Potential career paths in anesthesia

[timeturner]

Hi everyone!
MS-3 here who's finishing up rotations and recently (and finally) made the decision to pursue anesthesia!
I was wondering if any residents/attendings/wise MS-4's could elaborate on different career options for anesthesia? I know the rough big picture - academic vs. private, pain management, crit care, etc. However I am interested in learning more about the specifics of different paths in the field.

The reason I am asking is that I think medical students typically get exposure to OR anesthesia in an academic institution, however I am curious what the specialty looks like outside of that setting. I was inspired to ask this question recently when I was discussing IM with a friend (also in med school), and the topic of rounds came up. Long story short, he pointed out that private medicine attendings don't do teaching rounds, and this was mind blowing to me as the daily highlight of the entire past year was rounds on various services. It's so simple but surprising to a MS-3 just coming out of clinical year.

Thanks in advance!

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[skypilot]

Hi everyone!
MS-3 here who's finishing up rotations and recently (and finally) made the decision to pursue anesthesia!
I was wondering if any residents/attendings/wise MS-4's could elaborate on different career options for anesthesia? I know the rough big picture - academic vs. private, pain management, crit care, etc. However I am interested in learning more about the specifics of different paths in the field.

The reason I am asking is that I think medical students typically get exposure to OR anesthesia in an academic institution, however I am curious what the specialty looks like outside of that setting. I was inspired to ask this question recently when I was discussing IM with a friend (also in med school), and the topic of rounds came up. Long story short, he pointed out that private medicine attendings don't do teaching rounds, and this was mind blowing to me as the daily highlight of the entire past year was rounds on various services. It's so simple but surprising to a MS-3 just coming out of clinical year.

Thanks in advance!

The main thing is you won't actually be administering Anesthesia. You will be mainly signing charts and doing H&Ps in preop. 😉

 

[deleted162650]

the daily highlight of the entire past year was rounds on various services

Anesthesia is not for you.

 

[AdmiralChz]

Anesthesia is not for you.

Unless you want to do CCM, especially cardiac ICU, rounds can last an eternity and when you’re done woo it’s tike for PM follow up rounds!

But I get the impression he DOESNT enjoy the rounding aspect.

 

[Beach bum]

Hi everyone!
MS-3 here who's finishing up rotations and recently (and finally) made the decision to pursue anesthesia!
I was wondering if any residents/attendings/wise MS-4's could elaborate on different career options for anesthesia? I know the rough big picture - academic vs. private, pain management, crit care, etc. However I am interested in learning more about the specifics of different paths in the field.

The reason I am asking is that I think medical students typically get exposure to OR anesthesia in an academic institution, however I am curious what the specialty looks like outside of that setting. I was inspired to ask this question recently when I was discussing IM with a friend (also in med school), and the topic of rounds came up. Long story short, he pointed out that private medicine attendings don't do teaching rounds, and this was mind blowing to me as the daily highlight of the entire past year was rounds on various services. It's so simple but surprising to a MS-3 just coming out of clinical year.

Thanks in advance!

Hopefully you have done rotation in anesthesia and love it! If you do and don’t have a lot of student debt than pursue it. With current environment reimbursement will continue to be ratcheted down and amount you need to earn to service average student debt will create significant hardship.

 

[yobynaes]

wow, why is everyone so negative. anesthesia is a great gig. What exactly are you looking for, OP? It sounds like you already know about the major paths (or subspecialties) available as anesthesiologists.

 

[Stank811]

Hopefully you have done rotation in anesthesia and love it! If you do and don’t have a lot of student debt than pursue it. With current environment reimbursement will continue to be ratcheted down and amount you need to earn to service average student debt will create significant hardship.

Reimbursement for services provided are not being ratcheted down they continue to increase.

 

[deleted162650]

Reimbursement for services provided are not being ratcheted down they continue to increase.

This is true. Unfortunately the number of jobs where you get to keep what you bill/collect continues to decrease, while the number of jobs where you get paid what some non-clinical suit halfway across the country tells you you’re worth continues to increase.

 

[Nivens]

Hi everyone!
MS-3 here who's finishing up rotations and recently (and finally) made the decision to pursue anesthesia!
I was wondering if any residents/attendings/wise MS-4's could elaborate on different career options for anesthesia? I know the rough big picture - academic vs. private, pain management, crit care, etc. However I am interested in learning more about the specifics of different paths in the field.

The reason I am asking is that I think medical students typically get exposure to OR anesthesia in an academic institution, however I am curious what the specialty looks like outside of that setting. I was inspired to ask this question recently when I was discussing IM with a friend (also in med school), and the topic of rounds came up. Long story short, he pointed out that private medicine attendings don't do teaching rounds, and this was mind blowing to me as the daily highlight of the entire past year was rounds on various services. It's so simple but surprising to a MS-3 just coming out of clinical year.

Thanks in advance!

To answer your question in very broad strokes:

1) You can work in the OR, either supervising (more common) or doing your own cases (less common). This can be done in a variety of settings, from fast-paced ambulatory surgery centers to big tertiary referral centers, with case and patient complexity to match.
2) You can work in an ICU, functioning similar to how you have seen intensivists from other specialties work
3) You can work in a chronic pain clinic, seeing patients and performing procedures and even small surgeries (implants)
4) You can work on an OB floor, placing and managing epidurals and providing anesthesia for C-sections
5) You can work as part of an acute pain service, managing patients post-op with complicated pain needs with advanced medications, peripheral and truncal nerve blocks, or neuraxial techniques

Many practitioners mix and match these things, both in academic and private practice. Acute pain service some weeks, general OR the rest. Or cardiac anesthesia some weeks, ICU for the rest. Because we don't "own" patients (unless you're a chronic pain specialist), our time is actually fairly flexible with regards to *what* we are doing. For some, this is a huge advantage, though it does have some disadvantages that are beyond the scope of this post.

Hope that helps!

 

[Beach bum]

Thanks for the responses thus far!
I actually cannot stand rounds, I guess "highlight of the day" makes it sound like it was a true highlight in a positive sense, but really it's because it seems to be the only important part that a student gets to participate in 😛

I guess another way to rephrase my question is what does anesthesiology look like outside the OR setting, or outside an academic setting? I see how I phrased everything it may have been confusing.

OR setting is Where it’s at....not sure what you are looking for?

 

[timeturner]

Anesthesia is not for you.

I actually cannot stand rounds. I guess by calling it "highlight of the day" I just meant that it seems to be the only time that a student gets to participate in. On medicine services it also seems to be the only time in which "real medicine" is happening - i.e. clinical decision making, exams, etc (rest of the time is more about making stuff happen). I hope no one gets offended by this, just my own observation, and as I said, rounds aren't for me. It was a confusing word choice though.

wow, why is everyone so negative. anesthesia is a great gig. What exactly are you looking for, OP? It sounds like you already know about the major paths (or subspecialties) available as anesthesiologists.

Sorry for the confusing way in which I asked the question! I guess another way to rephrase would be - what does anesthesia look like outside the OR? And outside the academic setting?

Thanks for all the responses thus far!

 

[timeturner]

OR setting is Where it’s at....not sure what you are looking for?

I think some people end up doing critical care or pain management? To be honest I don't know much about these career paths and how one gets there from an anesthesia residency. Would love to be informed about these options.

 

[Carbocation1]

What kind of opportunities are there to open your own clinic besides the following? For some, the idea of not being your own boss may get old after a while, though we will all probably be govt employees within a decade.

1. Pain
2. Sleep Medicine
3. Ketamine Clinic $$$
4. Addiction Clinic
5. Hyperbaric therapy?
6. Concierge anesthesia?
7. BOTOX clinic

 

[GravelRider]

What kind of opportunities are there to open your own clinic besides the following? For some, the idea of not being your own boss may get old after a while, though we will all probably be govt employees within a decade.

1. Pain
2. Sleep Medicine
3. Ketamine Clinic $$$
4. Addiction Clinic
5. Hyperbaric therapy?
6. Concierge anesthesia?
7. BOTOX clinic

What's concierge anesthesia? Is that what Michael Jackson was paying for?

 

[It's lupus!]

What's concierge anesthesia? Is that what Michael Jackson was paying for?

If it was it didn't work out too well. Lol

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[Mehd School]

The main thing is you won't actually be administering Anesthesia. You will be mainly signing charts and doing H&Ps in preop. 😉

My attending the first day of my anesthesia rotation told me exactly this and on that day I crossed it off my list. Luckily I caught up with a younger guy that gave me an accurate description of potential work settings, and I look forward to matching in anesthesia in March.

Please stop telling medical students this.

 

[naijacardriodoc]

My attending the first day of my anesthesia rotation told me exactly this and on that day I crossed it off my list. Luckily I caught up with a younger guy that gave me an accurate description of potential work settings, and I look forward to matching in anesthesia in March.

Please stop telling medical students this.

Do u mind describing the accurate description of the work setting? Thank you!


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[Mehd School]

Do u mind describing the accurate description of the work setting? Thank you!


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This post did a better job than I could:

To answer your question in very broad strokes:

1) You can work in the OR, either supervising (more common) or doing your own cases (less common). This can be done in a variety of settings, from fast-paced ambulatory surgery centers to big tertiary referral centers, with case and patient complexity to match.
2) You can work in an ICU, functioning similar to how you have seen intensivists from other specialties work
3) You can work in a chronic pain clinic, seeing patients and performing procedures and even small surgeries (implants)
4) You can work on an OB floor, placing and managing epidurals and providing anesthesia for C-sections
5) You can work as part of an acute pain service, managing patients post-op with complicated pain needs with advanced medications, peripheral and truncal nerve blocks, or neuraxial techniques

Many practitioners mix and match these things, both in academic and private practice. Acute pain service some weeks, general OR the rest. Or cardiac anesthesia some weeks, ICU for the rest. Because we don't "own" patients (unless you're a chronic pain specialist), our time is actually fairly flexible with regards to *what* we are doing. For some, this is a huge advantage, though it does have some disadvantages that are beyond the scope of this post.

Hope that helps!

 

[pgg]

What's concierge anesthesia? Is that what Michael Jackson was paying for?

Michael Jackson paid a cardiologist to administer his nightly anesthesia.

If he'd paid one of us, the King Of Pop would still be alive.

 

[bigdan]

OP -

I can say that my experiences color my opinions and my outlook, as I suspect they do for everyone here. I'll detail my career path below, but give you the advisory that there must be dozens of different avenues and arrangements in which anesthesiologists work. I've been on this site since 2002 or so, and saw all the doom and gloom about anesthesia, and chose it anyways. Love my profession, and am thrilled with my choice. There are of course daily frustrations (big one for me: cardiac surgical team doesn't help transport with patients down from ICU to OR), but overall, I am very happy with what I do. Could be lucky. Could be delusional. Could be both. But very happy.

I did "the usual" anesthesiology residency, then fellowship training in Critical Care Medicine and Cardiac Anesthesia. I work in a large healthcare network with a residency program. Clinically, I do one week/month of cardiac ICU (mixed medical and surgical cardiac, vascular, and thoracic patients) and three weeks/month of OR anesthesia, a large portion of which is cardiac, thoracic and vascular. I am one of the liver transplant anesthesiologists, and share those responsibilities with 5 other guys. I also do non-clinical work for the residency program and cardiac anesthesia fellowship, for which a get a day or two out of the OR per month. I am on a couple departmental committees, and two hospital-wide committees. I work hard, and I get reasonable time off. I come from humble beginnings, but the compensation is way more than I ever imagined. Got a home I like. Wife is happy. Life is pretty good.

A pathway that has worked out well for me was to choose a subspecialty focus that does not require me to be in the OR. It's a little break from the workaday stuff in the ORs that pisses everyone off. Through anesthesiology training, you can do Pain Medicine, Sleep Medicine, Hospice/Palliative Care, and Critical Care in only one year of extra training (or two, if so desired😉), and then either split your time or never enter an OR again.

Lots of options. As for now, I'm very happy with what I've done. Good luck with whatever you choose.

 

[GravelRider]

Michael Jackson paid a cardiologist to administer his nightly anesthesia.

If he'd paid one of us, the King Of Pop would still be alive.

Maybe. I would imagine that any anesthesiologist that would be willing to engage in that sort of "concierge" practice might not be the type of anesthesiologist you would want caring for your family member undergoing a big procedure.

This question still remains, is this what is meant by "concierge" anesthesia? Rich people paying to get high?

 

[deleted162650]

I think the concierge comment was meant to be tongue in cheek. While I don’t know about “concierge” anesthesia, there are certainly plenty of guys that run what you could consider “boutique” practices doing almost exclusively cash pay plastics cases.