Attending Anesthesiologist Ask Me Anything (AMA)

[anbuitachi]

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.

@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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It's usually the surgeon, not the anesthesiologist. THere are surgeons who treat people like crap no matter where they are, including other doctors. Some surgeons think they are gods and are the only doctors who matter. Surgery also attracts those types of med students. You will see surgeons treating EM docs, pediatricians, Internists, anesthesiologists, radiologists, inferiorly. In the old days, abuse from surgeons to residents/med students was rampant. There used to be instrument throwing, cursing/verbal often. I've never heard of an anesthesiologist throwing sevoflurane at a resident/student. When you work with surgeons on a daily basis, you just have to pick your battles. Unfortunately some surgeons are so narrow minded or arrogant that they see their surgery as the most important thing without looking at the whole picture. The anesthesiologist also works to the surgeons schedule. I've done completely elective cases (breast reduction, gastric sleeve..etc) in the middle of the night (like 12am..) because the surgeon felt like doing it then.

And also because surgeons usually hold more influence, because they bring in patients and make the hospital a lot of money. You'll occasionally see news articles or hear about it in your hospital about surgeon XYZ did a few bad things, yet isn't fired, etc, or surgeon xyz receives a ton of complaints but isn't fired. Patients often choose hospital XYZ for a specific surgeon. Sometimes they even come from out of state or out of country just for that proceduralist. No one is going to do that for an anesthesiologist.

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[anbuitachi]

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?

ROAD acronym is super old, from the 1980s i believe. Medical students need to really know a specialty before choosing it. In my opinion, not many people choose anesthesia for the lifestyle, because the lifestyle is awful. Go to AAMC.org for more information. The data is a bit old (from ~2010-2013), but are generally still in the ballpark. AAMC.org lists anesthesiologists as working 61 hours per week. (Rad onc at 52/Rad is 58, Derm at 45, Optho at 51). It's also the only one with varying hours! (in hospital calls of different lengths including overnight)

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!

Yes, almost always anesthesiologist. I dont think it has to be but who would want a surgeon to be running your code..? For unstable patients, just like any areas of medicine, it has to be tailored to the individual patient (comorbidities, reason for being unstable)

 

[naijacardriodoc]

ROAD acronym is super old, from the 1980s i believe. Medical students need to really know a specialty before choosing it. In my opinion, not many people choose anesthesia for the lifestyle, because the lifestyle is awful. Go to AAMC.org for more information. The data is a bit old (from ~2010-2013), but are generally still in the ballpark. AAMC.org lists anesthesiologists as working 61 hours per week. (Rad onc at 52/Rad is 58, Derm at 45, Optho at 51). It's also the only one with varying hours! (in hospital calls of different lengths including overnight)



Yes, almost always anesthesiologist. I dont think it has to be but who would want a surgeon to be running your code..? For unstable patients, just like any areas of medicine, it has to be tailored to the individual patient (comorbidities, reason for being unstable)

Can you suggest ways medical students can know a medical speciality for example anesthesiology besides rotations bc the only one that I have ruled out is derm (shocker) lol. I think skin checks are icky, monotonous and boring. I also think the average patient that the specialty attracts is super high maintenance and the pace is super fast like a new patient every 5 minutes. I didn’t like it.


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[anbuitachi]

Can you suggest ways medical students can know a medical speciality for example anesthesiology besides rotations bc the only one that I have ruled out is derm (shocker) lol. I think skin checks are icky, monotonous and boring. I also think the average patient that the specialty attracts is super high maintenance and the pace is super fast like a new patient every 5 minutes. I didn’t like it.


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It's tough. I think rotation is definitely the best way, but of course elective time is limited. I couldn't do some electives i wanted before application season (like ophthalmology) so i ended up not choosing those specialties. Other options include shadowing on your own time... and just doing research online (SDN is a pretty good resource in my opinion)

 

[The Physician Philosopher]

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!

Anesthesiologist runs the code. Literally in the operating room, the surgeon operates and the anesthesiologist is responsible for everything else (amnesia, analgesia, waking up, hemodynamics, etc). We are the pharmacist, physiologist, code runner, you name it.

This is one of the things that attracted me to anesthesiology. When someone is crashing, we are who you want in the room.

I use checklists for safety (cannot understate their importance for timeouts), but not for effectively taking care of a patient. That's why I went to medical school. To know what to do and why. I don't need to follow an algorithm to do that. Checklists in dire situations are not a good thing because you become dependent on them. When something happens you haven't experienced before, you don't know how to act/think.

 

[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?

I joke around about this (ROAD) myself. However, anesthesiology is not for the faint of heart. We take care of people at their sickest, plain and simple. You have to be able to deal with stress and not let it get in the way of your thinking/acting to save a patient's life. The good anesthesiologists in training become calm (on the surface) even when they are nervous (paddling like a mad duck underneath). Eventually, you learn to deal with the pressure and stress that comes with a dying patient and just do your job.

Apart from that, the pay is still very good. The lifestyle depends on where you work (some docs work 70 hours a week in PP, don't know I'd call that a "lifestyle" work schedule).

However, what I will say is I LOVE my job. Couldn't imagine doing anything else. I love being the expert in the hospital at airways, pain, resuscitation, codes, and so much more.

 

[The Physician Philosopher]

Can you suggest ways medical students can know a medical speciality for example anesthesiology besides rotations bc the only one that I have ruled out is derm (shocker) lol. I think skin checks are icky, monotonous and boring. I also think the average patient that the specialty attracts is super high maintenance and the pace is super fast like a new patient every 5 minutes. I didn’t like it.


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If you don't like fast paced, you will not like anesthesiology. I am often running four rooms (going to sleep, waking up, doing pre-op eval on next patient, doing blocks, putting in lines/tubes, checking on patients in PACU). To be an effective anesthesiologist you have to be extremely efficient and have the ability to multi-task.

That said, you can check out my post on that question if you want. Go to website below this and I have one on choosing the right medical specialty.

 

[naijacardriodoc]

If you don't like fast paced, you will not like anesthesiology. I am often running four rooms (going to sleep, waking up, doing pre-op eval on next patient, doing blocks, putting in lines/tubes, checking on patients in PACU). To be an effective anesthesiologist you have to be extremely efficient and have the ability to multi-task.

That said, you can check out my post on that question if you want. Go to website below this and I have one on choosing the right medical specialty.

I see. I don’t mind fast paced as long as it’s not derm fast paced. They see almost 40 ppl in one day. Is anesthesiology like this?


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[The Physician Philosopher]

I see. I don’t mind fast paced as long as it’s not derm fast paced. They see almost 40 ppl in one day. Is anesthesiology like this?


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Well it's a completely different kind of fast paced. I think the best way for you to experience it may be to shadow an attending anesthesiologist on one of your rotations (or one of your off days). Some days are pretty slow and there is not an incredibly fast pace. For example, if I have two rooms that both have large cases in them (say an exploratory laparotomy with tumor debuling in one room and a robotic nephrectomy in my other room), I may only do five cases that day. Likely the majority of my time will be spend teaching the resident I am working with and popping between the two rooms to make sure all is well and make any necessary adjustments.

Other days, I may have an optho room and have 15 cases in that one room in addition to my other room, which may be a ortho/regional room where I need to perform blocks. In private practice, they can have two additional rooms, or 4 rooms, the entire day (we go up to 4 once the residents leave for conference in the afternoon).

This is one of the other reasons I like anesthesiology. A lot of variance. My day is never the same each day. Keeps me on my toes!

 

[drdoom12]

So in private practice you get 0 days off per week?


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[The Physician Philosopher]

So in private practice you get 0 days off per week?

This depends on the PP.

However, from the friends I have that work in PP or from the practices I've visited... by true "off days" the answer is yes. Now, they still get post call days off. They also get much more vacation in terms of "weeks off."

So, they trade their days for weeks being off.

 

[zurc2014]

Without being PC, do you think CRNAs will have a negative effect on MD employment/scope/ect? I am interested in anesthesiology but I am worried about the strong push for CRNAs to have more autonomy and such.

 

[anbuitachi]

I see. I don’t mind fast paced as long as it’s not derm fast paced. They see almost 40 ppl in one day. Is anesthesiology like this?


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People's lives are on the line in anesthesiology. I can't really say that about derm clinic. Plus as a dermatologist attending if it is your own clinic you are the boss. You set your own pace. In anesthesiology you are 99.9 percent never the boss. if you aren't efficient, that may cost you your job/promotion.

Personally I hate the crna 4:1 model. I think it is done purely for financial reasons for the hospital. They are cutting you as thin as you can with an 'acceptable' level of complications

 

[68PGunner]

It's usually the surgeon, not the anesthesiologist. THere are surgeons who treat people like crap no matter where they are, including other doctors. Some surgeons think they are gods and are the only doctors who matter. Surgery also attracts those types of med students. You will see surgeons treating EM docs, pediatricians, Internists, anesthesiologists, radiologists, inferiorly. In the old days, abuse from surgeons to residents/med students was rampant. There used to be instrument throwing, cursing/verbal often. I've never heard of an anesthesiologist throwing sevoflurane at a resident/student. When you work with surgeons on a daily basis, you just have to pick your battles. Unfortunately some surgeons are so narrow minded or arrogant that they see their surgery as the most important thing without looking at the whole picture. The anesthesiologist also works to the surgeons schedule. I've done completely elective cases (breast reduction, gastric sleeve..etc) in the middle of the night (like 12am..) because the surgeon felt like doing it then.

And also because surgeons usually hold more influence, because they bring in patients and make the hospital a lot of money. You'll occasionally see news articles or hear about it in your hospital about surgeon XYZ did a few bad things, yet isn't fired, etc, or surgeon xyz receives a ton of complaints but isn't fired. Patients often choose hospital XYZ for a specific surgeon. Sometimes they even come from out of state or out of country just for that proceduralist. No one is going to do that for an anesthesiologist.

These anecdotes sound horrible. How common are these bs among your colleagues? Do you also get this kind of treatment at a VA? I personally could see myself doing Gas but I don’t know how much patience I have for bs considering that I’m the typical Type A person.

 

[The Physician Philosopher]

These anecdotes sound horrible. How common are these bs among your colleagues? Do you also get this kind of treatment at a VA? I personally could see myself doing Gas but I don’t know how much patience I have for bs considering that I’m the typical Type A person.

Like I said before, not a common experience for me at all. I cannot speak for other places where the anesthesiology department is not quite as strong.

 

[The Physician Philosopher]

Without being PC, do you think CRNAs will have a negative effect on MD employment/scope/ect? I am interested in anesthesiology but I am worried about the strong push for CRNAs to have more autonomy and such.

I've already answered this in a previous post, but will say this: Any physician in any field who is not practicing to the full breadth and depth of their license will be at risk in the future of medicine. Plain and simple. Costs in our healthcare system are unsustainable and, unfortunately, not at the benefit of providing "better" medicine when compared to other countries in terms of mortality rates.

Do I fear that my job will ever be encroached upon? No. But I work in academic medicine where my clinical practice allows me to take care of the sickest of the sick. I do a bunch of clinical research and education in addition to my clinical practice.

Now if I worked at a 8 to 3 GI center where all we did was take care of ASA 1's and 2s and had no nights, weekends, or holidays? I would certainly be worried about encroachment there, but this doc is not practicing to the breadth OR depth of their license.

I know many people who are worried about the sky falling in our specialty (mostly here on SDN), but I am just simply not worried about it because my skill set would be impossible to replace with an advanced practice provider (APP). However, I've built my job to be that way.

 

[IlDestriero]

“Practicing to the full breadth and depth of their license” is a nursing term. You should probably stop using it. As you probably know, there is no breadth and depth to a physician’s license. You’re only limited by your credentialing at whatever facility you’re practicing in, what your malpractice carrier will cover, and your imagination.



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Il Destriero

 

[The Physician Philosopher]

“Practicing to the full breadth and depth of their license” is a nursing term. You should probably stop using it. As you probably know, there is no breadth and depth to a physician’s license. You’re only limited by your credentialing at whatever facility you’re practicing in, what your malpractice carrier will cover, and your imagination.--
Il Destriero

Don't disagree with your concept that there is no limit outside of your credentialing and imagination, IlDestriero.

However, regardless of where the verbage comes from, you do in fact have a medical license. And I am encouraging the full use of that license (to the extent of your credentialing and imagination) just as you are, but simply choosing to use different terms (that apparently come from the nursing world?).

Regardless, both of us are right in that the physician who does not practice to the extent of their credentialing and imagination (which is permitted by a medical license) may be in a bad place.

 

[Psai]

Don't disagree with your concept that there is no limit outside of your credentialing and imagination, IlDestriero.

However, regardless of where the verbage comes from, you do in fact have a medical license. And I am encouraging the full use of that license (to the extent of your credentialing and imagination) just as you are, but simply choosing to use different terms (that apparently come from the nursing world?).

Regardless, both of us are right in that the physician who does not practice to the extent of their credentialing and imagination (which is permitted by a medical license) may be in a bad place.

Practicing to the full extent of license is nursecode for playing doctor. Basically they're saying that even though they don't have a medical degree, the necessary experience/training and aren't regulated by the board of medicine, they feel entitled to the same practice as a physician. But of course that's without the same malpractice or level of responsibility.

We don't need to say full use of license because that's already implied by who we are. "Any man who must say I am the king is no true king".

 

[The Physician Philosopher]

Practicing to the full extent of license is nursecode for playing doctor. Basically they're saying that even though they don't have a medical degree, the necessary experience/training and aren't regulated by the board of medicine, they feel entitled to the same practice as a physician. But of course that's without the same malpractice or level of responsibility.

We don't need to say full use of license because that's already implied by who we are. "Any man who must say I am the king is no true king".

I hear what you guys are saying, but just feel it is splitting hairs.

Point taken, though.

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[W19]

@The Physician Philosopher

It might be splitting hairs; it might also be that their propagandas are working.

 

[xClashx]

what percentage of your patients have had a major complication during the procedure? What percentage crash?

 

[IlDestriero]

It’s not splitting hairs. You’re using it wrong.
You mean that anesthesiologists shouldn’t be relying on ambulatory surgery only type jobs on relatively healthy people, etc. GI clinic scope sedation and the like is the lowest hanging fruit for take overs by CRNA only or fireman fall guy practice models.
Nurses use that phrase to mean that their nursing certification says they can do blocks, pain procedures, prescription drug prescription, ordering consults, being consulted as “experts”, etc. and they should be allowed to do all of those things with minimal to no supervision because their advanced practice nursing license suggests they can.
VERY different meaning.
Or are you suggesting that anesthesiologists should be performing surgery and opening cosmetic laser centers because our licenses allow for that?



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Il Destriero

 

[The Physician Philosopher]

@The Physician Philosopher

It might be splitting hairs; it might also be that their propagandas are working.

That definitely isn't the case, at least not for me. I am very politically active on the topic in my public life both in meeting with congressmen/congresswomen and in educating residents.

I just find it interesting how hard-wired you guys are at being offended by the language I used. I completely see your point. And I understand language matters. It drives me crazy when people use the phrase "MDA," but I can understand that from a philosophical perspective (MDA is redundant... "there is only one kind of anesthesiologist, a doctor.")

I do appreciate you guys fighting the good fight. I really do. If it helps facilitate conversation I can certainly use more "non-nursing" language.

 

[The Physician Philosopher]

what percentage of your patients have had a major complication during the procedure? What percentage crash?

This is an impossible question to answer. Well, not impossible. Just cannot happen in any sort of formal sense. A small percentage of patients experience true perioperative (<24 hours from surgery) morbidity and mortality. However, in a wider perioperative picture (within 30 days of surgery) morbidity and mortality is a different story as complications are much more frequent.

That, in my mind, is where the focus is heading.

 

[Psai]

what percentage of your patients have had a major complication during the procedure? What percentage crash?

Nice try, prosecutor

 

[Cryc_to_the_point]

Alright, I might look a little foolish asking this but I'm an OMS-1, so I'm used to knowing nothing.

To what degree does Anesthesia and EM overlap? In much of Europe they are in-fact, one-in-the-same. Can you describe to me in what manner they interact? Does the dual residency of Anesthesia/EM make sense?

As far as CCM, do you find Anesthesiologists are able to cover MICU or only SICU, CCU, etc? I ask as generally, it seemed our local tertiary care center had only Pulm in their MICUs. Thanks!

 

[LLCoolK]

So in private practice you get 0 days off per week?


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I find this hard to believe... I haven't met any anesthesiologists in private practice or academic that get 0 days off per week, not counting post-call day. that's just begging for burnout... Is this common?

 

[The Physician Philosopher]

Alright, I might look a little foolish asking this but I'm an OMS-1, so I'm used to knowing nothing.

To what degree does Anesthesia and EM overlap? In much of Europe they are in-fact, one-in-the-same. Can you describe to me in what manner they interact? Does the dual residency of Anesthesia/EM make sense?

As far as CCM, do you find Anesthesiologists are able to cover MICU or only SICU, CCU, etc? I ask as generally, it seemed our local tertiary care center had only Pulm in their MICUs. Thanks!

1A. Anesthesia and EM are different specialties in the States for a reason. They do have some common components (procedures: intubations, central lines, arterial lines, etc), but for the most part are distinct. Taking care of a patient in the emergency room and working them up for acute abdmonal/chest/leg pain is a very different thing than making a perioperative anesthetic plan.
1B. Cannot speak for every hospital, but in my tertiary academic level 1 trauma center in the south, the only time we really interact is during level 1 traumas. The ED gets the first shot and if they are having trouble or are unsuccessful, then we take over. As soon as it is determined the patient is heading upstairs for an emergent procedure, we will also take over at that point.

2. I don't think that doing a combined residency makes much sense, but (though being interested in emergency medicine for a good part of my MS 2 year) that is also because I couldn't deal with the negative aspects of working in the emergency department.

3. In my hospital, MICU is staffed by pulm CC docs. CCU and SICU are staffed by other (non-pulm CC docs) docs for the most part.

 

[The Physician Philosopher]

I find this hard to believe... I haven't met any anesthesiologists in private practice or academic that get 0 days off per week, not counting post-call day. that's just begging for burnout... Is this common?

I don't think so. 8-10 weeks of vacation + post call days can prevent burnout, I think. Basically get a week off every month or two plus your post call time. Also depends on how often you get called in for call. May get a post-call day without a crushing day on call.

Also, every practice varies in their structure and schedule.

 

[IlDestriero]

Yes. PP doesn’t usually get any academic or admin days. They run lean and mean. Work hard (and make a lot of money) and play harder does wonders to keep burn out away.


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Il Destriero

 

[anbuitachi]

These anecdotes sound horrible. How common are these bs among your colleagues? Do you also get this kind of treatment at a VA? I personally could see myself doing Gas but I don’t know how much patience I have for bs considering that I’m the typical Type A person.

Varies by hospital/VA. The VA i went to, the OR is run by the anesthesiology department. They are the boss. They wont let you run an elective case in the middle of the night because they dont have the staff for it, and also they are salaried. At larger academic hospitals, it can be very different. I feel like its fairy common esp if you are in a large hospital, to have a bunch of jerk surgeons, esp in orthopedics, CT surgery, vascular surgery, sometimes neurosurgery. I never been in PP, but i hear it matters even more there, relationship w surgeon, even if the surgeon is a ****. Your job depends on it

 

[Quizlet04]

How much time do you spend doing table tech support, crawling around to find tubes, and generally acting like an underpaid circulator?

 

[The Physician Philosopher]

How much time do you spend doing table tech support, crawling around to find tubes, and generally acting like an underpaid circulator?

None. I am an attending. And trust me when I say (particularly for academics), I am not underpaid. I don't sit my own cases. CRNA's and residents do that.

 

[Cryc_to_the_point]

1A. Anesthesia and EM are different specialties in the States for a reason. They do have some common components (procedures: intubations, central lines, arterial lines, etc), but for the most part are distinct. Taking care of a patient in the emergency room and working them up for acute abdmonal/chest/leg pain is a very different thing than making a perioperative anesthetic plan.
1B. Cannot speak for every hospital, but in my tertiary academic level 1 trauma center in the south, the only time we really interact is during level 1 traumas. The ED gets the first shot and if they are having trouble or are unsuccessful, then we take over. As soon as it is determined the patient is heading upstairs for an emergent procedure, we will also take over at that point.

2. I don't think that doing a combined residency makes much sense, but (though being interested in emergency medicine for a good part of my MS 2 year) that is also because I couldn't deal with the negative aspects of working in the emergency department.

3. In my hospital, MICU is staffed by pulm CC docs. CCU and SICU are staffed by other (non-pulm CC docs) docs for the most part.

So from this should I infer that anyone wanting to keep non-academic ICUs or community hospital ICUs open shouldn't go Anesthesia/CCM? Are they not prepared for MICU patients?

 

[The Physician Philosopher]

So from this should I infer that anyone wanting to keep non-academic ICUs or community hospital ICUs open shouldn't go Anesthesia/CCM? Are they not prepared for MICU patients?

I wouldn't think that at all. My hospital may be unique. In addition, as stated before, I think anesthesia CC docs are the best sort.

You could also go the other way and say... Would pulm CC docs be limited since they don't see a ton of post surgical patients? I'd think this would be harder.

DKA, sepsis, and strokes happen in every ICU. Not just the medical ICUs.

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[Cryc_to_the_point]

Well that's good news!

 

[Quizlet04]

None. I am an attending. And trust me when I say (particularly for academics), I am not underpaid. I don't sit my own cases. CRNA's and residents do that.

I've seen attendings and residents do this, mostly residents though.

 

[The Physician Philosopher]

I've seen attendings and residents do this, mostly residents though.

Well, let me rephrase the response. I do this when I want to. I don't ever have to do this. I am happy to help anyone I am working with as a team player, because that's the right thing to do and how you earn respect. I am not above anything, which my response may have suggested.

I just do not routinely do that because usually the resident or CRNA I am working with is available for the "technical support" kind of stuff.

 

[Eagles6389]

On my general surgery rotation, I really admired the physician-patient relationship in that it's self-fulfilling and gratifying to fix a patient's problem (even if it's a routine appendectomy) as well as rounding on patients to monitor their post-op recovery. How much of a physician-patient relationship is there in your anesthesiology position? How much time do you usually spend with each patient pre-op and post-op?

 

[Psai]

What is a physician-patient relationship?

 

[The Physician Philosopher]

On my general surgery rotation, I really admired the physician-patient relationship in that it's self-fulfilling and gratifying to fix a patient's problem (even if it's a routine appendectomy) as well as rounding on patients to monitor their post-op recovery. How much of a physician-patient relationship is there in your anesthesiology position? How much time do you usually spend with each patient pre-op and post-op?

This is going to be a different answer for me because I do regional and acute pain. So, we round on all of the post-total joint patients and all the patients with catheters (thoracic epidurals, brachial plexus catheters, etc). I have a decent amount of patient interaction both before and after surgery in my practice.

That said, many anesthesiologists who practice mainly OR anesthesia have limited interactions. Critical care, acute pain, chronic pain are the specialties that tend to have more patient interaction for us.

 

[aymar]

For anyone planning on going into anesthesiology in the next several years, would you recommend planning to do a fellowship from the get-go? I've spoken to some attendings that swear subspecialization are the only things that will provide job security/allow you work when and where you want in the future

 

[The Physician Philosopher]

For anyone planning on going into anesthesiology in the next several years, would you recommend planning to do a fellowship from the get-go? I've spoken to some attendings that swear subspecialization are the only things that will provide job security/allow you work when and where you want in the future

Given that I just finished a fellowship, I am prone to say that doing one is beneficial. It gives you further expertise and depth.

That said, I know plenty of people who graduated in the last two years without fellowship and are working at jobs that they really like. Who knows what that will look like in 10 or 20 years though?

 

[Neopolymath]

For anyone planning on going into anesthesiology in the next several years, would you recommend planning to do a fellowship from the get-go? I've spoken to some attendings that swear subspecialization are the only things that will provide job security/allow you work when and where you want in the future

I worked in the OR for years before school and this is the advice I got from mentors. Just plan on it unfortunately.

 

[Matthew9Thirtyfive]

I worked in the OR for years before school and this is the advice I got from mentors. Just plan on it unfortunately.

Not to be contrarian, but I worked in the OR for many years, and almost none of the docs had done a fellowship. But I left that job like 6 years ago.

 

[Neopolymath]

Not to be contrarian, but I worked in the OR for many years, and almost none of the docs had done a fellowship. But I left that job like 6 years ago.

Of course, many older anesthesia docs don't have fellowship training because it was a different time and yada yada. They all mentioned that if I should pursue their field that I would be remiss to not do fellowship based on how they saw the field changing. The younger docs were especially strong in their beliefs about fellowship.

 

[Matthew9Thirtyfive]

Of course, many older anesthesia docs don't have fellowship training because it was a different time and yada yada. They all mentioned that if I should pursue their field that I would be remiss to not do fellowship based on how they saw the field changing. The younger docs were especially strong in their beliefs about fellowship.

Yeah I totally see that. Like I said, this was a few years ago, and the times, they are a’changin.

 

[CIrcleofWillis504]

Hey! Just ran across this thread and was looking for advice. I am very interested in anesthesia but due to some family issues I have had multiple red flags( remediated first year, had to remediate 2 blocks second year and due to a family issue took a LOA after my second year). Throughout all of this I am still very interested in anesthesia and have tried stay involved by having 3 publications so far in my medical school career. If I manage to do well on Step 1, will good clerkship performance, Step 2 and LOR's give me a shot at any anesthesia program? I am really interested in the field and am willing to my residency absolutely anywhere. Any advice is greatly appreciated!

 

[The Physician Philosopher]

Hey! Just ran across this thread and was looking for advice. I am very interested in anesthesia but due to some family issues I have had multiple red flags( remediated first year, had to remediate 2 blocks second year and due to a family issue took a LOA after my second year). Throughout all of this I am still very interested in anesthesia and have tried stay involved by having 3 publications so far in my medical school career. If I manage to do well on Step 1, will good clerkship performance, Step 2 and LOR's give me a shot at any anesthesia program? I am really interested in the field and am willing to my residency absolutely anywhere. Any advice is greatly appreciated!

First of all, I am not a PD. That said, I served on the recruitment committee from intern to chief year. So have some experience there.

Thing a leave of absence is certainly concerning and something that is going to need to be explained in your application somewhere (LOR, personal statement, etc).

If you perform well on step 1, step 2, and have strong clinical grades as an MS3 that will obviously diminish some of the other concerns. That said, what will get rid of that concern even more are rock solid letters of rec from outstanding people.

You have some work cut out for you, but you also still have a chance and I wouldn't write it off yet.

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