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Will somebody please tell me how many hours a week anesthesiologists work. Everyone talks about this being a "lifestyle" speciality, but I don't really see that. 
life in anesthesiology
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Hi Pick,
This is just my experience, so take it with a grain of salt. From what I've seen, anesthesia is NOT a lifestyle specialty. I think that is the biggest myth most med students hear about it.
Think about it, it's pretty simple. Surgeons are notorious for their long hours and getting called in all the time to clean up some mess (MVA, etc.). Surgeons can't operate with anethesiologists. So if a surgeon gets called in, the gas guy does too. In addition, the anesthesiologist covers OB too. So from what I've seen, anesthesiologists work pretty long hours, unless they work in a really big group and don't have to take call as often. Another thing, I'd like to mention is how CRNA's typically fit in the call schedule. The Doc is almost always called in for the first. If they need another gas guy, then the CRNA is called in.
The rest of the stuff you heard about anesthesia is true though (cool personalities, fun work environment, etc.). Any one else got an opinion on this?
Doc_Halo
This is just my experience, so take it with a grain of salt. From what I've seen, anesthesia is NOT a lifestyle specialty. I think that is the biggest myth most med students hear about it.
Think about it, it's pretty simple. Surgeons are notorious for their long hours and getting called in all the time to clean up some mess (MVA, etc.). Surgeons can't operate with anethesiologists. So if a surgeon gets called in, the gas guy does too. In addition, the anesthesiologist covers OB too. So from what I've seen, anesthesiologists work pretty long hours, unless they work in a really big group and don't have to take call as often. Another thing, I'd like to mention is how CRNA's typically fit in the call schedule. The Doc is almost always called in for the first. If they need another gas guy, then the CRNA is called in.
The rest of the stuff you heard about anesthesia is true though (cool personalities, fun work environment, etc.). Any one else got an opinion on this?
Doc_Halo
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i hate to say this... but please take everything doc-halo has to say (regarding anesthesia) with a grain of salt - he is a 2nd year med. student.
Anesthesia is absolutely a lifestyle choice!!! and nobody can argue with that... While it is true that surgeons have horrible hours, and yes they do require anesthesia providers for all those long hours - but here is the key, a lot of the surgical hours of a surgeon are NOT necessarily spent operating in the OR, instead they have paperwork and patient managament on the floor or in the ICU to worry about. And on top of it, most anesthesia groups work in shifts so that regardless of the surgery (well except for transplant, cardiac/thoracic/pedi) the anesthesia provider gets relieved after a certain amount of time - something that never happens for surgeons.
As an an attending in academic practice you would work 50 hours a week, in private practice it can range from 30 to 70 hours depending on contract and location... As a resident you work long hours during the day (6 am to 6 pm), but you have far less call per month - all in all you would average less than most medicine or surgery programs (i average between 60 and 90 hours per week). Plus the big beauty of anesthesia is that when you are done at the end of your day, you are done... no more pages, no patients to worry about --- on the weekends when you aren't on call you actually have the whole weekend to yourself... life just doesn't get better!
and what doc halo said about personality and work environment is true - very happy, congenial and relaxed...
tenesmus
Anesthesia is absolutely a lifestyle choice!!! and nobody can argue with that... While it is true that surgeons have horrible hours, and yes they do require anesthesia providers for all those long hours - but here is the key, a lot of the surgical hours of a surgeon are NOT necessarily spent operating in the OR, instead they have paperwork and patient managament on the floor or in the ICU to worry about. And on top of it, most anesthesia groups work in shifts so that regardless of the surgery (well except for transplant, cardiac/thoracic/pedi) the anesthesia provider gets relieved after a certain amount of time - something that never happens for surgeons.
As an an attending in academic practice you would work 50 hours a week, in private practice it can range from 30 to 70 hours depending on contract and location... As a resident you work long hours during the day (6 am to 6 pm), but you have far less call per month - all in all you would average less than most medicine or surgery programs (i average between 60 and 90 hours per week). Plus the big beauty of anesthesia is that when you are done at the end of your day, you are done... no more pages, no patients to worry about --- on the weekends when you aren't on call you actually have the whole weekend to yourself... life just doesn't get better!
and what doc halo said about personality and work environment is true - very happy, congenial and relaxed...
tenesmus
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Tenesma,
I've been reading your posts with interest. I hope you don't mind my asking some questions:
1. Are you satisfied with the impact you are having on your patients' life?
2. Are you satisfied with the amount of respect you receive from other specialties? (I don't expect anesthesiologists to be in the limelight, but I do believe physicians of all specialties are due some modicum of respect from their peers.)
3. How is the surgeon-anesthesiologist relationship at MGH?
4. Would it be fair to say that an anesthesiologist is free (to an extent, of course) to enjoy as much patient interaction as they like?
I've been reading your posts with interest. I hope you don't mind my asking some questions:
1. Are you satisfied with the impact you are having on your patients' life?
2. Are you satisfied with the amount of respect you receive from other specialties? (I don't expect anesthesiologists to be in the limelight, but I do believe physicians of all specialties are due some modicum of respect from their peers.)
3. How is the surgeon-anesthesiologist relationship at MGH?
4. Would it be fair to say that an anesthesiologist is free (to an extent, of course) to enjoy as much patient interaction as they like?
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Tenesmus, thanks for the input. It's good to hear a perspective on this from a more experienced position. However, I do stand by my earlier post about what I've experienced to be the case w/ gas (that's what the disclaimer in the other post was for). I'm no authority, but if you read one of my earlier posts, you would know that I grew up around the OR (my dad's a surgeon) so I got a chance to talk to some of his anesthesia colleagues about their lifestyle. I'm just relaying what they told me about their work hours. Also, I used to work nights at my county hospital, so I'd see these guys come in at all sorts of wierd hours of the night to do trauma cases. Keep in mind these guys aren't in the big city where there are tons more anesthesia docs around to spread the call with (I'm from a physician shortage area - I forgot to mention that earlier). I haven't had the chance to talk with any big city anesthesiologists yet, but I'm guessing their experience is similar to what you've mentioned. I assume you must be doing your program in the big city. Glad to see you're digging your program. Hope I can say the same in a few years.
Once again, thanks for taking the time to teach us less experienced rookies the ropes. You've reinforced my career decision even more.
Once again, thanks for taking the time to teach us less experienced rookies the ropes. You've reinforced my career decision even more.
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I am also a CA1. I have to agree more w/ Tenesmus than Doc Halo. Its true that if you are in a small group practice, as an anesthesiologist, you may be called in at all times of the day and night for emergency surgeries and c/s's.
However, Tenemus is more right. Most anesthesiologists, even in smaller city, work in group practice of something like 10 or more anesthesiologists and generally do shift work and shifts calls. They generally stay in the hospital at designated time and go home when the shift is up. This is much less true w/ surgeons.
Also, I agree w/ Tenemus also that anesthesiologists innately have it easier in hours b/c we DON'T ROUND on patients AND WE DON'T SEE PATIENTS IN THE OFFICE. All these activities take time. We are there when the surgeon is there in the OR. Now, when surgery is done, we go home. Guess where the surgeon is going? Dictating the case? Rounding on the patients preop, post op, etc? Going back to the office? We have NONE of these duties. So, you figure out why we have less hours. Its obvious!
That being said, there are always specialties w/ less hours than even anesthesia. But, then again, I was never looking for the least amount of work possible.
However, Tenemus is more right. Most anesthesiologists, even in smaller city, work in group practice of something like 10 or more anesthesiologists and generally do shift work and shifts calls. They generally stay in the hospital at designated time and go home when the shift is up. This is much less true w/ surgeons.
Also, I agree w/ Tenemus also that anesthesiologists innately have it easier in hours b/c we DON'T ROUND on patients AND WE DON'T SEE PATIENTS IN THE OFFICE. All these activities take time. We are there when the surgeon is there in the OR. Now, when surgery is done, we go home. Guess where the surgeon is going? Dictating the case? Rounding on the patients preop, post op, etc? Going back to the office? We have NONE of these duties. So, you figure out why we have less hours. Its obvious!
That being said, there are always specialties w/ less hours than even anesthesia. But, then again, I was never looking for the least amount of work possible.
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I stand corrected! Sorry to anyone if I was misleading...that certainly wasn't my intention. The stuff I posted was just hearsay from some doc's I talked to back home. I guess I must have misunderstood them. I plan on using a GREAT deal more discretion on what I post next time so this doesn't happen again.
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First, I will preface my answer with 2 caveates: 1 - I am not Tenesma & 2 - I am merely a senior medical student...in light of the above interactions, in my own experiences, what Tenesma and GasDoc describe appears to be more congruent with reality.
Regarding your questions...in a nutshell, these appear to be questions from someone who is trying to satisfy their own inner-cravings to determine their unique career aspirations. And, you are wise to ask them of folks further along than yourself. But, I wanted to point out that the answers that you seek only dwell within you. And, the "correct" answer for you is not necessarily the 'correct' answer for me, Tenesma, Doc_Halo or GasDoc...except for Q #3, which is an entirely subjective point of view.
If your concept of "Doctor & how you intend to practice as a physician" leans toward the microresolution of an internist or the high-level of personal interaction/bonding of an FP -- then anesthesiology might not be your best choice. The question of whether or not you significantly or satisfactorily impact patients' lives lies in how you define "impact". For me, to know that I watched over them while heinous things were done to them by some dude with a knife in his/her hand, prevented them from crashing, dying, hurting or remembering is a massive contribution.
The amount of respect that receive from your colleagues will be commensurate with the amount you earn and what you demand. If you do not do your job well...they will not respect you. If you walk into the very competitive, alpha-male oriented world of the OR like a meek boy, whipped pup or a sheep -- you will get the dogs set upon you. It is very much a dog-eat-dog world...do not wear milk bone flavored underwear in it!
In essence, I am suggesting that you do some sincere introspection about who YOU are and what YOU need of your personal & professional life to be successful as YOU define successful. That will go a long way in helping make your choices.
I hope my advice is helpful & does not appear patronizing -- the intent was golden.
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OldManDave,
First off, thanks for replying, and for listing your intent as golden; since you can't place an affect into emails, this helps me read your reply in the correct light.
Thanks also for telling myself (and those with similiar questions) what we need to hear, rather than want to hear.
As you guessed, I'm still preclinical; 3rd year is approaching quick, and I couldn't be happier about that.
My questions arose from some observations I've made in my work history (as an anesthesiology tech) and from other interests/observations in clinics. For instance, I've been told that traditionally, the FP/clinic-type physician-patient relationship is where the long-term relationships are formed. Yet...as pediatricians and anesthesiologists alike point out, it's becoming harder to forge such relationships 10 minutes at a time. I guess this model works in rural FP (or subspecialties like peds cardio), but other than that, many of my (admittedly still limited) observations contradict this traditional model.
I also read/listend to some med students state they enter anesthesiology to avoid pt. contact. On further reflection, this might be the point of womansurg's post in the CRNA thread. You're absolutely correct; I haven't figured this part out, but I'd like to affirm that anesthesiology would give the option to spend as much or little time with a particular patient as necessary/desired.
I've seen MDA's sit down w/ a pt. w/ PRE-op n/v, put their arm around the pt's shoulder, and hold them while they heaved; have met cardiac MDA's who spend > an hour pre-op w/ pt's and their families. Met patients who were pissed at never seeing their surgeon on operative day, but were thrilled with their pre/post-op care and personalized attention given by the CRNA and MDA.
In my experience, and this holds true for NP's/RN's/etc, the best CRNA's are those whose experience has taught them humility in the complexity of dealing w/ human pathophysiology; they know when they're in over their heads, and they're thankful to have an MD to consult with. THis same advice was independently given by at least 3-4 amazing neonatologists; always know when to call for help!
I noticed you also had an interest in peds ICU or peds cardiology; I was wondering what lead you to pursue anesthesiology rather than these subspecialties?
In the end, I'll end up moving through my clerkships, probably enjoying many/most of them, and THEN make a decision. A blessing in disguise, if you will, the inability to definitively choose a career path at this stage. Alas, nice to keep one eye on the future; if nothing else, it keeps one motivated through preclinicals!
Thanks again, OldManDave...
First off, thanks for replying, and for listing your intent as golden; since you can't place an affect into emails, this helps me read your reply in the correct light.
Thanks also for telling myself (and those with similiar questions) what we need to hear, rather than want to hear.
As you guessed, I'm still preclinical; 3rd year is approaching quick, and I couldn't be happier about that.
My questions arose from some observations I've made in my work history (as an anesthesiology tech) and from other interests/observations in clinics. For instance, I've been told that traditionally, the FP/clinic-type physician-patient relationship is where the long-term relationships are formed. Yet...as pediatricians and anesthesiologists alike point out, it's becoming harder to forge such relationships 10 minutes at a time. I guess this model works in rural FP (or subspecialties like peds cardio), but other than that, many of my (admittedly still limited) observations contradict this traditional model.
I also read/listend to some med students state they enter anesthesiology to avoid pt. contact. On further reflection, this might be the point of womansurg's post in the CRNA thread. You're absolutely correct; I haven't figured this part out, but I'd like to affirm that anesthesiology would give the option to spend as much or little time with a particular patient as necessary/desired.
I've seen MDA's sit down w/ a pt. w/ PRE-op n/v, put their arm around the pt's shoulder, and hold them while they heaved; have met cardiac MDA's who spend > an hour pre-op w/ pt's and their families. Met patients who were pissed at never seeing their surgeon on operative day, but were thrilled with their pre/post-op care and personalized attention given by the CRNA and MDA.
In my experience, and this holds true for NP's/RN's/etc, the best CRNA's are those whose experience has taught them humility in the complexity of dealing w/ human pathophysiology; they know when they're in over their heads, and they're thankful to have an MD to consult with. THis same advice was independently given by at least 3-4 amazing neonatologists; always know when to call for help!
I noticed you also had an interest in peds ICU or peds cardiology; I was wondering what lead you to pursue anesthesiology rather than these subspecialties?
In the end, I'll end up moving through my clerkships, probably enjoying many/most of them, and THEN make a decision. A blessing in disguise, if you will, the inability to definitively choose a career path at this stage. Alas, nice to keep one eye on the future; if nothing else, it keeps one motivated through preclinicals!
Thanks again, OldManDave...
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Gator5,
You are quite welcome & I am glad that you took my message in the context in which it was intended. I had no desire to appear patronizing! Thankfully it was rare, but I encountered several Docs that when I made inquiries similar to your own, their repsonse was, "you're not far enough along to worry about that...focus on xyz, and then owrry about that in another year or more". In my humble opinion, that signifies someone not sufficiently confident in their own choices as to discuss the methodology of choosing...but I digress...
Regarding pt contact & anesthesia - you are 100% on the money! I am very much a 'people person' and love, usually, interacting with patients. Anesthesia affords me the potential luxury of allocating time to them when I choose or merely inducing them when I do not wish to "bond". Crass that may seem...but I can guarantee you that even the most hard-core bleeding heart will eventually become saturated and desire 'controlled' levels of pt interaction, at least from time to time.
My choosing to opt out of pedsICU & peds cardio -- an immensely personal choice that stems from many years of caring for critically ill children. I don't want to bore you, but to add credence to my claims, I feel compelled to provide some background -- before medical school, I was Reg Resp Therapist who spent 10+ years working in pedsICU, peds trauma/ER, peds cardio & neonatalICU. I absolutely loved my career as an RRT -- it was rewarding, challenging and has provided me with a wealth of real-world knowledge/experience that has paid immense dividends during my clinical years. But, caring for critically ill children is an extremely taxing emotional roller-coaster to ride for that long. Most PI Docs "burn out" somewhere b/t 10 to 15 years...the emotional cost becomes too much.
Granted I was not a physician, but I had simply seen too much to continue in that same career path. Every PI Doc I worked with & whom I have trained with in years 3 & 4 mentioned to me, "Dave, are you sure that PICU is where you want to go? You already have 10+ years...can you spend 3 years in a PI fellowship and another 10 to 15 working? Do you have the emotional reserves to do it?". I was uncertain, but had my fears confirmed in fiery detail just before last Christmas. Now, to be honest, I was already SERIOUSLY considering trading pedsICU for anesthesia, but a single incident sealed that decision. Some woman here saw it fit to allow her b/f toss her 3 y/o son against the wall a few times for ****s & grins yielding a complete hemispheric infarct...and eventually a brain-dead little boy. The moring I walked into his room, I knew beyond any shadow of a doubt that I could no longer ride that ride any more. I have simply seen too many children suffer similar fates.
But, my affinity for caring for children remains quite strong. Within anesthesiology, I highly intrigued by the possiblity of a career in pediatric cardiothoracic anesthesia. Yes, I know these children die too...but it is generally not at the hands of their parents or a spurious bed-mate. The most gratifying elements of my RRT career lay in facilitating the survival & eventual recovery of children...or, in aiding parents & family cope with their loss. I could not ask for a more satisfying career than to continue this with an even higher level of repsonsibility.
Thanks for asking...
Best of luck to you! I hope you are able to find something that excites & thrills you the way that anesthesiology does for me.
You are quite welcome & I am glad that you took my message in the context in which it was intended. I had no desire to appear patronizing! Thankfully it was rare, but I encountered several Docs that when I made inquiries similar to your own, their repsonse was, "you're not far enough along to worry about that...focus on xyz, and then owrry about that in another year or more". In my humble opinion, that signifies someone not sufficiently confident in their own choices as to discuss the methodology of choosing...but I digress...
Regarding pt contact & anesthesia - you are 100% on the money! I am very much a 'people person' and love, usually, interacting with patients. Anesthesia affords me the potential luxury of allocating time to them when I choose or merely inducing them when I do not wish to "bond". Crass that may seem...but I can guarantee you that even the most hard-core bleeding heart will eventually become saturated and desire 'controlled' levels of pt interaction, at least from time to time.
My choosing to opt out of pedsICU & peds cardio -- an immensely personal choice that stems from many years of caring for critically ill children. I don't want to bore you, but to add credence to my claims, I feel compelled to provide some background -- before medical school, I was Reg Resp Therapist who spent 10+ years working in pedsICU, peds trauma/ER, peds cardio & neonatalICU. I absolutely loved my career as an RRT -- it was rewarding, challenging and has provided me with a wealth of real-world knowledge/experience that has paid immense dividends during my clinical years. But, caring for critically ill children is an extremely taxing emotional roller-coaster to ride for that long. Most PI Docs "burn out" somewhere b/t 10 to 15 years...the emotional cost becomes too much.
Granted I was not a physician, but I had simply seen too much to continue in that same career path. Every PI Doc I worked with & whom I have trained with in years 3 & 4 mentioned to me, "Dave, are you sure that PICU is where you want to go? You already have 10+ years...can you spend 3 years in a PI fellowship and another 10 to 15 working? Do you have the emotional reserves to do it?". I was uncertain, but had my fears confirmed in fiery detail just before last Christmas. Now, to be honest, I was already SERIOUSLY considering trading pedsICU for anesthesia, but a single incident sealed that decision. Some woman here saw it fit to allow her b/f toss her 3 y/o son against the wall a few times for ****s & grins yielding a complete hemispheric infarct...and eventually a brain-dead little boy. The moring I walked into his room, I knew beyond any shadow of a doubt that I could no longer ride that ride any more. I have simply seen too many children suffer similar fates.
But, my affinity for caring for children remains quite strong. Within anesthesiology, I highly intrigued by the possiblity of a career in pediatric cardiothoracic anesthesia. Yes, I know these children die too...but it is generally not at the hands of their parents or a spurious bed-mate. The most gratifying elements of my RRT career lay in facilitating the survival & eventual recovery of children...or, in aiding parents & family cope with their loss. I could not ask for a more satisfying career than to continue this with an even higher level of repsonsibility.
Thanks for asking...
Best of luck to you! I hope you are able to find something that excites & thrills you the way that anesthesiology does for me.
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OldManDave,
Sorry to hear about your PICU experiences, but from those intensivists I've had the fortune to speak with, seems not uncommon.
Crass? No, you mean human. Not realistic to think you'll enjoy all your patients all the time.
Just wondering if you've encountered in your travels many peds anesthesiologists/cardiac anesthesiologists who spend time rounding in ICU's? I know of some places in which the anesthesiologists split their time b/t the OR and the ICU, which sounds like another point for anesthesiology in the great game of "choose your specialty".
Were your PICU MD mentors full time peds intensvists? If so, do you think splitting their time in the ICU/OR would have eased the emotional burden?
Thanks again for your advice, wish you the best of luck in the match!
-Gator05
Sorry to hear about your PICU experiences, but from those intensivists I've had the fortune to speak with, seems not uncommon.
Crass? No, you mean human. Not realistic to think you'll enjoy all your patients all the time.
Just wondering if you've encountered in your travels many peds anesthesiologists/cardiac anesthesiologists who spend time rounding in ICU's? I know of some places in which the anesthesiologists split their time b/t the OR and the ICU, which sounds like another point for anesthesiology in the great game of "choose your specialty".
Were your PICU MD mentors full time peds intensvists? If so, do you think splitting their time in the ICU/OR would have eased the emotional burden?
Thanks again for your advice, wish you the best of luck in the match!
-Gator05
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it is funny how people say that they went into anesth. to avoid patient contact...nothing could be further from the truth... the relationship between anesthesia and patient is unlike any other, as the patient is about to go through their most traumatic experience ever (or at least close to it), and they desperately need somebody with good people skills...
there are quite a few pedi anesth who do pedi icu and quite a few card. anesth who do icu ... it is just an extension of the OR environment...
there are quite a few pedi anesth who do pedi icu and quite a few card. anesth who do icu ... it is just an extension of the OR environment...
the truth of the matter is that few medical schools require students to rotate through anesthesia. because of this, few students consider it because their perception of the field is that is boring. i was guilty of this myself. but after two years of internal medicine residency, all it took was one rotation on the anesthesia service to realize how complex, demanding, and rewarding it is with a great lifestyle to boot! the bottom line is that if more students were required to do a month of anesthesia, interest in the field would skyrocket. but then again, that might not be such a great thing with the market being as red hot as it is.
drreg
CA-2, PGY4
drreg
CA-2, PGY4
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I had to respond to this post by you drreg b/c I can't agree more. Most people see anesthesia as boring b/c they don't understand that it looks "boring" only b/c the anesthesiologist or nurse anesthetist doing it is so GOOD at it! If they weren't, the patient would be crashing andlitterally dying b/c of hypotension, hypertension, hypoxia, blood loss, and the list goes on and on.
Case in point. Only the senior and attg surgeons seem to understand the importance of anesthesia and at the same time, the dangers of anesthesia. Its really a miracle for doctors to have discover or stumble into anethesia, thus allowing us to now safely make a patient asleep and unaware to someone cutting them open.
A case in point about medical student and even unexperienced surgery residents (i.e. interns) to the importance and danger of anesthesia. The other day, we were about to extubate a patient from a neck mass excision. Unfortunately, the 300 lb patient went into bronchospasm. My attg just stepped into the room w/ me, luckily, b/c I just paged him for emergence. Anyway, the patient started DESATURATING rapidly into the 80s to like 80%. To any anesthsia related personel, including the anesthesia tech and the OR nurses, this is like "emergency...danger...react...help...panic...patient in big trouble...etc". Well, guess what? While the attending anesthesiologist and I were busily giving albuterol and bagging 100% O2 at 12 L/min to break the bronchospasm AND LITERALLY SAFE THE PATIENT'S LIFE, the ONLY THING that the STUPID or I should say INEXPERIENCED surgical intern can do was keep asking me..."What's the volume of crystalloids used?...What's the blood loss?" What's the u/o?" She WAS OBLIVIOUS TO THE FACT THAT THE PATIENT WAS IN DANGER OF DYING and that my hands were busy and that we should be focusing on the patient and not on the In/outs. Man, I was personally pissed at her. But, I didn't say anything and neither did my attg b/c we were too busy saving the patient's life. Also, the senior surgery resident was also oblivious to the desat...but at least she didn't keep bothering us for the in/outs.
Bottomline, as my attg told me, "YOU ARE THE ONLY ONE GUARDING THE PATIENT'S LIFE!"
So, once again, the patient emerges from the anesthesia safe and alive, w/o any harm done. But, to the unaware person, including that surgical intern, it was like nothing happened. Patient went in and came out. It was so easy...all that "anesthesia" person did was pass some gas and sat on his ass all the time. In the mean time, she has helped excise a mass. It doesn't matter to her that if it wasn't for the anesthesiologist/anesthetist, the patient would not be asleep for her to perform the procedure.
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i hear you...
it is funny how many times i correct a fatal problem in a patient while the surgeons are totally oblivious to it all... and i think it has to do with showmanship....
in surgery when something is going to hell, the surgeons will scream/yell/bitch/ask for the music to be turned off, etc... and thus letting everybody know that they are in deep ****... in anesthesia, it usually gets taken care of without much fanfare... and the funny thing, is that despite the surgeons best efforts to make a patient bleed we are the ones who keep the patient alive now most surgeons will take offense to that, but it is amazing how deferential they get when the patient no longer is a lap. chole, but instead a big sickie.
as to when the surgical intern/junior asks me for fluids/EBL/urine output - I usually give them astronomically ridiculous answers (EBL??? 12 liters Fluids??? 5 cc) if the situation is dire, otherwise i tell them to ask me later.
but i have to be honest with you, the more i communicate with the surgeons the better the relationship gets... they become friendlier and actually respect me (well i think they do..) I usually will tell the surgeon when the pressure starts falling, i usually warn them that the patient is getting light and may move (which pre-empts them from looking funny at me when the patient starts bucking), etc... and they in turn become more communicative, warn me about blood loss, give me a heads up on time to closure, etc...
i love my decision about anesthesia, but i have to admit i went into it with a lot of trepidation... during med school i had minimal exposure, and my exposure could be summed up as follows: "boring".... i thought there could be nothing worse than just sitting behind the screen doing nothing all day... in fact, i was doing tons of surgical sub-Is during 4th year when i realized i needed a better lifestyle - so anesthesia was a difficult choice... i even agonized over it during internship... i really thought i would start day 1 of anesthesia and be miserable... nothing could be further from the truth.... Every moment of anesthesia is exciting: preparing the patient, creating a comfortable/stress-free environment for the patient, induction and intubation, creating a smooth anesthetic so that there are no bumps or glitches, pre-emptively avoiding **** from happening, and then emerging(waking up) with minimal delay, no pain, no nausea, and relatively alert!!! it is both a science and an art, and i walk home everyday happy with my choice....
it is funny how many times i correct a fatal problem in a patient while the surgeons are totally oblivious to it all... and i think it has to do with showmanship....
in surgery when something is going to hell, the surgeons will scream/yell/bitch/ask for the music to be turned off, etc... and thus letting everybody know that they are in deep ****... in anesthesia, it usually gets taken care of without much fanfare... and the funny thing, is that despite the surgeons best efforts to make a patient bleed we are the ones who keep the patient alive
now most surgeons will take offense to that, but it is amazing how deferential they get when the patient no longer is a lap. chole, but instead a big sickie.as to when the surgical intern/junior asks me for fluids/EBL/urine output - I usually give them astronomically ridiculous answers (EBL??? 12 liters Fluids??? 5 cc) if the situation is dire, otherwise i tell them to ask me later.
but i have to be honest with you, the more i communicate with the surgeons the better the relationship gets... they become friendlier and actually respect me (well i think they do..) I usually will tell the surgeon when the pressure starts falling, i usually warn them that the patient is getting light and may move (which pre-empts them from looking funny at me when the patient starts bucking), etc... and they in turn become more communicative, warn me about blood loss, give me a heads up on time to closure, etc...
i love my decision about anesthesia, but i have to admit i went into it with a lot of trepidation... during med school i had minimal exposure, and my exposure could be summed up as follows: "boring".... i thought there could be nothing worse than just sitting behind the screen doing nothing all day... in fact, i was doing tons of surgical sub-Is during 4th year when i realized i needed a better lifestyle - so anesthesia was a difficult choice... i even agonized over it during internship... i really thought i would start day 1 of anesthesia and be miserable... nothing could be further from the truth.... Every moment of anesthesia is exciting: preparing the patient, creating a comfortable/stress-free environment for the patient, induction and intubation, creating a smooth anesthetic so that there are no bumps or glitches, pre-emptively avoiding **** from happening, and then emerging(waking up) with minimal delay, no pain, no nausea, and relatively alert!!! it is both a science and an art, and i walk home everyday happy with my choice....
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No..... they just tolerate you
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they better do more than tolerate me... i have full access to the radio in the OR - so they have to also tolerate my taste in music... i also have full access to the room thermometer - nothing like making you guys sweat for 4 or 5 hours, because the patients temperature is "33.8"
oh... and for some "strange" reasons there are quite a few surgeons among my anesthesia colleagues... most of them were surgical residents, and a few were practicing general and thoracic surgeons.... maybe they saw the light ;D
oh... and for some "strange" reasons there are quite a few surgeons among my anesthesia colleagues... most of them were surgical residents, and a few were practicing general and thoracic surgeons.... maybe they saw the light ;D
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In the grand scheme of what everyone is trying to accomplish during the time that we work together to provide patient care, there are people who are helpful, and there are people who create problems. It's clear you fall into the former category, Tenesma.
Everyone has different agendas which they hold in varying degrees of importance. Everything goes so much better when you know that your surgery team shares your primary goal of providing for the best possible experience and the best possible outcome for the patient that they share, and that it's not about being right or being the one in charge. There are lots of stories (far too many) about surgeons who generate problems where none should have existed, simply because of their egos - you guys have provided some examples. We see this across the board of medical professionals, unfortunately.
This week I did a lysis of adhesions for complete small bowel obstruction on a frail gentleman with significant COPD, CAD, CHF, and pulmonary hypertension. The decision to go to surgery was made in conjunction with the patient's personal cardiologist, as his risks were extremely high, but he would have died without intervention at this point. The anesthesiologist told the family that he would be putting in a cordis and swan-gantz catheter. The cardiologist overheard and stated - in an open, sincere fashion - that a pulmonary artery catheter would be unhelpful due to the abnormal pressures- no one would know how to use the numbers to guide fluid management. So it would be a risk without benefit. Unfortunately this other physician's fragile ego interfered with good judgement: he angrily insisted that it was HIS case and he would place whatever monitoring interventions he thought necessary.
Well, the case was delayed a good hour while he struggled unsuccessfully for internal jugular approaches. He finally got the cordis in the right subclavian on the second pass (this patient was in shock, hypovolemic, and had been instrumented frequently in the past; he was a hard stick..). He never could get the swan to float because of the guy's hugely dilated right ventricle - it just coiled up and caused a lot of ventricular ectopy. So finally we did the case, which only took about 20 minutes anyway, without the information from the swan that this guy had fought so hard for.
Two days later, after pulling this huge catheter out of a vessel with such high pressures (his PA pressure ended up being in the 90's) we couldn't get the bleeding to stop. It was like having a pencil sized hole in the subclavian artery - the patient had to sit bolt upright with an ICU nurse holding direct pressure for almost an hour. We ended up having to tranfuse him afterward. All because this doc was threatened by the idea of not being right about something (as if we will ever stop learning..).
Long story. Anyway, kudos to you for your maturity and plain old common sense. I'd be happy to see you across the ether screen on any of my cases.
regards,
-ws
T
trg2002
Hey Tenesma,
Well said. It's nice to hear someone else's opinion on anesthesiology. Your thoughts are similar to many other anesthesiologists I have spoken to. Which was one of the many reasons I am going into anesthesiology. I can't wait.
-TRG
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Originally posted by Tenesma
they better do more than tolerate me... i have full access to the radio in the OR - so they have to also tolerate my taste in music... i also have full access to the room thermometer - nothing like making you guys sweat for 4 or 5 hours, because the patients temperature is "33.8"
That is so true....It's why I control the radio
Nothing makes my day longer then Shania Twain or Celine Dion in the background
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i'd like to see you (droliver) change the radio - while you are still scrubbed - right after i put in my favorite boy-band... hehe
and bigfrank ... you don't have to worry about a pissing contest... I definitely feel surgery is a noble calling - and thank god they need anesthesiologists! i love what i do, and i have great respect for what surgeons do... we have a very symbiotic relationship (at least at my institution)
and bigfrank ... you don't have to worry about a pissing contest... I definitely feel surgery is a noble calling - and thank god they need anesthesiologists! i love what i do, and i have great respect for what surgeons do... we have a very symbiotic relationship (at least at my institution)
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Originally posted by Tenesma
i'd like to see you (droliver) change the radio - while you are still scrubbed - right after i put in my favorite boy-band... hehe
No, I think the worst was when one of the eastern European Anesthesia residents that are here put some Latvian Euro-pop on. Talk about your collective groans!!!
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Originally posted by droliver
No, I think the worst was when one of the eastern European Anesthesia residents that are here put some Latvian Euro-pop on. Talk about your collective groans!!!
LOL!!!
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Well I've been passing gas for kids for so long now that it's beyond a lifestyle, I guess in a lot of ways it IS my life, or it seems that way.
I got into this game because as a kid I spent more time in the OR as a patient than I seemed to spend any place else. Now don't laugh too hard but I harken back to the days when anaesthesia was administered by open drip Ether and if you think a mask induction in kids is difficult today, you haven't lived until you used Ether . . . need I say it's nasty stuff and makes DESflurane smell like perfume.
So I got the full treatment every time I was wheeled off to the OR. There seemed to be a never ending supply of gorillas to hold me down as I screamed for relief from the Ether being dumped onto the surface of the gauze pad suspended over my face . . . believe me it was NO FUN AT ALL.
It was always known that I would follow the family into Medicine and I chose the art of anaesthesia as my profession if only to prove it could be done a lot better than the experiences I had as a kid . . . so was it a lifestyle decision?
In some ways I guess it was, I'm still doing it and enjoying it although I'm winding down and doing more teaching. The old dogs passing on a few tricks of the trade to those that follow in his path.
Kjel
I got into this game because as a kid I spent more time in the OR as a patient than I seemed to spend any place else. Now don't laugh too hard but I harken back to the days when anaesthesia was administered by open drip Ether and if you think a mask induction in kids is difficult today, you haven't lived until you used Ether . . . need I say it's nasty stuff and makes DESflurane smell like perfume.
So I got the full treatment every time I was wheeled off to the OR. There seemed to be a never ending supply of gorillas to hold me down as I screamed for relief from the Ether being dumped onto the surface of the gauze pad suspended over my face . . . believe me it was NO FUN AT ALL.
It was always known that I would follow the family into Medicine and I chose the art of anaesthesia as my profession if only to prove it could be done a lot better than the experiences I had as a kid . . . so was it a lifestyle decision?
In some ways I guess it was, I'm still doing it and enjoying it although I'm winding down and doing more teaching. The old dogs passing on a few tricks of the trade to those that follow in his path.
Kjel
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anesthesia is absolutely not a lifestyle choice..
long hours... little respect for anesthesia services by hospital and surgeons. call is more than light.... risky.. dealing with a lot of ancillary staff.. pay is decreasing a lot..
long hours... little respect for anesthesia services by hospital and surgeons. call is more than light.... risky.. dealing with a lot of ancillary staff.. pay is decreasing a lot..
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the only lifestyle specialties left are rads (not interventional), derm, path and family practice.
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Sorry Guys Anesthesia is a total lifestyle specialty..................six months of intern year has taught me that.
Forget hours, forget money, forget respect, forget patient contact..........the true "lifestyle" aspect of anesthesia is that in 25 years i am still going to be happy to go to work in the morning.
For me no other specialty could offer that.
Forget hours, forget money, forget respect, forget patient contact..........the true "lifestyle" aspect of anesthesia is that in 25 years i am still going to be happy to go to work in the morning.
For me no other specialty could offer that.
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..........the true "lifestyle" aspect of anesthesia is that in 25 years i am still going to be happy to go to work in the morning.
this is soo hilarious. How do you know how youll feel in 25 years? Ive been at this 6 years, and im not thrilled going to work. way too much hassle! little reward. too early in the morning. and you know what? in residency i didint mind it too much it wasnt too bad.
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path? Try finding a decent job.
FP? Only if you're one of the smart ones who does a boutique, cash only, or urgent care practice: or all three combined. Most FP's get killed, dumped on, and then killed again. Now, it's usually their own fault. Oh, and you think the CRNA problem is bad? How about some NP clinics "practicing" FP coming to a street corner near you?
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Medicine in general is not a lifestyle profession. Some specialties are better than others. But even in those specialties you are responsible for some aspect of your patient's health and well being. It doesn't matter if you are in Derm/radiology, you are still responsible for making a call on that mole or breast mass/cyst. It is this responsibilty that makes medicine stressful. Anesthesiology is about middle of the road hours wise. Some specialties are better some are worse. As far as stress goes, anesthesiology is very intense at times. Almost every patient you see is or will be in an ICU like setting (OR). Some are sicker than others, but all are depending on you to keep them alive during their operation and afterwards. Most of the times things go well. You anticipated and planned for anything that should, would and could happen and you did everything you could to give the patient the best chance. Sometimes no matter what you do, things don't go well. That is just the way things are. If you are looking for a lifestyle specialty be a ski instructor or professional fisherman (or woman). You probably won't be happy in medicine because there are no true lifestyle specialties.
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Here's my perspective from 13.5 years in pvt practice:
In residency, they told me I'd work until 3pm everyday and make $400k. Well, my hours are often alot longer, but my income is also alot higher. Docs who work until 3pm in Houston make more like $250k. Docs who take call and work as partners with more variable hours can make twice that easily. Lifestyle is about the BALANCE of time away from work and the money to enjoy that time. It is also about the enjoyment of the work itself.
In my practice we work with a strict rotating departure list, such that as the ORs finish for the day, each of us is relieved in order by the next available MD that is below us in the departure list. This interchangeability is the core of our lifestyle. When I'm relieved, I am DONE for the day. I am all about home and family with no worries of the pager dragging me back to the hospital. My father was a surgeon and was ALWAYS on-call for himself, but I probably have 5 calls and a weekend per month. I work when I am at work, and I am home when i am at home. Compartmentalization. This interchangeability also allows me to "buy" time away from work, that is, I can pay someone to fill my spot on the departure list. I can buy extra vacation from them.
Of all the Docs in my large hospital, the Anesthesiologists are the most atheletic, best travelled, most "normal" ones. We are also the best insulated from external admin/political BS.
Most practices offer fixed-salary, fixed-hours positions. If you want lifestyle i suggest you seek one of these. The downside is you will make less $.
As far as respect, only YOU can really give that to you. Work everyday, imagining that no one but you will ever know the care and quality you put into it. At the end of each day, go over what you've done and make sure that you would have wanted your family treated that well. Quit looking outward for respect. Its rare and unfulfilling. We work in the shadows doing one of the most important dangerous jobs on earth, all the while trying to keep that scary thought out of out patients' minds. Once you have renounced the importance of second-hand respect, ironically, your integrity will draw the kind of attention you once sought. If you need adulation and idol worship, switch to surgery (note my Dad was a surgeon, so please know I'm not flaming).
In residency, they told me I'd work until 3pm everyday and make $400k. Well, my hours are often alot longer, but my income is also alot higher. Docs who work until 3pm in Houston make more like $250k. Docs who take call and work as partners with more variable hours can make twice that easily. Lifestyle is about the BALANCE of time away from work and the money to enjoy that time. It is also about the enjoyment of the work itself.
In my practice we work with a strict rotating departure list, such that as the ORs finish for the day, each of us is relieved in order by the next available MD that is below us in the departure list. This interchangeability is the core of our lifestyle. When I'm relieved, I am DONE for the day. I am all about home and family with no worries of the pager dragging me back to the hospital. My father was a surgeon and was ALWAYS on-call for himself, but I probably have 5 calls and a weekend per month. I work when I am at work, and I am home when i am at home. Compartmentalization. This interchangeability also allows me to "buy" time away from work, that is, I can pay someone to fill my spot on the departure list. I can buy extra vacation from them.
Of all the Docs in my large hospital, the Anesthesiologists are the most atheletic, best travelled, most "normal" ones. We are also the best insulated from external admin/political BS.
Most practices offer fixed-salary, fixed-hours positions. If you want lifestyle i suggest you seek one of these. The downside is you will make less $.
As far as respect, only YOU can really give that to you. Work everyday, imagining that no one but you will ever know the care and quality you put into it. At the end of each day, go over what you've done and make sure that you would have wanted your family treated that well. Quit looking outward for respect. Its rare and unfulfilling. We work in the shadows doing one of the most important dangerous jobs on earth, all the while trying to keep that scary thought out of out patients' minds. Once you have renounced the importance of second-hand respect, ironically, your integrity will draw the kind of attention you once sought. If you need adulation and idol worship, switch to surgery (note my Dad was a surgeon, so please know I'm not flaming).
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Great post....
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Lifestyle? What other specialty requires permission to take a leak?
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Now that I am in private practice, I think that the lifestyle is decent. It isn't 7-3 everyday and no weekends. It isn't a day spent socializing or relaxing leisurely with colleagues. The days start early and can be stressful and exhausting. We do have to take call, and in our practice we have 24 hour OB call which can result in 24 hours straight of running around taking care of fat OB patients. We take pager call once a week or more, when we are tied to our pager and have to rush in if there is a trauma.
No that being said, when we have the weekend off, it is off. No patient calls to answer. Post-call is off. Surgery center days end when the last patient leaves the PACU and the evening is free. We don't have to deal with running an office, doing piles of paperwork or dictations. My work week is about 50 hours. Maybe another extra 20 hours of pager call where I am tied to my pager. And then the rest is off. Totally off. Which is a luxury that a lot of surgeons or internists don't have.
Like others have said. We are doctors. And like all doctors we work hard.
No that being said, when we have the weekend off, it is off. No patient calls to answer. Post-call is off. Surgery center days end when the last patient leaves the PACU and the evening is free. We don't have to deal with running an office, doing piles of paperwork or dictations. My work week is about 50 hours. Maybe another extra 20 hours of pager call where I am tied to my pager. And then the rest is off. Totally off. Which is a luxury that a lot of surgeons or internists don't have.
Like others have said. We are doctors. And like all doctors we work hard.
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I'm in my eleventh year of private practice.
The first eight were spent in bum f u k egypt in a bustling, lucrative practice. Trinity Alumnus was there. He saw how hard the docs worked. That job made me, knowledge, skill, and technical wise, what I am today. I made serious bank at that job. Location Hazardous Duty Pay, so to speak.
Then I geographically limited myself. Moved. But ya know what? Its still all good. I work half as hard with less stress for about 2/3s what I made at original gig.
Today, I awaken before the alarm, set for 0517.
I have fun at work.
Some days are long, some days are early.
Most days are alotta fun.
Some suck.
I get nine weeks vacation.
I have 5 outta six weekends off.
Theres nothing materially I need or want that I don't already have.
My retirement accounts are worth way more than accounts of most people my age.
I get paid very well for what I do.
I have no regrets.
I like my job.
