Part time anesthesiologists?

[echod]

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This question is for attendings. How confident about your skills would you be if you practiced anesthesiology part time for only 1 day out of the week? Would you have any concerns for the safety of your patient because of rusty skills, etc? Thanks a lot!

 

[imfrankie]

This question is for attendings. How confident about your skills would you be if you practiced anesthesiology part time for only 1 day out of the week? Would you have any concerns for the safety of your patient because of rusty skills, etc? Thanks a lot!

Depends on how long you'd practiced prior, how many cases you'd done, what kind of cases you were going to be doing the one day per week, whether it was going to be primary provider or supervised cases... Many factors.

 

[jetproppilot]

This question is for attendings. How confident about your skills would you be if you practiced anesthesiology part time for only 1 day out of the week? Would you have any concerns for the safety of your patient because of rusty skills, etc? Thanks a lot!

I'll answer your question by reflecting on an interaction with a buddy of mine.

Said dude and I owned an aircraft together.

My partner in the aircraft we owned, dude's name was Larry.

Larry is a

CORPORATE PILOT.

Flys like 800 hours a year.

Pilots out there get that number.

For my (unfortunate) non pilot friends, dudes, Larry spends an INSANE AMOUNT OF TIME FLYING AIRPLANES.

Assume Larry knows how to fly.

Larry has confided in me: "Jet, when I take a week or two off, my instrument approaches aren't as CRISP."

Here's a pilot that flies for a living, almost every day, and when he takes a week or two off his instrument approaches feel different to him.

Larry has been flying airplanes for forty years.

Back to your question,

There's alotta similarity between anesthesia and flying an airplane.

Larry The Stud Pilot feels a difference in his instrument approaches after

JUST A CUPPLA WEEKS OFF.

So you tell me.

 

[epidural man]

I'll answer your question by reflecting on an interaction with a buddy of mine.

Said dude and I owned an aircraft together.

My partner in the aircraft we owned, dude's name was Larry.

Larry is a

CORPORATE PILOT.

Flys like 800 hours a year.

Pilots out there get that number.

For my (unfortunate) non pilot friends, dudes, Larry spends an INSANE AMOUNT OF TIME FLYING AIRPLANES.

Assume Larry knows how to fly.

Larry has confided in me: "Jet, when I take a week or two off, my instrument approaches aren't as CRISP."

Here's a pilot that flies for a living, almost every day, and when he takes a week or two off his instrument approaches feel different to him.

Larry has been flying airplanes for forty years.

Back to your question,

There's alotta similarity between anesthesia and flying an airplane.

Larry The Stud Pilot feels a difference in his instrument approaches after

JUST A CUPPLA WEEKS OFF.

So you tell me.

Jet,

compare an instrument approach - to what kind of case in anesthesia?

My point is - an instrument approach is the more difficult correct?

OP - I probably do a little more anesthesia then that, but I agree with Jet. Sometimes, I feel really uncomfortable - not that I think the patient isn't safe - I can do that, I'm good at that - good at recognizing early problems, changing things to make the case smoother, etc. But I am not as smooth as I once was.

I did a tonsil a few weeks ago and I hadn't done one in a long time. It was kind of choppy and slower turn around than someone that does them all the time. But at no point was the patient in danger or were there problems. It's a finesse thing.

Also, at my hospital, I have incredible back up 30 seconds away. I think that helps me feel safe. I would be scared moonlighting in a hospital in a small town, with no backup, and surgeon pressing me to do cases that were questionable and way - suboptimal.

Ultimately, I think you would be fine doing part time. But you would feel more stress I think.

 

[UTSouthwestern]

Jet,

compare an instrument approach - to what kind of case in anesthesia?

My point is - an instrument approach is the more difficult correct?

OP - I probably do a little more anesthesia then that, but I agree with Jet. Sometimes, I feel really uncomfortable - not that I think the patient isn't safe - I can do that, I'm good at that - good at recognizing early problems, changing things to make the case smoother, etc. But I am not as smooth as I once was.

I did a tonsil a few weeks ago and I hadn't done one in a long time. It was kind of choppy and slower turn around than someone that does them all the time. But at no point was the patient in danger or were there problems. It's a finesse thing.

Also, at my hospital, I have incredible back up 30 seconds away. I think that helps me feel safe. I would be scared moonlighting in a hospital in a small town, with no backup, and surgeon pressing me to do cases that were questionable and way - suboptimal.

Ultimately, I think you would be fine doing part time. But you would feel more stress I think.

I will chime in on this topic in that I am now effectively part time due to my medical condition. Have had very light weeks of work and days off unexpectedly and long gaps between doing kids, hearts, scoli, etc.

Along the lines of your tonsil, I had not done pedi ENT since maybe March due to my susceptibility to infection and had to do one recently. It went very smoothly. I feel that the volume I had done previously allowed me to treat that situation as "riding a bike" rather than an "aircraft instrument landing". I personally feel you reach a critical mass of case load for each case type that allows you to have longer gaps in practicing without compromising smoothness and efficiency. Also at that point, your need for backup manifests only in situations where an extra pair of hands would be useful but not necessary.

It is one of the main reasons I picked a residency program where I could get as much volume as possible in every case type and likewise picked a group to work with that sees high acuity and volume.

I have worked locums to help a friend who owns a locums placement company and worked at some truly astronomical ****hole facilities. In those situations, I would take charge and ensure that the patient's health took priority over a surgeon's ego or cavalier approach. I find it unacceptable that a surgeon would try to push an anesthesiologist to start a procedure that a facility is not qualified to support except under true life threatening conditions preventing transfer to an appropriate facility for appropriate level of care.

 

[eosinophilic]

Dont most of the pain and critical care dudes practice anesthesia part time?

Like a week on week off for critical care

And from what Ive seen pain guys do a couple days of clinic each week and get back to the or on the other days.

 

[nycitygas]

Sheeet, what happens when you spent a year running the ICU for fellowship?
Have u noticed those attendings being slow or unsafe?

I'll answer your question by reflecting on an interaction with a buddy of mine.

Said dude and I owned an aircraft together.

My partner in the aircraft we owned, dude's name was Larry.

Larry is a

CORPORATE PILOT.

Flys like 800 hours a year.

Pilots out there get that number.

For my (unfortunate) non pilot friends, dudes, Larry spends an INSANE AMOUNT OF TIME FLYING AIRPLANES.

Assume Larry knows how to fly.

Larry has confided in me: "Jet, when I take a week or two off, my instrument approaches aren't as CRISP."

Here's a pilot that flies for a living, almost every day, and when he takes a week or two off his instrument approaches feel different to him.

Larry has been flying airplanes for forty years.

Back to your question,

There's alotta similarity between anesthesia and flying an airplane.

Larry The Stud Pilot feels a difference in his instrument approaches after

JUST A CUPPLA WEEKS OFF.

So you tell me.

 

[Masseter Spasm]

As a junior attending you can not become a competent clinical anesthesiologist, when you only work 1 day a week in the OR, ICU, etc.

Academic organizations seem to allow/encourage this. Typically these attendings supervise and are only paired with individuals who can protect their patient from their clinical incompetence. (e.g. senior resident or fellow) Or they are assigned to an "easy" room (e.g. cataract, cystoscopies, etc.) Because they work so little clinically, it is not safe to assign them to the call schedule.

Once you have 10-20 years experience, you may be able to minimize your clinical work. The breadth of cases you feel comfortable doing, however, will likely narrow. You may feel uncomfortable doing peds, cardiac, major vascular, etc.

 

[cchoukal]

Sheeet, what happens when you spent a year running the ICU for fellowship?
Have u noticed those attendings being slow or unsafe?

I did this and I didn't feel slow or unsafe. I am frequently approached to help others, in fact, and to "poke my head in" when something isn't going well.

I did, however, have a number of small events when I first started. IV blew on induction (right after drugs were pushed), a can't-intubate-can't-ventilate, and a few other minor things. You get back up to speed pretty quick!

Could I bang out a T6 epidural without some anxiety? No, I could not.

Currently, I do about a week per month in one of 4 different ICUs, and average 3-4 days in the OR each of the remaining weeks. I don't know if that counts as part time or not.

 

[IlDestriero]

Could I bang out a T6 epidural without some anxiety? No, I could not.

Weak. 😉
I've gone a month before and 2 wks for Vaca, etc. My only problem is I forget my locker combo.😕
I think 50% is probably fine, unless you are taking months off at a time.

 

[octane11]

i would venture to say that almost 50 percent of the chairs of anesthesia.. NEVER GO TO THE OR..... another 35 percent only one day a week and the remainder work full time in the OR. certainly they dont take call.. SO WTF?

 

[nycitygas]

Thanks thats comforting!
How did you like your UCSF CCM experience?

 

[cchoukal]

Thanks thats comforting!
How did you like your UCSF CCM experience?

Liked it enough to stay on faculty. Pros and cons, like anywhere. I'd be happy to answer specific questions if you PM me.

 

[kmurp]

I agree with Jets' first posted opinion. It reflects my own experience. On a related note, I was having a discussion with my partners about peds. We used to see a decent amount of healthy infants. Now it's rare, maybe 6-8 a year in our practice. I wonder if we should refuse to do any of these 3-4 mo olds at this point. It's hard to remain comfortable...

 

[IlDestriero]

We get healthy teenage transfers all the time for simple fractures, lap appys, etc. I think the surgeons just don't want to do them, or they don't have the super premium insurance, so they dump them on the children's hospital. They're a nice change from the usual train wrecks that get added on.

 

[MTGas2B]

Sheeet, what happens when you spent a year running the ICU for fellowship?
Have u noticed those attendings being slow or unsafe?

I "took a year off" while I did my critical care fellowship. I definitely felt a bit rusty getting back in the OR. However, things came back quickly. I too had a number of "fun" situations hit me when I was up and running after fellowship. A can't intubate, can't ventialte patient, machine failure mid case, several awake fiberoptics. It went fine.

Back to the OP, if you were going to come out of residency start practicing one day a week, you could probably do okay, especially if had a relatively narrow population in your practice. However, if five years later you went looking for a new job making the leap somewhere else might be tough. Personally, I think it would be in one's best interest, irregardless of residency experience, to work full time at your first job and try to get a solid broad experience, such as a community hospital. My $0.02

 

[periopdoc]

In all deference to Jet, I think it is more like riding a bike. Once you learn, it is pretty easy to get back on and go for a leisurely ride (do the straight forward case). You may be a little wobbly at first, but you will quickly get back into the groove.


However


You won't be the X-games BMX'er of riders (anesthesia rokkstar) if you don't practice every day. The tough cases that the regular guy can pull off without even thinking will be really rough for you. Fast turnovers that are second nature for most of us regulars will seem unsafe to you.

Jet's buddy isn't unsafe when he pulls off an ILS approach, and he and his pilot buddies may be the only ones who notice the difference. Still, it isn't as crisp.

So ask yourself... Do you want to be the X-Games BMXer of anesthesia or do you want to be the beach cruiser? What happens when you find yourself at the top of the ramp on a beach cruiser? You gonna be comfortable taking that drop on your beach cruiser or are you gonna ask your buddy who's been working in the foam pits day in and day out to take the drop for you? When you loose control of your bike halfway down are you going to reflexively remember how to fall the right way to protect yourself from getting hurt?

You tell me.

Which one you wanna be?


[YOUTUBE]g5IYMXbTgeE[/YOUTUBE]

or

[YOUTUBE]iO7HsWf8cbI[/YOUTUBE]


Which one would you want to anesthetize you?

- pod

 

[countingdays]

Weak. 😉
I've gone a month before and 2 wks for Vaca, etc. My only problem is I forget my locker combo.😕
I think 50% is probably fine, unless you are taking months off at a time.

Me too. Multiple facilities with different combinations on every door, cart, and locker makes it worse. Got this and programmed to something I can't forget.

 

[imfrankie]

This question is for attendings. How confident about your skills would you be if you practiced anesthesiology part time for only 1 day out of the week? Would you have any concerns for the safety of your patient because of rusty skills, etc? Thanks a lot!

Give the guy some slack. He's got a PhD, maybe he wants to do some science too. PLENTY of academics do one or two days a week. Don't sweat it. You probably won't want to do pedi-hearts, but mentoring residents learning to do the basics will be fun and comfortable. Best of luck winning the Nobel Prize also.