Legitimate Question

[baller71457]

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As someone who is researching potential fields i have what I believe is a very legitimate question. Why would ANY anesthesiologist endure the rigors of medical school and all the additional training it takes to become an anesthesiologist finish their training and NEVER do another case by themselves again?

(please excuse spelling and grammatical errors....posting from my iPhone)

 

[rsgillmd]

As someone who is researching potential fields i have what I believe is a very legitimate question. Why would ANY anesthesiologist endure the rigors of medical school and all the additional training it takes to become an anesthesiologist finish their training and NEVER do another case by themselves again?

(please excuse spelling and grammatical errors....posting from my iPhone)

Never is a pretty strong word. You are mistaken in probably most places to use it.

 

[ProRealDoc]

As someone who is researching potential fields i have what I believe is a very legitimate question. Why would ANY anesthesiologist endure the rigors of medical school and all the additional training it takes to become an anesthesiologist finish their training and NEVER do another case by themselves again?

(please excuse spelling and grammatical errors....posting from my iPhone)

There are several practices where anesthesiologists do their own cases. In the majority of situations and mostly for financial reasons, supervision of midlevel providers is the norm.

 

[baller71457]

Never is a pretty strong word. You are mistaken in probably most places to use it.

Very true. However, at the few places I've shadowed the docs don't do any cases. He usually comes in for the start of cases and makes frequent visits in and out of rooms

 

[imfrankie]

You can do your own cases if you want. Plenty of practices have the all MD model.
There are advantages to both--independent of the financials.

 

[Ellie321]

If the anesthesiologist's main role becomes supervisory in nature, do they lose or become less proficient with their procedural skills?

 

[countingdays]

As someone who is researching potential fields i have what I believe is a very legitimate question. Why would ANY anesthesiologist endure the rigors of medical school and all the additional training it takes to become an anesthesiologist finish their training and NEVER do another case by themselves again?

(please excuse spelling and grammatical errors....posting from my iPhone)

I think you are mistaken in your assumption that the goal of training for all Anesthesiologists is to do cases alone. Some people want to do that, others don't. Some want a mix.

You have to be able to do cases yourself to know what it going on in the OR to adequately supervise and get more actively involved as needed. I think most people who supervise don't think watching one patient at a time and charting vitals is the best use of their training.

You view supervision as a negative. Many anesthesiologists view it as a positive to be able to care for more patients.

Doing cases yourself is great for some people, but supervision isn't the negative you assume it is.

 

[countingdays]

If the anesthesiologist's main role becomes supervisory in nature, do they lose or become less proficient with their procedural skills?

Depends on your practice and who does the procedures.

Where I'm going to work after fellowship this July, it is mostly supervision in the day, and doing your own cases in the late afternoon and on call. The procedures (lines, blocks, epidurals, tee) are performed by the docs so if anything, it will allow for better refinement of procedural skills since I'll have probably three times as many patients to do procedures on compared to an MD only practice.

I think you'd find that the vast majority of ACT practices tend to have docs doing the procedures and nurses doing intubations and interop monitoring. More senior folks on here can comment on their experience, but I suspect that maintaining your skills isn't much of an issue in most practices.

 

[imfrankie]

If the anesthesiologist's main role becomes supervisory in nature, do they lose or become less proficient with their procedural skills?

Realize also that your pure procedural numbers can actually go up dramatically with supervising.

 

[jetproppilot]

As someone who is researching potential fields i have what I believe is a very legitimate question. Why would ANY anesthesiologist endure the rigors of medical school and all the additional training it takes to become an anesthesiologist finish their training and NEVER do another case by themselves again?

(please excuse spelling and grammatical errors....posting from my iPhone)

Lemme ask you a question, Baller...

When a cardiologist admits a congestive heart failure patient to the ICU which requires diligent nursing care...including but not limited to: meticulous ins and outs, titrating nitroprusside, documenting SWAN numbers and communicating them to the cardiologist...lasix...beta blockers...

UHHH DUDE A CARDIOLOGIST DOES

none of this personally.

Zero.

He just gets reports, and tells the nurse to adjust accordingly.

DOES THAT MEAN ITS NOT HIS CASE?

 

[baller71457]

Umm dude I think that is an extreme comparison and you know full well what I meant by "doing your own cases". However, in your example the cardiologist made the diagnosis and prescribed the treatment. That is exactly what he was trained to do. During his cardiologist residency he wasn't titrating drips, emptying bed pans, etc. During anesthesia residency are you supervising are doing your own cases? "sitting the stool" as I've heard some people say

 

[Stillwater45]

As a CA-1 resident who just finished a weekend call shift I can tell you that an Anesthesiologist skill set is very well served by supervising. Compare my role this weekend to my upperlevel CA-3 to my attending. I "stool sat" for the most part and managed my own cases while CA-3 who was acting as a junior attending helped pre-op, induce, supervise, and wake up with me and the 2 other CRNA's also working. Our Attending oversaw all of this and also managed L and D and oversaw us on Codes and Rapid Response intubations on the floor. Over the weekend (Fri/Sun) I personally managed 7 cases and 4 RRI's. My upper level managed well over 15 and my Attending managed >30 at least.... Your responsibility and roles change as you progress through residency and through your career.

So why go to medical school to do what we do?

My favorite attending always says "you get paid to think" or otherwise known as "medical decision making". This decision making stands on a foundation of knowledge that is acquired during the first two years of medical school and refined during the last two years and residency. Remember those first two years when our solitary focus was to cram as much information in our heads as possible and we never felt like there was enough time to learn everything because there was such a vast amount of detailed information....that experienced can't be bypassed. There is no shortcut for that. Then the next two years where we put that knowledge into practice and rotate through all the different fields of medicine and learn to MANAGE patients... those two years can't be bypassed either. All the nursing midlevels like to talk about how they "manage" patients as nurses but I would argue that the person who truly manages the patient is the one who writes the order, not the one who carries it out.

When it comes to procedures its the same idea.... you have the monkey skill aspect that we all have to learn and then you have the management aspect (indication, differential, potential complications) that is truly important. Monkeys could be trained to start IV's, Drop probes, block nerves. Medical decision making involves knowing the indications, variant anatomy, potential complications, diagnostic and therapeutic management potential for every procedure that you perform.

So yes, a medical education is well served in the field of Anesthesia. Im still learning that every day.

 

[rsgillmd]

........
My favorite attending always says "you get paid to think" or otherwise known as "medical decision making"......

👍👍

 

[sevoflurane]

As someone who is researching potential fields i have what I believe is a very legitimate question. Why would ANY anesthesiologist endure the rigors of medical school and all the additional training it takes to become an anesthesiologist finish their training and NEVER do another case by themselves again?

(please excuse spelling and grammatical errors....posting from my iPhone)

As mentioned, never is a very strong word and unrealistic.


There are extremes in both directions: Practices exists where CRNA take care of ALL OB cases that hit the floor. In other words, over the course of a year , CRNA’s are prolly sinking in more epidurals than any MD in that particular practice. I know of a practice that let the surgery PA’s place a-lines and swans pre-bypass (I kindly declined an offer to join that group because it was not what I wanted for me or the specialty).

Although I have not worked in the ACT model, I’m sure that an anesthesiologist gets plenty of procedural experience. Think about it... An MD running 3 ortho rooms and a vascular room. To me that sounds like a busy day of regional + some lines. How often that actually happens depends on the Hospital/ASC volume and how many orthopods/vascular surgeons are present.

Generally, the further west you go the more autonomy you will get in regards to solo practice. You’ll likely sacrifice income, but that is OK. Some are fulfilled with this model. As mentioned above, there are plenty of those still around, and not all are paying out $300k a year.

My practice is in a small community hospital of 300 beds. All specialties represented except for trauma, transplant and sick peds.

A couple of weeks ago I had 4 TKA’s (4fems, 4 ant. sciatics), 3 C/S (3 spinals), a couple of epidurals, a couple of chillaxin appy’s/chole’s, and a ruptured AAA that came in the middle of the night (a-line, mac catheter, and epidural post-op). Except for the ruptured AAA, it was a pretty typical call day.

I think there are plenty of procedures to keep one busy in the MD solo and ACT model. Both require medical decision making throughout the day/night/shift.

Anesthesia is pretty sweet regardless of the model you choose, and this is why you should elect to come into the specialty.

 

[baller71457]

To sevo and Stillwater, thank you for your insight. I hadn't thought of things that way. And to everybody else please don't mistake my question as an insult to the supervisory role. It was just a question that came up and non of the docs I shadowed really gave any clear answer to it.