Real World Anesthesia

[lucy07]

---

Members do not see this ad.

I am just out of residency, sitting here on my first night on call with a few questions for the PP guys/gals:

Do you have to stay in house while a labor epidural is running? ( As I am now)

Do you have the post call day off? ( I never will)

Also, as an aside, I am a little surprised by the apparent lack of professionalism exhibited by some of my colleagues..frank laziness, snoozing in the OR, doing crossword puzzles in the OR, lack of hygiene (both surgeons and anesthesiologists)...I will admit that I am fresh out and trying not to compare residency with PP...and I took a job with a AMC. My rose colored glasses may be coming off! 😱

Thanks for your comments.

 

[Consigliere]

Well, you work for an AMC so none of the behavior you mentioned surprises me in the least. At my gig, the CRNAs do all the labor epidurals and take in house call. The anesthesiologists take call a week at a time since it is so benign. The week you are not on call you are usually out by noon at the latest.

I worked like a slob for the past 5 years - good experience; I recommend it to anyone.

Now I've got the job I want.

Best of luck, kid!

 

[Planktonmd]

I am just out of residency, sitting here on my first night on call with a few questions for the PP guys/gals:

Do you have to stay in house while a labor epidural is running? ( As I am now)

Do you have the post call day off? ( I never will)

Also, as an aside, I am a little surprised by the apparent lack of professionalism exhibited by some of my colleagues..frank laziness, snoozing in the OR, doing crossword puzzles in the OR, lack of hygiene (both surgeons and anesthesiologists)...I will admit that I am fresh out and trying not to compare residency with PP...and I took a job with a AMC. My rose colored glasses may be coming off! 😱

Thanks for your comments.

You seem to be in a bad situation.
I never stayed in house for epidurals, I used to place them and hit the road, when the hospital started to push for in house coverage we told them they need to pay for a CRNA to remain in house and they did.
We always have post call day off.
Now about lazy people: Unfortunately there is plenty of those in this specialty, they are comparable to STD's: embarrassing, they give us a bad reputation and they are very difficult to eliminate.
So you either learn to live with them or go somewhere where they don't exist (rare).

 

[jetproppilot]

I am just out of residency, sitting here on my first night on call with a few questions for the PP guys/gals:

Do you have to stay in house while a labor epidural is running? ( As I am now)

Do you have the post call day off? ( I never will)

Also, as an aside, I am a little surprised by the apparent lack of professionalism exhibited by some of my colleagues..frank laziness, snoozing in the OR, doing crossword puzzles in the OR, lack of hygiene (both surgeons and anesthesiologists)...I will admit that I am fresh out and trying not to compare residency with PP...and I took a job with a AMC. My rose colored glasses may be coming off! 😱

Thanks for your comments.

I think a poster whose first post has the content above has TROLL written all over it.

I'd caution any of our readers in responding to this individual.
Jet searches in vain for the virtual thirty-ought-six........trolls are rare nowadays....."GEEZ, WHERE IS IT?" he thinks quietly...."OH YEAH....IN THE TRUCK SINCE THE SHOOTOUT WHERE VENTY AND I HAD TO ELIMINATE SOME TROLLS" he remembers.....down the stairs and into the lifted beast, he grabs the rifle put away in the left storage bin.....

 

[lucy07]

Wow, not a troll, just looking for some advice dude.

 

[urge]

I'd caution any of our readers in responding to this individual.
Jet searches in vain for the virtual thirty-ought-six........trolls are rare nowadays....."GEEZ, WHERE IS IT?" he thinks quietly...."OH YEAH....IN THE TRUCK SINCE THE SHOOTOUT WHERE VENTY AND I HAD TO ELIMINATE SOME TROLLS" he remembers.....down the stairs and into the lifted beast, he grabs the rifle put away in the left storage bin.....

 

[militarymd]

Wow, not a troll, just looking for some advice dude.

OK...then I'll tell you what I do...

I can sleep anywhere....after learning how to sleep on a US Navy warship underway in a war zone...and directly under the flight deck....you can sleep anywhere....so I choose to just sleep at the hospital.

It saves me travel time if I have to come back for anything else....and the hospital is closer to my gym than my house...so post call...I get to the gym faster......

 

[pmichaelmd]

I am just out of residency, sitting here on my first night on call with a few questions for the PP guys/gals:

Do you have to stay in house while a labor epidural is running? ( As I am now)

Do you have the post call day off? ( I never will)

Also, as an aside, I am a little surprised by the apparent lack of professionalism exhibited by some of my colleagues..frank laziness, snoozing in the OR, doing crossword puzzles in the OR, lack of hygiene (both surgeons and anesthesiologists)...I will admit that I am fresh out and trying not to compare residency with PP...and I took a job with a AMC. My rose colored glasses may be coming off! 😱

Thanks for your comments.

In which part of the country did you take a job? It's too bad that you have colleagues that are frankly lazy. I think it's possible to relax, have fun, and still provide great anesthesia care.

Our hospital tried to tell us that we were supposed to stay in-house for running epidurals. I will stay if the pt. looks like they'll have a difficult course. What we told the hospital was...we'll stay in-house if the OB does. Think about the complications...most of which end with delivery. If the OB takes off and you stay, are you going to do a McRoberts and deliver that shoulder dystocia? I'm not. Since OB doesn't stay, I don't stay (at the hospital that is close to my house). If I'm at the far hospital (20 min away), I'll usually stay just because it's convenient.

Our call coverage has increased because we took a new hospital and we no longer always take off post-call, but we got the hospital to pay us good money to stay post-call, so it evens out.

I've just finished my first year in private practice and have to say that, overall, things are going quite well. I like my partners and never dreamed I'd make this much coin my first year out, especially as a hospital employee.

Best of luck!

PMMD

 

[Noyac]

Our hospital tried to tell us that we were supposed to stay in-house for running epidurals. I will stay if the pt. looks like they'll have a difficult course. What we told the hospital was...we'll stay in-house if the OB does. Think about the complications...most of which end with delivery. If the OB takes off and you stay, are you going to do a McRoberts and deliver that shoulder dystocia? I'm not. Since OB doesn't stay, I don't stay (at the hospital that is close to my house). If I'm at the far hospital (20 min away), I'll usually stay just because it's convenient.

Funny but we had the same thing come up as our OB's tried to push VBAC's on us which would have required us to stay in-house. They tried to require us to be in-house for epidurals w/c would have made it easy to get VBAC's instated b/c anesthesia was already in-house. We countered with the exact same argument as PMM, what are we gonna do without an OB present. And added that we have epidurals running all over the hospital, OB floor, gen surg floor, ortho floor and ICU. How are these any different? We have trained the nurses to manage/evaluate the epidurals and therefore so can the OB nurses. But just to show that we were not obstructionists we said we would be happy to stay in-house for a price. I guess that price was a little too high.

 

[lucy07]

Thanks for the insight. I am in the New England region. I definately plan on not being lazy, giving excellent anesthesia, and having fun as well. Perhaps after I am more comfortable in my current situation I can attempt to change the way the epidural service is run.

 

[Laryngospasm]

I am just out of residency, sitting here on my first night on call with a few questions for the PP guys/gals:

Do you have to stay in house while a labor epidural is running? ( As I am now)

Do you have the post call day off? ( I never will)

Also, as an aside, I am a little surprised by the apparent lack of professionalism exhibited by some of my colleagues..frank laziness, snoozing in the OR, doing crossword puzzles in the OR, lack of hygiene (both surgeons and anesthesiologists)...I will admit that I am fresh out and trying not to compare residency with PP...and I took a job with a AMC. My rose colored glasses may be coming off! 😱

Thanks for your comments.

How does doing crossword puzzles in the OR make someone less than professional or lazy? I suppose you stare at the monitor for the entire case? Crossword puzzles keep the mind sharp.

 

[Burnt2]

How does doing crossword puzzles in the OR make someone less than professional or lazy? I suppose you stare at the monitor for the entire case? Crossword puzzles keep the mind sharp.

I agree completely- it exercises the mind, and it doesn't require all consuming attention. If it's a stable case it's a stable case - you don't have to sit tensed and poised for open heart massage for every lap chole.



Another question though...do any of the computer game generation bring in the PSP in to play God of War 2 while they are doing a case?

That's something I would not feel comfortable with.

 

[militarymd]

How does doing crossword puzzles in the OR make someone less than professional or lazy? I suppose you stare at the monitor for the entire case? Crossword puzzles keep the mind sharp.

I guess that's why there's all that rhetoric in the "Anesthesiology Club" forum.

It takes a special someone to do crossword puzzles....not a non-physician.

 

[lucy07]

"How does doing crossword puzzles in the OR make someone less than professional or lazy? I suppose you stare at the monitor for the entire case? Crossword puzzles keep the mind sharp."

Doesn't it just look bad and somewhat unprofessional? I can see reading anesthesia literature, but general magazines and doing puzzles seems somewhat less than vigilant. Again, just out of residency, never exposed to an OR besides during med school and residency....

 

[ozzie20]

eh, personally I don't mind it. Its actually better for you in a sense because you slightly distract yourself and then can see the big picture better. I find when i'm concentrating on something too much, you end up seeing the same problems over and over, and then tend to miss the other ones.

 

[jwk]

"How does doing crossword puzzles in the OR make someone less than professional or lazy? I suppose you stare at the monitor for the entire case? Crossword puzzles keep the mind sharp."

Doesn't it just look bad and somewhat unprofessional? I can see reading anesthesia literature, but general magazines and doing puzzles seems somewhat less than vigilant. Again, just out of residency, never exposed to an OR besides during med school and residency....

This is an oft-debated topic. Reading anesthesia literature vs magazines or something else really doesn't make a difference. If you don't have a problem with reading in the OR, then it doesn't really matter what you read. If you do have a problem with it, then thinking it's OK just because you're reading anesthesia material is just a smokescreen.

 

[buckhorn]

I am just out of residency, sitting here on my first night on call with a few questions for the PP guys/gals:

Do you have to stay in house while a labor epidural is running? ( As I am now)

Do you have the post call day off? ( I never will)

Also, as an aside, I am a little surprised by the apparent lack of professionalism exhibited by some of my colleagues..frank laziness, snoozing in the OR, doing crossword puzzles in the OR, lack of hygiene (both surgeons and anesthesiologists)...I will admit that I am fresh out and trying not to compare residency with PP...and I took a job with a AMC. My rose colored glasses may be coming off! 😱

Thanks for your comments.

You have made the mistake of working for a AMC. They don't care about you, The only thing the AMC care about is making more money for the owner. To them you are just another cheap gullible new graduate, who they don't expect to keep for much more than a year, or until you wake up and decide to get a better job. I assume you are paid a salary with an imaginary bonus promised for the end of the year, so your employer has no cost in keeping you unnecessarily all night to baby sit OB epidurals. If you were paid a fair hourly wage to sit idle all night you can be sure the AMC call policy would change immediately.


How did you, not know you did not get the post call day off before you took this job? Did you fall for the same lie you hear at about every place I have ever interview? "Call is easy and you never get called in, so you routinely work the day after call, but if you have a rough night you will get the next day off.

"I am a little surprised by the apparent lack of professionalism exhibited by some of my colleagues..frank laziness, snoozing in the OR, doing crossword puzzles in the OR, lack of hygiene (both surgeons and anesthesiologists)" What do you expect from an AMC, Their sole hiring criteria is to get the cheapest anesthesia providers available. That means they employ, gullible new graduates, visa worker indentured servants, or Physicians with disciplinary, competency or attitude problems that makes them otherwise unemployable.

Unless you enjoy not getting paid fairly and enriching an absentee AMC owner, I would suggest you start looking for a better job working for a real anesthesia group.

 

[Dejavu]

For five years I put in epidurals with a PCEA option for the pt, stayed around until it started to set up without hemodynamic changes and then went back home. Pt was able to add extra if they needed it so we didn't need to be there to "top off" the epidural. I rarely had to come back in.

As for "in- house" for VBAC, I thought ACOG recommendations were that a c-section had to be able to be started in 20-30 minutes (or something like that). If you live close enough, "at-home" call shouldn't violate any recommendations.

 

[Noyac]

As for "in- house" for VBAC, I thought ACOG recommendations were that a c-section had to be able to be started in 20-30 minutes (or something like that). If you live close enough, "at-home" call shouldn't violate any recommendations.

Actually for VBAC's the recommendation is that everyone be "immediately" available. For every other c/s it's 30 minutes from decision to incision. but local parameters also apply.