So, what's the catch??

[buddym]

Hey everyone!

I am reading a lot of these anesthesiology forum threads and this is what I see: good pay, lots of job opening, great lifestyle, but then LOW to MODERATE competiveness (at least for american graduates). So, what's the deal? Why is there not as much competition for this as EM, Rads, etc? Usually, good hours + good pay = HIGHLY competitive.

Thanks

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[GeddyLee]

Well, I'd just be guessing here, but for one thing, there's a lot more spots available than specialties like ENT, OPH, Urology, Neurosurg, Rads. Take Ophthalmology for example....around 650 spots available....80% match. If there were 200 more spots, OPH would be on the same competetive level as anesthesiology. It's a numbers thing.

 

[Skip Intro]

Hey everyone!

I am reading a lot of these anesthesiology forum threads and this is what I see: good pay, lots of job opening, great lifestyle, but then LOW to MODERATE competiveness (at least for american graduates). So, what's the deal? Why is there not as much competition for this as EM, Rads, etc? Usually, good hours + good pay = HIGHLY competitive.

Thanks

Anesthesiology is considered "boring" (and, IMHO, wrongfully so) by many. You are considered to be an order-taker with no real autonomy, and you have fairly limited patient interaction most of the time.

These are traits that are not appealing to a lot of future doctors. That, and the undercurrent of competition and in-fighting amongst CRNAs turns a lot of people off.

The need for anesthesiologists has historically waxed and waned over time. Many attendings tell me stories of the mid-1990's when they couldn't find jobs, and what few job openings that were out there were topping-out in the mid $150K range. As a result, a lot of people steered away from going into anesthesia as a career. We're now seeing the upswing and results of what happened ten years ago with lack of people going into the field (they were practically begging graduates to come to programs). Ten years from now, with more CRNAs going into the field and currently filled or near-filled anesthesiology residency slots, we may again see what happened in the mid-1990's - a glut of people for fewer jobs. Salaries are all about supply and demand, and that's what's driving the interest now in large part (again, not everyone is motivated by this).

So, choose anesthesiology because you like it first and foremost, and it suits your personality. Other perceived advantages which may be paramount to you now (salary, lifestyle, etc.) may not always be there in the future.

-Skip

 

[UTSouthwestern]

Anesthesiology went through a very hard period of unpopularity in the '90's when the Clinton health care reforms came into play and speculation about massively declining numbers of surgery due to interventional procedures, preventive medicine, etc. remained just that - speculation. Groups put a freeze on hires both for that and the decline in private insurance and medicare reimbursements.

This in turn led to almost a decade of thin interest in the field and bare bones recruiting for many programs. When the fears past, the groups which had not hired, noticed that their workloads had doubled or even tripled and that they had not hired accordingly to account for the increasing volume of work. Trickle down being what it is, now you had a ton of available positions but few candidates from residencies to fill them (and a good portion of what was taken into residency programs in the '90's was in all honesty substandard).

Residency programs heard the calls for help and the word filtered through to the medical students that all was not lost in this field as was previously forecasted and what you have now is a 10 year period of catch up going on to make up for the deficits and mistakes of the previous decade.

Is everything perfect in this profession? Of course not. Issues with competition with mid level providers, while not unique to our profession, has been discussed ad nauseum on other threads, so I will not dredge them up again. Despite the great reimbursement at this time (median $250-500 k/year), the best reimbursement period passed after the early '90's when you could work with one surgeon only and make >$800,000/year. We are experiencing a relative dearth of interest in academic anesthesiology that is needed to continue expanding the horizons of our field. This also applies to pain management where I find it disturbing that we continue to train PM&R, neurologists, and primary care physicians to perform what we should consider our proprietary procedures.

Do you want continuity of care situations and strong bonds with your patients that develop over a lengthy period of time? This field will not give that to you unless you do pain management or pedi anesthesia where repeat business with the very sick kids usually entails you doing multiple anesthetics of that patient.

At this time, the competitiveness of the field OVERALL is not greatly increasing, however the competitiveness of placing at desirable programs is increasing greatly. This year alone, my program has seen an incredible rise in the quality of applicants such that AOA candidates are becoming more common. Some programs are using this renewed interest to set higher admission standards (we have not simply because our program believes in bringing in good people, not just a good score or grade).

However, there will always be programs labeled as "less than desirable" that a less than desirable candidate can match into. Don't be fooled by a program's namesake - it may have a high powered name next to it, but can still be a horrible program and each of the past three years, I have been disappointed to hear from colleagues that chose those programs that the programs have treated them as cheap labor. I understand that it is residency and a high degree of self-motivation is required, but abuse is abuse no matter how you paint it.

In the end, you need to decide if the parameters of anesthesia practice fit your goals of practice and must decide what you are looking for in a residency program (location, training, hopefully both, etc.).

 

[buddym]

Thanks to everyone for some detailed, well thought out responses. I am decided to shadow an anesthesiologist to see how I like the work!

 

[Dorian Gray]

However, there will always be programs labeled as "less than desirable" that a less than desirable candidate can match into. Don't be fooled by a program's namesake - it may have a high powered name next to it, but can still be a horrible program and each of the past three years, I have been disappointed to hear from colleagues that chose those programs that the programs have treated them as cheap labor. I understand that it is residency and a high degree of self-motivation is required, but abuse is abuse no matter how you paint it.

UT, that was a great summary of the last decade or so of the anesthesiology profession - a lot of that info was new to me. On a side note, which are the programs that your friends are at that are using them as cheap labor? I have heard of quite a few (MGH, UCSF, etc.), but I would trust your judgement and the reports of your friends more than some other sources that may not be as accurate or be trying to better their prospects of getting into said residency programs. Thanks.

 

[Swaydaa]

Yale is a classic example of having a big name and working the residents to the bone. The people at UCONN always have a smile on their face when they talk about residents at Yale.

 

[wangstar]

Anesthesiology is considered "boring" (and, IMHO, wrongfully so) by many. You are considered to be an order-taker with no real autonomy, and you have fairly limited patient interaction most of the time.

i think others feel the field is not only boring but, but you aren't really the attending on any of these patients and you don't directly fix the patients.

 

[Tenesma]

MGH should not be included in that list - residents work hard, are paid $45 to 55k/year and are usually well taken care of - we were not worked to the bone, but we worked hard.

 

[Skip Intro]

i think others feel the field is not only boring but, but you aren't really the attending on any of these patients and you don't directly fix the patients.

[rant]

Well, I once had the "balls" and the "audacity" (as an attending surgeon put it, who happened to be eavesdropping over the curtain on my conversation with my anesthesia attending [watch out for those surgeons, folks, they have BIG ears]) to insinuate that the surgeon's job, during the surgery, was to "take care of the problem" and the anesthesiologist's job was to "take care of the patient."

This biznitch blew a gasket. And, we got into a full-blown argument - yes, yours truly and an attending surgeon - in the middle of her doing a breast biopsy. My anesthesia attending just laughed... at both of us, actually. But, I think I did a pretty good job of defending my position.

I gotta admit that sometimes I really hate the territorial bullsh*t that occurs in the OR... you know, the "my patient" crap like the surgeon (or anyone else) actually "owns" the person and/or their problem. Give me a break. Point is, when I'm an anesthesiology attending (and I will be an anesthesiology attending in about 4.5 years), I have just as much responsibility for keeping the patient alive during the procedure as the surgeon does. If the surgeon f*cks up, my rear-end will be standing in court right next to them as the wild finger-pointing and attempted blame-shifting starts. (I've only been in the OR as in an "anesthesia" capacity for three months as a student, and you can't believe some of the silly - no, utterly asinine - things the surgeon will say trying to blame the anesthesiologist when something goes wrong... them: "you didn't paralyze the patient", us:"umm... usually we do not keep the patient paralyzed since you're operating on the spine", them: "well, I can't operate - the patient is moving - make them deeper", us:"ummm... isn't that going to screw-up your EMG? are you sure you want me to do that?", them:"well, do something!!", etc., etc.)

So, you know what? When I'm an attending and I don't want to do a case, I will say to the surgeon (in so many words), "you're an idiot if you think you're going to operate on this sick patient." I will then write my note. And, you know what else? That surgery will not get done at that time unless someone else is willing to put their own ass on the line.

In the end, this means only one thing: I am the attending, and yes, it is my patient too.

[/rant]

-Skip

 

[kinetic]

In blasting someone else for their arrogance, you're only revealing your own. If taking care of a patient is indeed a "team effort," then you should realize that different specialists take different things into consideration when approaching a problem. The surgeon has different priorities than you and vice versa. How are you any better than the surgeon by saying, "if I don't think the patient should undergo this procedure, then it won't happen"? Your rant was just a lame "people shouldn't be arrogant because it gets in the way of my arrogance" post. Take a look in the mirror.

 

[hoyden]

OMG! I thought it's just OUR surgeons being the bullies( or trying to be) - just kidding. I know it's international, truly "doctors without borders".
You have to get used to it. The best way is to use the most mature defence - humor. Of course, it doesn't apply to really serious or grave situations. Then you'll have to defend your point, which often clashes with their point, and have the "balls" to be firm.
To the defendants - unfortunately, in real life you see not only "team work", but a lot of stupidity, too. Or wishing to wear a crown. You can figure out who wants to be a "king".
Been there, for sure.

 

[CambieMD]

Anesthesiology is considered "boring" (and, IMHO, wrongfully so) by many. You are considered to be an order-taker with no real autonomy, and you have fairly limited patient interaction most of the time.

i think others feel the field is not only boring but, but you aren't really the attending on any of these patients and you don't directly fix the patients.[/QUOTE] :

I think that many medical students and others fail to realize the role that anesthesiologists play. Anesthesiologists are physician tecnichians(? sp).
That is not a bad thing. You are given a task to complete and move on once that task is completed.I understand this is a gross understatement.
Is there shame in dealing with some of the most complicated aspects of a patients care?

I have "owned "patients for the past 3.5 years. The problem with owning patients is that they think that they own youtoo

Do what makes you happy.

CambieMD

 

[Tenesma]

i hate to say this... but the surgeon is the primary care provider to this patient. We, as anesthesiologists, are consultants on the case. Albeit, very important consultants.... We are there to do things safely for the patient and allow for the best possible outcome for the patient. I love how the younger residents are constantly trying to prove themselves vis-a-vis the surgeons....ahhh... it reminds me of my younger days...

What it boils down to is optimizing the communication between surgeon and anesthesiologist before the surgery so as to improve the safety and outcome of the case. If it is a mundane case, I rarely discuss it with the surgeon. If I have any concerns I discuss it with the surgeon privately (no nurses, surgical residents etc - so that they don't have to worry about their eg0) and share with them what the anesthetic/physiologic issues are. In my experience, this leads to a better understanding of what we both provide for the patient.... As far as your example (skip intro) about patient movement during spinal surgery, this is an important discussion to have with the NS/ortho-spine people... If they need muscle monitoring then you can't paralyze them, but you can still keep them areflexic so that they don't move while they are working near the spinal cord - ie: high dose narcotic (ie: remifentanil) or more propofol usually does the trick without interfering with monitoring.

Now every so often, there are some surgeons (primarily in academic settings) who don't know how to "co-operate" who will just say stupid things over and over again.... I find that they usually quiet down when they realize that you know more than they do (and that is why it is important to stay well-read).

so bottom line, the patient belongs to the surgeon (they come to see the surgeon not the anesthesiologist), so the surgeon can dictate their management outside of the operating room. In the operating room, you are their guardian..... so do what's right for the patient, and work on good communication with your fellow surgeons

 

[wangstar]

so bottom line, the patient belongs to the surgeon (they come to see the surgeon not the anesthesiologist), so the surgeon can dictate their management outside of the operating room. In the operating room, you are their guardian..... so do what's right for the patient, and work on good communication with your fellow surgeons [/QUOTE]

i would tend to agree with this, the anesthesiologist is kind of a mercenary- a person hired to give the anesthetic and manage the patient for a transient amount of time. I like this role and I thoroughly embrace it for many reasons. On the contrary, I think a lot of people don't go into anesthesia because the patients will not identify the anesthesiologist as being "their doctor," and they will for the surgeon, pmd, etc- which is why alot of people go into medicine in the first place- they want to be incontrol for long term care and value that type of doc- patient interaction. I think career options in anesthesia, however, offer some oppurtunities more along this spectrum (chronic pain, ICU).

 

[Skip Intro]

In blasting someone else for their arrogance, you're only revealing your own. If taking care of a patient is indeed a "team effort," then you should realize that different specialists take different things into consideration when approaching a problem. The surgeon has different priorities than you and vice versa. How are you any better than the surgeon by saying, "if I don't think the patient should undergo this procedure, then it won't happen"? Your rant was just a lame "people shouldn't be arrogant because it gets in the way of my arrogance" post. Take a look in the mirror.

Blah, blah, blah... whatever.

The point was, I was right - and this surgeon got a HUGE bug up her ass with a "how dare you" attitude.

I don't own any patients or their problems. I strive to help the person. That's why I'm in medicine. Not to get into territorial pissings. Call that arrogant, if you want. I really don't care.

-Skip

 

[kinetic]

"Blah, blah, blah ...whatever" is right.

 

[PsychoSomatic]

How often is it, though, that these struggles occur in the academic setting...I mean surgeons do have this reputation and all, but how much of the friction between surgeon/anesthesiologist is restricted to the academic field?

 

[Tenesma]

in academics there are far fewer concerns re: litigation (they tend to do sicker patients) as well as the missing burden of efficiency... in private practice, surgeons and anesthesiologists work together for safety reasons as well as pump out as much mullah as possible...

 

[soon2bdoc2003]

The OR is a huge production... The hospital invests alot in providing an operating room, nursing, instruments, a recovery room, etc. and the surgeon is usually operating on someone who they have built a relationship with and who the patient trusts. Most patients will remember you as "the guy that put the IV in" and most surgeons wont remember you at all. This is a job you really have to do for your own gratification because there isnt going to be any from others. That said, with 5 months into my ca1 year i LOVE my job. The hours are great (as good as the hours i had in medicine), the work is an intellectual and physical challenge, and at the end of the day I dump my last patient in the pacu, give myself a pat on the back and go home. No patient lists to carry, no sign out rounds, no 4 hours of rounding to deal with... and the list goes on.

As far as med students fighting with attendings.. I would personally paralyze and intubate you if you pulled that crap in my room. I hope you werent planning on getting into that program.

 

[timtye78]

Quote:
Trickle down being what it is, now you had a ton of available positions but few candidates from residencies to fill them (and a good portion of what was taken into residency programs in the '90's was in all honesty substandard).
This year alone, my program has seen an incredible rise in the quality of applicants such that AOA candidates are becoming more common. Some programs are using this renewed interest to set higher admission standards (we have not simply because our program believes in bringing in good people, not just a good score or grade).

However, there will always be programs labeled as "less than desirable" that a less than desirable candidate can match into.
--End Quote
UT:
When I rotated at UTSW as a fourth year, I heard several residents at your program give the "I wouldn't be able to get in today" speech. I am comforted knowing you are not by your criteria, substandard.

I find your statements in this post unusually condescending. Anesthesiology residencies are just like every other position with applicants, supply and demand determines who goes where. As far as UTSW goes, no one will deny the excellent reputation, teachers, and experience you get. You must also factor in geography for determination of some of popularity. Many residents end up basing their rank on geography as a big if not deciding factor. Parkland,the county hospital, or ZLUH, for example, isn't exactly the land of milk and honey, but it is in Dallas!

Many excellent attendings as well as private anesthesiologists are IMGs,FMGs, and AMGs from regular state university medical centers. These people have worked hard and studied for years, and now you call some of them "less than desirable?" Wow. I have never heard any anesthesiologist walk into preop area introducing himself as "DrX, trained at X university, top 5 percent of my class, etc"

Some programs should be a little less high-opinionated about themselves or they find themselves in situations like I think WashU (or wherever that was) who under-ranked their applicants and found themselves emptyhanded on match day. Talk about new meaning to the word "scramble."

Other than this post, I do credit your posts with the majority of them useful, professional, and objective.

On that note, I like to encourage everyone who is interested in gas to apply. Sometimes I get the feeling that some people out there with sky-high numbers who realize that they are lackluster in person are still intimidated by those less than stellar numbers who may blow them out of the water in the clinical/interview arena!

 

[timtye78]

Anesthesiology is considered "boring" (and, IMHO, wrongfully so) by many. You are considered to be an order-taker with no real autonomy, and you have fairly limited patient interaction most of the time.

i think others feel the field is not only boring but, but you aren't really the attending on any of these patients and you don't directly fix the patients.

You don't consider acheiving the lost airway to be "directly fixing" pts?
What does the "A" in ABCs of ACLS or emergency medicine stand for?

Have you ever been in an OR with an anesthesiologist? Have you ever seen the whole surgical team take two steps back from the table and watched the anesthesiologist leap in and save patients? Gas docs are said to be the trainers and experts in ACLS. No patient fixing? Give me a break!

Try a rotation before you make statements like that!

 

[UTSouthwestern]

I find your statements in this post unusually condescending. Anesthesiology residencies are just like every other position with applicants, supply and demand determines who goes where. As far as UTSW goes, no one will deny the excellent reputation, teachers, and experience you get. You must also factor in geography for determination of some of popularity. Many residents end up basing their rank on geography as a big if not deciding factor. Parkland,the county hospital, or ZLUH, for example, isn't exactly the land of milk and honey, but it is in Dallas!

Many excellent attendings as well as private anesthesiologists are IMGs,FMGs, and AMGs from regular state university medical centers. These people have worked hard and studied for years, and now you call some of them "less than desirable?" Wow. I have never heard any anesthesiologist walk into preop area introducing himself as "DrX, trained at X university, top 5 percent of my class, etc"

Some programs should be a little less high-opinionated about themselves or they find themselves in situations like I think WashU (or wherever that was) who under-ranked their applicants and found themselves emptyhanded on match day. Talk about new meaning to the word "scramble."

Didn't mean to sound condescending in any way, Tim. I have heard the statement from all of my attendings that a lot of residents they took in the 90's were not highly thought of both here and at other programs and for many years, they needed to fill spots with bodies no matter what. At one point, you could simply walk into the chairman's office and say "I want to change programs" and be instantly accepted. Supply and demand as you said and the supply was very small at that time. Many of those residents have gone on to stellar academic and private careers. Many have not.

As for the quality of applicants, also a fact that there are simply a lot more high scoring candidates in the applicant pool. Does that mean we will all of a sudden rank only AOA and 240+ board score candidates? Hell no. We prefer strong personality, work ethic, etc. over raw scores. Does that also mean we stop looking at DO's? With the strong performances of the seven DO's in our CA1-3 classes, no way. FMG's and IMG's are also a source that has produced some of the best residents we have ever had including last year's chief resident who published 5 articles in residency.

Can you make yourself into a great anesthesiologist? You can be a great anesthesiologist, radiologist, internist, etc. no matter where you go if you are motivated, but differences in programs DO make a difference especially if you are getting beat into the ground working 80 hour weeks with little or no teaching and not doing as many cardiac, neuro, and major vascular cases. I think that it is always good to compare your program with other programs because you may find flaws that you didn't previously notice and can act to upgrade/rectify the situation. That was the case with our program two years ago: We thought we had placed the residency in the best possible position to educate our residents, but when I and a fellow resident compared it to our friends' programs (UCSF, Emory, Duke, Wake, etc.) we realized that we weren't utilizing a lot resources we had available in the best way and over the past two years we made a lot of the changes you see today. That gives us a better opportunity to become a great anesthesiologist. Certainly you can still be a great one coming from any program, but the path you take to get there can be straight and level or a journey through the Grand Canyon. That's not to say that the straight path won't be filled with difficulties of its own but those obstacles are the ones you want to see in residency.

Of course most of us aren't going to mention our program of training when introducing ourselves (and by the way, we are a state university program as well), but you will be asked on job interviews (I know as I have interviewed all over Dallas, California, Arizona, and Washington state) and even by some of your patients. The groups look at your information and the program's information to give themselves a global picture of your training. One California group even asked me to bring a complete breakdown of my cases to the interview.

Everyone should have a high opinion of the program they are in. If they don't, they have to wonder why that is the case and if/why they aren't doing enough to change the problems and continue to grow. It certainly doesn't mean you consider your program the best in the nation. That's a reputation you need to earn but you would hope that your program strives to reach that pinnacle one day, whether or not it actually does.

 

[timtye78]

Well put, UTSouthwestern. I appreciate your cool response and explanation.
Now I see where you were coming from. I can see how comparing the strengths of programs can improve other programs.

There are many med students on this forum who I have talked with who would be happy to go anywhere, just to become an anesthesiologist and others who come into this forum to "take the pulse" of what is going on in the specialty from young residents and others in the match process. Some of these people get very intimidated by some of the tones, and even outright bragging-you have not been this way. I am a purist in the sense that anyone with a medical degree and some potential, can become a competent anesthesiologist, as well as repeat what I have been told by countless gas residents that there is enough demand for anesthesiologists that it almost doesn't matter where you do your residency, you can still achieve your dream and pursue the field you like.

I appreciate your insight!
Take care!

 

[UTSouthwestern]

No problem Tim. Take a gander at the Dallas market if you are heading toward private practice.

 

[Skip Intro]

Most patients will remember you as "the guy that put the IV in" and most surgeons wont remember you at all. This is a job you really have to do for your own gratification because there isnt going to be any from others.

Ummm.... lemme guess. Third-year medical student?

That said, with 5 months into my ca1 year i LOVE my job.

Cripes! Coulda fooled me. What program are you in? No, wait. What city are you in? I want to stay at least five hundred miles away if possible.

As far as med students fighting with attendings.. I would personally paralyze and intubate you if you pulled that crap in my room. I hope you werent planning on getting into that program.

Ummm... I'll assume you're talking about "paralyzing and intubating" the surgeon, and not me. You weren't there, so why don't you keep your little tough-guy comments to yourself since you don't really know how it played out. Again, my attending took my side. And, the colossal pain-in-the-ass surgeon (as she's known to be around this particular hospital) should have kept her mouth shut and not butted into our conversation in the first place. I stood my ground, like any good (future) anesthesiologist should, and didn't allow her to marginalize me, my comments, or my attending's role in the case - which she apparently felt it her responsibility to do while grandstanding in front of her resident and student. I shut her down. Yes, me, a lowly med student - and a Caribbean one doing a visiting rotation at that! I assure you, she had a lot more respect for me after that incident (a lesson maybe you could learn so you don't leave the impression with your patients that you are just "the guy who put the IV in").

And, FYI, I have already interviewed at that program, favorably received, and it is no slouch gas program either. I'll let you know how it goes come Match time.



-Skip

 

[CambieMD]

Ummm.... lemme guess. Third-year medical student?



Cripes! Coulda fooled me. What program are you in? No, wait. What city are you in? I want to stay at least five hundred miles away if possible.



Ummm... I'll assume you're talking about "paralyzing and intubating" the surgeon, and not me. You weren't there, so why don't you keep your little tough-guy comments to yourself since you don't really know how it played out. Again, my attending took my side. And, the colossal pain-in-the-ass surgeon (as she's known to be around this particular hospital) should have kept her mouth shut and not butted into our conversation in the first place. I stood my ground, like any good (future) anesthesiologist should, and didn't allow her to marginalize me, my comments, or my attending's role in the case - which she apparently felt it her responsibility to do while grandstanding in front of her resident and student. I shut her down. Yes, me, a lowly med student - and a Caribbean one doing a visiting rotation at that! I assure you, she had a lot more respect for me after that incident (a lesson maybe you could learn so you don't leave the impression with your patients that you are just "the guy who put the IV in").

And, FYI, I have already interviewed at that program, favorably received, and it is no slouch gas program either. I'll let you know how it goes come Match time.



-Skip

Hi Skip,

no one can marginalize you.The type of behavior that you describe points to your insecurity and immaturity. I don't care what the surgeon was saying.

CambieMD

 

[Skip Intro]

Hi Skip,

no one can marginalize you.The type of behavior that you describe points to your insecurity and immaturity. I don't care what the surgeon was saying.

CambieMD

Whatever. You weren't there either. When my attending is asking me questions and having a conversation with me, directing those questions to me, and I am auditioning the program... and some egomaniacal surgeon butts in - showing HER insecurity - and tries to put anesthesia, as a discipline, in its place, I'm going speak up and defend the profession - and I'm going to do it every time. You can call that "immature" and "insecure" all day long if you want. But, I got honors on the rotation after the incident. And, I got the interview.

I'm really amazed how some of you are jumping on me for this. Aren't you proud of your profession and what you do for the patient? If you act like a doormat, you're going to get stepped on. There's a time to speak-up and a time to shut-up. This was a time to speak-up, especially since (1) she challenged me and (2) this conversation involved nothing to do specifically with this surgeon... and she said a lot of sh*tty things about anesthesiology (e.g., "you guys always leave the room", "read newspapers", "don't really care about the patient", etc.). I pointed out her blanket bias - flipped the script - and left her stammering for words. And, she shut up. No complaints from her later, but definitely more respect. My attending just smiled and laughed, later telling me that this attending has a reputation for being a loud mouth and that I shouldn't worry about her too much, although he was impressed with the way handled myself. That's all that matters. Certainly not what you (or anyone else on this forum) thinks about me. If you're so nonplussed and judgmental about such a trivial matter, I hope you never have to come to NYC to practice anesthesia. You won't survive if you're that fragile.

-Skip

 

[timtye78]

I am sorry you had to deal with that stuff. Truth be known, and it has been discussed on other boards that there are definitely some surgeons who don't appreciate anesthesiologists as much as others.

There have been whole discussions about issues like this. I would recommend that whether you are being attacked or you feel your specialty is being attacked that you shouldn't get into any type of fight in the OR unless there are patient safety issues at hand. Save debates like for out of the OR arena. I was asked on several interviews how I would react to being "cussed out" by surgeons. It is an issue. Like they said before, humor is a great idea. When someone accuses you of going into a 'lowly' position, laugh and agree with them! They know anesthesiology has a great lifestyle, great pay, etc. I think its a fair bet that some are not only envious or jealous. Everytime I was scrubbed in as a student I would look over there at the gas doc, and he or she would be there, smiling/enjoying life. Of course there were emergencies, and the surgeon puts their hands in the air (trying to stay sterile, of course) and takes several steps back to let the anesthesiologist "do something-quick."

Remember, there is no captain of the ship in the OR. Surgeons are good at what they do and anesthesiologists are good at what they do. Neither would function without each other. Not to mention all the ancillary staff that it takes to complete a surgery. As a group, most are professional and courteous, respectful of everyone else functions in the OR. Remember, they cannot decide whether or not to accept you in the university setting, but in private practice, they can and do request not to work with certain gas docs, so try not to get a reputation wherever you go as being confrontational. You should try to be the 'facilitator' of surgeries. If you are argumentative, people will give you the same reputation as the 'loudmouth' surgeon you despise.
Best wishes!
Tim

 

[Skip Intro]

Remember, there is no captain of the ship in the OR.

Hey man, thanks for your comments. But I hope you know that you're preaching to the choir here. It's just that the surgeon almost always thinks he/she is the captain of the ship... and in some respects they are. If it weren't for them, we wouldn't have a job in the OR (i.e., we don't just put patients to sleep for no reason).

But, they should at least respect our role. If they can't do that, then they should keep their mouth shut - and certainly not butt into a conversation during an audition, or at least not do it the way she did. This biotch was just a busybody. And, I guess she thought it fair game to try to pick on a Caribbean medical student (speaks volumes about her character, doesn't it?). All bark and no bite types I usually just ignore, but she called me out. Trust me, she was surprised when I had the cohones to bark back.

-Skip

 

[bigfrank]

Now here is the Skip Intro I know and love.

[rant]

Well, I once had the "balls" and the "audacity" (as an attending surgeon put it, who happened to be eavesdropping over the curtain on my conversation with my anesthesia attending [watch out for those surgeons, folks, they have BIG ears]) to insinuate that the surgeon's job, during the surgery, was to "take care of the problem" and the anesthesiologist's job was to "take care of the patient."

This biznitch blew a gasket. And, we got into a full-blown argument - yes, yours truly and an attending surgeon - in the middle of her doing a breast biopsy. My anesthesia attending just laughed... at both of us, actually. But, I think I did a pretty good job of defending my position.
....
So, you know what? When I'm an attending and I don't want to do a case, I will say to the surgeon (in so many words), "you're an idiot if you think you're going to operate on this sick patient." I will then write my note. And, you know what else? That surgery will not get done at that time unless someone else is willing to put their own ass on the line.

In the end, this means only one thing: I am the attending, and yes, it is my patient too.

[/rant]

-Skip

 

[Tenesma]

.... you know skip.... not that it happens often, but when surgeons would say something stupid like this one did to you... then my usual response is to humiliate them. IE: remind them of the time they ligated the SMA during a whipple ...

 

[HomerSimpson]

You guys have to remember that if you are going into private practice, these people(surgeons) will be your referral base. They are in effect your customers. If they are unhappy then they can always find a willing anesthesia group who will cover them. Therefore, there will be lots of "ordering" and complying happening in the OR. My philosophy is to treat them like 3 yr olds (which is how they act sometimes) If they want something to boost their egos then i usuallylet them have it. e.g. ok johnny the blood loss was 25 not 125 like i calculated. If it going to endanger patient care or increase my or her liability then I will intervene e.g. no johnny you may not do this patient with a K of 2.0 This may seem a little depressing to some BUT

Remember, they also have to get their patients from somewhere. Surgeons are all referral docs just like us. If they make a primary care physician mad because for instance they refused to perform a particular surgery then they may also lose that referring doctor. Remember that you are a specialist physician, therefore handling conflicts in the OR should be in a professional manner. Pissing contests between anesthesia and surgeons can cause unruly and unsafe outcomes in the OR. I would say that the main things that you have to do is maintain your confidence and know your stuff ( as well as turn the monitor away from them and have some neo handy. There is nothing more dangerous or frankly funny than a surgeon who thinks he/she knows how to do anesthesia)

as far as appeal for the specialty, well, i got home about 4:30 today did 3 cases made about $2500 and have no patients to worry about in the hospital. no phone calls for vicodin, no rounds, no worries.

 

[CambieMD]

You guys have to remember that if you are going into private practice, these people(surgeons) will be your referral base. They are in effect your customers. If they are unhappy then they can always find a willing anesthesia group who will cover them. Therefore, there will be lots of "ordering" and complying happening in the OR. My philosophy is to treat them like 3 yr olds (which is how they act sometimes) If they want something to boost their egos then i usuallylet them have it. e.g. ok johnny the blood loss was 25 not 125 like i calculated. If it going to endanger patient care or increase my or her liability then I will intervene e.g. no johnny you may not do this patient with a K of 2.0 This may seem a little depressing to some BUT

Remember, they also have to get their patients from somewhere. Surgeons are all referral docs just like us. If they make a primary care physician mad because for instance they refused to perform a particular surgery then they may also lose that referring doctor. Remember that you are a specialist physician, therefore handling conflicts in the OR should be in a professional manner. Pissing contests between anesthesia and surgeons can cause unruly and unsafe outcomes in the OR. I would say that the main things that you have to do is maintain your confidence and know your stuff ( as well as turn the monitor away from them and have some neo handy. There is nothing more dangerous or frankly funny than a surgeon who thinks he/she knows how to do anesthesia)

as far as appeal for the specialty, well, i got home about 4:30 today did 3 cases made about $2500 and have no patients to worry about in the hospital. no phone calls for vicodin, no rounds, no worries.

Hi HomerSimpson,

as I guy who has worked as a pcp before applying to anesthesia I totally agree with you. Surgeons love to poke fun at anesthesiologists but so what.

The patient is the captain of the ship in the 21st century. The patient is the client. If we (referring to all the members of the team) do not please them they will exact revenge. Has anyone heard of litigation. Also, it is amazing how quickly folk start to point fingers when there is a bad outcome. "Captains," tend to jump ship when the lawyers come a calling.

I don't want to beat a dead horse but argumentative types do not do well in medicine in general. Argumentative types with a point to make usually don't work well in teams.

CambieMD

 

[timtye78]

You guys have to remember that if you are going into private practice, these people(surgeons) will be your referral base. They are in effect your customers. If they are unhappy then they can always find a willing anesthesia group who will cover them. Therefore, there will be lots of "ordering" and complying happening in the OR. My philosophy is to treat them like 3 yr olds (which is how they act sometimes) If they want something to boost their egos then i usuallylet them have it. e.g. ok johnny the blood loss was 25 not 125 like i calculated. If it going to endanger patient care or increase my or her liability then I will intervene e.g. no johnny you may not do this patient with a K of 2.0 This may seem a little depressing to some BUT

Remember, they also have to get their patients from somewhere. Surgeons are all referral docs just like us. If they make a primary care physician mad because for instance they refused to perform a particular surgery then they may also lose that referring doctor. Remember that you are a specialist physician, therefore handling conflicts in the OR should be in a professional manner. Pissing contests between anesthesia and surgeons can cause unruly and unsafe outcomes in the OR. I would say that the main things that you have to do is maintain your confidence and know your stuff ( as well as turn the monitor away from them and have some neo handy. There is nothing more dangerous or frankly funny than a surgeon who thinks he/she knows how to do anesthesia)

as far as appeal for the specialty, well, i got home about 4:30 today did 3 cases made about $2500 and have no patients to worry about in the hospital. no phone calls for vicodin, no rounds, no worries.

 

[Tenesma]

homer has a great point ..

 

[Celiac Plexus]

As a general surgery resident, I sometimes troll this board to see how the other side of the curtain is training.

It seems that a good number of you have arrogant surgeon stories. I too have a few arrogant surgeon stories myself. As a pgy-2 I have already endured a few hair-raising scream sessions with me as the focal point.

The best way to deal with these situations is not to get your hackles up. How you behave under fire is generally how people judge you. If you maintain your cool, and remain professional at all times, you will develop a rep as a "good" person/physician: cool under fire. You will also develop a rep as the kind of person that can get along with everyone.

I know that occasionally you will catch some hell for something you are not responsible for. This is the best time to play it cool. Everyone will know that the person doing the yelling is the a$$holio, and you will come out looking great if you remain calm. If you give in to your temper and fire back, you will probably say something you wouldn't ever normally say, and you will lose the professional high ground. That being said, if you feel that you have been singled out by an individual for personal reasons, and you are sick of their bull$h*t, then take it to your PD, or your adviser. That is a professionally accepted way of presenting your case in a calm, controlled, dignified, and respectable manner... and the one way that is most likely to get favorable results.

Finally, even though surgeons seem to be the ones at the center of these kind of workplace horror stories, I have found that the vast majority of surgeons at my university institution are quite friendly with the gas docs, and especially the OR staff. When it comes down to it, the patient is the boss, and we all must work (ideally) in harmony to provide the best care for the patient. If the surgeon is the captain, then can a captain sail a boat effectively with a crew that disdains him/her, and fights the captain on every little order? And likewise can a crew be efficient if the captain lacks leadership skills, and commands in a tyrannical fashion? Remember this the next time that you feel like grandstanding in the OR (and if there are any surgeons reading this, this definitely applies to you too). Take a deep breath if you need to, and be professional. If you have something to say, the OR is not the place for histrionics. Stay focused, do your job the best that you know how to, and then later when you are calm decide what to do... speak to the surgeon privately, or your PD, or chairman, or ....whatever.

Good luck.

 

[VentdependenT]

Amen. Solid post.

Whenever I encounter a colleague behaving in an unprofessional grandstanding manner I immedately think of two things. 1) These people allowed themselves to be conditioned this way. Which I view as a sign of weakness. 2) Thank God I'm not the poor bastard that is married to this person and is forced to put up with their crap all the time.

When embedded in these situations I can now take pity on these poor souls. I just nod, give an extremely subtle yet perceptible smile (the one which combines pity and understanding. Mothers use it a lot.), turn, and perfom my job as there is a patient which needs to be attended to.

 

[mike327]

This is one area where being an RN before med school comes in really handy. I've been on the recieving end of so many tantrums from Surgeons, GI docs, ENT guys, OB/GYNs (even, god forbid... the occasional gas doc...). I really don't even notice anymore.

My favorite reply to a prolonged rant is ,"I'm sorry what?"

 

[UTSouthwestern]

This is one area where being an RN before med school comes in really handy. I've been on the recieving end of so many tantrums from Surgeons, GI docs, ENT guys, OB/GYNs (even, god forbid... the occasional gas doc...). I really don't even notice anymore.

My favorite reply to a prolonged rant is ,"I'm sorry what?"

Fan the flame.

 

[Idiopathic]

Skip just wants us to think that he had balls, when he was a 4th year. EVERYONE has balls as a 4th year, btw. I can't imagine even having a conversation that in any way denigrated my superior directly within earshot. And whatever you thought of that surgeon personally, she was definitely your superior. But whatever, Im sure this helps the US medical community's impression of Carib grads, Skip...way to go!!

 

[Skip Intro]

Skip just wants us to think that he had balls, when he was a 4th year. EVERYONE has balls as a 4th year, btw. I can't imagine even having a conversation that in any way denigrated my superior directly within earshot. And whatever you thought of that surgeon personally, she was definitely your superior. But whatever, Im sure this helps the US medical community's impression of Carib grads, Skip...way to go!!

She was not my superior, and I was certainly not "denigrating" my attending. If anything, he was amused and respected the fact that I didn't back down, but instead defended what I said - the thing she butted-in and could not resist commenting on.

And, yes, I have balls. Big ones.

-Skip

 

[bigfrank]

But whatever, Im sure this helps the US medical community's impression of Carib grads, Skip...way to go!!

I'm not sure even your "240's Step I score" can save you now, Skip.