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[narcusprince]

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Where can I find posters or flyers about the ASA? I am so tired of coming to work and seeing a bunch of AANA propaganda all over the walls of my department. I would like to put up some stuff about the ASA.

 

[Consigliere]

Where can I find posters or flyers about the ASA? I am so tired of coming to work and seeing a bunch of AANA propaganda all over the walls of my department. I would like to put up some stuff about the ASA.

Why? You looking to get labeled as a "disruptive physician?"

 

[narcusprince]

No, I work in a environment where patients and fellow physicians do not see the presence of the ASA. With plenty of AANA banners in patient care areas we also need a presence. Anesthesiologist are not respected in my facility. I have had to correct staff members on calling nurse anesthetist doctor. As well as trying to establish a culture of not calling us MDAs. Put some RESPEK on my name!

 

[jwk]

No, I work in a environment where patients and fellow physicians do not see the presence of the ASA. With plenty of AANA banners in patient care areas we also need a presence. Anesthesiologist are not respected in my facility. I have had to correct staff members on calling nurse anesthetist doctor. As well as trying to establish a culture of not calling us MDAs. Put some RESPEK on my name!

Really a great idea! I looked all around the ASA website, but all I came up with was some brochure downloads. http://www.asahq.org/WhenSecondsCount/policymakers.aspx

 

[Consigliere]

No, I work in a environment where patients and fellow physicians do not see the presence of the ASA. With plenty of AANA banners in patient care areas we also need a presence. Anesthesiologist are not respected in my facility. I have had to correct staff members on calling nurse anesthetist doctor. As well as trying to establish a culture of not calling us MDAs. Put some RESPEK on my name!

I got news for you my brother from another mother - anesthesiologists are not respected at ANY facility.

 

[GravelRider]

I got news for you my brother from another mother - anesthesiologists are not respected at ANY facility.

There has never been a truer statement. You may THINK you are respected, but you are really just a way to help surgeons get their work done...a means to an end.

 

[ProRealDoc]

Everyone who works in a hospital is a means to an end unless you own the facility. Yes that includes surgeons.

 

[GravelRider]

Surgeons are less replaceable in the eyes of the administration. Anesthesiologists are interchangeable with nurses.

 

[deleted171991]

Surgeons are less replaceable in the eyes of the administration. Anesthesiologists are interchangeable with nurses.

Lmftfy.

 

[narcusprince]

This is Bs that anesthesiologist are not respected. Where we trained the anesthesiologist were respected and valued as part of the care team. Heck where pgg is now anesthesiologist are respected around the hospital and through certain policies anesthesiologist does not equal nurse.

 

[GravelRider]

Anesthesiologists are PRETEND respected...only as much as it helps to grease the wheels of the OR. Behind closed doors Anesthesiologists are not respected no matter how much you think you are. You are replaceable and expendable. Even Rambo was expendable...

 

[deleted171991]

This is Bs that anesthesiologist are not respected. Where we trained the anesthesiologist were respected and valued as part of the care team. Heck where pgg is now anesthesiologist are respected around the hospital and through certain policies anesthesiologist does not equal nurse.

No offense but we are not. In the OR, the surgeon rules. We are only the "cancelators". We are a cost center, and all that matters is how much we cost. pgg works in a different universe.

Outside of the OR, we don't like to exist, hence we don't have much influence. We are just intubators (or intubationists?). The surgeons are way too strong in most hospitals, even in the SICU (that's why most are open). But if you step outside of the SICU as an intensivist, you will feel the appreciation, wherever you can help and make a difference as a consultant. That's the key.

Let me put it this way: people don't tend to spend time with people they look down on. See who's friends with you, who is interested in your life, and you will know who might give a damn if you are replaced tomorrow.

 

[sevoflurane]

I think the truth is in the eye of the surgeon.

I can tell you that bailing out a surgeon from a major disaster will catch their eye. Especially if you remain calm and collected through the ordeal and give them confidence to do their job. You will be seen as valued member of the team- of course this requires a surgeon that isn't self centered and engulfed with themselves.
Fortunately, most of them out there (at least the ones I have worked with) are reasonable people.

Recently did a huge IVC tumor from RCC. After manipulation, I checked out my TEE and saw tumor embolus bouncing around in the RA and RV.
Pressors went up throughout the case and vitals went down. We closed rather quickly with my HR around 50 bpm.
The surgeon left the room to talk to family.
Before I left the OR I called for a CXR as I was suspicious for other causes beyond a PE for my deteriorating vitals. Sure enough this is very similar to what I saw:

I called the surgeon back in. Chest tube was placed and things started to get better.

We as anesthesiologists, are in the background until we are not. Good surgeons recognize this and remember these events.

 

[dhb]

Same thing happened to me after a pace maker implantation.
Though I don't think the surgeon will stick his neck out for me because i had sense to call for an x ray...

 

[deleted171991]

Same thing happened to me after a pace maker implantation.
Though I don't think the surgeon will stick his neck out for me because i had sense to call for an x ray...

That's the problem with anesthesia. We are the unknown heroes. We don't specialize in fixing problems, but in preventing them. We are like the immune system: people mostly know they have one when it fails, or when the crap really hits the fan, not when it prevents cancer on a daily basis.

It's like with good primary care physicians: very few people know who they are, and even fewer will put their money where their mouth is. The motto of the day is "good enough", and that means value, not performance.

 

[narcusprince]

I can say without a doubt when you have good forward thinking leadership it breeds an environment of respect. My former chairmen at the place where I trained instilled an environment where Anesthesiologist were involved with In the OR and out of the OR activities. For instance the rapid response teams were led by anesthesiologist and they decided whether to send or not send to the ICU. We also controlled most of the work force as anesthesia residents outnumbered the rest of the individual departments residents hence lobbying power. Also the chairman of the Anesthesia division was also the chairman of the emergency medicine division within the hospital. Our leadership was respected and it was never really an US versus the Surgeons argument. In the military nurses have pulled in the lobbying power by sticking around and getting involved in leadership. That fight is over.

 

[pgg]

Anesthesiologists are PRETEND respected...

Oh for **** sake, ER docs aren't "respected" because all they do is consult, FM docs aren't respected because they're just primary care monkeys who only did a 2-year residency, dermatologists aren't respected because they're zit docs, radiologists aren't respected because they can get outsourced to a basement sweatshop in India, general surgeons aren't respected because they aren't vascular or bariatric or CT or colorectal or X fellowship trained subspecialists and they get called for butt pus and gross manual disimpactions at 1 AM, pediatricians aren't respected because they're poor, do I really need to go down the list?

If you think you're not respected, maybe it's because you suck, or because your ego is so frail and pathetic that you need constant ego-fellatio from everyone around you (from the janitor to the CEO), or maybe because your job sucks and you're too lazy/weak/afraid to move.

Do your job, cash your paycheck, and get a life.

 

[narcusprince]

PGG, You very well know the .mil is very different in terms of power structure versus civilian practice. I work both inside and outside of the .mil and being valued like a physician with no repercussions from making decisions on patients. In the .mil you are asked to not be a doctor until they need a doctor then when you are called into a total **** storm and expected to extinguish the flames. Versus other places your preventive management strategies lead to good outcomes and the surgeons are grateful for those outcomes and attribute it to anesthesia. Respect doesn't mean licking my shoes, or giving me the reach around, respect to me is about autonomy. I respect the surgeons by trusting their autonomy(wait maybe we need to put a screw there, or you missed the appendices artery). Autonomy to make decisions to govern your own department and to meet the need assigned. The .mil does not understand that and thats why when my clock is punched.....

 

[pgg]

I feel like I've been respected everywhere I've worked, in and out of the Navy.

Most of the places I moonlight offer me a permanent job within the first week or two.

I had total autonomy at NHL, even before I was the DH. Then I took the surgical services director job and had total power and dominion over my minions in the surgical departments.

I'm a worker bee now at the Slave Ship, which you know well, and although at times it feels like our department is pushed around, that pushing is generally limited to things like the number of rooms and remote locations we are required to support each day. And of course that kind of decision making has to be made with input from us, the surgical depts, the OR, the directors, all in the context of optimizing production and gainful employment of everyone who's there. We have a voice at that table that seems to be heard and considered, though we don't always get our way. I've got total autonomy clinically, though of course I'll go along with surgeon requests if they're reasonable (e.g. the orthopod block hater who doesn't want regional).

I make a good living doing interesting work that has an impact on my patients' lives, I rarely spend more than 50 h/week at work, fellowship starts in 47 days. Life is good.

Maybe my standards are too low and I should demand more compliments. 🙂

 

[criticalelement]

PGG, You very well know the .mil is very different in terms of power structure versus civilian practice. I work both inside and outside of the .mil and being valued like a physician with no repercussions from making decisions on patients. In the .mil you are asked to not be a doctor until they need a doctor then when you are called into a total **** storm and expected to extinguish the flames. Versus other places your preventive management strategies lead to good outcomes and the surgeons are grateful for those outcomes and attribute it to anesthesia. Respect doesn't mean licking my shoes, or giving me the reach around, respect to me is about autonomy. I respect the surgeons by trusting their autonomy(wait maybe we need to put a screw there, or you missed the appendices artery). Autonomy to make decisions to govern your own department and to meet the need assigned. The .mil does not understand that and thats why when my clock is punched.....

In the .mil, the janitor, head nurse, nursing aid and the neurosurgeon are all equals and treated the same way. this is why the only doctors who work at the va and the military are inferior in quality... This is a general statement. And this is why government run healthcare can never be really good. Only mediocre at best. There is no meritocracy in the government. mediocrity flourishes.

 

[jwk]

I can say without a doubt when you have good forward thinking leadership it breeds an environment of respect.

There really isn't much of an us vs. them mentality at our hospitals. Our department is well respected. Anesthesiologists at our hospitals have at various times served as Chief of Staff and chairman of the Board of Trustees. Members of our department are intimately involved with numerous hospital committees and medical staff governance. We have never taken a stipend so there's never a money issue. We don't cancel cases unnecessarily, but are consistent in what our expectations are for all our patients. We're not obstructionist at all, but there will be times when we say "no".

 

[Consigliere]

fellowship starts in 47 days. 🙂

What fellowship are you doing?

 

[pgg]

What fellowship are you doing?

Adult CT

46 days

 

[Consigliere]

Adult CT

46 days

Excellent. I've flirted with the idea of doing a peds fellowship for long term stability and future marketability. I'm making too much money now to do that though.

 

[kidthor]

Excellent. I've flirted with the idea of doing a peds fellowship for long term stability and future marketability. I'm making too much money now to do that though.

You'd be the most cynical peds anesthesiologist evarrrrr.

But, respect for telling it like it is.

 

[Mad Jack]

No offense but we are not. In the OR, the surgeon rules. We are only the "cancelators". We are a cost center, and all that matters is how much we cost. pgg works in a different universe.

Outside of the OR, we don't like to exist, hence we don't have much influence. We are just intubators (or intubationists?). The surgeons are way too strong in most hospitals, even in the SICU (that's why most are open). But if you step outside of the SICU as an intensivist, you will feel the appreciation, wherever you can help and make a difference as a consultant. That's the key.

Let me put it this way: people don't tend to spend time with people they look down on. See who's friends with you, who is interested in your life, and you will know who might give a damn if you are replaced tomorrow.

Anesthesia did all of the intubations outside the OR where I worked, and we had a few CC anesthesiologists in the ICUs. We really respected anesthesia, because without then we were very often screwed, particularly during codes and rapid response events.

I guess the moral of that story is that if you want respect, you've gotta leave the OR sometimes.

 

[Mad Jack]

Excellent. I've flirted with the idea of doing a peds fellowship for long term stability and future marketability. I'm making too much money now to do that though.

If you're making so much bank, why exactly are you so down about the profession all the time? Is it the worst job in the world? Is it the trajectory? Is it the lack of respect? Trying to figure out why you're miserable so I can determine if I would be as well.

 

[pgg]

Excellent. I've flirted with the idea of doing a peds fellowship for long term stability and future marketability. I'm making too much money now to do that though.

It'd sure be hard to leave a upper private practice income to be a fellow again, especially in this era where the "make hay while the sun shines" wisdom may be truer than ever.

But I'm not taking a significant pay cut to do it, since the Navy's paying me my usual salary to go. It's not 90th %-ile MGMA pay, but it's sure not PGY-5 pay, either. I'll lose what I currently make moonlighting, but even so my opportunity cost is very low. I don't have to leave a partner job or track. No household relocation costs to speak of. I accrue retirement credit from the government and there's a nice loophole that won't extend my service commitment.

The only downside is leaving my reasonably cushy and low stress attending life to be a trainee again for a year. I've wanted to do it for a while. I'm 7 years out of residency, far enough away that I'm rested and recovered from the pain of residency. Not having to worry about written/oral boards as a fellow is a nice perk over going straight from residency to fellowship. Looking forward to a little academic rigor.

And of course the reward on the other side, in skills and knowledge and echo certification and opportunity are huge. It's gonna be an awesome year. 🙂

 

[deleted171991]

Anesthesia did all of the intubations outside the OR where I worked, and we had a few CC anesthesiologists in the ICUs. We really respected anesthesia, because without then we were very often screwed, particularly during codes and rapid response events.

I guess the moral of that story is that if you want respect, you've gotta leave the OR sometimes.

My point exactly.

And be involved in hospital committees, go to other departmental Grand Rounds if a case of yours is being discussed, don't shy away from all the consults which don't make you much money but help other physicians a lot (uncontrollable pain comes to mind) and be gracious about them, generally get to be known both as people and experts in the big physician community, outside of surgeons (who mostly don't give a **** who's at the head of the bed, and who mostly think that they are better than you anyway) etc. Be a doctor, in the Osler way, don't just behave like an OR tech or nurse. Btw, that starts with how you dress. 😉

 

[deleted162650]

It'd sure be hard to leave a upper private practice income to be a fellow again, especially in this era where the "make hay while the sun shines" wisdom may be truer than ever.

But I'm not taking a significant pay cut to do it, since the Navy's paying me my usual salary to go. It's not 90th %-ile MGMA pay, but it's sure not PGY-5 pay, either. I'll lose what I currently make moonlighting, but even so my opportunity cost is very low. I don't have to leave a partner job or track. No household relocation costs to speak of. I accrue retirement credit from the government and there's a nice loophole that won't extend my service commitment.

The only downside is leaving my reasonably cushy and low stress attending life to be a trainee again for a year. I've wanted to do it for a while. I'm 7 years out of residency, far enough away that I'm rested and recovered from the pain of residency. Not having to worry about written/oral boards as a fellow is a nice perk over going straight from residency to fellowship. Looking forward to a little academic rigor.

And of course the reward on the other side, in skills and knowledge and echo certification and opportunity are huge. It's gonna be an awesome year. 🙂

PGG, just curious how you're gonna handle things on the personal side. Will you be relocating the fam for a year (I know you have school age kids), or are you looking at this as a year long deployment?

 

[pgg]

PGG, just curious how you're gonna handle things on the personal side. Will you be relocating the fam for a year (I know you have school age kids), or are you looking at this as a year long deployment?

Fellowship location is about 2.5 hours from our house. Family is staying - will have a senior and sophomore in HS with a lot of extracurricular activities. It'd be hard to move them for a year. I've rented an apartment across the street from the hospital. Large program, lots of fellows. Should be home most weekends. Not ideal, but it's not like I'd have a lot of free time even if I was living at home.

It's a shorter commute than Kandahar, at least.

 

[narcusprince]

Pgg,
Good luck in your transition. I give it 2-3 years back and you may be specialty leader 🙂. As a positive I will say I appreciate our specialty leader a bit more when he was DH. He kept the DSS out of our business and was a strong negotiator at the command level. After seeing a lack of this I understand his position more. Enjoy the good southern food and check out Fosters Market!

 

[Consigliere]

If you're making so much bank, why exactly are you so down about the profession all the time? Is it the worst job in the world? Is it the trajectory? Is it the lack of respect? Trying to figure out why you're miserable so I can determine if I would be as well.

Money isn't everything; I work very hard for what I make ergo SOME of my consternation. The lack of autonomy, constant midlevel encroachment, ever increasing bureacratic burden, blah, blah, blah. I am fortunate to be owner of my own group which is EXPANDING rather than selling out to an AMC like everyone else. I'm gonna ride this horse as long as I can and hopefully when it dies I'll be financially secure. More important, I'll have the psychological advantage of being able to say "piss off" to any subsequent job I have if I want to.

 

[seinfeld]

I got news for you my brother from another mother - anesthesiologists are not respected at ANY facility.

I couldn't disagree more. At my shop when things get tough they look to anesthesia to fix. This is from admin medical staff stuff to OR related issues

 

[Consigliere]

I couldn't disagree more. At my shop when things get tough they look to anesthesia to fix. This is from admin medical staff stuff to OR related issues

Right. You're their "fix-it-monkey." That's not respect.

 

[Twiggidy]

No, I work in a environment where patients and fellow physicians do not see the presence of the ASA. With plenty of AANA banners in patient care areas we also need a presence. Anesthesiologist are not respected in my facility. I have had to correct staff members on calling nurse anesthetist doctor. As well as trying to establish a culture of not calling us MDAs. Put some RESPEK on my name!

YESSSS!

 

[Twiggidy]

If you're making so much bank, why exactly are you so down about the profession all the time? Is it the worst job in the world? Is it the trajectory? Is it the lack of respect? Trying to figure out why you're miserable so I can determine if I would be as well.

You can make a bunch of money and be down on the future. It's cliche, but money doesn't equal happiness, but it is one heck of a down payment.

I love the optimism on the board but you really have to no "listen" to what people like @Consigliere and @FFP are saying, rather "hear" them. The FACT remains, that until you as an anesthesiologist finds a way GENERATE money for a hospital and not COST them money, you are just a "get stuff done body" and if you fall out of line, they'll go down the street to the residency or to Gaswork and find another. The admin will smile in your face and tell you how valuable you are and a few people may even say you're great for saving some patient or getting IV access when no one else can, but the minute you have something you need to do the conflicts with what THEY need to do, ie, lets start a case "but sir I have dinner reservation or I have a flight or etc" now you're just another lazy anesthesiologist who doesn't want to work. I have a feeling the really positive people on her are either A: still in training or B: early out of training.

I'm telling you, listen to people like Consig and FFP and etc. They are telling you what the real world is like and how to keep you out of trouble and from being "disruptive". Yes a few guys work a places where they can wield their swords but those places are few and far between. Even that big bad attending where I trained, I heard to the grapevine, eventually got put in his place (story for another thread). I'm slowly SLOWLY learning....show up, be nice, keep you mouth shut, don't kill anyone.....get paid. Rinse. Repeat.

I.E......

especially if it's an anesthesiologist.....

 

[deleted171991]

I couldn't disagree more. At my shop when things get tough they look to anesthesia to fix. This is from admin medical staff stuff to OR related issues

I can believe this. If I am not mistaken, you guys are also running the ICU, and are generally present outside the OR. The anesthesia group is a part of the fabric of the hospital, not an outsourced problem. You have a number of competent partners, not mostly employees who care only about clocking in, doing the "job", and getting out, apres moi le deluge. Etc.

Anesthesia used to be looked up to like this. It's no surprise that so many quality improvements came from the field, when bean counters still listened to us. I can believe that this still happens in selected places. It's just the exception, in my book, not the rule. This is the kind of place any good anesthesiologist, who is also a good periop consultant (not just the person at the head of the bed), would love practicing at, I am sure.

 

[seinfeld]

Right. You're their "fix-it-monkey." That's not respect.

Although I can respect disbelief, I understand that many hospitals dont listen but I take offense to being called a monkey of any sorts, I am a skilled and highly respected physician . Perhaps you dont know what respect looks like, either on the giving end or the receiving end.

Had a patient whose family member worked for hospital on the administrative side of the pharmacy department, never met her before. She knew of my reputation and was glad I was on call. You dont get there by constantly thwarting every ask or by being reactionary/contrarian. How many anesthesiologist out there would, after intubating a patient for a mucous plug causing lung collapse, have spent an hour doing a bronch?

We lead by being out in front, clinically and administrativly . We are the ones make suggestions in the peri-operative realm for improvements. I meet with he COO and VPMA regularly. I sit on 3 different hospital management boards.

FFP is right, We are an integral part of our hospital. Its about compromise, its about working toward a common goal. If the past 2 years myself , my department chair and the surgeons have put policies in place that have been able to increase surgical volume while at the same time decreasing the number of cases running late. You dont get there without being respected, and you dont get respect by being a PITA.