Now I'm doing anethesia...

[plainolerichie]

Long story short, I applied into ortho, did not match, but scrambled into anesthesia. I did a 4 week rotation and liked it of course, but otherwise, I don't know that much about the specialty, especially the academic side of things. I can intubate okay and know the basics about the medications used, etc.

-What books would you recommend to read to help prepare for anesthesia? I had largely been studying ortho during 4th years and my fourth year rotations were heavily ortho. I had heard that learning more about cardiology, pulmonary, and renal are also great for anethesia. Do you recommend any good review books in those areas.

-What rotations must I do as a prelim? I am doing a surg prelim. I heard at least 1 month or ER, and 1 month of ICU. I do not believe I'll have too much flexibility or say in the decision however but I think I could work something out with my prelim program director. I'm still in medical school, but I cannot do any more rotations since all elective time is full before graduation.

-Any other recommendations?


Thanks for your help! It is really confusing not matching and scrambling into another specialty but hopefully it can work out. I'm still a little shell shocked, but I believe it was the right decision.

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[leaverus]

Why do you say you believe it was the right decision? First thing is make sure this is your calling - ESPECIALLY now with the new healthcare bill and the likely downturn anesthesia's going to take - cuz you're gonna be doing this for the rest of your life. Saying you "liked it of course" doesn't really sound very enthusiastic.

Anyway, it probably doesn't really matter whether you do a prelim surg or med year. I would take cards & pulm months though and the stuff you learn there should be very applicable - any standard texts in those fields should be good (West's respiratory physiology book is great). I wouldn't worry too much about reading anesthesia-specific books your intern year - you won't really have much time for that and it's probably not worth it; same for skills such as intubating, etc. You'll become expert in that when the time comes also.

 

[Pilot Doc]

Let's be nice to this guy. He's a colleague, and he came here with a good attitude.

My advice - don't worry so much about anesthesia reading. Learn to be a doctor this year. Learn the basic management of common pre and post op problems - DM, pneumonia, chest pain, SOB, hypotension, etc.

 

[countingdays]

Do 2 months of ICU if you can; they'd both count toward your 4-month requirement for anesthesia. I doubt people are fighting to be the unit intern, so it should be possible. When you get your schedule I'd book step 3 at the end of whatever your lightest rotation is (or even better follow your lightest rotation with a week of vacation and take it then). There's no sense reading too much anesthesia until after step 3. After step 3, I think some easy books to get a foundation of anesthesia knowledge are Secrets, baby Miller, or Morgan&Mikhail.

 

[Licoricestick]

Why do you say you believe it was the right decision? First thing is make sure this is your calling

Well, I guess that rules me out. Do I enjoy anaesthesia? Do I prefer it over ward based jobs or general practice? Do I think I will, one day, make a competent, safe, consultant anaesthetist? Yes, yes and yes.

Is it my calling? Heck no! It's a JOB! Certainly it's a job I've gone to a lot of trouble to get, but at the end of the day it is still a job, it doesn't define my life.

Richie - welcome to anaesthesia, if you like it - stay, and that's great. If you don't - it isn't the end of the world, you can change your mind. Sounds like you have a good attitude in terms of getting prepared. I'm not in the US so can't really offer rotation advice (still struggling with the 1 month rotation concept!) but anything that helps you get a hand on physiology - esp CVS and resp (but any physiology is good) is good experience. Pharm not so important as an intern as it is very hard to get a handle on drugs unless you're using them. But reading a basic intro text in the leadup and knowing a little bit about the basic anaesthetic drugs before you start is a good idea. I like Morgan and Mikhail - but there are a number of texts out there that are good.

Edit: And Pilot Doc's advice is probably the best - basic medical problems are very important - they are the things that are guaranteed to happen pre, intra and post op!

 

[paiute]

i think all the above advice is great: understand basic pharm and physiology. also, i would get a book on anesthesia equipment and learn the basics of how an anesthesia machine works. concentrate on safety aspects: how many ways can you kill a patient with the machine. this will hopefully keep you out of trouble.

also, if you get tired of anesthesia, its possible to get out. i did. i now do GP.

 

[IN2B8R]

i think all the above advice is great: understand basic pharm and physiology. also, i would get a book on anesthesia equipment and learn the basics of how an anesthesia machine works. concentrate on safety aspects: how many ways can you kill a patient with the machine. this will hopefully keep you out of trouble.

also, if you get tired of anesthesia, its possible to get out. i did. i now do GP.

Care to elaborate more on your practice and what is it, specifically, that you now do?

 

[MCYan]

Care to elaborate more on your practice and what is it, specifically, that you now do?

+1^

Did you have to re-do a family medicine/internal medicine residency?

 

[Doctor4Life1769]

Pretty sweet, PDs taking people who default into anesthesiology as a backup ... but spurning those who are genuinely interested in anesthesiology.

 

[igottaquestion]

doesn't one only have to complete the intern year to do g.p.?

 

[Jay K]

doesn't one only have to complete the intern year to do g.p.?

My understanding is this is possible in Texas; I'm not familiar with other states. I'd heard rumors that this might still prove problematic in obtaining privileges at hospitals and/or obtaining malpractice insurance if you've only completed an internship.

With this in mind though, my understanding is for the longest time, most ER physicians were not ER-trained physicians (ie: residency/boarded in ER), but FP or IM trained. I suppose you could always be an ER physician if you left anesthesiology or maybe an intensivist (we certainly completed training in critical care during residency).

 

[plainolerichie]

I apologize, I didn't mean to offend anyone! I was just asking about what to do or read or learn about before and during intern year since I had relatively limited exposure to more complicated and academic anesthesia other than a 4 week rotation.

 

[sethco]

doesn't one only have to complete the intern year to do g.p.?

My understanding is this is possible in Texas; I'm not familiar with other states. I'd heard rumors that this might still prove problematic in obtaining privileges at hospitals and/or obtaining malpractice insurance if you've only completed an internship.

With this in mind though, my understanding is for the longest time, most ER physicians were not ER-trained physicians (ie: residency/boarded in ER), but FP or IM trained. I suppose you could always be an ER physician if you left anesthesiology or maybe an intensivist (we certainly completed training in critical care during residency).

This practice is done all the time in the military. All of the peeps who do their intern year apply for a medical license. Most states only require the completion of your intern year and passage of steps I-III to get a license. Additionally, in a lot of these states these GMOs (or what would be called a General Practioner in the civilian world) will moonlight in clinic and urgent care centers in the local area that may or may not pay for malpractice insurance. Obviously, this would require a medical license in that state. However, it would be very hard to get admitting priviledges at most US (especially non-rural) hospitals. I know several people that have decided not to go into residency after completing their military GMO tours. They decided that it would just be easier to continue practicing in these urgent care centers than to start all over in residency. I call these people "GMOs for life".

 

[cfdavid]

regarding non-IM subspecialty---->>> PC/GP, I'd say this could become increasingly possible if the primary care shortage (with this new demand) gets too severe.

Like one of my Belorussian colleagues once said "the government can do whatever it wants". He should know as he grew up under a communist dictatorship.....

I could see a mini-certification or something. Perhaps 1 year of CME and online testing/learning. Whatever, but never underestimate the power of government these days.

 

[countingdays]

regarding non-IM subspecialty---->>> PC/GP, I'd say this could become increasingly possible if the primary care shortage (with this new demand) gets too severe.

Like one of my Belorussian colleagues once said "the government can do whatever it wants". He should know as he grew up under a communist dictatorship.....

I could see a mini-certification or something. Perhaps 1 year of CME and online testing/learning. Whatever, but never underestimate the power of government these days.

Yeah. The interstate commerce clause was definately written with the intention of giving the government unlimited power to control every aspect of your life. Thanks corrupt courts!

 

[Gimlet]

This practice is done all the time in the military. All of the peeps who do their intern year apply for a medical license. Most states only require the completion of your intern year and passage of steps I-III to get a license. Additionally, in a lot of these states these GMOs (or what would be called a General Practioner in the civilian world) will moonlight in clinic and urgent care centers in the local area that may or may not pay for malpractice insurance. Obviously, this would require a medical license in that state. However, it would be very hard to get admitting priviledges at most US (especially non-rural) hospitals. I know several people that have decided not to go into residency after completing their military GMO tours. They decided that it would just be easier to continue practicing in these urgent care centers than to start all over in residency. I call these people "GMOs for life".

There is a 40-something old guy finishing his internal medicine residency here who essentially did the same thing from the civilian side for the past 20 years. He did an internship and then left residency to pursue a career in competitive jump-rope dancing (not joking, the proof is on Youtube somewhere), earning money by basically working locums in rural ERs and urgent care centers around the midwest. He finally had to go back and finish residency because all of the hospitals stopped allowing him priveleges unless he was at least board eligible. A good gig while it lasted, I guess, but increasingly harder to make it work.

 

[Jeep23Guy]

He did an internship and then left residency to pursue a career in competitive jump-rope dancing

For some reason, that's the only part of your post I can see.

 

[Gimlet]

For some reason, that's the only part of your post I can see.

I know, right? I was a little hesitant about posting this because I know the guy and he's actually pretty cool and normal, so with that as a disclaimer...here it is:

Dr. Jump
[YOUTUBE]http://www.youtube.com/watch?v=ckp8ulsfYF4[/YOUTUBE]

 

[Jeep23Guy]

I know, right? I was a little hesitant about posting this because I know the guy and he's actually pretty cool and normal, so with that as a disclaimer...here it is:

Wow. Hilarious. He's actually pretty good, but it's still funny. My favorite part is when he does the running man.

 

[McGillGrad]

I know, right? I was a little hesitant about posting this because I know the guy and he's actually pretty cool and normal, so with that as a disclaimer...here it is:

Dr. Jump
[YOUTUBE]http://www.youtube.com/watch?v=ckp8ulsfYF4[/YOUTUBE]

This thread has officially become awesome!

 

[countingdays]

I know, right? I was a little hesitant about posting this because I know the guy and he's actually pretty cool and normal, so with that as a disclaimer...here it is:

Dr. Jump
[YOUTUBE]ckp8ulsfYF4[/YOUTUBE]

It's like a clip from Napoleon Dynamite II!