Ask an Attending Anesthesiologist Anything!

[DrRiker]

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As long as we’re measuring, Dr. Destriero’s wife actually was a model and is the shiniest trophy in the case.


--
Il Destriero

Is 200 volunteer hours holistic enough for this?

 

[HomeSkool]

*ahem*...Mrs Dr Goro is quite the hottie herself.

As long as we’re measuring, Dr. Destriero’s wife actually was a model and is the shiniest trophy in the case.

Sorry, @Allnew, looks like the best you can hope for is fourth place. But that's still OK, I guess...

Edit: Just noticed that @Allnew is female. But she's still out of luck, because Mrs. HomeSkool, Mrs. Dr. Goro, and LaDestriera already snapped up the hottest dudes.

 

[RNthenDoc]

*scribbling in notes*
“Anesthesiologists... get.... qt 3.14 wives.... must...match... gas.....”

 

[HomeSkool]

Bumpity bump! I'm more than happy to field more questions and discussion if any of y'all have them.

 

[21Rush12]

Bumpity bump! I'm more than happy to field more questions and discussion if any of y'all have them.

Hi Homeskool! Thanks for offering to help out. Can you comment on some of the things you think we should look for in a residency program that might be less than obvious?

 

[Matthew9Thirtyfive]

Is it realistically possible to split time between the ICU (with a CCM fellowship) and the OR?

 

[getdown]

Is it realistically possible to split time between the ICU (with a CCM fellowship) and the OR?

Yes it can be done but it largely depends on the group you're with. If you go PP they want you in the ORs as that's where you make them the most money. It's not impossible but you might have to find a side gig doing ICU on top of your OR obligations. If you're in academia it's easier to split time between OR and ICU.

 

[Matthew9Thirtyfive]

Yes it can be done but it largely depends on the group you're with. If you go PP they want you in the ORs as that's where you make them the most money. It's not impossible but you might have to find a side gig doing ICU on top of your OR obligations. If you're in academia it's easier to split time between OR and ICU.

How hard is it to moonlight in anesthesiology? Could I get an ICU job and moonlight a couple times a month?

 

[seanm028]

I am a non-trad with a background in EMS, and I have realized that I want to continue my passion for prehospital medicine when I become a physician (i.e. medical director, or at least heavily involved in EMS education). I recently spoke with a trauma anesthesiologist who told me that he splits his time between the OR and EMS work (e.g. teaching inservice classes for local agencies, serving as an associate medical director for a HEMS program).

In your experience, how common is this? Would an academic hospital be likely to support this sort of model, or do you think he's an outlier?

 

[getdown]

How hard is it to moonlight in anesthesiology? Could I get an ICU job and moonlight a couple times a month?

They're usually called per diem gigs, not necessarily moonlighting. And it's relatively easy to get as long as your jobs are flexible. I do a per diem gig one day a week on top of my main VA job. I get emails all the time about random places all over my state that need anesthesia coverage. Might be a little harder for ICU since their coverage needs are different but I know people who do ICU on the side. The nice thing about Anesthesia is that you can carve out your own schedule with what you want to do as long as your flexible.

 

[Matthew9Thirtyfive]

They're usually called per diem gigs, not necessarily moonlighting. And it's relatively easy to get as long as your jobs are flexible. I do a per diem gig one day a week on top of my main VA job. I get emails all the time about random places all over my state that need anesthesia coverage. Might be a little harder for ICU since their coverage needs are different but I know people who do ICU on the side. The nice thing about Anesthesia is that you can carve out your own schedule with what you want to do as long as your flexible.

That's awesome. My only real concern with anesthesiology is that i sort of like rounding and seeing patients over the course of days/weeks/whatever. I think the option to do CCM might mitigate that concern a bit if it's anything like it was when I was shadowing.

 

[detroitzugzwang]

Bumpity bump! I'm more than happy to field more questions and discussion if any of y'all have them.

What advice would you have for an incoming M1 to get more exposure in the field? Do you think most anesthesiologist's would be willing to accept shadowing and would that be a good way to learn more about the field?

 

[ggr805]

Bumpity bump! I'm more than happy to field more questions and discussion if any of y'all have them.

I'm interested in pain medicine due to a lot of personal exposure to the field and interest in research in pain management. I've seen in thrown around that you shouldn't go into anesthesia just to do pain medicine--not sure whether that's along the lines of "don't expect to get into a pain fellowship since it's hard" or because the two are very different fields. I do know you can match into a pain fellowship from different specialties, but I'm somewhat interested in performing interventional procedures, so I thought anesthesiology would prepare me best for that. I also do think approaching pain from a PM &R or psych perspective would be interesting, especially for research, but don't know whether it looks much different in a clinic perspective (esp for psych...). As an incoming MS1, this is all conjecture though. I know you're in gen anesthesia, but any light you can shed would be great! Thanks so much for taking the time to do this.

 

[Matthew9Thirtyfive]

I'm interested in pain medicine due to a lot of personal exposure to the field and interest in research in pain management. I've seen in thrown around that you shouldn't go into anesthesia just to do pain medicine--not sure whether that's along the lines of "don't expect to get into a pain fellowship since it's hard" or because the two are very different fields. I do know you can match into a pain fellowship from different specialties, but I'm somewhat interested in performing interventional procedures, so I thought anesthesiology would prepare me best for that. I also do think approaching pain from a PM &R or psych perspective would be interesting, especially for research, but don't know whether it looks much different in a clinic perspective (esp for psych...). As an incoming MS1, this is all conjecture though. I know you're in gen anesthesia, but any light you can shed would be great! Thanks so much for taking the time to do this.

Obviously you’ll get a real answer soon, but I just wanted to add my anecdote that all the pain docs I worked with went to fellowship from anesthesia. It seems much more common and they seemed to think it was the best way (they were at least a little biased though lol).

 

[orthomyxo]

I’m going to be shadowing an anesthesiologist next week. Any tips or good questions to ask?

 

[Matthew9Thirtyfive]

I’m going to be shadowing an anesthesiologist next week. Any tips or good questions to ask?

@HomeSkool
To piggy back off this, we have a required anesthesia rotation. We can either do a 2 week rotation or a 4 week. Is there any harm in doing a longer rotation? I know like in rads they say that rotations can actually hurt you because it’s hard to stand out in a good way. Is gas like that? How enthusiastic is too enthusiastic? Assume I want to do anesthesiology.

 

[getdown]

What advice would you have for an incoming M1 to get more exposure in the field? Do you think most anesthesiologist's would be willing to accept shadowing and would that be a good way to learn more about the field?

The best way to expose yourself to the field is to do shadowing. If your school has a surgery department (which it should) then you'll have an anesthesia department that you can contact in order to arrange shadowing experiences. Most anesthesiologists are happy to have students around. The only issue is that Anesthesia has a lot of background thinking that happens in terms of patient optimization, risk factors and anesthesia choices. It's very dull when you actually plan right and nothing happens to the patients.

 

[getdown]

I'm interested in pain medicine due to a lot of personal exposure to the field and interest in research in pain management. I've seen in thrown around that you shouldn't go into anesthesia just to do pain medicine--not sure whether that's along the lines of "don't expect to get into a pain fellowship since it's hard" or because the two are very different fields. I do know you can match into a pain fellowship from different specialties, but I'm somewhat interested in performing interventional procedures, so I thought anesthesiology would prepare me best for that. I also do think approaching pain from a PM &R or psych perspective would be interesting, especially for research, but don't know whether it looks much different in a clinic perspective (esp for psych...). As an incoming MS1, this is all conjecture though. I know you're in gen anesthesia, but any light you can shed would be great! Thanks so much for taking the time to do this.

The reason that that quote exists is because in order for you to be able to do Pain through Anesthesia is that you have to go through Anesthesia residency. This can be challenging for those individuals that just want to do Pain clinic and not deal with the OR because the residency can be very stressful. You're dealing with sick ICU patient on multiple drips, trauma patients trying to die on you requiring massive resuscitation, cardiac patients, pediatric patients and the 24 hour calls. If you're not actually interested in Anesthesia and you're just using it as a way to get into Pain, then it's likely you're not going to be very happy during residency. And no one wants to work with an unhappy and whiny resident. If Pain is your goal and you have any interest in those other ways of getting into Pain then maybe that's what you should do. You're not wrong in saying that those from Anesthesia tend to have better procedural skills since that's what you're doing when you're putting in lines in patients.

So bottom line: if you're not gung ho with general Anesthesia, consider going some other route in order to get into Pain.

 

[IMGASMD]

As an incoming MS1, this is all conjecture though. I know you're in gen anesthesia, but any light you can shed would be great! .

Too early. Get through your step 1 first. Many things can change your first two years of med school. Plenty to worry about before you decide if you want pain and/or which path you take.

 

[getdown]

I’m going to be shadowing an anesthesiologist next week. Any tips or good questions to ask?

Well this may be a little late but things to do: be interested, ask questions. Obviously, your questions will depend on how experienced you are and how much knowledge you're working with but simple things like machines and monitors, drugs. Next level questions would involve asking about why they chose a particular anesthetic plan/drug/intervention for this patient. You need to understand WHY we do certain things and not that we just do them. There're multiple options to put people to sleep, keep them asleep, intubate people but usually there's a reason why we do it one particular way. If the patient's healthy then it's fine but if they're more complicated it gets trickyer.

@HomeSkool
To piggy back off this, we have a required anesthesia rotation. We can either do a 2 week rotation or a 4 week. Is there any harm in doing a longer rotation? I know like in rads they say that rotations can actually hurt you because it’s hard to stand out in a good way. Is gas like that? How enthusiastic is too enthusiastic? Assume I want to do anesthesiology.

In all honesty, med students are kind of a bother in Anesthesia. That's why we tend to send them home after the first intubation.
1. If the patient's stable there's not a lot of stuff to do or exciting to talk about.
2. If the patient's not stable, there's not a lot of time to talk about stuff anyway and you're just in the way
3. We have to chart and do things during the case and so having a student there for long periods of times is a little awkward. You run out of convo topics.

From my personal experience for students doing anesthesia, they come as 2 groups:
1. they're excited about doing intubations
2. they just want to go home and anesthesia is a chill rotation with minimal oversight

So this can make it hard to be overly enthusiastic as a student. If you're truly interested in Anesthesia, the way to show enthusiasm is to ask good questions regarding WHY a certain anesthetic choice is made. It's often good to be paired with someone long term so they can follow your knowledge growth throughout the rotation. They ask you read up on the different induction medications and next time you can tell them the pros/cons of each. But the most important thing is to be normal and not annoying.

 

[dr_kateb]

What’s your favorite sedative?

 

[IMGASMD]

In all honesty, med students are kind of a bother in Anesthesia. That's why we tend to send them home after the first intubation.

But the most important thing is to be normal and not annoying.

Above sums up everything you should know regarding anesthesia as a medical student. Other than the hard knowledge.

Do you like the OR?
Do you want to be a surgeon?
Do you mind playing second fiddle? Sometimes make life or death decisions without ever get the credit, but always( >80%) get the blame for anything that does not go right.

If 1 is no. Maybe you shouldn’t do anesthesia.
If 2 is yes. Maybe you shouldn’t do anesthesia.
If 3 is yes. Maybe you shouldn’t do anesthesia.

 

[getdown]

What’s your favorite sedative?

ketafol

 

[Matthew9Thirtyfive]

Well this may be a little late but things to do: be interested, ask questions. Obviously, your questions will depend on how experienced you are and how much knowledge you're working with but simple things like machines and monitors, drugs. Next level questions would involve asking about why they chose a particular anesthetic plan/drug/intervention for this patient. You need to understand WHY we do certain things and not that we just do them. There're multiple options to put people to sleep, keep them asleep, intubate people but usually there's a reason why we do it one particular way. If the patient's healthy then it's fine but if they're more complicated it gets trickyer.



In all honesty, med students are kind of a bother in Anesthesia. That's why we tend to send them home after the first intubation.
1. If the patient's stable there's not a lot of stuff to do or exciting to talk about.
2. If the patient's not stable, there's not a lot of time to talk about stuff anyway and you're just in the way
3. We have to chart and do things during the case and so having a student there for long periods of times is a little awkward. You run out of convo topics.

From my personal experience for students doing anesthesia, they come as 2 groups:
1. they're excited about doing intubations
2. they just want to go home and anesthesia is a chill rotation with minimal oversight

So this can make it hard to be overly enthusiastic as a student. If you're truly interested in Anesthesia, the way to show enthusiasm is to ask good questions regarding WHY a certain anesthetic choice is made. It's often good to be paired with someone long term so they can follow your knowledge growth throughout the rotation. They ask you read up on the different induction medications and next time you can tell them the pros/cons of each. But the most important thing is to be normal and not annoying.

Perfect. Thanks!

 

[Matthew9Thirtyfive]

Above sums up everything you should know regarding anesthesia as a medical student. Other than the hard knowledge.

Do you like the OR?
Do you want to be a surgeon?
Do you mind playing second fiddle? Sometimes make life or death decisions without ever get the credit, but always( >80%) get the blame for anything that does not go right.

If 1 is no. Maybe you shouldn’t do anesthesia.
If 2 is yes. Maybe you shouldn’t do anesthesia.
If 3 is yes. Maybe you shouldn’t do anesthesia.

Worked in the OR as a scrub tech for 8 years before med school. I love the OR, but I really don’t want to be a surgeon. I also don’t mind being second fiddle. I’ll know what I do is important, and that’s good enough.

 

[deleted938090]

Addiction and Substance Abuse in Anesthesiology - PMC

Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the anesthesia workplace and outcomes have not appreciably changed. ...

www.ncbi.nlm.nih.gov

Is there really a significant issue of drug abuse in the anesthesiology community?

 

[getdown]

Addiction and Substance Abuse in Anesthesiology - PMC

Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the anesthesia workplace and outcomes have not appreciably changed. ...

www.ncbi.nlm.nih.gov

Is there really a significant issue of drug abuse in the anesthesiology community?

Yes, there is a higher incidence of these in Anesthesiology due to ease of access to narcotics and other controlled substances, the stressful nature of the job and the type A personality of people that choose the field.

 

[HomeSkool]

Well geez, looks like I missed the party. That's what I get for letting work and my personal life get in the way of SDN, I suppose. 😉

Hi Homeskool! Thanks for offering to help out. Can you comment on some of the things you think we should look for in a residency program that might be less than obvious?

Look for a program that teaches residents rather than simply seeing them as worker bees. My department's residents work hard but we take steps to prioritize education. We steer educational cases toward the residents, for example, and we have an army of terrific CRNAs who get residents out of rooms so they can attend their lectures and other learning sessions. The program I trained in had a different practice model but was still structured to function just fine if residents weren't present. That's what you want to find: a program that works you hard but doesn't rely on you to generate revenue.

What advice would you have for an incoming M1 to get more exposure in the field? Do you think most anesthesiologist's would be willing to accept shadowing and would that be a good way to learn more about the field?

In addition to what @getdown said, see if your school has an anesthesiology interest group. If not, start one.

If you're truly interested in Anesthesia, the way to show enthusiasm is to ask good questions regarding WHY a certain anesthetic choice is made.

Agreed, and students can demonstrate interest by being even more proactive than that. As an MS4, I would read up on my patients ahead of time, develop anesthetic plans, and then discuss them with my attending and/or resident. On my audition rotation at the program I ultimately attended, I overheard one of those attendings telling a selection committee member that my plans were as good or better than most of the residents' and that the program needed to grab me before the other Army program did.

But the most important thing is to be normal and not annoying.

The importance of this cannot be overstated.

 

[Matthew9Thirtyfive]

Agreed, and students can demonstrate interest by being even more proactive than that. As an MS4, I would read up on my patients ahead of time, develop anesthetic plans, and then discuss them with my attending and/or resident. On my audition rotation at the program I ultimately attended, I overheard one of those attendings telling a selection committee member that my plans were as good or better than most of the residents' and that the program needed to grab me before the other Army program did.

Do you have any suggestions for where to read up on developing anesthetic plans?

 

[HomeSkool]

Do you have any suggestions for where to read up on developing anesthetic plans?

Basics of Anesthesia (AKA Baby Miller) is a good place to start, and then just being inquisitive and asking why the anesthesiologist and resident are choosing or avoiding a specific drug or technique. If you have access to Anesthesiologist's Manual of Surgical Procedures, you can get some additional insight into the anesthetic considerations for a given procedure. Anesthesia and Coexisting Disease is also good for understanding how a patient's comorbidities may affect perioperative management.

 

[Matthew9Thirtyfive]

Basics of Anesthesia (AKA Baby Miller) is a good place to start, and then just being inquisitive and asking why the anesthesiologist and resident are choosing or avoiding a specific drug or technique. If you have access to Anesthesiologist's Manual of Surgical Procedures, you can get some additional insight into the anesthetic considerations for a given procedure. Anesthesia and Coexisting Disease is also good for understanding how a patient's comorbidities may affect perioperative management.

Bookmarking this, thanks.

 

[CidHighwind]

Would you consider your field to be the best in medicine? Were you ever disrespected by surgeons during training? Also, how much “down time” do you have during cases where you could be on your phone or doing a crossword puzzle?