Ask a PGY-4...

[Green Grass]

I'll be on my computer the next few hours, so ask a PGY-4 resident any questions you have regarding medicine!

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[WhittyPsyche]

Resident in?


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[Green Grass]

Resident in?


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Anesthesia.

 

[Ho0v-man]

Is the job market really as awful as SDN hypes it up to be? Especially if you're willing (or in my case would prefer) to live rurally?

Also, what general info can you give someone with broad interests about the field and it's different fellowships?

Thanks.


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[Green Grass]

Is the job market really as awful as SDN hypes it up to be? Especially if you're willing (or in my case would prefer) to live rurally?

Also, what general info can you give someone with broad interests about the field and it's different fellowships?

Thanks.


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I can only answer your question based on the graduating class of residents - all of them have jobs, some better than others, but no one had an issue finding a job. I don't think any one got the exact job they wanted in the exact city they wanted with the exact lifestyle. But I think getting two out of the three is possible (location, salary, lifestyle).

The field is extremely dynamic. It's been better and more engaging than I expected. The fellowships allow you to specialize in one area and become extremely proficient in your area of expertise. They include: critical care, peds, pain, regional (not ACGME certified yet, but likely soon), OB, and cardiac. I think fellowship is going to become more common as the years go by.

 

[Cyberdyne 101]

Are you interested in pain management?

 

[Green Grass]

Are you interested in pain management?

Sure am.

 

[Psai]

Do you think it matters if a program has a lot of fellows or not? The places with a ton of fellows said that their caseload made it so that residents get to see a lot of good cases too and the places without too many fellows said their residents get first crack at the toughest cases.

I'm interested in cardiac and peds

 

[Ho0v-man]

I can only answer your question based on the graduating class of residents - all of them have jobs, some better than others, but no one had an issue finding a job. I don't think any one got the exact job they wanted in the exact city they wanted with the exact lifestyle. But I think getting two out of the three is possible (location, salary, lifestyle).

The field is extremely dynamic. It's been better and more engaging than I expected. The fellowships allow you to specialize in one area and become extremely proficient in your area of expertise. They include: critical care, peds, pain, regional (not ACGME certified yet, but likely soon), OB, and cardiac. I think fellowship is going to become more common as the years go by.

Sorry but I thought of another.

How do you feel about working with crnas? My personal experiences have been nothing but positive, but the anesthesia forum makes it seem like they treat you guys like garbage and they aren't very competent yet try to exert more and more independence.

Im just trying to figure out if all the doom and gloom is actually doom and gloom or if it's the same way it is in rads where it's just a bunch of people complaining that their lives aren't really awesome-their just pretty awesome.

Thanks again.


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[Green Grass]

Do you think it matters if a program has a lot of fellows or not? The places with a ton of fellows said that their caseload made it so that residents get to see a lot of good cases too and the places without too many fellows said their residents get first crack at the toughest cases.

I'm interested in cardiac and peds

I think fellows could potentially "steal" some good cases from the residents, but I have a hard time believing you wouldn't get what you need from residency to be competent. Especially if you plan to do a fellowship yourself - in which case during that year you'd be doing the same thing back to the residents.

You could also look at it from this perspective - if they have enough exposure and cases to sponsor a fellowship, you will likely see more of that subspecialty, which could be a good thing depending on your interests.

 

[Green Grass]

Sorry but I thought of another.

How do you feel about working with crnas? My personal experiences have been nothing but positive, but the anesthesia forum makes it seem like they treat you guys like garbage and they aren't very competent yet try to exert more and more independence.

Im just trying to figure out if all the doom and gloom is actually doom and gloom or if it's the same way it is in rads where it's just a bunch of people complaining that their lives aren't really awesome-their just pretty awesome.

Thanks again.


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I think it's something that will be a constant thought during your work life. In my experience, they are generally nice and approachable (some moreso than others). However, their training is not equivalent to ours yet their national leadership tries to paint a picture of equivalency which I don't agree with.

Which is why I promote fellowships to my co-residents and medical students. I think subspecialty training will become more common.

 

[NotYou20]

Could you describe the patient interaction aspect of anesthesia?

 

[Green Grass]

Could you describe the patient interaction aspect of anesthesia?

Typical day - meet 2-3 new patients. Introduce yourself, quick rundown of the anesthesia plan, quick history and physical, answer any questions. In the operating room it is your job to keep the patient calm and pain free. Afterwards, get them to the PACU, make sure they are stable, sign off, and move on to the next patient.

If you are in pre-op screening clinic, that is a different beast. It's a clinic day, so it's all patient interaction.

Overall, no long term follow-up in general anesthesia. This can be good or bad depending on what you want from medicine.

 

[Psai]

What do you know now at the end of residency that you would have liked to know when you first started?

 

[Green Grass]

What do you know now at the end of residency that you would have liked to know when you first started?

1. Choose life over medicine. I love medicine and being involved in patient care, but there are specialties which allow good lifestyles and those that don't.
2. Location of residency should one of the most important aspect of where you decide to go.
3. Study moderately hard year round rather than cram around exam time. You look smarter to your attending and understand your cases.
4. Drop the ego.
5. The clock is always moving. Keep your head down and get through the hard days with a smile.

 

[frosted_flake]

Do you prefer using a Glidescope (or similar) versus a regular laryngoscope? I'm a pre-hospital care provider interested in anesthesia

Thank you for your time!

 

[Green Grass]

Do you prefer using a Glidescope (or similar) versus a regular laryngoscope? I'm a pre-hospital care provider interested in anesthesia

Thank you for your time!

Every advanced airway device has its use. Standard case - regular ole DL. Anticipated difficult airway - fiberoptic. I don't think their is an airway I can't intubate with a fiberoptic scope. Spent my time learning it's use and nuances while in the SICU, and it's paying dividends in the OR years later.


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[frosted_flake]

Every advanced airway device has its use. Standard case - regular ole DL. Anticipated difficult airway - fiberoptic. I don't think their is an airway I can't intubate with a fiberoptic scope. Spent my time learning it's use and nuances while in the SICU, and it's paying dividends in the OR years later.


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Thanks!

 

[Green Grass]

Thanks!

Good luck!


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[iforget2]

Do you have time during residency for hobbies and social life?

 

[Green Grass]

Do you have time during residency for hobbies and social life?

Yeah, Anesthesia allows a social life. Which is very very nice and needed. In my past life (surgery), absolutely not. Lived and breathed work, and I got burnt out.


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[Ambiences]

Yeah, Anesthesia allows a social life. Which is very very nice and needed. In my past life (surgery), absolutely not. Lived and breathed work, and I got burnt out.


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When you say your past life in surgery, do you mean to say you had switched residencies?

Also, having recently gained interest in anesthesia, I was wondering: what opportunities in medical school were influential in your decision to pursue the specialty?

Thank you!

 

[Green Grass]

When you say your past life in surgery, do you mean to say you had switched residencies?

Also, having recently gained interest in anesthesia, I was wondering: what opportunities in medical school were influential in your decision to pursue the specialty?

Thank you!

Exactly. I'm a transplant.

Tbh, my experience with anesthesia during medical school was very limited. Through my surgery years I spent countless hours with anesthesia and saw them work. When I decided to switch specialties, it was a no brainer for me since I knew the OR so well already.


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[Sardinia]

@Green Grass When I worked as a blood transfusion technician in the OR it seemed like the anesthesiologists were under way less pressure than the surgeons. Then again the sites I worked at were in the city where they were booked back to back bypass cases with no end in sight.

 

[Ambiences]

Exactly. I'm a transplant.

Tbh, my experience with anesthesia during medical school was very limited. Through my surgery years I spent countless hours with anesthesia and saw them work. When I decided to switch specialties, it was a no brainer for me since I knew the OR so well already.


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Why did you decide to transplant over? I read about a similar transplant case recently on this blog: http://www.blog.greatzs.com/2010/09/why-i-chose-anesthesiology.html

 

[Green Grass]

@Green Grass When I worked as a blood transfusion technician in the OR it seemed like the anesthesiologists were under way less pressure than the surgeons. Then again the sites I worked at were in the city where they were booked back to back bypass cases with no end in sight.

It's a far less stressful job than most surgery gigs. Although, those heart cases are a ton of work from the anesthesia side and they are some of the most intelligent people in the hospital.

 

[Green Grass]

Why did you decide to transplant over? I read about a similar transplant case recently on this blog: http://www.blog.greatzs.com/2010/09/why-i-chose-anesthesiology.html

Honestly, I just didn't like the job enough to continue to work that hard at it. Plain and simple.

Listen to those people who tell you - "if you can picture yourself doing anything other than surgery, don't go into surgery"

 

[Sardinia]

It's a far less stressful job than most surgery gigs. Although, those heart cases are a ton of work from the anesthesia side and they are some of the most intelligent people in the hospital.

Working in the OR is life consuming. It's not only a matter of intelligence, but making intelligent decisions even when you got little sleep due to an on call or because a surgery procedure didn't go as expected. It takes a certain type of stamina and grit. Maybe I'm tainted by the urban surgical environment working for a big name hospital, but you walked into the locker room of the surgical nurse specialists and you could read burn out on their faces and in the atmosphere of the locker room in general.

 

[Green Grass]

Working in the OR is life consuming. It's not only a matter of intelligence, but making intelligent decisions even when you got little sleep due to an on call or because a surgery procedure didn't go as expected. It takes a certain type of stamina and grit. Maybe I'm tainted by the urban surgical environment working for a big name hospital, but you walked into the locker room of the surgical nurse specialists and you could read burn out on their faces and in the atmosphere of the locker room in general.

Yep, I'm at a big name busy trauma hospital and its the same thing here. Surgeons are burnt out, but the anesthesiologists keep their sanity a little better. Call nights are busy though and you make life/death decisions every night.

 

[NotYou20]

Typical day - meet 2-3 new patients. Introduce yourself, quick rundown of the anesthesia plan, quick history and physical, answer any questions. In the operating room it is your job to keep the patient calm and pain free. Afterwards, get them to the PACU, make sure they are stable, sign off, and move on to the next patient.

If you are in pre-op screening clinic, that is a different beast. It's a clinic day, so it's all patient interaction.

Overall, no long term follow-up in general anesthesia. This can be good or bad depending on what you want from medicine.

Thank you!

 

[Cyberdyne 101]

Exactly. I'm a transplant.

Tbh, my experience with anesthesia during medical school was very limited. Through my surgery years I spent countless hours with anesthesia and saw them work. When I decided to switch specialties, it was a no brainer for me since I knew the OR so well already.


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Was it difficult to switch programs? Did you have to relocate?

 

[Green Grass]

Was it difficult to switch programs? Did you have to relocate?

Not at all. I left a competitive field and had the application to show for it. And I left my previous program without any ill will or negative comments, I was well liked. Plus, my current PD is amazing and was very upfront with me throughout the process. I felt very comfortable making the switch.

No relocation. I stayed at the same institution, same hospital, same everything. Glad I did.

 

[Cyberdyne 101]

Not at all. I left a competitive field and had the application to show for it. And I left my previous program without any ill will or negative comments, I was well liked. Plus, my current PD is amazing and was very upfront with me throughout the process. I felt very comfortable making the switch.

No relocation. I stayed at the same institution, same hospital, same everything. Glad I did.

I'm happy it worked out well for you!

 

[Green Grass]

I'm happy it worked out well for you!

Thanks! Appreciate it.


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[PreMedTex]

What do you enjoy most about anesthesiology? dislike most?
Also do you have any advice for pre-meds or med students that have an interest in anesthesiology?

 

[Green Grass]

What do you enjoy most about anesthesiology? dislike most?
Also do you have any advice for pre-meds or med students that have an interest in anesthesiology?

Most: using all my medical knowledge, periods of busy-ness/periods of relaxing, lifestyle, lots of small procedures, laid back group of residents/attendings
Dislike: CRNA encroachment, night shifts, occasional lack of respect around the OR
Advice: reach out to most anesthesiologists and they'd be happy to chat with you and have you shadow, most will likely give you a nice introduction to anesthesia over the course of a week. For the med students - learn your drugs and physiology because it all becomes real life important after you leave med school and start putting people to sleep.