Noob questions about anesthesiology

[quickfeet]

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Noob inquiry questions about anesthesiology


1. What is the extent of anesthesia patient management outside of the OR? Do you round on patients pre and post operatively and manage their meds, pain, etc.?


2. To what extent do anesthesiologist participate in the non-OR care of patients? (kind of like the last question but more expanded)


3. Is anesthesia a good specialty for critical care? What is the benefit of anesthesiology then pain fellowship vs. straight PM&R.


4. What kind of consults do you get on anesthesia? Is it just for difficult airways or what kind of other stuff?


5. Do you get annoying consults on anesthesia (i.e. expected to fix nightmare emergent scenarios in the ER at 3 am, etc.) How common is this?


6. Do most anesthesia residency programs include side-by-side training with CRNAs? Are anesthesia residents ever supervised by CRNAs?


7. What about anesthesia makes it a relatively high paying specialty?


8. What kind of internship year do peeps do in anesthesia interns do at programs which include it as part of the 4 years? Seems mostly internal medicine-based. I ask because I am more interested in doing an IM intern year as opposed to a surgical intern year (would rather not be forced into doing the latter).

 

[WholeLottaGame7]

Noob inquiry questions about anesthesiology


1. What is the extent of anesthesia patient management outside of the OR? Do you round on patients pre and post operatively and manage their meds, pain, etc.?
Depends on what you mean. Anesthesiologists will see all of their patients on the morning of surgery. Sometimes earlier if they staff a pre-op clinic or if they are already inpatients. Some will do a post-op check the following day. Typically does not involve managing pre- or post-meds with the exception of acute or chronic pain services.

2. To what extent do anesthesiologist participate in the non-OR care of patients? (kind of like the last question but more expanded)
Anesthesiologists will also see patients in chronic pain clinic, as part of an acute pain service (mostly in academics), in the ICU, in pre-op clinic, OB, etc etc. But it is not usually one person doing all of the above.

3. Is anesthesia a good specialty for critical care? What is the benefit of anesthesiology then pain fellowship vs. straight PM&R.
Yes. You will be coming from a slightly different philosophical position than surgery or IM docs, but there are pluses and minuses to each path. I don't know a ton about the PM&R path to pain fellowship, so can't talk extensively about that.

4. What kind of consults do you get on anesthesia? Is it just for difficult airways or what kind of other stuff?
With the exception of chronic pain, everything we do is a consultation. I'm guessing you mean non-OR consults, in which case the common ones are things like: patient suitability for surgery, non-OR airway management, OB management, pain management.

5. Do you get annoying consults on anesthesia (i.e. expected to fix nightmare emergent scenarios in the ER at 3 am, etc.) How common is this?
Every service has annoying consults; I don't find anesthesia ones to be particularly annoying. That disaster airway in the ER is your chance to rescue a bad situation and look like a rock star. The trick to sustained employment is be able to provide a service that no one else can provide. So if you can get a line no one else can get, fix someone's difficult-to-manage pain, or secure a challenging airway, then you are proving that you have value.

6. Do most anesthesia residency programs include side-by-side training with CRNAs? Are anesthesia residents ever supervised by CRNAs?
Many programs have CRNAs or SRNA training programs. Their presence in and of itself is not a problem. It's only a problem if they are impinging on your learning experience. Residents should never be supervised by CRNAs.

7. What about anesthesia makes it a relatively high paying specialty?
High stress, high stakes, time/production pressure, procedure-based specialty.

8. What kind of internship year do peeps do in anesthesia interns do at programs which include it as part of the 4 years? Seems mostly internal medicine-based. I ask because I am more interested in doing an IM intern year as opposed to a surgical intern year (would rather not be forced into doing the latter).
Most are a combination of IM, surgery, peds, and electives. The ratio varies according to program. If you want to do an IM-only year, you might want to look at a separate IM year and an advanced anesthesia slot.

 

[cbrons]

5. Do you get annoying consults on anesthesia (i.e. expected to fix nightmare emergent scenarios in the ER at 3 am, etc.) How common is this?

I wanna hear #5 especially.

 

[teeva]

As a resident, I got paged a lot in the middle of the night for codes on old pts who were unresponsive and when I got there they were just sleeping and the pts were like wtf why are you waking me up in the middle of the night. ****ing codes wasting my time, disturbing my sleep.

 

[teeva]

And then there's the 3am code in the ICU because some resident or fellow or attending decided to extubate a pt around 7pm or 12am and pt is failing.

 

[pgg]

I wanna hear #5 especially.

Consults for IV placement happen at some hospitals more than others.

Some ER consults for headaches which may or may not be post dural puncture headaches are frustrating. Certain ER attendings will call us for virtually any headache in a person who's had a LP, spinal, or epidural in the previous 3 months (though usually after a head CT).

Recent shenanigans of particular egregiousness:
- consult for a blood patch for a HA in someone who fell off a horse
- consult for a blood patch for a HA in someone with pseudotumor cerebri with a VP shunt who they'd LP'd (!) a few days earlier


Mostly though, consults are appreciated because they're usually an early heads up on something we'll have to deal with eventually anyway.