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does anyone hate anesthesia?

Discussion in 'Anesthesiology' started by scrubs, Oct 12, 2001.

  1. scrubs

    scrubs Junior Member
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    Hi everyone!

    I am new to this website - I have answered a couple of threads, but never started one. I really like reading everyone's comments, so I was wondering if I could get some honest opinions...

    I am an anesthesia resident and I am on the verge of quitting. I have posted before why I dislike this field, but here are my concerns in a nutshell:

    1)I find it so unbelievably stressful to have this level of responsibility for my patients' lives. Being in the OR all day is mentally exhausting.
    2)I have no autonomy over my schedule - when I finish my cases I am told to take over another room or do add-on cases.
    3) There is no respect from anyone in the OR (surgeons, surgery residents, nurses) that I am even human.
    4) It is very difficult to open a book at night and read about physics and pharmacology.

    Anyway, I could go on, but those are my major issues. I was wondering if there are any anesthesia residents going through the same concerns. And for those going into anesthesia - maybe you can remind me why I went into this field in the first place :) :(

    Thanks in advance for the replies - I anxiously await your replies! :)
     
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  3. Magree

    Magree Senior Member
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    Hi scrubs:

    Sorry you are having such a difficult time. I was wondering about the residency program you are in. If you feel so fearful in the OR - could it be because you are not getting sufficient teaching and support to feel more confident? Does the PD support you? Do you get any support from the other attendings. A friend is in anesthetics and he say that most people are very "freaked out" their R1 year - but it gets better. However, he is in a very good residency.

    M-
     
  4. Justin4563

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    hey scrubs.. I am an anesthesia resident in jersey and i absolutely love it... You are a vital person to the surgical team, who cares what anyone else thinks.. Who the **** wants respect from ignorant surgeons who only see what they do as important. You have to have confidence in yourself, do a good job and go home.. Conduct the treatment. anesthetic better than anyone. Being in the Or is mentally exhausitng day in and day out but it is fulfilling nas satisfying.. There are a billion things that can go wrong as you know; you just have to know when they do and interene appropriately, Plus the salary is good. Youll start put 200,000 plus if not more.. SO stick with it it is stressful but you haev to figure out if you are a wolf or a sheep.

    where are you in residency??
     
  5. scrubs

    scrubs Junior Member
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    Thank you both for your replies...

    Magree -
    I am a resident at a competitive program in Chicago. The atmosphere is not entirely friendly (i.e., we don't get much support- if any - from our attendings). There are others than myself who are thinking of leaving, which makes me think that part of this is just where I am. We have a wonderful chair, but the chair's attitude does not trickle down to the residents. I do have the best resident colleagues a person could wish to have, the problem is we never see each other.

    Justin 4563 - thanks for the words of encouragement. I think you understand how I feel. I agree with the salary - unfortunately that is the only reason why I am sticking around right now. I'm glad you enjoy it - I think I probably just need a major attitude adjustment... If you don't mind answering: what are your days like and what is the atmosphere like where you are?

    Take care and thanks again...
     
  6. am

    am Junior Member
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    scrubs,

    you sound like radiology may be a good alternative for you. :confused:
     
  7. droliver

    Moderator Emeritus 10+ Year Member

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    Scrubs,

    Its sad to hear somone who doesn't their training. I'm a surgery resident & I love what I do. There is nothing more reassuring than having a talented person doing the anesthesia (be it a CRNA or MD), especially when you may occasionally have someone who is horrible with intubations, fluid management, or waking the patient up on time.

    Perhaps some of the subspecialties may suit you better : Pain managment, Critical care, and pediatric or Obstetric anesthesia.
     
  8. Whisker Barrel Cortex

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    I think the lack of respect from surgeons, residents and nurses will improve a great deal once you are an attending. I've been at a couple private hospitals and the most of the anesthesiologists get along well with the surgeons and get respect too.
     
  9. Justin4563

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    Hey Scrubs:


    I dont think i get much attention or reassurance from my attendings. The teaching is rather poor and the atmosphere dismal.. But i like anesthesia.. You prob get to leave at 3- 4 pm to do your preops and get out we dont get relieved until 5 30 pm


    Basically the hours are 630 til about 530-6pm usually, I have been at the hospital until 8-9 pm before. Not much didactics. Its all in the book if you are motivated enough.. I scored ok on the intraining, How did you do.. You prob are in a much cusshier program than i am....
     
  10. scrubs

    scrubs Junior Member
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    Hi all - thanks for the replies...

    am - I would agree, but I think radiology is very competitive and at this point may not be realistic for me to get into... Not that I didn't have decent stats, but I'm sure programs would not like to have a "drop-out" from another program when they could have a "fresh" medical student.

    droliver - I appreciate your sentiments, but you have also brought up another issue which troubles me... CRNAs. While I realize our training is different than theirs, it seems that others do not appreciate that fact. I am getting the feeling that I am easily replaced by a CRNA in the future...

    DoctorB19 - I agree, but truthfully, it is not just the respect that really bothers me, there are other issues involved. Mainly, I think I really just don't like the subject... I don't think I'm doing what I thought I would as a physician.

    Justin4563 - Like your program, we have no didactics to speak of, we too are encouraged to read if we want to know anything (I did poorly on the in-training, but I was not at all motivated). I actually get up at 4:45am to be at the hospital by 6am. We don't usually leave until 5:30-7:30pm. And if we have pre-ops, we do them after this. We are only relieved early if we are pre-call, and that is 3-4pm. Our hospital is very busy, so there are always add-on cases (which residents do). Also the CRNAs who work at our institution have contracted to work 7am-3pm. So guess who has to relieve them at 3pm, when they get to go home? Yes, the residents - which has engendered a lot of tension, but we don't really have a choice. We work very hard - I don't think I am at a "cushier" program. I have talked to other residents at other universities and in comparing programs, they agree. But I want to say that I worked easily as hard, if not more hours, during my internship, and I never felt like this...
    Has anyone switched out of your program or do you know anyone who left anesthesia? If so, what did they do?

    Thanks to all of you - I really appreciate your comments! :) If any of you know of anyone who has changed residencies (even non-anesthesia) I would like to hear your stories. Take care!
     
  11. am

    am Junior Member
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    scrubs,

    I think that you are describing some of the frustrations of being a resident in general. Anesthesia is a great field when you compare it to the alternatives. As you become more competent you will start to appreciate it more. When you graduate you will get a nice salary and the joy of having a more predictable schedule. You will do your job, make a nice living and go home with a mind free of worry and frustration. Unless you are on call (which you will know ahead of time) you can make that dinner or baseball game without any hesitation. I think you should stay with it for a little more before you switch. Think back to your intern year and whether you were *really* saving lives or even helping people much of the time.

    I myself am going into Radiology next year With each day of my intern year I am happier with my decision. I will have rough days during my training and often question my decision. But thank god I did an intern year so that I saw what the other side of medicine is like. :) Good luck to you and remember that we are lucky to be in this relatively recession proof profession.
     
  12. Justin4563

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    hey scrubs


    one girl left because she hated our attendings, not because she hated anesthesia and she went to do surgery cateforical pgy-2 she is crazy..

    but other than that no one has left for another specialty,,

    we dont leave our specialty, its just too nice my friend...

    who wants to round and round all over the place getting no where fast..

    It is nice however eating lunc with the whole team as opposed to running and scarfing something down real quick


    Jd
     
  13. DO2

    DO2 Junior Member
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    Report: U.S. Facing Shortage of Anesthesiologists
    NEW YORK (Reuters Health) - There is a shortage of anesthesiologists in the US that will continue for years unless more people are attracted to the field, according to a report in the October issue of the Mayo Clinic Proceedings.

    ``It appears now that, in addition to focusing on the financial resources needed to support the healthcare needs of an aging population, national health policymakers need to re-examine whether the number of healthcare professionals is sufficient to care for the elderly, in particular when they require surgery, are afflicted by painful conditions, or become critically ill,'' Dr. Armin Schubert from the Cleveland Clinic Foundation said in a clinic statement.

    Schubert and colleagues used data from federal agencies, the American Medical Association and the American Society of Anesthesiologists to estimate the supply of anesthesiologists in 2001 and beyond.

    Based on the growth of the need for anesthesia since 1994, there is currently a shortage of anesthesiologists that ranges from 1,200 to 3,800, the investigators determined. They calculated that by 2005, assuming continued growth, the shortage will increase to between 1,000 and 4,500 anesthesiologists.

    However, by 2010 the shortage may disappear or be reduced to a shortfall of 1,000 anesthesiologists, assuming that the number of residency positions increases by 15% per year until 2006, Schubert's team notes.

    The researchers believe that to address the shortage, almost 60% more anesthesiologists will need to be trained by 2005 than were graduated in 2000, and almost 100% more will need to be trained by 2010.

    The need to increase the number of anesthesiologists suggests that training programs should admit more graduates of foreign medical schools, according to the authors. They add that the Medicare fee structure needs to be modified to allow anesthesiologists to earn more, in order to attract people to the field.

    In an accompanying editorial, Dr. Ronald D. Miller from the University of California, San Francisco and Dr. William L. Lanier, editor-in-chief of the journal, note that the shortfall of anesthesiologists results from policies in the 1990s that encouraged a return to general practice.

    ``It can happen in other specialties as well,'' Miller and Lanier note. ``Ultimately, the erosion of any important component specialty will do harm to the future intellectual and service missions of medicine and, unfortunately, the patients we serve.''

    SOURCE: Mayo Clinic Proceedings 2001;76:969-970, 995-1010.
     
  14. Magree

    Magree Senior Member
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    Hi:

    I am not that familiar with U.S. anesthesiology - what training do CRNAs get? I watched some the other day and they did all the anesthetic work - from beginning to end and very well. Are there a lot of CRNAs? Do they make as much money as an anesthesiologist? Its kind of confusing. Thanks.

    M-
     
  15. brownman

    brownman Member
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    CRNA's are nurses who, in addition to basic training as nurses, pursue an additional one to two years (depending on the program) of specific training in anesthesia and anesthesia techniques. In general, for basic procedures, they do very well. They are a good complement in many ambulatory centers and are used as the sole anesthesia providers in some states where there are multiple ambulatory procedures to perform and not enough anesthesiologists to staff. CRNA's have a few inherent difficulties (that even HMO's understand). THEY ARE A FAR LARGER INSURANCE RISK. Becuase many hospitals have balloon coverage, they are able to spread out risk over the many medical fields. And at a significantly lower cost during training...they are willing to act as training centers for CRNA's. They unfortunately, because of insurance risk, have to cap their CRNA's at a certain number (same with their anesthesiologists, but there are far fewer of those of late). And half the reason they can absorb the CRNA's they have, is because they are "supervized" by anesthesiologists. Whether the laws change or not is irrelevant. Because insurance premiums (this applies even more so to out patient ambulatory centers and clinics because they have more pronounced overhead)are determined by actuarial metrics, there will always be a greater risk profile for CRNA's then anesthesiologists (unless those anesthesiologists make SOME HUGE MISTAKES). So the cost/benefit in the end actually far makes up for the differential in pay (which in a hospital setting is actually minimal if you count volume - ie attendings to CRNA's because a resident's salary in that pool is negligable). Anyway..more than you needed to know. In the end, both parties have to work together. We could each annihilate each other...so a middle ground needs to be reached. If we don't..we will both price ourselves out of the market (because...a 200,000 dollar anesthesiologist may seem like less of a bargain then a 100,000 dollar CRNA...but a 100,000 dollar CRNA is less of a bargain than a 60,000 anesthesiology assistant). Anyway..an econometric two cents. Hope it helps...
     
  16. jylu

    jylu Junior Member
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    2 years above the usual nursing school education. They typically charge 50% less than an anesthesiologist per case.

    Anesthesia assistants are like physician assistants, with fixed salaries.
     
  17. Magree

    Magree Senior Member
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    Hi:

    Thanks for the responses. I can better understand why people worry about the CRNAs taking their jobs. Do anesthesia assistants have special training too? Thanks again.

    M-
     
  18. meandragonbrett

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    Hey,
    What are Anesthesia Assistants?j\w never heard of that. As far as CRNA's go, I'm planning on being one. At the hospital that I work at, the CRNA's do um... I would say 80% of all cases involving anesthesia. If there is a transplant or something like that, there is an Anesthesia Team doing it, but for the most part CRNA's do everything with little supervison from the MD's, and I see nothing wrong with having a CRNA. CRNA training is a very difficult program. It's a two year master's program, and the students are not able to hold a job down and still make good grades. The student is either, studying, in class,or doing clinicals. It's a very tough two years, but it's worth it. Is there anybody else out there FOR CRNA's? Now don't get me wrong, i'm not saying that CRNA's should take over ALL anesthesia and just get rid of the MD counterparts. That's NOT what i'm saying, so please don't crawl all over me because of this post. I don't understand why the MD's don't like the CRNA's because in fact, nurses were the first people to give anesthesia. CRNA's have been around a lot longer than the MD counterparts.

    my .2 cents worth
    let me know what you think

    brett
     
  19. AJM

    AJM SDN Moderator
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    *Med students* used to administer anesthesia during surgeries as recently as the 1950's and in a few locations until the 1960's, but that doesn't mean that med students should be independently administering anesthesia now. Anesthesiology only became a medical specialty in the 1940's, and it wasn't until the late '60s that anesthesiologists were the norm. Since that time, however, perioperative mortality has drastically decreased. I therefore don't think that it's a valid argument to say that just because a group of people have been in a specialty longer, that they are more deserving now to be in control of that specialty than others.

    I don't want to get into a CRNA vs. anesthesiologist debate. I have not worked directly with any CRNA's, nor am I going to be an anesthesiologist. However, I have heard several anesthesiologists share their opinions about this, and this is what I often hear them say: First, a lot of it is a political/job market thing. That's already been discussed in other threads, so I won't go into it. Second, I think many anesthesiologists are concerned that CRNA's are allowed to practice independently in many states given that they have less training than MD/DOs (ie the MD/DOs have 4 years of undergrad, 4 years of med school, and 4 years of residency, and many continue on in a 1 or 2 year fellowship).

    I personally don't think I would have a problem with CRNA's if they are doing basic cases and the patients are pretty healthy to begin with. However, in the more complicated cases or in patients with medical problems that would change the peri-operative care, I would want an MD/DO.

    Just my 0.02 :cool:
     
  20. meandragonbrett

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    I'm not saying that CRNA's should take over. Yes I agree 100% w\you that it's all politics. I agree with you in that I don't want to get involved in a heated discussion. I was simply stating my point of view and that's all it was :) I don't think CRNA's should manage extremely complex cases by themselves. I don't see a problem with them doing it as long as a MD is in there w\them.

    TTYL,
    brett
     
  21. emedpa

    emedpa GlobalDoc
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    info on anesthesia assistants: there are(I believe) currently 2 aa programs in the country at emory and case western. A.A.'s are the legal and medical equivalent of crna's. the difference is that most AA'S have a background other than nursing.respiratory therapists,paramedics, as well as nurses and others can attend a 2 year graduate level program structured like a crna program and learn the same skills. admission to these programs is very competitive, requiring premed science prereqs and the mcat.hope that helps
     
  22. meandragonbrett

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    Ok, I did some research on the Anesthesia Assistan thing. An AA is somewhat like a CRNA, but they must be under DIRECT supervison of either the Anesthesiologist or the CRNA on the case. They are limited to things they can do, and their salaries supposedly cap off at about 50K a year. It's a 2year Master's program. Why do that when you can become a CRNA, and be able to do more things, and not be supervised during the entire case by another anesthesia personel?j\w

    brett
    If there are any Anesthesiologists (SP) or CRNA's out there. please e-mail me. [email protected]
     
  23. emedpa

    emedpa GlobalDoc
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    more A.A. info from the mory graduate program:
    What is the average salary for a new graduate?
    Salaries vary depending on the experience of the individual and the regional
    cost of living. The average starting salary for a newly graduated
    Anesthesiologist Assistant is approximately $60,000 to $70,000 for a 40-hour
    work week plus benefits and consideration of on-call activity. An increase
    of approximately 25 to 30% should be expected after the first 1 to 2 years
    post graduation. Salaries are comparable to compensation paid to Certified
    Registered Nurse Anesthetists (CRNA) nationally. Information gathered
    from Health Professions Education Directory, 1998-1999.

    Is the job description for the Anesthesiologist Assistant (AA) profession
    equivalent to that for a Certified Registered Nurse Anesthetist
    (CRNA)?
    Yes. When AAs are employed within the same organizations as CRNAs, the
    job description is usually identical. One fundamental difference is that AAs
    must work under the medical supervision of a licensed anesthesiologist.
    Conversely, in some unique clinical settings (usually not at tertiary care
    centers), a CRNA can practice under the medical supervision of any
    physician (not necessarily an anesthesiologist).
     
  24. emedpa

    emedpa GlobalDoc
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    please excuse the typo. that should read emory grad program
     

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