First year attending woes

[patriot6]

First year out in a busy private practice (50% own cases). I don’t think I really appreciated just how difficult the transition would be. It’s a totally different ball game when there is no one to call in a pinch to bail me out. I think that’s probably an impossible lesson to simulate in residency, even in programs that afford their residents a good bit of autonomy. I find myself a bit nervous for nearly everything, even the routine cases, despite being confident in my skill set. Also, the daily grind of the stress that comes with trying to perform smoothly in the OR so as to make a good impression on partners, surgeons, anesthetists, OR staff, literally everyone... is brutal. To all the more experienced folks... does this get better? Any advice?

Happy new year!

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[Lecithin5]

First year out in a busy private practice (50% own cases). I don’t think I really appreciated just how difficult the transition would be. It’s a totally different ball game when there is no one to call in a pinch to bail me out. I think that’s probably an impossible lesson to simulate in residency, even in programs that afford their residents a good bit of autonomy. I find myself a bit nervous for nearly everything, even the routine cases, despite being confident in my skill set. Also, the daily grind of the stress that comes with trying to perform smoothly in the OR so as to make a good impression on partners, surgeons, anesthetists, OR staff, literally everyone... is brutal. To all the more experienced folks... does this get better? Any advice?

Happy new year!

Yes, it gets better. Trust yourself and your skills. More than anything, if you’re personable and respectful and a good team player, you will be afforded a lot of leeway from everyone around you- don’t worry about ‘actively’ trying to make a good impression.

 

[caveat87]

As much as I can appreciate your wanting to come off as “smooth”, your number one priority should be to deliver safe care even if it takes a few extra moments to preoxygenate or put in the art line. People will respect you more if you are thoughtful about your care. I’d rather explain to an administrator why there was a short delay than a seriously adverse outcome. Don’t cut corners. If you trained at a program worth its weight you will likely bring a high standard of care if you go to a community practice.

Also, don’t be afraid to ask others how they might handle a challenging situation or even if they can give you a set of hands for something you may not have much experience with. This does not demonstrate weakness or incompetence. It shows willingness to learn from others and a healthy level of humility

 

[ItBurnsInMyHand]

First year out in a busy private practice (50% own cases). I don’t think I really appreciated just how difficult the transition would be. It’s a totally different ball game when there is no one to call in a pinch to bail me out. I think that’s probably an impossible lesson to simulate in residency, even in programs that afford their residents a good bit of autonomy. I find myself a bit nervous for nearly everything, even the routine cases, despite being confident in my skill set. Also, the daily grind of the stress that comes with trying to perform smoothly in the OR so as to make a good impression on partners, surgeons, anesthetists, OR staff, literally everyone... is brutal. To all the more experienced folks... does this get better? Any advice?

Happy new year!

I can relate! Also first year out and still get nervous about starting cases. Will I get the spinal? What if I can’t intubate? And yes, despite confidence in skills. I think it’s because I feel like there is a lot to learn and see (just myriad scenarios) in my career. It leads to a lot of anxiety! That being said, getting the day going and having momentum is helpful. And I don’t hesitate to ask the OR nurses to find an extra set of hands if I feel like I need it. I get really frustrated when I do need to call but I think it’s better to have help if you suspect things could go south.

 

[Guillemot]

I worry more about people that don't realize they don't know everything.

 

[Volatile]

those that don’t worry are either too confident or have stopped caring. A healthy “hopefullness” that the day will go well is a good thing. If that anxiety/fear/stress is impacting your ability to care for patients, talk to someone.
A wise mentor told me it takes 10 years post residency to feel comfortable with most cases.... I think there’s probably a lot of truth to that.

 

[Justice4all]

Thanks for posting ! I am also first year out and the anxiety is still there even after the case with each decision making even if it all goes smooth. An healthy dose of anxiety is good but I think with each case and each call, slowly making progress.

 

[IMGASMD]

It’ll get better. I call on my partners when **** hits the fan. If they don’t come or just walk away, you are in bigger problem than you think you are.

I tried to show up for them when there are cases which are not in their wheelhouse. Peds, complicated vascular.... etc. they’re your employer now, but eventually your “partners”; you should be able to trust them to put the groups and partners interests in mind.

My hardest lesson was dealing with nurses anesthetists. Some of the partners are very hands off. When I tried to manage them, it was very hard on my psyche. You learn to ask your partners for some guidance. They will tell me, so and so isn’t so good with bigger cases, someone sucks at airway, need more hand holding.

OR and/or PACU staff, even though they do impact on your daily work, but in the end they really don’t matter THAT much. They think it matters, but they can go pound sand if they aren’t happy with what you do. I don’t go out of my ways to make their lives difficult.

Lastly, don’t be stupid. Ask if you don’t know how they do certain things.

It’ll get better once you’re “in”.

Happy New Year.

 

[DrOwnage]

Agreed. 4 months into it and the accountability now does breed some anxiety. The worst part is when people are clearly not optimized and there are reasons to cancel, but you hate to be that guy. I've already had a bunch of bleeding airways, had to intubate lateral, and a pseudocholinesterase deficiency patient I had to keep intubated for 6 hours. One thing that I'm still getting used to is how different every day can be, or how a run of a bad days/tough cases can happen and it wears on you.

 

[deleted126335]

One thing that I'm still getting used to is how different every day can be, or how a run of a bad days/tough cases can happen and it wears on you.

 

[Drwine]

I remember when LIJ got rid of their anesthesia department and hired Dr. Leibowitz from Mass General who edited the manual at that time. He brought a number of bright new graduates with him. In the first 6 months they averaged one clean kill a month and years later an expose was written in the NY Times. Experience is a great teacher and even a middle of the road attending in their prime has a lot to teach a new graduate. Rookies need to be humble and be willing to ask for assistance.

 

[deleted171991]

First year out in a busy private practice (50% own cases). I don’t think I really appreciated just how difficult the transition would be. It’s a totally different ball game when there is no one to call in a pinch to bail me out. I think that’s probably an impossible lesson to simulate in residency, even in programs that afford their residents a good bit of autonomy. I find myself a bit nervous for nearly everything, even the routine cases, despite being confident in my skill set. Also, the daily grind of the stress that comes with trying to perform smoothly in the OR so as to make a good impression on partners, surgeons, anesthetists, OR staff, literally everyone... is brutal. To all the more experienced folks... does this get better? Any advice?

Happy new year!

Are You Ready For Private Practice?

(ADDENDUM: I wrote this a cuppla years ago. Its got alotta useful information in it for you. I'm bumping it for the benefit of my CA-3 colleagues who may have missed it and are gonna be on their own in a few months.) I'm starting a thread that I hope will be useful for the current and future...

forums.studentdoctor.net

 

[deleted126335]

I remember when LIJ got rid of their anesthesia department and hired Dr. Leibowitz from Mass General who edited the manual at that time. He brought a number of bright new graduates with him. In the first 6 months they averaged one clean kill a month and years later an expose was written in the NY Times. Experience is a great teacher and even a middle of the road attending in their prime has a lot to teach a new graduate. Rookies need to be humble and be willing to ask for assistance.

That was in the early 90s. The consensus was that the department was filled with reasonably competent people, but most of them were very early in their careers. There were no experienced docs to bounce things off of.

 

[nimbus]

I remember when LIJ got rid of their anesthesia department and hired Dr. Leibowitz from Mass General who edited the manual at that time. He brought a number of bright new graduates with him. In the first 6 months they averaged one clean kill a month and years later an expose was written in the NY Times. Experience is a great teacher and even a middle of the road attending in their prime has a lot to teach a new graduate. Rookies need to be humble and be willing to ask for assistance.

That was in the early 90s. The consensus was that the department was filled with reasonably competent people, but most of them were very early in their careers. There were no experienced docs to bounce things off of.

Deaths at Hospital Said Not to Reflect Systemwide Flaws (Published 1996)

www.nytimes.com

Complications -- A special report.; Post-Surgery Deaths Promp Inquiry at a Queens Hospital (Published 1995)

www.nytimes.com

 

[deleted697535]

Well its tough. I guess it is what happens with one of the shortest anesthesia residencies in the English-speaking world but an extremely complex medical system that advertises impellas on tv as a means to get back on the golf course!?! Wtf

Just remember keep it simple. Hypertension rarely kills anyone, hypotension almost always harms.

We have in total like 6 drugs to ever use. That is it... Use ketofol if you're not sure how someones heart is. Always always have a Glidescope in the room. Always get 100 phenyl with each induction...

If youre not sure intubate everything. Blocks can go fuxk off and die, same with lma's.
At the end of the day our job is 90% airway. The asshats that think were periop physicians can go **** a duck

Dont take on extra bullsh1t in year one. No teaching, no residents no research no audits no admin,


If you have epic learn to snoop your experienced colleagues charts for similar cases and do exactly as they did for whatever case... I do this all the time and its gold


The biggest **** ive ever gotten into involved an lma, a hip with a dodgy spinal i should never have started the case with, and a ward intubation... Thankfully i didnt kill many but i guess i was lucky... I guess im over the hump now but in 20 years time as i grow senile my killing days will return... 😬

 

[DocMcCoy]

Just remember keep it simple.

If youre not sure intubate.

If you have epic learn to snoop your experienced colleagues charts for similar cases and do exactly as they did for whatever case... I do this all the time and its gold

The EMR snoop is gold. Three years out snd I do this everyday. Study others cases and decision making as if you were going to be an expert witness.

Ask for help. Before or after a case. Bounce stuff off the old partners you respect. Review your difficult cases with them post hoc to see how you can improve next time.

DONT BE AFRAID TO SAY NO

 

[anbuitachi]

That was in the early 90s. The consensus was that the department was filled with reasonably competent people, but most of them were very early in their careers. There were no experienced docs to bounce things off of.

still.. thats what residency is for.. 1 clean kill is way too many a year

 

[Realgassy]

I’m also living the new attending life and am enjoying it. I do 90-95% of my cases solo. I have no shame asking partners how they would do a case to bounce off ideas and I definitely snoop old records. My group is great about finding a free person to help start large complex cases. Seeing the older partners being thoughtful and conservative in their anesthetic approach gives me confidence in my team and my decision making process.

Personally, developing relationships with the surgeons/icu has been a bit tougher. It sounds weird, but I still find it odd to call other attendings by their first names especially if there’s a large age gap. While it’s easy to hide behind the curtain, I try to stay engaged with the whole team.

 

[deleted126335]

still.. thats what residency is for.. 1 clean kill is way too many a year

Agreed, but, young, recent grads are still on the learning curve. How much better of a doc were you five years after finishing than when you finished training?

 

[BLADEMDA]

The first year out is critical to polishing your skills. Those who join a practice where they can actually DO cases are in a much better situation than those who ONLY supervise from day 1. IMHO, the best supervisors are those anesthesiologists who have several thousand cases personally performed under their belts. I really think the number needed is round 3,000-5,000 cases to become truly proficient in the field with sufficient exposure to many of the things that can/do go wrong.

There simply is no substitute or shortcut for experience.

 

[anbuitachi]

Agreed, but, young, recent grads are still on the learning curve. How much better of a doc were you five years after finishing than when you finished training?

will see i guess. only 2 years out. feels the same as when i just finished..

 

[coffeebythelake]

I'm 5 years out now. Confidence much improved, planning is solid, recognizing and anticipating problems, troubleshooting. The errors are a lot fewer but occasionally I do a case and recognize a gap in my knowledge (or maybe I knew it at one point and forgot about it, or perhaps a new study that came out that changes practice). Stress and anxiety level probably went up as an attending, i feel im always chart stalking patients afterwards to review their postop course and outcomes. As others have said, discussing cases with colleagues is helpful to reinforce concepts. Debrief after difficult case (outcome and physiology). Learned a lot along the way. Anyways like everythjng in medicine it is a life long learning game.

Happy New Year everyone

 

[linkin06]

just remember, you're never truly alone. if things are crashing, don't be afraid to ask for help. people can and will leave their stable cases to rush in and help you. they can tell the circulator to just keep an eye...make sure the alarms don't start going crazy for a few min.

 

[dhb]

As other have said don't be afraid to consult with partners and ask for help. Looking back i was afraid to bother the partners thinking they would disaprove while i realise now it's the opposite.
Almost had a kill my first month or so, first years out or first time at a new place are always the most dangerous.

 

[okayplayer]

Some really great advice from sage veterans on here.

It behooves your partners (or future partners) for you to do well. We want you to do well. Our group's reputation depends on everyone's success. In my opinion, the best thing to do when posed with a concerning case is to find one of your trusted senior partners before the case, describe the case briefly, tell them your plan and ask them what they think. Most of the time they will agree with your plan. Occasionally they will have a few ideas to offer. In any case, you will proceed with more confidence.

If you are really worried and feel you need an extra set of hands (anticipated difficult airway, spinal, whatever), try to find someone who can go in the room with you or at least be available. If you have a practice where some physicians are supervisory and some are in OR solo, the supervisory or OB anesthesiologist may be able to offer some help. I remember well that just knowing you had a strong backup plan/contingencies in place brought my personal stress level down and improved my performance in these situations as a junior attending.

 

[deleted500612]

Well its tough. I guess it is what happens with one of the shortest anesthesia residencies in the English-speaking world but an extremely complex medical system that advertises impellas on tv as a means to get back on the golf course!?! Wtf

Just remember keep it simple. Hypertension rarely kills anyone, hypotension almost always harms.

We have in total like 6 drugs to ever use. That is it... Use ketofol if you're not sure how someones heart is. Always always have a Glidescope in the room. Always get 100 phenyl with each induction...

If youre not sure intubate everything. Blocks can go fuxk off and die, same with lma's.
At the end of the day our job is 90% airway. The asshats that think were periop physicians can go **** a duck

Dont take on extra bullsh1t in year one. No teaching, no residents no research no audits no admin,


If you have epic learn to snoop your experienced colleagues charts for similar cases and do exactly as they did for whatever case... I do this all the time and its gold


The biggest **** ive ever gotten into involved an lma, a hip with a dodgy spinal i should never have started the case with, and a ward intubation... Thankfully i didnt kill many but i guess i was lucky... I guess im over the hump now but in 20 years time as i grow senile my killing days will return... 😬

Having difficulty discerning if this is sarcastic or serious, hard to tell these days... Blocks are too hard to learn, so screw 'em? Not sure how to safely use an LMA so just tube everyone? No confidence in my ability to examine an airway so I need a glidescope physically in the room for every single case? We shouldn't act as perioperative physicians, just intubation monkeys? Only use the same 6 drugs for all cases? This sounds more like the practice of a CRNA after a few years of working at an ASC.

I agree with the bit about anesthesiology residency in the US being questionably short though. Every other first world country (not just english speaking) has an anesthesiology residency of at least 5 years, which I believe is totally reasonable. Maybe with an extra year of training more anesthesiologists would be comfortable thoughtfully managing sick patients and not disparage themselves as nothing but airway monkeys performing cookie-cutter anesthetics alongside the nurse anesthetists.

 

[deleted171991]

Having difficulty discerning if this is sarcastic or serious, hard to tell these days... Blocks are too hard to learn, so screw 'em? Not sure how to safely use an LMA so just tube everyone? No confidence in my ability to examine an airway so I need a glidescope physically in the room for every single case? We shouldn't act as perioperative physicians, just intubation monkeys? Only use the same 6 drugs for all cases? This sounds more like the practice of a CRNA after a few years of working at an ASC.

I agree with the bit about anesthesiology residency in the US being questionably short though. Every other first world country (not just english speaking) has an anesthesiology residency of at least 5 years, which I believe is totally reasonable. Maybe with an extra year of training more anesthesiologists would be comfortable thoughtfully managing sick patients and not disparage themselves as nothing but airway monkeys performing cookie-cutter anesthetics alongside the nurse anesthetists.

That's EXACTLY the way many of us are seen by outsiders, except for ICU and cardiothoracic settings. Any medical student expecting more will have a very rude awakening.

I used to think it was our fault, but it's not only. It's the curse of the specialty. To an untrained eye, it's all about artistic impression, and very little about technical merit. Unlike our foreign counterparts, we also don't regularly cover the ICU, which makes us look even less like real doctors. I can demonstrate a lot of medical knowledge and thinking in an ICU note; it's much harder in anesthesia.

I wonder if many anesthesia attendings don't fall back to a common denominator also because they don't seem appreciated for going the extra mile. It pays much more to excel at kissing the surgical behind than at medical knowledge.

Also, in many private practices, limiting the number of available drugs is a cost-cutting measure.

 

[Status Sciaticus]

Having difficulty discerning if this is sarcastic or serious, hard to tell these days... Blocks are too hard to learn, so screw 'em? Not sure how to safely use an LMA so just tube everyone? No confidence in my ability to examine an airway so I need a glidescope physically in the room for every single case? We shouldn't act as perioperative physicians, just intubation monkeys? Only use the same 6 drugs for all cases? This sounds more like the practice of a CRNA after a few years of working at an ASC.

I agree with the bit about anesthesiology residency in the US being questionably short though. Every other first world country (not just english speaking) has an anesthesiology residency of at least 5 years, which I believe is totally reasonable. Maybe with an extra year of training more anesthesiologists would be comfortable thoughtfully managing sick patients and not disparage themselves as nothing but airway monkeys performing cookie-cutter anesthetics alongside the nurse anesthetists.

Why would we want to do 5 years of anesthesia in residency? Learning doesnt stop after residency... its just another year of cheap labor.
If people want to opt that route, they can add a fellowship year. Most first world countries also have bridge programs and dont waste the full 4 years in college.

 

[dannyboy1]

That's EXACTLY the way many of us are seen by outsiders, except for ICU and cardiothoracic settings. Any medical student expecting more will have a very rude awakening.

I used to think it was our fault, but it's not only. It's the curse of the specialty. To an untrained eye, it's all about artistic impression, and very little about technical merit. Unlike our foreign counterparts, we also don't regularly cover the ICU, which makes us look even less like real doctors. I can demonstrate a lot of medical knowledge and thinking in an ICU note; it's much harder in anesthesia.

I wonder if many anesthesia attendings don't fall back to a common denominator also because they don't seem appreciated for going the extra mile. It pays much more to excel at kissing the surgical behind than at medical knowledge.

Also, in many private practices, limiting the number of available drugs is a cost-cutting measure.

Agreed. You may be the smartest doc in the room, but all that is expected is to put em to sleep and wake em up safely. Not exactly the most difficult task in the world.....

 

[abolt18]

Agreed. You may be the smartest doc in the room, but all that is expected is to put em to sleep and wake em up safely. Not exactly the most difficult task in the world.....

Until it is

 

[Drwine]

The 2 most important things to learn during training are to master your autodidactic skills and how to find and accept mentorship. Also be humble and learn to accept suggestions and help from those who you don't think are on your level.
I have been amazed that surgery practices that turn rookies loose and let them struggle and flounder instead of assisting and mentoring them.

Your goal should be to not to have the artistic impression of your clinical skills compared to Jackson Pollock. 🙈😜

 

[MDanesth]

First year out in a busy private practice (50% own cases). I don’t think I really appreciated just how difficult the transition would be. It’s a totally different ball game when there is no one to call in a pinch to bail me out. I think that’s probably an impossible lesson to simulate in residency, even in programs that afford their residents a good bit of autonomy. I find myself a bit nervous for nearly everything, even the routine cases, despite being confident in my skill set. Also, the daily grind of the stress that comes with trying to perform smoothly in the OR so as to make a good impression on partners, surgeons, anesthetists, OR staff, literally everyone... is brutal. To all the more experienced folks... does this get better? Any advice?

Happy new year!

I think some level of anxiety about such things is normal for sure, but I've seen plenty of people who would benefit from an SSRI in day to day life. There is a point where caring is good but caring too much is not. Also, peak performance is good to have a bit of anxiety, but the further ends of that spectrum become completely counterproductive and will hurt your performance if unchecked. I'm being completely serious and not a dick.

 

[IlDestriero]

Best advice is don’t be afraid to ask for help or how a senior/experienced colleague would manage a complicated case. I still do this after 20 years. Large departments dilute uncommon cases so experience goes out the window. It’s also a problem with the proliferation of small specialized teams managing most of the x cases, for those not on the x team.

 

[GassYous]

My favorite thing is to look at previous records and do it exactly the same way.

 

[rywalker84]

I can relate! Also first year out and still get nervous about starting cases. Will I get the spinal? What if I can’t intubate? And yes, despite confidence in skills. I think it’s because I feel like there is a lot to learn and see (just myriad scenarios) in my career. It leads to a lot of anxiety! That being said, getting the day going and having momentum is helpful. And I don’t hesitate to ask the OR nurses to find an extra set of hands if I feel like I need it. I get really frustrated when I do need to call but I think it’s better to have help if you suspect things could go south.

I’m in a similar boat as you guys. The spinals that really seem to give you trouble (old, poor postured patients etc) and delay the flow of the day are what give me the most heartburn now. I’m at a hospital where we do our own cases and bill fee for service. So there aren’t exactly many extra hands around unless there’s an emergency

 

[GassYous]

I’m in a similar boat as you guys. The spinals that really seem to give you trouble (old, poor postured patients etc) and delay the flow of the day are what give me the most heartburn now. I’m at a hospital where we do our own cases and bill fee for service. So there aren’t exactly many extra hands around unless there’s an emergency

Just lay them down and put in the lma

 

[2Fast2Des]

Definitely some nerves initially in practice but once I learned the system, the staff, how to get around and get things done I got comfortable. I fall back to my knowledge and training to keep me going, but I also look up stuff for things I may have forgotten or need to rehash if needed. Once you get your routine then you can start pushing things to become faster and efficient. When you work fast and are nice to work with, people notice and that buys good will. Sure it still feels ****ty when I struggle with a difficult procedure but I'm able to rely on whomever may be free to give a hand and get bailed out on the rare occasion when shtf. Keep reading sdn and learn all the tips and tricks! That's where I got many of tricks!

 

[Shimmy8]

Lot of truth in this thread:

1. Be NICE to people. Support staff, custodians, preop nurses, PACU, first assists, charge nurses, ICU nurses...maybe even a surgeon or two. Goes a LONG WAY.
2. Ask for help, and don't be afraid to help others. Extra set of hands is ALWAYS helpful.
3. Patient safety first.

 

[2Fast2Des]

Lot of truth in this thread:

1. Be NICE to people. Support staff, custodians, preop nurses, PACU, first assists, charge nurses, ICU nurses...maybe even a surgeon or two. Goes a LONG WAY.
2. Ask for help, and don't be afraid to help others. Extra set of hands is ALWAYS helpful.
3. Patient safety first.

Yes the be NICE is important. We already are disposable as it is, I've gotten protected in the past from unfounded accusations due to the fact that staff and nurses liked me. Also you'll be known as the nice doctor, since other doctors, especially surgeons, don't always treat nurses and other staff well, being a normal, well adjusted human being somehow is an accomplishment that can be exalted lol

 

[deleted171991]

Lot of truth in this thread:

1. Be NICE to people. Support staff, custodians, preop nurses, PACU, first assists, charge nurses, ICU nurses...maybe even a surgeon or two. Goes a LONG WAY.
2. Ask for help, and don't be afraid to help others. Extra set of hands is ALWAYS helpful.
3. Patient safety first.

Then why is it third?

 

[Shimmy8]

To see how long it'd take a smartass to question it?

 

[deleted162650]

Then why is it third?

My motto is Safety Third.

 

[deleted171991]

To see how long it'd take a smartass to question it?

At least I'm a smart ass.

Seriously, if one puts patient safety first, one will have to piss off some people. Some of us do put the patient first... after the surgeon and other co-workers.

 

[dannyboy1]

At least I'm a smart ass.

Seriously, if one puts patient safety first, one will have to piss off some people. Some of us do put the patient first... after the surgeon and other co-workers.

Like everything else in life there is a balance....

 

[GassYous]

Lot of truth in this thread:

1. Be NICE to people. Support staff, custodians, preop nurses, PACU, first assists, charge nurses, ICU nurses...maybe even a surgeon or two. Goes a LONG WAY.
2. Ask for help, and don't be afraid to help others. Extra set of hands is ALWAYS helpful.
3. Patient safety first.

So true. Sometimes things go south in the or, a patient has an issue in pacu or you just don't get along with someone. It's a lot easier to deal with when you have people supporting you. When you're the new guy it's hard to get the benefit of the doubt.

 

[Shimmy8]

At least I'm a smart ass.

Seriously, if one puts patient safety first, one will have to piss off some people. Some of us do put the patient first... after the surgeon and other co-workers.

Also in all seriousness, one can put the patient first, disagree with others (especially surgeons), and piss people off...WITHOUT being an ass.

I’m certainly no angel, but there are definitely times I have to take a few deep breaths and chill myself out so I don’t say something I regret. We’re just a replaceable service line for the hospital.

 

[WholeLottaGame7]

My motto is Safety Third.

Agreed. First-responder-style. Your own safety first, the safety of your crew second, the patient third.

 

[deleted697535]

I’m in a similar boat as you guys. The spinals that really seem to give you trouble (old, poor postured patients etc) and delay the flow of the day are what give me the most heartburn now. I’m at a hospital where we do our own cases and bill fee for service. So there aren’t exactly many extra hands around unless there’s an emergency

give em 30 prop, lump em on their side. shove it in, wiggle it about for 10-15 mins then flip em back and shove in an LMA, go back to buying crap off amazon and ****ty stocks

 

[dchz]

The first year out is critical to polishing your skills. Those who join a practice where they can actually DO cases are in a much better situation than those who ONLY supervise from day 1. IMHO, the best supervisors are those anesthesiologists who have several thousand cases personally performed under their belts. I really think the number needed is round 3,000-5,000 cases to become truly proficient in the field with sufficient exposure to many of the things that can/do go wrong.

There simply is no substitute or shortcut for experience.

Agree. I joined a practice that allowed me to do my own cases, tough cases. We will see how I come out the other side.

I'm also a first year attending. It was more humbling that I've ever thought: I had a two week stretch where I had a run of close calls and even had an MI on induction.

Last weekend call I literally had my first on table death. They tell me it gets easier dealing with bad outcomes. May be I'll be less emotionally invested each time but I'm sure I'll remember all those cases for the rest of my life.

Thanks y'all for all the good advice in this thread.

 

[deleted171991]

Agree. I joined a practice that allowed me to do my own cases, tough cases. We will see how I come out the other side.

I'm also a first year attending. It was more humbling that I've ever thought: I had a two week stretch where I had a run of close calls and even had an MI on induction.

Last weekend call I literally had my first on table death. They tell me it gets easier dealing with bad outcomes. May be I'll be less emotionally invested each time but I'm sure I'll remember all those cases for the rest of my life.

Thanks y'all for all the good advice in this thread.

Don't let the PTSD get to you. You're a good doctor (though brainwashed by a year of cardiac anesthesia fellowship).