How Exciting is Anesthesiology?

Yes. Except your whole purpose in anesthesia is essentially to prevent the poo from even getting in the same room as the fan...some still sneaks through. I guess you could create chaos in every single case if you wanted though. ‍♂️

If you love the crazy stuff that much, do EM.

 

I think it's high stress but most of the stress from day to day is not even due to patient care. At least for me its more due to production pressure. Feels like everyone's always in a rush, and patient care comes 2nd. 10 hour case with potential for massive blood loss and some surgeons give you push back because you want to spend a few extra minutes to put in an Arterial line. It's ridiculous. I'm sure it depends on where you work, but it feels like anesthesia is a very poorly understood field even to people who you work with in the OR.
Also, the goal of our job is to be prepared and to prevent **** from hitting the fan. I agree with above poster in that you should go into EM if you like that stuff, in a trauma center or something. Who knows what they will bring in.

I dont think CCM is very high stress clinically either. Not much stuff hitting the fan. ICU is generally a very controlled setting, there's not much ACUTE decompensation that happens in the OR

 

Anesthesia is 99% boredom and 1% terror.
Anesthesia is like submarine warfare. It's hours watching and waiting, but minutes trying not to panic and keeping the submarine afloat and not sinking.
CCM is IM at 100 mph, CCM is slow anesthesia, anesthesia is fast CCM.
EM is acute FM.
EM is like being a waiter at a busy restaurant. You're juggling a bunch of different customers with a bunch of different orders all at the same time, trying to keep them all happy, and trying not to upset management or the chefs in the back who criticize you for not really knowing what food the customer wants or when you mess up and put in the wrong order.
This is probably enough specialty stereotypes!

 

Being bored out of your mind means things are going well for the patient. If you are having a lot of excitement on a daily basis then you are doing it wrong.

 

Couldn't say it better myself, I used to do EM and switched to Anesthesia. A crazy trauma going to the OR is so much crazier than receiving in the EC and paging the consultants. Don't let ER people fool you into thinking they do 'trauma.' All they do is page the people who do it.

 

Sounds like trauma surgery may be a good fit. Hard to know for sure until you do your rotations tho.

 

For 95+% of traumas you know it’s coming, and at most academic centers (all?) the trauma surgeons are in the trauma bay waiting for the arrival along with the anesthesiology team. I’ve now worked at 3 academic institutions, and at all 3 the EM guy had minimal responsibilities beyond airway (with anesthesia as backup) and primary (ABCs) survey.

If you’re looking for crazy roller coaster balls-to-the-wall days, I guess EM is what you’re looking for. But trust me, out in the community it isn’t all crazy traumas it’s much more dealing with dispo amongst groups that don’t really want to admit.

 

I, too, was an EMT for quite some time before medical school. Almost all of my peers that became MDs went into EM with only a few going into surgery and anesthesia. Interestingly, none to my knowledge have entered primary care fields.

While I totally understand your desire for action and doing some cool stuff as a doc, nearly all of what you see on TV or imagine just doesn’t happen. Traumas should be controlled, systemic evaluations not crazy **** shows with needles and scalpels flying around. Occasionally it happens, but the best results happen when everyone stays cool and collected.

But yeah, definitely getting ahead of yourself. First you need to get into school, then get exposure.

 

If you want some crazy **** then do anesthesia at a level I trauma center / quarternary cardiac referral center.

 

“Better” is totally in the eye of the beholder. There’s literally no way to answer that question as it’s an individual decision. Pay, work hours, satisfaction and even experience is so vastly different across the country it’s not easy to just paint a broad picture.

 

I can tell you we see some crazy stuff at a major pediatric hospital, but that’s not every day in your room. Every day for sure though. Modern technology and proper prior planning make Anesthesia safer than ever, but there’s still plenty of gray hairs being made.
Look hard at surgery. There’s something to be said for being the man and the buck stops there with you every day.


--
Il Destriero

 

Do you find it exciting watching someone die in front of you? Do you find it exciting watching someone breathe for a couple hours? Anesthesia is, on average, somewhere in the middle.

 

CCM is rarely high stress, and even then there are usually many hands on deck. When I am in the ICU, I am on vacation (we also have an easy caseload).

 

Like many other cases, trauma doesn't really need a doc on this side of the drapes, just a skilled "provider".

Large bore IVs, fluids, warming, transfusions, what's the big science?

 

I'm a second year EM resident at a level 1. Anesthesia doesn't even come to the traumas. We intubate, cric, chest tubes, lines, do reductions/sedations, etc. As third years we run the show (except actual surgeries which is the vast minority of traumas). Out in the community, the ED doc is the trauma doc and anesthesia. There is no "paging the people who do it" at a critical access hospital.

In my opinion, I would much rather get a sick trauma patient, stabilize them/do some quick procedures, then ship them to somebody else to mess around in the OR for hours, make them poop post op, find a nursing facility for them, etc. (Guess that's why I did EM)

That said, the majority of EM is primary care. But if you want that crazy/SHTF situation, the ED is probably the best place. Gangs dropping off GSWs to the chest in the ambulance bay, COPD'er with a silent chest rolling in, etc. ICU/OR is usually controlled. By that point, they have labs/a diagnosis/a plan/etc. (like others have said - it is your job to prevent **** from hitting the fan at that point).

 

Of course a lot of surgeons think they are perfect and that an 8 hour, 10 level spine fusion has blood loss of 5 cc. Your placement of an a-line, large bore IV's, or getting blood T+C is you implicitly telling them that they aren't the scalpel maestros they think they are. These surgeons exist everywhere, and it's usually the less capable ones that are more likely to give you push back.

 

Telling the CRNA that no, etomidate isn't needed for the patient who was brought up from the ED coding, telling the CRNA not to hyperventilate the TBI to etco2 25, telling the CRNA that more cryo and plts are needed for what looks like evolving DIC, telling the CRNA that the acidosis isn't improving because 5% albumin is 95% NS, telling the CRNA that yes, we do need to monitor the pt's temperature when they're trying to bleed to death, telling the CRNA that 99.9% of VATS can be done with a 37 or smaller DLT, telling the CRNA that the heart is totally empty, there's no tamponading on TEE so turn the epi down and hang more blood, telling the CRNA to hand over the a-line/IV needle cause they're taking too long and making a mess etc etc etc

 

LMAO at OPs handle

 

sounds like your program might be a busy, underfunded, county hospital!!

 

I think the summation here, for the OP, should be there are a bunch of exciting fields that deal with SHTF situations. At my house, anesthesia is present for and knuckle deep in what is quoted here. It definitely varies between institutions, both small and large. My best advice would be to do some rotations in the fields you find exciting and see where your flag drops. There's a lot of straightforward and routine in all aforementioned specialties, so you really need to make sure you enjoy that part too.

 

The other thing to keep in mind is that whatever you go into will become routine. The adrenaline rush is unlikely to last your entire career so make sure you enjoy the management of these situations too. It has been surprising to me how quickly any situation can become routine. One of my newer attendings commented on how she recently felt established the first time she walked into a room with a coding kid and didn't have that adrenaline rush, it was just part of the job that she enjoys and is good at.

 

THIS....THIS will be the reality for >90% of current anesthesiology residents.

 

That may be true for the CRNA who seldom does trauma cases, but not for the one who does one every week. Again, not rocket science (for the most part), and, for the complicated cases, there is always a sucker/firefighter, aka physician anesthesiologist.

 

SHTF gets old fast (especially as one ages) and is not worth it except for the proper pay (which mostly happens only in EM). Don't forget the malpractice component.

I had to do a critical care fellowship to figure out that the best job for me would be a 7-3 ambulatory surgicenter working solo. Boring is good. So are normal hours, no calls/weekends, no midlevels, low malpractice risk, working at the "bottom" of one's license.

 

I used to feel stressed and rushed, but then I realized it's not my fault that these slow aholes booked 2 5 hour cases that everyone knows will take 8 hours each. Our attendings are good about keeping them away from us while we're working and I have no problem giving **** to surgeons that messed with me. Oh, you're redoing that stitch? Seems like this closure is taking a lot longer than with dr other resident

 

Yeah, until you look at your paystub.

 

Trauma surgeons have to do every lap chole (with insurance) they can find to put food on the table.

I'll put snark on hold so you can understand a little better. For the most part (I'd say greater that 95% of the time) a trauma surgeon has to work in a major city hospital where the majority of your patients aren't paying (insured) customers. So that GSW for the chest is taking up more of your time rather than paying your bills. It's all relative. The urologist buddy of the trauma surgeon is driving his Porsche home while the trauma surgeon is waiting for the next knife and gun club patient in the hospital.

You may have the need...the need for speed now, and I'm not sure your financial situation, ie debt, but once you're done with medical school that radiology residency may start to look good. Again, at least the paystub will look good.

 

No. We are actually on the lower end. Being in a tort reform state also helps tremendously.

 

I like: “Are you closing by 2nd intention?”

Or: “Man, it’s Vicryl vs fibroblast over there.”

 

Geez, get a job where you don't have to work with nurses.

 

I'm going to have to steal that one.

 

I stole it from one my mentors/heroes/smartest human I’ve ever met, John Drummond.

 

It cuts both ways. I've seen many anesthesiologists who insist on putting in (very slowly) A-lines on every robotic prostate. Here's a tip. If they're sick enough to need an A-line for that surgery, they probably don't need their prostate out. Alternatively, we've found ourselves with crap access and no art-line on giant partial nephrectomies in solitary kidneys. There is fault on both sides, and what is needed is open and honest communication between surgeon and anesthesiologist before cases. The problem is half the time they don't even cross paths because anesthesia tubes and leaves while surgeon isn't in room until prep is dry.

 

Well then the surgeon needs to be in the room for communication to happen. Are we supposed to chase them around the hospital?
Sometimes a lines are put in for other reasons besides severity of illness. For example an 8 hour robotic prostatectomy comes to mind from residency.

 

While I understand and agree with your general idea here of communicating effectively, your "pro tip" is unfortunately way off.

1. We don't decide whether the patient gets their prostate out, that is a decision made long before we see them on the day of surgery. This is 'murica and in the land of entitlement an 85 year old sick patient will get his prostate out if he wants to. Our goal is to optimize them and keep them safe from the surgery and anesthetic with whatever horrible como4bidites they have.

2. We don't choose to put in art lines slowly. In fact to the contrary we like to put them in quick. Maybe you think it's slow and a waste of time but consider that our prep work usually takes 10 to 15 minutes while your surgery takes xxx hours. In the scheme of things not long at all. What I see often are surgeons complaining because we spend literally 30 seconds putting in a second IV while they muck around for hours and have a medical student do a 45 minute closure.

3. In my experience it is almost always the surgeon who is unavailable or refuses to listen. We don't bring up important issues after intubating the patient. We bring them up before the patient goes into the OR.

4. Just like surgeons there are some anesthesiologists who are more conservative and others that are less conservative. We gladly take your input and opinions about what you think regarding blood loss and timing. That helps us plan the anesthetic. But we don' really care if you agree or disagree when it comes to placing an art line or whatever other procedures or monitors we feel is necessary. Our service is first and foremost to the patient and his/her safety.

 

Most academic/urban centers will want a fellowship-trained trauma surgeon. There are plenty of them out there.

Again, this is sort of where it’s hard to discuss things since you aren’t in medical school yet.

 

1/4. I get it's not your job to decide surgical indications. And I also get that some patients may have indications for more intensive monitoring. Putting an A-line in on EVERY prostate as many of our anesthesiologists do is wasteful and inefficient. I have trouble believing that is personalizing care to the risk of the patient and doing what is necessary.

2. I know anesthesia is (usually) not trying to be slow. Many (in academia) give little thought to going fast, however, as it doesn't effect their bottom line or when they get home. Incentives are a powerful thing. After years at an academic center I was utterly blown away by what a experienced and motivated anesthesia team could accomplish at our affiliated surgicenter. Of course there they don't work in shifts, they stay until the day is done, so motives are aligned.

3. Before the OR is as it should be. Communication could break down on both sides, but generally I agree the buck stops with the surgeon and its my job to make sure you're aware of potential issues from the operative standpoint with the case just as you need to let me know forseen anesthetic issues.

 

1. I'm not going to put in an a-line for a reasonably healthy patient going for a robot prostate, unless there is a SURGEON factor here. (Are you THAT surgeon?) I think the vast majority of anesthesiologists feel the same way -- that arterial lines are advanced monitors and not indicated for routine healthy patients. either your hospital anesthesiologists are uber conservative or you are being a bit disingenuous.

2. Ditto. You think we like to anesthetize a patient for a 3 hour lap chole? It happens in academic medicine. That's where people learn. Just as there are surgery residents there are anesthesiology residents. If you can't understand this then there's no point even trying to have a discussion with you.

3. Most of the time the breakdown in communication exist for the very reason YOU just pointed out.... that the surgeon is rarely around until they are ready to cut. I page them, talk with their PA or residents with concerns. I don't bring a patient back into the OR until I am satisfied.

 

1. Indications for an Arterial line: 1) CPB 2)Tight BP control 3)Frequent blood gas analysis

2. As was said about, everyone, and I mean everyone is slow in academics because it's a learning environment. You see fast anesthesiologists in surgi-centers because they are likely very experienced and very confident. When I was a resident I used to be so hesitant to turn off my gases/infusions because the patient may "wake up". Well hell, in private world, surgeons are fast so you need to know how to wake someone fast. Those things don't always align in academia

3. Communication is frequently an issue in academia because academics is far from collegial. Surgery residents are annoyed by anesthesia residents and vice versa. The same with attendings. Again, in the private world we all work together everyday. Residents and in flux every 4-5 years.