Attending Anesthesiologist Ask Me Anything (AMA)

[theonlytycrane]

Are away rotations common / recommended for anesthesia?

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[Psai]

Are away rotations common / recommended for anesthesia?

No and no. Enjoy 4th year.

 

[The Physician Philosopher]

Are away rotations common / recommended for anesthesia?

Agree with Psai above with a couple of exceptions:
1) your department doesn't have an academic anesthesia group. You need to do one away rotation to get some letters from people others in academia may actually know.
2) if there is a reach program you would not get an interview at and you want to take a month long interview there to prove yourself.

Unfortunately, most away rotation students to themselves more harm than good. It's much easier to look good on paper than it is to look good in person with a lot of different people who each have a different expectation for you.

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[theonlytycrane]

@Psai @The Physician Philosopher

I'm a noobie M1 so I appreciate the insight! Would connections / letters from my home academic anesthesia program be accomplished through electives in 3rd/4th year (if not earlier through research)?

 

[CIrcleofWillis504]

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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Really needed to hear this right now. I will continue to keep working hard, thank you very much for your response!

 

[The Physician Philosopher]

@Psai @The Physician Philosopher

I'm a noobie M1 so I appreciate the insight! Would connections / letters from my home academic anesthesia program be accomplished through electives in 3rd/4th year (if not earlier through research)?

Yes, they would. Some get interactions earlier through research. But most through Ms 3 and Ms 4

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[The Physician Philosopher]

Really needed to hear this right now. I will continue to keep working hard, thank you very much for your response!

Always happy to help! That's what I am here for.

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[shortcoatdream15]

Hi, thanks for doing this. What are your thoughts on the Hopkins combined 6-year EM/gas residency?

 

[The Physician Philosopher]

Hi, thanks for doing this. What are your thoughts on the Hopkins combined 6-year EM/gas residency?

Hmm, tough question to answer. I don't know a lot about it.

I would say that Hopkins gas residency is kind of middle of the road in my opinion. They rely a lot on their name, which was (of course) made famous in internal medicine and not anesthesia.

That said, I don't know a bunch about that particular residency. I also cannot imagine what that work would look like in most settings. Certainly you'd be joining an academic gig, though I don't know how many hospitals could accommodate that.

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[IlDestriero]

Hopkins is a good place to look if you’re serious about a research career. They take their research very seriously.


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Il Destriero

 

[aymar]

What is your least favorite part about your job?

 

[The Physician Philosopher]

What is your least favorite part about your job?

Probably dealing with unrealistic surgeons who post patients that have no business getting surgery or when the surgeon doesn't care about what you do for the patient so long as they are "not delayed."

For the most part, though, I love my job.

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[Southplains]

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

Do you mind elaborating on why you think gas-CC > EM CC > Pulm CC? Your given example, airway management, I can definitely see the advantage there, but is that just observed at the fellow level? It seems experience will in time close that gap. Do you think a gas-CC could step into the MICU and be comfortable/superior? @jdh71 if you care to weigh in

 

[Low Flow]

I'm a third year applying anesthesia this upcoming year. Do you have any advice for someone considering a career in academics? Would you recommend it (why or why not)? What do you enjoy most about it?

I've done research in the past and I don't anticipate doing it in the future, but I do enjoy teaching. I think I would enjoy practicing as an attending at an academic center where I can teach/lecture students and residents. How easy is it to get hired as clinical faculty at the institution you completed residency? How about at other places?

 

[jdh71]

Do you mind elaborating on why you think gas-CC > EM CC > Pulm CC? Your given example, airway management, I can definitely see the advantage there, but is that just observed at the fellow level? It seems experience will in time close that gap. Do you think a gas-CC could step into the MICU and be comfortable/superior? @jdh71 if you care to weigh in

I'm not going to make a big deal argument about who I think is "better" because I think what you quoted while tagging me is largely nonsense. I'm not interested in an argument or online penis measuring contest. I'll always cede an airway to those who do the most. But the rest is pretty ignorant in my opinion.

I guess we all have our biases. The ICU is much more than an airway. Heck it's more than the vent and the infusions (titration of which isn't hard). These days is mostly a lot of multiple chronic illness in the setting of all of those critical care needs. Because of this it is *my bias* coming out of IM is the superior way to go and adding in the pulmonary part gives an expert advantage to the critical care physician for a whole range of disease that leads to respiratory failure and it's work up and treatment you can't and won't get through any other pathway. Plus the bronchoscopy skills. That is my bias.

You need to go through the pathway that you prefer though. It's not like going through anesthesia or EM makes someone a bad critical care doc. I merely think that on balance I have more tools and knowledge in the aggrgate.

 

[Southplains]

I'm not going to make a big deal argument about who I think is "better" because I think what you quoted while tagging me is largely nonsense. I'm not interested in an argument or online penis measuring contest. I'll always cede an airway to those who do the most. But the rest is pretty ignorant in my opinion.

I guess we all have our biases. The ICU is much more than an airway. Heck it's more than the vent and the infusions (titration of which isn't hard). These days is mostly a lot of multiple chronic illness in the setting of all of those critical care needs. Because of this it is *my bias* coming out of IM is the superior way to go and adding in the pulmonary part gives an expert advantage to the critical care physician for a whole range of disease that leads to respiratory failure and it's work up and treatment you can't and won't get through any other pathway. Plus the bronchoscopy skills. That is my bias.

You need to go through the pathway that you prefer though. It's not like going through anesthesia or EM makes someone a bad critical care doc. I merely think that on balance I have more tools and knowledge in the aggrgate.

This sounds more like what I’ve observed as a student.

 

[The Physician Philosopher]

I'm not going to make a big deal argument about who I think is "better" because I think what you quoted while tagging me is largely nonsense. I'm not interested in an argument or online penis measuring contest. I'll always cede an airway to those who do the most. But the rest is pretty ignorant in my opinion.

I guess we all have our biases. The ICU is much more than an airway. Heck it's more than the vent and the infusions (titration of which isn't hard). These days is mostly a lot of multiple chronic illness in the setting of all of those critical care needs. Because of this it is *my bias* coming out of IM is the superior way to go and adding in the pulmonary part gives an expert advantage to the critical care physician for a whole range of disease that leads to respiratory failure and it's work up and treatment you can't and won't get through any other pathway. Plus the bronchoscopy skills. That is my bias.

You need to go through the pathway that you prefer though. It's not like going through anesthesia or EM makes someone a bad critical care doc. I merely think that on balance I have more tools and knowledge in the aggrgate.

My response was certainly biased. We all are, I guess. Not trying to create a pissing match. Seriously. My apologies for being a douche bag there for a second.

Part of my bias comes from pulm cc attendings jumping off an airway bridge without a parachute. Those experiences have been so burned into my memory it's kind of hard not to be biased.

I think we also aren't separating CC specialties well here either. A pulm CC doc is certainly going to have a better background for MICU patients. I'd argue anesthesia would cater to good SICU docs. Cardiac ICU may be where they meet in the middle. For those ICUs in PP that are mixed, it's probably a toss up.

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[The Physician Philosopher]

I'm a third year applying anesthesia this upcoming year. Do you have any advice for someone considering a career in academics? Would you recommend it (why or why not)? What do you enjoy most about it?

I've done research in the past and I don't anticipate doing it in the future, but I do enjoy teaching. I think I would enjoy practicing as an attending at an academic center where I can teach/lecture students and residents. How easy is it to get hired as clinical faculty at the institution you completed residency? How about at other places?

Good questions.

I love academic. Love teaching. Even love research, thought I am stepping back from that for a bit while I write a few manuscripts from prior research.

You have to be strong in at least two of the academic pillars to succeed in academics (clinical, education, and research). Being good at only one of the three makes it tough. Obviously one of the three you must be good at is the clinical side. You can certainly have a lean towards clinical and education while only dabbling in research if you find something interesting.

It was pretty straight forward for me staying on.... But I did all my training where I stayed.

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[Scrubs101]

Hey! Thanks for doing this!

How competitive are pain fellowships now a days? And what makes an applicant competitive for pain, is it just residency pedigree/research?

Also, what does the practice of interventional pain look like outside of the US? Is it as common practice other places as it is here?

 

[The Physician Philosopher]

Hey! Thanks for doing this!

How competitive are pain fellowships now a days? And what makes an applicant competitive for pain, is it just residency pedigree/research?

Also, what does the practice of interventional pain look like outside of the US? Is it as common practice other places as it is here?

Scrubs101, I am gonna be straight up with you. I do acute pain (regional) not chronic pain. So, I don't have a lot of valid answers for you. Sorry. Would like to help, but don't wanna blow smoke either.

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[Scrubs101]

Scrubs101, I am gonna be straight up with you. I do acute pain (regional) not chronic pain. So, I don't have a lot of valid answers for you. Sorry. Would like to help, but don't wanna blow smoke either.

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Ahh sorry i must have missed that, thanks anyways!

 

[SteyrFWB]

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!

Do the best you can in school. Get in a senior elective in anesthesia early. Vis-a-Via, face to face, eyes to eyes, impress your anesthesia attending why you want to go into anesthesia, then let HIM come to bat for you.

Have a fourth year student, might be slightly below average academically, but he impressed me enough to write him a recommendation that even his mom would not recognize. He did well in the interview. He will be going to an anesthesia power house.

Just impress a single anesthesia attending mightily, and let HIM come to bat for you. He might hit a home run for you.

 

[The Physician Philosopher]

Do the best you can in school. Get in a senior elective in anesthesia early. Vis-a-Via, face to face, eyes to eyes, impress your anesthesia attending why you want to go into anesthesia, then let HIM come to bat for you.

Have a fourth year student, might be slightly below average academically, but he impressed me enough to write him a recommendation that even his mom would not recognize. He did well in the interview. He will be going to an anesthesia power house.

Just impress a single anesthesia attending mightily, and let HIM come to bat for you. He might hit a home run for you.

Only thing I would correct is that the anesthesia attending could also be a HER. The best damn attending I know is a woman (and I am a man). Just sayin'.

Otherwise good advice for the marginal candidate. For a lot of people who look good on paper an away can hurt them because it's easier to look good on paper than in person. If you are strong in person a strong letter of recommendation does go a really long way, though.

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[Eagles6389]

I'm possibly interested in going into critical care. Ideally, work 3 weeks in the OR and then 1 week in the ICU, or moonlighting in the ICU to get a change of pace.

How is the critical care ICU job market as an anesthesiologist? Is it tougher to get critical care gigs as an anesthesiologist as compared to the IM --> Pulmonary/Critical Care route?

 

[The Physician Philosopher]

I'm possibly interested in going into critical care. Ideally, work 3 weeks in the OR and then 1 week in the ICU, or moonlighting in the ICU to get a change of pace.

How is the critical care ICU job market as an anesthesiologist? Is it tougher to get critical care gigs as an anesthesiologist as compared to the IM --> Pulmonary/Critical Care route?

My impression is that hospitals love anesthesia trained ICU docs. My buddy who just finished fellowship in CC had no problem finding a job. Granted, he was looking into academics. He is planning 50/50 split between OR and ICU

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[ScrubsnScalpels]

I'm posting many months late, fingers crossed for a response. How common is it, in your experience, for someone to complete an anesthesiology residency, practice as an attending for a bit, and then complete a fellowship at a later time?

 

[Psai]

I'm posting many months late, fingers crossed for a response. How common is it, in your experience, for someone to complete an anesthesiology residency, practice as an attending for a bit, and then complete a fellowship at a later time?

Happens. People generally don't like to do it because it's a year of significantly decreased income and following stupid random rules by people who may have been practicing for less time than you.

 

[kb1900]

Happens. People generally don't like to do it because it's a year of significantly decreased income and following stupid random rules by people who may have been practicing for less time than you.

Does your earning potential/day to day significantly change after that fellow ship though? I spoke to an attending the other day who said something along the lines of “nobody respected me as an anesthesiologist in the OR before until I had cardiac added to my title”. He also went on about how he couldn’t make enough working in the city he wanted to live in wo the fellowship.

 

[The Physician Philosopher]

Does your earning potential/day to day significantly change after that fellow ship though? I spoke to an attending the other day who said something along the lines of “nobody respected me as an anesthesiologist in the OR before until I had cardiac added to my title”. He also went on about how he couldn’t make enough working in the city he wanted to live in wo the fellowship.

Having a fellowship can make you more marketable depending on the needs of the group you are trying to join.

I agree with Psai that it is not common for people to go backwards towards fellowship because of the dramatic decline from an attending salary back to a PGY5. That said, I know some who have done this back in the day where they worked all the weekend shifts to make up the difference while they were a fellow that year.

I don't think most places pay you more in anesthesia just because you have a fellowship. (Unless it's PP pain and you eat what you kill).

Most academics get paid by rank. Most PP groups pay you based on whether you are partner or not and then have profit sharing among the group.

TPP

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