Leaving anesthesiology, need advice

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Agree with gypsydoc. Outside of an academic dept with a strong chair, the squeaky wheel gets squashed. I worked at a small group, did big cases, was requested by most of the staff to give their gas to them or their family members. Even in that situation we were expected to not complain, not cancel cases, just do the work. I didn't accept this, cancelled cases if the patients weren't fit for surgery and was given crap for it.

Money wins, and in a "service field" you have to do what is expected or be replaced. No matter how good you think you are, no matter how much you "own your patients" you are easily replaced. There were GIs who loudly proclaimed how they prefer the crnas because they never cared about preop ekgs or lab work, they just did the case. Needless to say, I no longer work there.

Surely there is some truth to this. Money DOES win. Always. Anesthesiology is a service business. As a friggin MED STUDENT, I had radiologists say "no, thank you" after I said "thank you" to them for doing a quicky read on some CT or whatever. It is what it is.

Do you NOT think that surgeons and others have to "play nice" when they step into clinic. They MUST sell themselves. Patients view them with incredible scrutiny, when the modern day "consumer" evaluates who's going to do a Whipple on their dad. Or, who is going to open up Grandma's chest.....

********One thing to keep in mind is that communication is paramount. Work on ways to convince that GI dude WHY doing a little bit up front BENEFITS HIM (and his patients), and PROTECTS HIM from potential disasters and liability. I feel this profession has a attracted some serious introverts that just don't know how to communicate.

Those who do? Well, just read on, they are often the ones with different attitudes towards their field and jobs (legitimate legal/political challenges aside).

cf
 
I thought that's what the surgeons always like to tell the medical students.....

Surgeons tell us if you are considering anything other than surgery then don't do surgery.
 
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Every time I read a thread like this, I wonder about the lack of respect people are talking about. Are the people who complain about constant disrespect actually dysfunctional people who need constant ego stroking? Maybe it's me that's dysfunctionally oblivious to disrespect flung in my direction. Maybe the nurses and surgeons are snickering at me when my back is turned? That seems unlikely.

I'm totally comfortable being in a "service" specialty. I know the patients come to the hospital for surgery, not anesthesia. I rarely cancel cases and when I do the surgeons don't give me crap or demand that a bully-able CRNA do the case instead.

Some surgeons are friendly and appreciative; great, we talk during the cases. If they view themselves as the most important person in the room and me as a cog in their surgical support machine, so what? Others are jerks and I'm happy to sit there silently the whole time while they bitch and moan about alimony to wife #2 or dull scissors.

A safe comfortable patient in the PACU and a paycheck are all the personal or professional recognition I need to get through the day. Anesthesia's not a good field for people who need daily reaffirmation of their worth from other people.

Outside of residency, which sucks no matter who you are, I've been treated well. I really can't see myself in any other field of medicine. I hate clinic. I hate inpatient work. I tried out path and rads as a student and again as an intern - maybe could've been happy in path, but pushing propofol in endo has got nothing on staring at pap smears all morning.
 
Man, then perhaps you're just not doing something right. Sure, I'm all wet behind the ears and naive etc. etc. (the predictable response) but I know a lot on this forum as well as many anesthesiologists personally, who love their jobs, get an adequate amount of "respect" (earned mind you), and feel well compensated and challenged.

So, what is making you, and a few others, so different? How can Noy say one thing and you another?

Maybe it IS time to change groups if it's that bad. OR, maybe you could look in the mirror and see if their's anything in your day to day behavior that may warrant a change?

Why are some more or less happy (with realistic expectations) with their careers and others so miserable. Is it REALLY the job, or is it the individual and that individual's ATTITUDE TOWARDS the job?? We should all reflect on this.

I see some dudes on this forum really embrace their measely positions as anesthesiologists (too many to name but we all know who they are). They embrace responsibility. They take ownership of their patients. They work to establish good report's with surgeons. They earn the respect of others by doing a good job, and MOST IMPORTANTLY adding value to the perioperative process. Whatever that means, and it surely means something different in different practices/institutions.

It's all up to us, people.

And let me speak to the future, for any fellow PGY1's or med students out there. I hear all the time how "impressed" people are with the quality of the anesthesiology interns. WE are currently working to EARN the respect of folks in the hospital. This isn't that hard, and it WILL translate into a more amiable environment in the OR when we work hard during our surgical months. When we take good care of post-op patients (OF SURGEONS WE'LL BE WORKING WITH very soon) in the SICU. When, on our various months, doing whatever, we work hard, take interest, CONTROL our attitudes (even when working crappy ER shifts kind of blows), taking INTEREST (even if you have to fake it and I mean that) in other specialties (thus in other specialISTS) etc. etc. It's really not that ****ing difficult. Have an attitude. Get some confidence. Do whatever it takes.

Do you know how valuable it is as a junior resident to walk up and INTRODUCE yourself to a well known/respected surgeon (or any other specialist for that matter, including those of our own specialty)???? This can be huge. Make a good first impression. Take an active role and itnerest in the care of their patients and I will gaurantee you will earn respect.

cf

Where are you doing residency? Lol, ok, it's a public forum, but seriously, you sound like a team player! I hope there are a growing number of residents with attitudes like this!
 
Since no one bit on my social prestige inquiry, let me ask this . . . why does the field of anesthesia suffer from lack of respect? It doesn't make much sense to me.
 
Everyone in the anesthesiology forum always talks about the lack of respect. I know you're referring to respect from colleagues and hospital staff, but what about when you're walking about town. Correct me if I'm wrong, but anesthesiology sounds pretty studly to the average person you meet at a BBQ. Right? That's got to count for something.

Imagine being a dermatologist or radiologist. A lot of professional respect, but out in the real world, everyone thinks you're a beautician or you put the lead apron on people getting a dental exam. Holy sh.t that would be frustrating. Half of your social interactions would turn into some bizarre attempt at qualifying your credentials to a Subaru mechanic or sandwich artist. And we all know they'd never really believe you anyway*.

*until they saw your car, but by then it's too late, you're leaving

Who cares what the schmuck at the barbecue thinks?

And why the heck does the fact that you are a doctor enter in the conversation with the mechanic or the guy fixing the sandwich for lunch?

I am not worried about what anyone thinks about my car, partly because it is a beat up hunk of junk (that is paid for).
 
Who cares what the schmuck at the barbecue thinks?

And why the heck does the fact that you are a doctor enter in the conversation with the mechanic or the guy fixing the sandwich for lunch?

I am not worried about what anyone thinks about my car, partly because it is a beat up hunk of junk (that is paid for).

If I were fully enlightened, I wouldn't give a damn what anyone thought. But I'm not.

Those are the guys at the BBQ (don't ask me why).

Get a new car.
 
Every time I read a thread like this, I wonder about the lack of respect people are talking about. Are the people who complain about constant disrespect actually dysfunctional people who need constant ego stroking? Maybe it's me that's dysfunctionally oblivious to disrespect flung in my direction. Maybe the nurses and surgeons are snickering at me when my back is turned? That seems unlikely.

I'm totally comfortable being in a "service" specialty. I know the patients come to the hospital for surgery, not anesthesia. I rarely cancel cases and when I do the surgeons don't give me crap or demand that a bully-able CRNA do the case instead.

Some surgeons are friendly and appreciative; great, we talk during the cases. If they view themselves as the most important person in the room and me as a cog in their surgical support machine, so what? Others are jerks and I'm happy to sit there silently the whole time while they bitch and moan about alimony to wife #2 or dull scissors.

A safe comfortable patient in the PACU and a paycheck are all the personal or professional recognition I need to get through the day. Anesthesia's not a good field for people who need daily reaffirmation of their worth from other people.

Outside of residency, which sucks no matter who you are, I've been treated well. I really can't see myself in any other field of medicine. I hate clinic. I hate inpatient work. I tried out path and rads as a student and again as an intern - maybe could've been happy in path, but pushing propofol in endo has got nothing on staring at pap smears all morning.

Words of wisdom.

Also, agree with cfdavid in that I've heard comments from off-service people that they love anesthesia residents because they are intelligent and hard-working. So I think as a group we are doing something right overall.
 
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This has turned into quite the thread.

The pap smears vs endo comment made my chuckle so thanks for that.

A lot of this has to come down to personal goals, wants, needs, expectations. I've been out of residency for five years now and perhaps my goals, wants etc have changed. I loved the notion of a safe, pain-free, nausea-free resting comfortably in the PACU after a big complicated case. I've saved a handful of lives because of managing airways, recognizing intraop pneumos, resuscitating traumas, septic bowels. I think there is plenty of room for job satisfaction if you are the right fit for anesthesia.

This post was not meant to dissuade any future students or current residents but do it with your eyes open. Know thyself and know what it means to be an anesthesiologist in whatever setting you choose to practice in. The money can't factor into your equation because it may not be there. Learn about the politics and legislation that may affect your profession forever. The AANA is no joke and they are working way harder than the ASA to remove you from the equation. Do a fellowship, no exceptions.

If these fairy tale practices exist then find them and join them. The ones where hard work and skill are recognized, you only are assigned challenging cases and everyone in the OR recognizes your awesomeness because you "own the patient".

I'm still in decision making stage and I am leaning towards pain. I recognize I'll be trading one set of problems for another but I think they are more in line with what I am looking for out of work. That's just me.
 
I know a lot of people reading this are thinking that I just need to suck it up and deal with it but I am with narcotized, I am ready to get out.

I also think you should suck it up. You should suck it up and do what it takes to get out.
 
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desflurane

It comes down to one thing. Do you love what you are doing? It sounds like you don't and hence, the change. I admire the courage to make a big change like you are considering. Its not easy.

I heard someone say once, "If you are not doing what you LOVE......then shame on you."
 
Luv2cut-

Perhaps it is just as simple as that. Do I love what I am doing? No, I don't. The negatives for me far outweigh the positives hence the post and the financial hit I am about to take.

As for UTSW being the post of the decade...can't agree with that. Perhaps it is the part of the country I am practicing in (NY/NJ) but every practice setting I have been in since training has been business first, medicine second. I'm friendly with many people in many groups in the area and its no different anywhere else.

Take the ultrasound for regional anesthesia example. Those of us trained to use it recognize the serious advantages it has once the operator becomes good at it. Most places I've been that had one either borrowed it from the vascular surgeons or didn't have one at all. Why? Because you can't make money from it. There is no extra reimbursement and therefore no way in the bean counters eyes to justify the cost. Block success of 100% not important enough to warrant the cost. Nerve stims are cheaper.

UTSW is perhaps in a setting where going that extra mile is recognized which is great and should provide hope for those coming out of training that yes anesthesia can be done right. The truth is the safer things get, the less value our place in the OR is. Its a simple truth the AANA is taking and running with. We know its our training and knowledge base that engenders that safety but nobody else does.
 
Well you know that the smackdown is coming if I post a reply:

Great post UTSW.. people like you are the ones I will be looking for when it comes time to leave my pp job and start my own group. As for me.. I'm now in my 4th year of practice, 2 of those were in a private setting working for a university group and the last 2 in a pure pp setting covering multiple community hospitals, surgery centers and even some scattered office work. Do I like what I do.. no.. I LOVE it.

1. That same orthopod who whines and moans if it takes me more than 3 minutes to place an interscalene block.. I'm usually back in bed or sipping drinks on my sundeck while he is driving over to see 30 patients in his office.

2. Nurses can give all the attitude in the world.. I have a woman and 2 little monsters at home who have made me an expert in selective listening. I don't need a nurse to tell me how nice my butt looks.. I need a nurse to be able to recognize the signs of a patient going south and be there with the code cart before I even say a word.

3. Work hours / lifestyle issues.. look it is always going to be a tradeoff between hours and money. That applies to you if you are a plumber or an accountant as well. There difference in anesthesia is that most of your time is billable. If you work in a well run setting you can literally bill for every minute of your work day whereas the surgeon and internist get paid NOTHING for anywhere from 1/3 to 1/2 of their total work hours. When I signed on with my group I knew that I would be joining a "lifestyle oriented group". What does that mean in the real world? An average of 30-35 hours a week which includes 1/8 call responsibility, 6 weeks of vacation and working for a boss who knows exactly how hard each and every one of his 30+ docs are working and makes sure you never suffer 2 days in a row.

A few of the more aggressive guys in my group have gone out and found locums and per diem positions at surgery and endo centers which put their incomes in the $500k range. Personally I am more than happy with the ~$300k I am making, especially as the great hours give me time to pursue several business ventures outside of medicine.

4. Self esteem issues: If you are the type of person who brings your work life home, needs constant reassurance from your coworkers or crumbles when on the receiving end of a verbal lashing than anesthesia is the WRONG JOB for you. You also need to realize that any anesthesia provider or any anesthesia group for that matter can be replaced virtually overnight and there is a constant stream of barely qualified docs and AMC's waiting to steal you piece of the pie. The only way to secure your position is to provide a service that is so far above and beyond what hospitals and surgeons have come to expect of out field that they would not consider replacing you at any price. Bringing in a new team of versed pushers for the eye rooms is easy.. replacing the in house pain service in an ortho heavy hospital is anything but.

The future of anesthesia? I think the writing is on the wall, we are either facing a drastic cut in pay or a complete paradigm shift in the current model of anesthesia practice. No matter how much or how little effort goes into the political fight the fact remains that bringing just 1000 new anesthesiologists into the pool each year will never meet that demand for anesthesia services. Remember when Clinton's health care reforms spelled "THE END" for MD anesthesia? When residency spots went unfilled year after year? That was right around the same time that one of my colleagues, a fellowship trained cardiac anesthesiologist, had to beg for a job in a university setting starting at $80,000/yr + benefits. Unless you are fully prepared to once again face that scenario I suggest you look to another specialty. For me the choice was simple, pass gas or go flip burgers as not a single other field of medicine was remotely palatable.
 
des- is moving not an option for you? Seems like it'd be easier to move to a place where the work you used to love to do is valued, rather than doing a whole new line of work just because you happen to live in an area where people have their heads up their collective asses about the value of the skills you bring to the hospital.
 
Desflurane,

for what it is worth, I had the same feelings as you did except I found out a lot of the business in anesthesiology during residency. My residency program used CRNAs to lunch out only other CRNAs. Instead of nurses getting residents out of C-sections to get another epidural in and learn more, they did the epidural UNSTAFFED and the resident usually missed lunch and didn't learn anything. this was b/c they paid our CRNAs less and wanted to keep them happy.

I pursued a pain fellowship, and it is a tricky subject. If you pursue pain (which i recommend 100%), make sure you go to an interventional program. I interviewed at 9 places and was offered positions at 8, the 9th after someone dropped out. I realized really quickly, after talking to other staff pain docs and interviewing, that if you do a fellowship in pain make sure it is interventional. Mixing up interventional pain with anesthesia makes the job much more rewarding. If you work with someone that knows how to diagnose a patient correctly, the interventions can help tremendously. also you are your own boss and work can be fun.

plus a lot of people on these forums talk a big game about ASA PAC and very few actually donate. my whole anesthesia residency program did not participate in the ASA PAC as to not piss off the nurses. if you do pain, join ASIPP and donate to their PAC..

my 2 cents.
 
How about dental school. Drilling for dollars. Seriously.

Dude, you are SO money, you don't even know it.

I would rather be a wino sleeping in a cardboard box under the freeway than to be almost any other kind of doctor.

I've always said that, if you told me I had to be a surgeon or no doctor, my response would be, "Would you like fries with that?"

I am an ER attending switching to anesthesia. This discussion makes me think medicine is becoming an unpleasant field for a lot of people. A lot of people view ER as a lifestyle field, but believe me it is not. Just like the original poster there are many things that cause ER to be a high burnout specialty. I work half the weekends and holidays, I literally do not have time to pee during a shift, the busiest times in the ER are in the evenings and overnights so the bulk of the scheduling is during that time so I am not home with my family for dinner and I still feel like I am on call multiple times a week when I am pulling into my driveway at 3am after a long shift.
My point is, it is very hard to see the details and intricacies of what the "real world" work life of a specialty will be like as you are drudging through med school and when you get on the other side it is often a surprise as to what it is really like.

Brother, your job sucks. I work 10 shifts a month in Hawai'i, and, although a slow department, virtually every one of the patients that comes in is sick - even the BS have something concrete and tangible wrong (although I have yet to have a Samoan or native Hawai'ian with fibromyalgia; the biggest losers in Hawai'i are white - not all whites are losers, but the biggest losers are whites). I don't mind the holidays and nights; I don't go home pissed off, white-knuckling the steering wheel, seething at the BS from the prior 8 or 10 or 12 hours.

The above person that said gas is like ER, where you can work 2 shifts a week and still make more than 95% of the populace, is right on. And, trust me - your 2 shifts a week kicks the ass of mine. Handily. (Up and down the court for money, and +20-25% for intellectual bones.)
 
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