Attending Anesthesiologist Ask Me Anything (AMA)

[The Physician Philosopher]

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I am an attending anesthesiologist.

Happy to answer any questions people may have about the specialty, life after residency/fellowship (whether to do a fellowship?), salary, jobs, etc.

I'll respond as quickly as I can!

Ask away,

The Physician Philosopher

 

[22yis]

Greetings, thanks for doing the AMA. Im a M2, soon to take on the monster and shortly after start rotations. No clue what field im interested in. My brother is an attending anesthesiologist and is telling me not to go into anesthesiology due to Nurse anesthesists and growing job scarcity. He says it is not the case yet, but likely to be so in the near future. It hurts to lose one of the ROAD specialties, so if you can weigh in on Nurse RNs, job availability, etc. would be appreciated. Thanks!

 

[zero0]

You're stranded on a deserted island. Mac or miller?

 

[theonlytycrane]

Thoughts on the future of gas? Is research a must for residency?

 

[SteyrFWB]

MAC or Miller? Use your freaking fingers !

 

[The Physician Philosopher]

Greetings, thanks for doing the AMA. Im a M2, soon to take on the monster and shortly after start rotations. No clue what field im interested in. My brother is an attending anesthesiologist and is telling me not to go into anesthesiology due to Nurse anesthesists and growing job scarcity. He says it is not the case yet, but likely to be so in the near future. It hurts to lose one of the ROAD specialties, so if you can weigh in on Nurse RNs, job availability, etc. would be appreciated. Thanks!

Here's what I think.

The encroachment battle is not unique to anesthesia. Look at family practice, peds, radiology (films to India for cheaper price), emergency medicine, burn surgeons, etc.

As a physician, if you are not practicing to the full level of your license, there could some day be an issue, regardless of your field. In anesthesiology, if you want to work at a GI center Monday to Friday from 8 to 5 with no nights, weekends, or holidays... You may have an issue. Same goes for private practice docs that don't have the sickest patients or don't do big/cutting edge procedures.

At the end of the day, I don't feel like the sky is falling like some of my colleagues. Then again, I work in academic medicine where I do research, clinical practice, and education of residents. I'll always be at the tip of the spear. And, for the record, I am a realist with pessimistic leanings. Not trying to spit-shine this topic.

I could go into more detail, but for the sake of brevity, I won't. I think the field is fine as long as you are using your whole skill set. I do think, however, that some subspecialties and practice models are better protectef than others.



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[The Physician Philosopher]

You're stranded on a deserted island. Mac or miller?

Miller 2

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[The Physician Philosopher]

Thoughts on the future of gas? Is research a must for residency?

Research is definitely not a must for residency. I essentially had none and am a pretty freshly minted attending.

It does, however, help your application if you are weak in other areas (step scores, evals, letters, etc).

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[The Physician Philosopher]

MAC or Miller? Use your freaking fingers !

I've done a few digital intubations during my training. Whatever gets the job done!

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[SteyrFWB]

George Clooney did a finger intubation in ER 25 years ago. We done a research on residents doing finger intubation. 45 out of 45 struck out.

It works only on neonates, when your finger actually can find the epiglottis. Even then, in the hands of ped anesthesia fellows, the success is still very dicy.

 

[22yis]

Here's what I think.

The encroachment battle is not unique to anesthesia. Look at family practice, peds, radiology (films to India for cheaper price), emergency medicine, burn surgeons, etc.

As a physician, if you are not practicing to the full level of your license, there could some day be an issue, regardless of your field. In anesthesiology, if you want to work at a GI center Monday to Friday from 8 to 5 with no nights, weekends, or holidays... You may have an issue. Same goes for private practice docs that don't have the sickest patients or don't do big/cutting edge procedures.

At the end of the day, I don't feel like the sky is falling like some of my colleagues. Then again, I work in academic medicine where I do research, clinical practice, and education of residents. I'll always be at the tip of the spear. And, for the record, I am a realist with pessimistic leanings. Not trying to spit-shine this topic.

I could go into more detail, but for the sake of brevity, I won't. I think the field is fine as long as you are using your whole skill set. I do think, however, that some subspecialties and practice models are better protectef than others.



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Thanks for your thoughts. I know this becomes an aside, but if you don't mind mentioning it, what do you think are some of the more protected from encroachment specialties/subspecialities? without the obvious modifiers of expertise, experience and such. Just something nice to hear from people in the field 😛

 

[Xavieous]

What do you think about critical care fellowships?
Do you spend any time in the ICU now, or are the CC fellowship's a must?
Er--> CC, or anesthesiology-->CC, or pulm.-->CC, What is the best/most effective path for being good/competitive in CC?

Thanks!

 

[The Physician Philosopher]

Thanks for your thoughts. I know this becomes an aside, but if you don't mind mentioning it, what do you think are some of the more protected from encroachment specialties/subspecialities? without the obvious modifiers of expertise, experience and such. Just something nice to hear from people in the field 😛

In the field of Anesthesiology:
1) academic medicine. Any specialty. Make it your niche topic (i.e. be the expert, have depth)
2) private practice. Clasicially it is said--> CT, peds, critical care, pain.

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[drdoom12]

I’m pretty much set on doing anesthesiology, but I’m not sure if I want to do a fellowship or not. What’s the biggest difference between pulm crit care vs critical care through the anesthesiologist route?


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[The Physician Philosopher]

What do you think about critical care fellowships?
Do you spend any time in the ICU now, or are the CC fellowship's a must?
Er--> CC, or anesthesiology-->CC, or pulm.-->CC, What is the best/most effective path for being good/competitive in CC?

Thanks!

Careful, some of my bias is about to show.

IMO, anesthesia docs make the best CC docs. I wouldn't wish a lot of the intubations I see by non-anesthesia trained CC docs on my arch nemesis. Also, titrating pressors/inotropes and resuscitation is what we do in the OR.
That said next closest is ED docs. Then pulm. Pulm went through internal medicine for a reason. Most pulm crit care fellows I know don't even look in the mouth before intubating (real story::: once had a college rescue a pulm attending who induced a patient with a wired mouth).

You may ask why most CC docs aren't from anesthesia. That's simple math. More emotionally taxing job with lots of nights and weekends... and you make less money doing it. Just doesn't pay. Now from internal medicine it's a step up in pay.

I don't do any CC time as all of our CC docs are fellowship trained.

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[Neopolymath]

My wife is a CRNA. Should I become an anesthesiologist to assert my dominance or a surgeon to annoy her? 😉

 

[Noisewater-TDX]

My wife is a CRNA. Should I become an anesthesiologist to assert my dominance or a surgeon to annoy her? 😉

Yes.

 

[The Physician Philosopher]

I’m pretty much set on doing anesthesiology, but I’m not sure if I want to do a fellowship or not. What’s the biggest difference between pulm crit care vs critical care through the anesthesiologist route?


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Man, I don't want to bad mouth anyone's specialty because I know some really good pulm cc docs.

I'll say this. A pulm crit care physician is probably better at choosing which antibiotic or enteral feeding regimen. Aside from that the more important things (titrating pressors, inotropic infusions, intubations, resuscitation, line placement, etc) goes to the CC anesthesia doc.

In the end they are both qualified to take care of critically ill patients. I've just had so many horror story rescues in the ICU of airways gone bad because of bad plans than I care to remember.

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[The Physician Philosopher]

My wife is a CRNA. Should I become an anesthesiologist to assert my dominance or a surgeon to annoy her? 😉

Haha neither. I view my CRNA colleagues with absolute respect. I also demand my own respect.

I believe in the anesthesia care team model, and it works. I think CRNAs have a very valuable and important job that is different than my own.

Though if I had to choose between dominance and annoyance... [emoji41]

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[DoctorCrush]

Could you break down in regards to what your schedule is like in terms of clinical, research, teaching etc? Thank you!

 

[Bobcat18]

Just a heads up- internationally outsourcing films is not a thing.

Here's what I think.

The encroachment battle is not unique to anesthesia. Look at family practice, peds, radiology (films to India for cheaper price), emergency medicine, burn surgeons, etc.

As a physician, if you are not practicing to the full level of your license, there could some day be an issue, regardless of your field. In anesthesiology, if you want to work at a GI center Monday to Friday from 8 to 5 with no nights, weekends, or holidays... You may have an issue. Same goes for private practice docs that don't have the sickest patients or don't do big/cutting edge procedures.

At the end of the day, I don't feel like the sky is falling like some of my colleagues. Then again, I work in academic medicine where I do research, clinical practice, and education of residents. I'll always be at the tip of the spear. And, for the record, I am a realist with pessimistic leanings. Not trying to spit-shine this topic.

I could go into more detail, but for the sake of brevity, I won't. I think the field is fine as long as you are using your whole skill set. I do think, however, that some subspecialties and practice models are better protectef than others.



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[The Physician Philosopher]

Just a heads up- internationally outsourcing films is not a thing.

Yet. You are right in that it stays within the confines of the U.S.

My point remains valid that teleradiology is experiencing similar creep in terms of trainees having tough times finding jobs, less income, etc.

 

[The Physician Philosopher]

Could you break down in regards to what your schedule is like in terms of clinical, research, teaching etc? Thank you!

This will vary depending on where you work. Where I work, I get an academic day per week. This can be off-day, a post-call day, a day to work on research. Really up to the individual. I'd say I am split 50/50 between teaching and clinical practice because the fellows and residents work with me to accomplish our clinical goals. I teach throughout that.

On average I probably work 40 to 50 hours per week.

 

[drdoom12]

What was your schedule like during residency? How did it compare to say internal medicine and surgery in terms of hours?


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[The Physician Philosopher]

What was your schedule like during residency? How did it compare to say internal medicine and surgery in terms of hours?

Intern year was comparable to internal medicine. I probably had three or four surgical rotations and majority of others were medicine. One month of anesthesia. Some critical care.

CA-1 to CA-3 years it completely varied. On average probably 55 hours per week. Some rotations slightly busier, others less so.

 

[68PGunner]

In a group practice, what's the typical # of hrs worked/wk and the expected salary range?

 

[The Physician Philosopher]

All completely dependent on where you live...but for me, in the south:

Private Practice: First two to three years (before partner) can expect $250,000. After partner varies quiet a bit. $350,000 to 500,000. Depends on whether practice is privately owned where you make more money and share profit or incorporated (MedNax, American, etc). Work probably 50 to 60 hours per week. More weeks of vacation than academics.

Academics: Work slightly less, make slightly less. Base salary is usually around $300,000 and incentives/bonuses can increase your salary from there. In addition when you increase in rank (Assisant--> Associate--> Full Professor), you make more money.

 

[Psai]

You hiring?

 

[deleted245139]

I've done a few digital intubations during my training. Whatever gets the job done!

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Saved me w a heavy upper GI bleed.... 👍

 

[kb1900]

How do you see the field changing in the next 20 years?

 

[The Physician Philosopher]

How do you see the field changing in the next 20 years?

I think several things will look different:
1) payments will change. It will be necessary for physicians, including anesthesiologists, to have a seat at the table to stake a claim for their part of the bundled payment. As they say, if you don't have a seat at the table, it's because you're on the menu.

2) it will not be sufficient for anesthesia docs to take care of 10 lap chole's each day. We will be pushed to practice at the full scope of our license.

3) Encroachment into each field to decrease costs will continue to occur. Being a good clinician may not be enough. You'll have to have other skill sets (business, leadership, subspecialty training, etc).

Overall, I think that the trajectory is up, but just like investing in the market there will be ups and downs.

At the end of the day, I love what I do. I love the fulfillment from it. I love coming home each day knowing I helped people. I don't just sign charts and make money. I affect real change in the lives of patients I see each day.

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[CECC110]

-Typically, what are the lifestyle/responsibilities of an academic pain management physician?
-Is it mostly procedures + clinic? Or are they also expected to carry patients on the floors and round?
-If they do see patients on the floors, what is the scope of their practice; is it primarily to optimize the pain regimen of patients or are there additional tasks?
-How do you envision the role + practice of pain docs, especially in the face of the opioid epidemic, for those who will be training within the next 5-10 years?

 

[The Physician Philosopher]

-Typically, what are the lifestyle/responsibilities of an academic pain management physician?
-Is it mostly procedures + clinic? Or are they also expected to carry patients on the floors and round?
-If they do see patients on the floors, what is the scope of their practice; is it primarily to optimize the pain regimen of patients or are there additional tasks?
-How do you envision the role + practice of pain docs, especially in the face of the opioid epidemic, for those who will be training within the next 5-10 years?

1) Lifestyle: I work 50ish hours per week. Sometimes its 60, sometimes its 35. Just depends. I am split 7 months regional/acute pain and 5 months general. Some places just intermingle individual days, but we do a week of pain call at a time.
-I do a boat load of procedures. This happens either because a resident needs help or at our joint hospital where there are no trainees. -I do NOT have clinic. I love that about my job. Get to round (see below) and do lots of procedures without constraint of clinic.
2) I round on patients. Today my list had about 25 patients. These are mostly post-surgical patients with peripheral nerve block catheters/epidurals and trauma patients with broken ribs who have epidurals. We also do the occasional medication recommendation (Med Rec) consult.
-We also have perioperative home physicians. As a regional attending, I can participate in that and basically care for the entire medical care of the patient.
3) I can tell you that having a regional anesthesia skill set is highly valuable in the face of this opioid epidemic. Regional anesthesia (catheters, adjuvants, etc) helps cut down on opioid exposure and increases both patient satisfaction and analgesic control.
-The field will evolve by learning the intricacies of optimizing pain through regional techniques and non-opioid adjuvants (ketamine infusions, lidocaine infusions, NSAIDs, neuropathic pain meds, etc)

 

[zero0]

Miller 2

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Agreed, the Miller is far superior at cracking open coconuts.

 

[VincentAdultman]

Why haven't you started the adductor canal block on my patient yet?

 

[The Physician Philosopher]

Why haven't you started the adductor canal block on my patient yet?

Because I finished it 20 minutes ago ;-)

 

[Pepe18]

.

 

[The Physician Philosopher]

What's happening with burn surgery?

I don't know if you have taken part in a burn surgery before, but they are not exactly complicated procedures. Advanced practice providers could easily perform those surgeries, and are heavily involved in performing the procedures I see at my regional burn center location.

 

[NYCdude]

Based on my limited experience in the OR, I've seen instances where surgeons treat the anesthesiologist like he/she was inferior and just a lackey. Did this ever happen to you?

I'm interested in anesthesia but I feel like I'd blow a fuse if another physician straight up belittled me, i.e. another physician.

 

[W19]

@NYCdude

I saw that many times as well when I was a RN. It's sad to see that physicians treating other physicians like that. Not to mention that a few years ago it was harder to become an anesthesiologist than a surgeon...

 

[naijacardriodoc]

@NYCdude

I saw that many times as well when I was a RN. It's sad to see that physicians treating other physicians like that. Not to mention that a few years ago it was harder to become an anesthesiologist than a surgeon...

I find it super odd when I see this as a medical student. Anesthesiologists are autonomous and are ALSO leaders of the OR in addition to the surgeons. They each have different roles. I talked with a pediatric anesthesiologist and she told me that one characteristic that a prospective anesthesiologist needs is assertiveness and I can see why that is needed in different instances in and out of the OR.


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[W19]

I find it super odd when I see this as a medical student. Anesthesiologists are autonomous and are ALSO leaders of the OR in addition to the surgeons. They each have different roles. I talked with a pediatric anesthesiologist and she told me that one characteristic that a prospective anesthesiologist needs is assertiveness and I can see why that is needed in different instances in and out of the OR.


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I think one needs a thick skin to be an anesthesiologist working in the OR... I once even asked (when I was a RN) one gas doc why the surgeon was treating him like that...

 

[Matthew9Thirtyfive]

I think one needs a thick skin to be an anesthesiologist working in the OR... I once even asked (when I was a RN) one gas doc why the surgeon was treating him like that...

TBF, I’ve worked in 3 different hospitals and have only seen that a handful of times. It’s definitely not universal, but it seems to happen more often in academic settings (in my limited experience anyway). I’m sure op can shed some light.

 

[neoexile]

I am an attending anesthesiologist.

Happy to answer any questions people may have about the specialty, life after residency/fellowship (whether to do a fellowship?), salary, jobs, etc.

I'll respond as quickly as I can!

Ask away,

The Physician Philosopher

Can you describe what your day/schedule is like?

 

[The Physician Philosopher]

Based on my limited experience in the OR, I've seen instances where surgeons treat the anesthesiologist like he/she was inferior and just a lackey. Did this ever happen to you?

I'm interested in anesthesia but I feel like I'd blow a fuse if another physician straight up belittled me, i.e. another physician.

I cannot answer for everywhere, but where I work (academic medical center in the south) this is a non-factor. Our anesthesiology department is very well respected. In fact, we run the operating room board, we run the safety culture here, and have a major say in the daily happenings. In addition to that, our anesthesiologists provide a sound service to our surgeons and the patients we help take care of everyday. If anything I've seen the exact opposite: respect and gratitude from our surgeons.

Now is there the occasional barking of surgeons where I work? Yes. However, I agree with some of the above poster's comments that in order to be a strong anesthesiologist (Read: patient advocate) you have to have thick skin.

This is what I've learned. Be a team player 100% of the time, be kind, hard working, humble, take good care and be involved in the care of your patients... and you will be respected. On the very rare occasion a surgeon barks at me (with the aforementioned hardworking/teamplayer/kind example already being laid as a foundation), I take some time to educate that surgeon on who I am and what I do, and simply tell them "You will not talk to me or anyone on my team that way. Understood?"

Because the surgeon's know I am a nice guy that will go out of my way to help anyone (and I do my job very well), I've never had a surgeon say a word to me after that statement above. Thing is, I've only needed to do it twice that I can remember.

At the end of the day, I am there to take care of the mother/father/sister/brother/daughter/son on that table who's life is as close to death as they will come before they meet their Creator. Making the surgeon happy is byproduct of good care, but has never (and never will be) a goal of mine.

 

[The Physician Philosopher]

Can you describe what your day/schedule is like?

Typical day in general OR: Get here at 6am, leave at 3-4pm. One day off each week. I am late usually one to two days per week (get off after 4pm). Usually run 2 to 3 rooms during day, pick up total of four rooms after 3 pm if working. Four weeks of vacation. One week of meeting days. Holidays off except the one I choose to work.

Regional/acute pain: Get here at 6am, leave anywhere between 3 and 5 pm. Days off vary. Work more, get paid more. I work one week of acute pain call per month on regional. Same vacation as above.

Where I work, I don't ever have to work nights and work only one holiday each year. We have a night shift system, but it is voluntary.

 

[drdoom12]

Is one day off per week the norm in academics? Do you have a better schedule if you work for a group?


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[The Physician Philosopher]

Is one day off per week the norm in academics? Do you have a better schedule if you work for a group?

In private practice you work every day (unless you are on a post call day or vacation... but we get those in academics, too). Difference in private practice is that they normally get more weeks of vacation, Say 7 or 8 weeks instead of 4. They just work every day of the week, though. It's a bit of a trade off, honestly.

 

[SpartanDOnoharm]

If you have a crashing patient/one that is coding, who runs the code in the operating room? Is it the anesthesiologist? What are some tips you have for effectively running a code if so?

Another question, I work in ER and I have no idea what happens once they cross those double doors. Say an unstable patient comes in and is transported ASAP to surgery, do you have a checklist you run through to quickly stabilize the patient and get them ready for the procedure? Do you try to utilize checklists as much as possible? Thank you for your time in doing this!

 

[neoexile]

I am an attending anesthesiologist.

Happy to answer any questions people may have about the specialty, life after residency/fellowship (whether to do a fellowship?), salary, jobs, etc.

I'll respond as quickly as I can!

Ask away,

The Physician Philosopher

Not going into Anesthesia myself, but I have another question about it. Several of my medical student friends say that "I want to do Anesthesia, because it gives a good lifestyle and the pay is good too. (It is often identified as the "A" in ROAD to success for best lifestyle)" If you were there, heard that and felt like responding, what exactly would you say to people who were just attracted to Anesthesia only because of those perceptions?