be totally fine with a CRNA doing your anesthetic with no anesthesiologists around at all? After many years of watching then work no way in a million years would I be ok with that. I still look back on those years and am dumbfounded that anyone thinks they could do this job at most facilities without supervision. So many missed airways I can't even begin to count.... Hell, most of them can't even do a central line. Even the best ones were maybe as good as a 2nd year anesthesia resident on a good day. MAYBE. And those were the best ones.
 
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otis86 said:
As my attending would say, "Anesthesiologists are doctors who should have been nurses, but made the mistake of going to med school."

Starting to agree since VA care is now totally CRNA controlled.
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How is the VA totally CRNA controlled?
 
Man o War said:
So those of you saying this is a nurses profession....are you saying that you'd go in for surgery or send your loved ones to the OR and be totally fine with a CRNA doing your anesthetic with no anesthesiologists around at all? After many years of watching then work no way in a million years would I be ok with that. I still look back on those years and am dumbfounded that anyone thinks they could do this job at most facilities without supervision. So many missed airways I can't even begin to count.... Hell, most of them can't even do a central line. Even the best ones were maybe as good as a 2nd year anesthesia resident on a good day. MAYBE. And those were the best ones.
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That's not what we said!!!
90 % of what you do is nursing but the 10% that is not nursing can not be done by nurses or anyone else!
That 10 % is what makes it a medical specialty!
 
otis86 said:
As my attending would say, "Anesthesiologists are doctors who should have been nurses, but made the mistake of going to med school."

Starting to agree since VA care is now totally CRNA controlled.
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Why do you think that?
 
pgg said:
4 hours ago I did a postop check on a patient, and the ward team was rounding.

Just left the ward again after going to see my next case, and they were still rounding.

Reason #62 why anesthesia is awesome.
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That only says that they are bad at rounding. 😉

Rounding in the ICU with midlevels should not take more than 10-15 minutes per patient. Rounds done at 10-10:30 or earlier, depending on the census. Not that it matters, since ICU billing is tied to time.
 
Man o War said:
How is the VA totally CRNA controlled?
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He's most likely referring to the current fight to allow CRNAs to practice without physician oversight which WILL happen. Save this post for when it occurs so I can say "I told you so."
 
Consigliere said:
He's most likely referring to the current fight to allow CRNAs to practice without physician oversight which WILL happen. Save this post for when it occurs so I can say "I told you so."
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Even if the proposal goes through (this gets proposed almost every year BTW), that's a Far cry from being totally CRNA controlled.
 
Honeeplz3 said:
Yes I did! It's so strange...how in the world could someone even consider these two specialties?? What the eff is wrong with me? Pain would definitely be a good option, but it is pretty competitive, and not sure how I feel contributing to the opioid addiction in the country.
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Dude or dudette, I liked everything including psychiatry. I was even president of the interest group in med school. It's not that unusually to have broad interests in medicine and still like anesthesia. The only rotation I ever disliked was OB. After a few years of doing primary care after internship I realized it sucked beyond belief. The time pressure to see patients in only 20 minutes and knowing that you couldn't talk to them completely or investigate all there issues in one sitting and stay on time sucks. Not to mention all the social work BS and following up on labs, consults etc. Work is never finished. Once I started anesthesia residency I realized I loved the procedures and performing safe anesthetics. Wait until you experience your first semi-emergency and see how you handle it. There is something very satisfying when it hits the fan and you "fix" it before your attending can even get back to the room.
 
DocFocker said:
Dude or dudette, I liked everything including psychiatry. I was even president of the interest group in med school. It's not that unusually to have broad interests in medicine and still like anesthesia. The only rotation I ever disliked was OB. After a few years of doing primary care after internship I realized it sucked beyond belief. The time pressure to see patients in only 20 minutes and knowing that you couldn't talk to them completely or investigate all there issues in one sitting and stay on time sucks. Not to mention all the social work BS and following up on labs, consults etc. Work is never finished. Once I started anesthesia residency I realized I loved the procedures and performing safe anesthetics. Wait until you experience your first semi-emergency and see how you handle it. There is something very satisfying when it hits the fan and you "fix" it before your attending can even get back to the room.
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thats definitely one way of looking at it.....
but what happens when a kiddie desats to 60s in a matter of seconds and turns blue and the ENT is like 'wtf are you doing'? Even if your attending rushes to the room it may be too late. The positive aspect of it all is that no one will know the immediate sequlae until the kid is in high school and scores a ****ty SAT and is only able to go to a community school.

lol. jk. im just kidding. stuff like this never happens.
 
Honeeplz3 said:
This made me laugh because it is exactly the ONLY thing I have ever done in anesthesia..for 6 weeks straight.
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If that's the case, then go to your program director or whoever makes the case schedule and tell them you want to do something different. I ended up doing a ton of big neurosurg spines my first few months, and was running TIVA, 2 lines, a-lines on most cases while my co-residents were doing the B&B surgery cases. Then a few months into the residency they rotated me to the B&B cases and was bored out of my mind (once I figured out how those weird gases and muscle relaxants worked... haha)
 
sigrhoillusion said:
If that's the case, then go to your program director or whoever makes the case schedule and tell them you want to do something different. I ended up doing a ton of big neurosurg spines my first few months, and was running TIVA, 2 lines, a-lines on most cases while my co-residents were doing the B&B surgery cases. Then a few months into the residency they rotated me to the B&B cases and was bored out of my mind (once I figured out how those weird gases and muscle relaxants worked... haha)
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This week I have definitely had my share of sick patients and learning a lot. I'm starting to even enjoy myself even!😛 I believe what a lot of posters were saying is true...that I need to give it several months of getting use to. Not every specialty is perfect, but I'm hoping the one I chose continues to grow on me.
 
You will probably go through a repeating cycle of ups and downs and there will be other points that you question your decision to go into anesthesia. Stay positive and keep your head down. It's residency, the whole point is to suffer now and then be an awesome attending. Embrace your pain, then put it aside when you leave the hospital. If you still feel the same way by the end of CA-1, go into pain. Or CCM, or something that fits you better. I am actually increasingly satisfied with working in the OR. I am just starting to feel like I know what I am doing some of the time! One thing that we can learn from CRNA's is that it is easy to feel like you know what you are doing with stable patients undergoing simple surgery. As you get assigned to bigger cases on sicker patients, I think you will find more than enough to stimulate your intellect. I could be wrong, maybe it's just not for you and that will become more apparent given more time. For example, today I was consulted to do a tube exchange in a guy with a retropharyngeal abscess from infected c-spine hardware. Neurosurgery removed his hardware yesterday and ENT drained his abscess. The OR anesthesia team placed an armored tube with a wire coil so they wanted me to replace it with a regular ETT so they could send this guy to MRI to rule out septic emboli to the brain and cord compression. They wanted to keep him intubated because he was agitated at baseline and whenever they gave him a sedation holiday, he was getting all worked up and tugging on his restraints. We helped them realize their scans weren't going to change management and they decided to extubate him instead. That's the short version, anyways. It gets much more interesting than lap appy's and ORIF's with the ortho bros.

And at all the geezers in the room: if SDN is any indication, you all whine and complain enough to hold your own against any entitled babies of the rising generation. Keep up the great work. 👍
 
rakotomazoto said:
You will probably go through a repeating cycle of ups and downs and there will be other points that you question your decision to go into anesthesia. Stay positive and keep your head down. It's residency, the whole point is to suffer now and then be an awesome attending. Embrace your pain, then put it aside when you leave the hospital. If you still feel the same way by the end of CA-1, go into pain. Or CCM, or something that fits you better. I am actually increasingly satisfied with working in the OR. I am just starting to feel like I know what I am doing some of the time! One thing that we can learn from CRNA's is that it is easy to feel like you know what you are doing with stable patients undergoing simple surgery. As you get assigned to bigger cases on sicker patients, I think you will find more than enough to stimulate your intellect. I could be wrong, maybe it's just not for you and that will become more apparent given more time. For example, today I was consulted to do a tube exchange in a guy with a retropharyngeal abscess from infected c-spine hardware. Neurosurgery removed his hardware yesterday and ENT drained his abscess. The OR anesthesia team placed an armored tube with a wire coil so they wanted me to replace it with a regular ETT so they could send this guy to MRI to rule out septic emboli to the brain and cord compression. They wanted to keep him intubated because he was agitated at baseline and whenever they gave him a sedation holiday, he was getting all worked up and tugging on his restraints. We helped them realize their scans weren't going to change management and they decided to extubate him instead. That's the short version, anyways. It gets much more interesting than lap appy's and ORIF's with the ortho bros.

And at all the geezers in the room: if SDN is any indication, you all whine and complain enough to hold your own against any entitled babies of the rising generation. Keep up the great work. 👍
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Lol

Dude you were called for a tube exchange not a huge 'intellect stimulating' process bro.
 
needachange2017 said:
Lol

Dude you were called for a tube exchange not a huge 'intellect stimulating' process bro.
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I've seen a patient die like a dog in front of me during a tube exchange (for pulmonary hemorrhage) in the ICU. Not a totally benign procedure and requires some thinking. I realize it isn't as intellectually stimulating as reading a patient's 19th daily CXR in a row, but still takes a little thinking.
 
Reading cxr is brutally boring believe me bro.

Stop trying to make tube xchanges anything more than it is. Tube xchanges are ezy peezy 90% of the time.

There are way more challenging procedures in anesthesia bro.
 
needachange2017 said:
Tube xchanges are ezy peezy 90% of the time.
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Of course. Which is why I never get to do the easy ones. They call me for the sphincter tightening ones. I find procedures to be mindless things you could teach a monkey to do. I get paid to use my brain to determine when and how to do things in the safest fashion possible.
 
Mman said:
Of course. Which is why I never get to do the easy ones. They call me for the sphincter tightening ones. I find procedures to be mindless things you could teach a monkey to do. I get paid to use my brain to determine when and how to do things in the safest fashion possible.
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And that's how a good anesthesiologist will get to the conclusion that the safest thing for the patient is not to do what other specialists asked him to do in the first place. Especially those stupid intensivists, reading the 19th CXR. No procedure, no risk, voila!

Now if they paid, for a tube exchange, a few thou... 😛
 
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FFP said:
And that's how a good anesthesiologist will get to the conclusion that the safest thing for the patient is not to do what other specialists asked him to do in the first place. No procedure, no risk, voila!
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Took the words right out of my mouth.
 
This is off topic, but I was on gaswork.com reading some of the job postings to get a better sense of life in the real world for anesthesia. (didn't really help) I was wondering what exactly was meant by first call. For instance one posting said Monday-Friday 8-4, first call q4, no second call. Does this mean every fourth night you're in the hospital doing a 24-hour call, or is it home call or is it impossible to tell exactly from the limited info given?
 
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Honeeplz3 said:
This is off topic, but I was on gaswork.com reading some of the job postings to get a better sense of life in the real world for anesthesia. (didn't really help) I was wondering what exactly was meant by first call. For instance one posting said Monday-Friday 8-4, first call q4, no second call. Does this mean every fourth night you're in the hospital doing a 24-hour call, or is it home call or is it impossible to tell exactly from the limited info given?
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Depends on the job. Some jobs are in house call and some aren't. 2nd call usually is a backup in case another room needs to be ran while the 1st call is solo in a case/c-section/etc
 
First call could be either in house or from home.

Basically means you are the last one to be done and the first to get called for any add-on.
 
Gotcha. So depending on how busy that particular surgeon group is, how much trauma, etc, it could be a real nice gig or hellish.
 
Honeeplz3 said:
Gotcha. So depending on how busy that particular surgeon group is, how much trauma, etc, it could be a real nice gig or hellish.
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True. Would also be nice to know if post-call day is off or a normal work day.

Keep in mind gas work jobs tend not to be good jobs. Quality groups don't need to advertise to total strangers. The exception are groups that are geographically undesirable.
 
SaltyDog said:
True. Would also be nice to know if post-call day is off or a normal work day.

Keep in mind gas work jobs tend not to be good jobs. Quality groups don't need to advertise to total strangers. The exception are groups that are geographically undesirable.
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This is true.....I lucked into my current gig and my other options coming out of fellowship were though "hookups"
 
chudat said:
thats definitely one way of looking at it.....
but what happens when a kiddie desats to 60s in a matter of seconds and turns blue and the ENT is like 'wtf are you doing'? Even if your attending rushes to the room it may be too late. The positive aspect of it all is that no one will know the immediate sequlae until the kid is in high school and scores a ****ty SAT and is only able to go to a community school.

lol. jk. im just kidding. stuff like this never happens.
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Was it an anoxic brain injury or is it just your run-of-the-mill dumb kid? Only the lawyers will ever know the Truth.
 
To the OP, give it some time. It's July. No offense, but right now you're lethal. No one in their right mind is going to let you get within 10 feet of anything remotely challenging. You should be getting familiar with the rhythm of the OR. Get comfortable with that rhythm and as you progress, the challenging cases will come. Here's a bit of unsolicited advice. Never, ever get complacent in this game. Anesthesia is crafty. She will lull you to sleep with endless ASA 1s and 2s that have pristine airways that go off without a hitch. Your confidence will soar. You will feel like a king amongst men. She will sense your confidence and slap you down with an airway from hell....
 
Honeeplz3 said:
This week I have definitely had my share of sick patients and learning a lot. I'm starting to even enjoy myself even!😛 I believe what a lot of posters were saying is true...that I need to give it several months of getting use to. Not every specialty is perfect, but I'm hoping the one I chose continues to grow on me.
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How's CA-1 treating you now?
 
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