CA1: When does it get better?

[happyabe]

I am a new CA-1 and I started about one month ago. I gotta say, life kinda sucks right now. In all honestly I'm frustrated with a few things. I did my transitional residency at a moderate-sized community hospital, where even interns were respected not only by fellow physicians (attendings included) but also nurses and other staff. I actually enjoyed going to work almost every day.

Now, even some of the staff anesthesiologists don't nod or say hello. A few of the surgeons are psychotic, and the OR nurses are just ok. I feel like a freaking technician sometimes. I am starting to wonder if I even went into the right field. Part of it is the disrespect, or lack of respect. But I'm constantly pushed by my attending for not doing x,y,or z, and being told that I should do things his way when I clearly know he's probably wrong. (For example, he tells me to place a bp cuff and ekg leads AFTER inducing the pt to save time for the surgeons.)

Surgeons are happy until the patient is "tight," after which they basically yell. I even had a urology resident yell at me the other day for accidentally dropping something on his prepped area before the op had started. I was like, this is nuts! I felt like a med student at a malignant program.

I guess, I am venting a lot here. But do things get better? Does one feel less like a technician and more like a doctor as one progresses in this field? Is it normal to feel this way? Most importantly, is life better in a community hospital as an anesthesiology attending? Already I know I will end up in private practice most likely. Part of me thinks that the problem is that I chose a top-notch program where many individuals are arrogant and not good at conversing. Any advice is appreciated!

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[smgilles]

I am a new CA-1 and I started about one month ago. I gotta say, life kinda sucks right now. In all honestly I'm frustrated with a few things. I did my transitional residency at a moderate-sized community hospital, where even interns were respected not only by fellow physicians (attendings included) but also nurses and other staff. I actually enjoyed going to work almost every day.

Now, even some of the staff anesthesiologists don't nod or say hello. A few of the surgeons are psychotic, and the OR nurses are just ok. I feel like a freaking technician sometimes. I am starting to wonder if I even went into the right field. Part of it is the disrespect, or lack of respect. But I'm constantly pushed by my attending for not doing x,y,or z, and being told that I should do things his way when I clearly know he's probably wrong. (For example, he tells me to place a bp cuff and ekg leads AFTER inducing the pt to save time for the surgeons.)

Surgeons are happy until the patient is "tight," after which they basically yell. I even had a urology resident yell at me the other day for accidentally dropping something on his prepped area before the op had started. I was like, this is nuts! I felt like a med student at a malignant program.

I guess, I am venting a lot here. But do things get better? Does one feel less like a technician and more like a doctor as one progresses in this field? Is it normal to feel this way? Most importantly, is life better in a community hospital as an anesthesiology attending? Already I know I will end up in private practice most likely. Part of me thinks that the problem is that I chose a top-notch program where many individuals are arrogant and not good at conversing. Any advice is appreciated!

It definitely gets better. The further you progress the more confident you will become in you abilities and skills. You will start feeling less like a technician and more like a clinician. You will also become more vocal and defend things not only for yourself but also for YOUR patient.

It's a tough transition. You went from admitting patients and doing work-ups on your own and now you are asking if it is okay to use the bathroom. Inducing a patient without a BP cuff or ECG leads is just plain stupid and unsafe.

Give it some time - read this thread in a few months and you will laugh you were even thinking about changing specialties already.

 

[hoyden]

But do things get better?

After you close behind the door of your department office, holding the Diploma in your hand - on June 30th of your CA-3 year.

There is the end of the tunnel. Though if your main problem is respect - it may not get better - you are not going to have that kind of respect you've had as an intern while in anesthesia residency.
On the other hand if you stop dropping stuff on the prepped field and make your patient "asleep" while surgery interns are embroidering the belly( you may get some area of small push here when senior and good) - you may not be yelled at as much as you are now.
Good luck and be patient. Get better fast - it helps

 

[Bertelman]

Now, even some of the staff anesthesiologists don't nod or say hello. A few of the surgeons are psychotic, and the OR nurses are just ok.

Sounds like my program (and every other program in the country).

The first month will likely be your most frustrating month of residency. Don't take the surgeons personally- they yell at everyone. You should have known that before choosing this field.

And quit dropping crap on a sterile field, even if it is just a Urology room.

 

[proman]

Your first year is your CRNA year. It's where you learn the technical skills needed to do an anesthetic. By the end of your first year you'll be pretty fast at most things. Years 2 and 3 are when you learn to be a consultant in anesthesia. I've ruined a few prepped sites, apologize and admit fault when you screw up.

 

[panetrain]

What makes you think that you deserve the respect of your anesthesia and surgical superiors? Sounds like you may have an entitlement issue! What ever happened to earning respect? Perhaps you went into the field of medicine to command respect from others? Well, your MD may entitle you to some respect at your local hillbilly community church or blue-collar pub, but in the OR you have to earn every last bit of it!!!

 

[lane]

What makes you think that you deserve the respect of your anesthesia and surgical superiors? Sounds like you may have an entitlement issue! What ever happened to earning respect? Perhaps you went into the field of medicine to command respect from others? Well, your MD may entitle you to some respect at your local hillbilly community church or blue-collar pub, but in the OR you have to earn every last bit of it!!!

was that really necessary?

 

[UBCmed09]

was that really necessary?

Indeed. I don't think there's anything wrong with a little respect if only in communicating in a way that empowers rather than chastises, for example. I'm all for having to earn your respect as a medical expert, that's what most of us strive for. That doesn't prevent a baseline level of respect that I am interpreting as being meant by the original poster.

 

[amyl]

there is a huge difference btwn commanding respect and basic professionalism. you should expect basic professionalism from the other doctors.

as far as respect, you have to earn that .... else it wouldn't mean anything, right?

also, just because everyone was nice and "respectful" to your face at your other hospital doesn't mean they really respected you and didn't talk smack behind your back. i have been to community hospitals like that...

i wondered if anesthesia was right for me at first too... it seemed so much harder than everything else. i mean medicine was no big deal as an intern after the first day... it takes longer than a day not to suck in the ORs.

as one Ca-1 to another, the sh_it sandwich is ours to eat, smear some guac on it and enjoy.... it will get better, thats what they say. the stressed out looks at my program mostly belong to the ca-1s....

 

[fakin' the funk]

I think the OP has 2 distinct complaints: 1) I am not respected as a human being, and 2) I am not respected as a physician and clinical decision-maker.

The first I think everyone should be entitled to though it sometimes goes out the window in high-stress or unfriendly academic environments...

The second...yea...even 5 weeks into internship, sounds like that's pretty much the deal with residency eh? Does it improve w/ time?

 

[drfeelgood]

[ Most importantly, is life better in a community hospital as an anesthesiology attending? Already I know I will end up in private practice most likely. Part of me thinks that the problem is that I chose a top-notch program where many individuals are arrogant and not good at conversing. Any advice is appreciated![/QUOTE]

Happyabe.....

I was told by my program director after my second month that some of my attendings didn't feel I had what it took to finish my residency. I worked extremely hard to gain their respect during the rest of my residency. imagine having to constantly look over your back for almost 3 years!!

I just finished my third year in private practice in a medium size Community hospital near Los Angeles.... and i got to say... life is better on the other side. (after you pass your orals) Though most of my surgeons are older than me...they insist on me calling them by their first names. I hang out with a lot of the O.R. nurses and some surgeons outside of the hospital... BBQs, Fishing trips, Trips to the casino, long bike rides to the beach.
Most surgeons don't question you if you explain to them in an consultant like manner why you need this echo or why you need to check a lab. It also helps that most of the surge0ns in my practice are also my partners in a large Multi-specialty gruop.

I got a nice house, nice cars, a fat salary and a trophy fiance. I pinch myself everyday to make sure i'm not dreaming. Keeping Working hard at it...... You WILL make it some day. KP

 

[happyabe]

Respect must be earned, no doubt. I appreciate all the comments. They are certainly reassuring. Now, back to hitting Lange. Peace! HA

 

[coprolalia]

Abe,

You're not as good or deserving as you now think you are. There is zero tolerance for incompetence in the OR, which was probably tolerated (more than you realize) during your TY.

Keep reminding yourself that during your residency. Someday you will be competent, and suddenly you'll realize just how bad you once were. Hopefully when you hit that stage, you'll look back and laugh... and not become bitter...

Boards soon. Catcha later. Good luck.

-copro

 

[maceo]

I am a new CA-1 and I started about one month ago. I gotta say, life kinda sucks right now. In all honestly I'm frustrated with a few things. I did my transitional residency at a moderate-sized community hospital, where even interns were respected not only by fellow physicians (attendings included) but also nurses and other staff. I actually enjoyed going to work almost every day.

Now, even some of the staff anesthesiologists don't nod or say hello. A few of the surgeons are psychotic, and the OR nurses are just ok. I feel like a freaking technician sometimes. I am starting to wonder if I even went into the right field. Part of it is the disrespect, or lack of respect. But I'm constantly pushed by my attending for not doing x,y,or z, and being told that I should do things his way when I clearly know he's probably wrong. (For example, he tells me to place a bp cuff and ekg leads AFTER inducing the pt to save time for the surgeons.)

Surgeons are happy until the patient is "tight," after which they basically yell. I even had a urology resident yell at me the other day for accidentally dropping something on his prepped area before the op had started. I was like, this is nuts! I felt like a med student at a malignant program.

I guess, I am venting a lot here. But do things get better? Does one feel less like a technician and more like a doctor as one progresses in this field? Is it normal to feel this way? Most importantly, is life better in a community hospital as an anesthesiology attending? Already I know I will end up in private practice most likely. Part of me thinks that the problem is that I chose a top-notch program where many individuals are arrogant and not good at conversing. Any advice is appreciated!

umm, it aint gonna get better.. there is no respect in anesthesia, you should have known that before you went into it. the only respect you get is when someone prolly sees your bank account provided you are not an jerk o** and spends every dime. but on day to day stuff you are just there to make the patient not move while the surgeon operates as far as anyone is concerned. The only time they need you is when something bad is happening and all of a sudden they look at you and say FIX IT and when you do they move on to do whatever it is they were doing. many malignant personalities, lot of women who arent getting it.. lot of women going through the change... get my drift.....

 

[Impromptu]

I met an amazing PGY-1 resident recently. He moaned about all the "incompetent" things people were doing to make his life miserable. He flat out stated that is going to treat everyone like garbage unless they earn his respect. What? Really? Do people actually go through life thinking that is okay? I thought this was just venting after long hours, but he has brought it up on several occasions when complaining about different "incompetent" people. Of course, he didn't want to bring up how many mistakes he has made during his first month. It really wouldn't be fair to judge him based on his own standard, now, would it?

 

[Bertelman]

I met an amazing PGY-1 resident recently. He moaned about all the "incompetent" things people were doing to make his life miserable. He flat out stated that is going to treat everyone like garbage unless they earn his respect. What? Really? Do people actually go through life thinking that is okay? I thought this was just venting after long hours, but he has brought it up on several occasions when complaining about different "incompetent" people. Of course, he didn't want to bring up how many mistakes he has made during his first month. It really wouldn't be fair to judge him based on his own standard, now, would it?

I hope you mean "amazing" in an amazingly horrible kind of way. People who always describe others as incompetent strike me as trying to divert attention away from their own shortcomings.

 

[panetrain]

The OR is a super Alpha personality driven environment. Big eats little, strong crushes weak. It's very toxic at times. I noticed right from the get that your anesthesia attendings (for the most part) will eat their young to survive. They will not back you up or defend your management decisions in front of your surgery counter parts. They will rather throw you under the bus to save their own ass every chance they get. However, what they don't seem to get is that the surgeons are on to them and don't buy it. They actually think its shameful to blame residents for their own lack of involvement or poor management of a case. Keep this in mind.

umm, it aint gonna get better.. there is no respect in anesthesia, you should have known that before you went into it. the only respect you get is when someone prolly sees your bank account provided you are not an jerk o** and spends every dime. but on day to day stuff you are just there to make the patient not move while the surgeon operates as far as anyone is concerned. The only time they need you is when something bad is happening and all of a sudden they look at you and say FIX IT and when you do they move on to do whatever it is they were doing. many malignant personalities, lot of women who arent getting it.. lot of women going through the change... get my drift.....

 

[happyabe]

umm, it aint gonna get better.. there is no respect in anesthesia, you should have known that before you went into it. the only respect you get is when someone prolly sees your bank account provided you are not an jerk o** and spends every dime. but on day to day stuff you are just there to make the patient not move while the surgeon operates as far as anyone is concerned. The only time they need you is when something bad is happening and all of a sudden they look at you and say FIX IT and when you do they move on to do whatever it is they were doing. many malignant personalities, lot of women who arent getting it.. lot of women going through the change... get my drift.....

No respect in anesthesia? I've gotta disagree there, chief. There are a number of anesthesiologists at our program that are well respected nationally. Now some surgeons may never respect any anesthesiologist regardless of their accomplishments, but they are rare at this program fortunately. With that said, I feel like one of my main jobs is to keep the surgeons happy; I'm fine with that. I do my job, I learn from my mistakes, and the surgeon stays happy. This makes for a good environment.

Additionally, we see from an earlier post and from my knowledge of PP anesthesiologists that, many are friends with the surgeons at work. They go out, golf, etc etc. So I gotta think that it will get better, and that it is possible to gain one's respect. Peace, Abe.

 

[happyabe]

The OR is a super Alpha personality driven environment. Big eats little, strong crushes weak. It's very toxic at times. I noticed right from the get that your anesthesia attendings (for the most part) will eat their young to survive. They will not back you up or defend your management decisions in front of your surgery counter parts. They will rather throw you under the bus to save their own ass every chance they get. However, what they don't seem to get is that the surgeons are on to them and don't buy it. They actually think its shameful to blame residents for their own lack of involvement or poor management of a case. Keep this in mind.

That is too bad. However, if an attending is too submissive like that, then of course he will neither be respected by the surgery counterparts nor the residents at that program. I have yet to have an attending stand up, or not stand up, for me. But again, you make a mistake, simply learn from it. I guess it doesn't matter in the long run whether or not my attending would "stand up" for me. After all, we are all big boys and girls at this stage in the game. Proper, Abe

 

[maceo]

No respect in anesthesia? I've gotta disagree there, chief. There are a number of anesthesiologists at our program that are well respected nationally. Now some surgeons may never respect any anesthesiologist regardless of their accomplishments, but they are rare at this program fortunately. With that said, I feel like one of my main jobs is to keep the surgeons happy; I'm fine with that. I do my job, I learn from my mistakes, and the surgeon stays happy. This makes for a good environment.

Additionally, we see from an earlier post and from my knowledge of PP anesthesiologists that, many are friends with the surgeons at work. They go out, golf, etc etc. So I gotta think that it will get better, and that it is possible to gain one's respect. Peace, Abe.

you are a resident. you aint seen nothing yet.

 

[miamidc]

what is that supposed to mean?

 

[pgg]

what is that supposed to mean?

Maceo's bitter and angry, that's all. He wishes he was a radiologist and we wish he was one too.

Lots of us enjoy the respect of our non-anesthesia physician colleagues, nurses, and support staff.

Granted, within the confines of residency, you'll always be a powerless peon, but it's possible to be a respected and liked powerless peon, provided you're a nice, competent, non-douchebag. Problem is, as copro pointed out, you're not likely to be competent in July of your CA-1 year ... it will take time.

If it's glory and adoration you're looking for, this isn't the field. Anesthesiologists will never be seen as the rock star hero cap'n-of-the-ship fearless leader the way (some) surgeons are, or want to be. Many of us like it that way.

 

[Tuohy]

Medicine attracts entitled individuals. Many of these folks are true bred silver spoons. Mommy and/or Daddy are doctors. Wow, son you are amazing! Let me buy you something. Get a grip on reality. Welcome to the F****** real world. Some of us were raised in the real world. OUT-

 

[maceo]

Maceo's bitter and angry, that's all. He wishes he was a radiologist and we wish he was one too.

Lots of us enjoy the respect of our non-anesthesia physician colleagues, nurses, and support staff.

Granted, within the confines of residency, you'll always be a powerless peon, but it's possible to be a respected and liked powerless peon, provided you're a nice, competent, non-douchebag. Problem is, as copro pointed out, you're not likely to be competent in July of your CA-1 year ... it will take time.

If it's glory and adoration you're looking for, this isn't the field. Anesthesiologists will never be seen as the rock star hero cap'n-of-the-ship fearless leader the way (some) surgeons are, or want to be. Many of us like it that way.

im not inherently bitter and angry i just calls it likes it is... If more people were like me we probably wouldnt be in the goat rodeo that we are in. in american medicine