some queries

[ALTorGT]

hi all
as that stage where Im choosing what to do after med school..
very inclined towards the R and A of the ROAD specialities....little clinical/ward work, great lifestyle vs income combo, instant gratification and interventional (at least can be made so with radiology)...

however, some queries about anesthesia that concern me:
1) dont understand how its fewer hours than surgery because as an anesthetist you have to arrive at surgery pre op..prep the patient..stay through the entire surgery and for a half hour more after the last stich is put in by the surgeon...so isnt it more hours than surgery that way? the surgery attending always gets to piss off earlier and arrive much later into surgery..and always gets the bulk of the fees of the surgery..
2) Also, I was still strongly considering surgery..and I get the feeling that in surgery, however difficult it may be in the initial stages of your career, (residency, fellowship etc.), with time, you become better and more respected/recognised practitioner in that area..i.e you're the man for doing whipples in all of north west manhattan..as in you develop a solid reputation amongst a patient base..no one can or at least more difficult for competition to just takeaway your business..but anesthetics and radiology.....I get the feeling that you become the surgeons beyatch...you know.the left hand man...never the godfather..so without any direct influence over the patient..another replaceable commodity/service to the lowest bidder..same it seems applies to radiology...how true is this? Am I wrong in my assumption? Much appreciate your input....

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[BassDominator]

1) Hours: I don't know much about private practice, but in an acadamic setting, you come in around 7 am and often leave between 3 and 5 pm. Any cases that go late are passed on to the on-call team. Preops are generally done the day before.

2) Pay: The nice thing about anesthesia is you not only get paid for the case you do, but also the cases you supervise.... so you can actually make more money than a lot of surgeons.

3) Respect: If you're good, you will get tons of respect from the surgeons. Some surgeons are very particular about who they will work with.... and are very interested in your expert opinion, especially in cardiac anesthesia.

 

[ALTorGT]

i figure in an academic setting..even the surgeon can leave after he takes out the tumor and leave his monkey resident to close him up...but in pvt practice..where u have to do the full case.....and if a surgery was scheduled from 8-2 ud have to come in 7 and leave at 2.30..get my drift?

 

[sean wilson]

Yep, we do.

However, you get a lot more money in private practice.

 

[undecided05]

I, too have had trouble deciding between surgery and gas. As for hours, don't forget that surgeons have lots of clinic time as well and they have to deal with the BS of talking to the patient's fmaily and follow-up. With gas, you're mostly done when the procedure is done; a lot less paperwork. With the respect issue, and it's a big issue for me, don't expect many people to appreciate what you do, but I guess that's why you get paid. The best compliment you can have is for a surgeon to ask you to do a procedure for them or to hear nothing at all. Patients though won't hardly remember you; unless something goes wrong. And most of the time they'll blame your ass. As for money, I know it depends on what specialty of surgery and how many cases you work for both surgery and gas, but I've been under the impression that pay is comprable... anyone have insight to that?
As for rads, most surgeons don't trust them anyway. While working on ortho, I realized that there is very little correlation between what the radiologist and what the orthopod are interested in. As for hours, can't be beat. As for pay, pretty damn good, but once again, not much respect factorl unless you're doing interventional radiology. Hope this adds some insight.

 

[Intubater_X]

i figure in an academic setting..even the surgeon can leave after he takes out the tumor and leave his monkey resident to close him up...but in pvt practice..where u have to do the full case.....and if a surgery was scheduled from 8-2 ud have to come in 7 and leave at 2.30..get my drift?

Right........then the surgeon has to talk to the family, most likely round, see all the consults that accumulated during his "8-2" day not to mention the q day follow up, progress notes, discharge summary, countless phone calls concerning this one particular case. Whereas the anesthesiologist is on the road at 2:35 with his pager OFF. Get my drift?

 

[Intubater_X]

.....I get the feeling that you become the surgeons beyatch...you know.the left hand man...never the godfather.....

Dude......first of all, as a Godfather of Gas, I must totally disagree. I never have been, nor will I EVER be a surgeon's beyatch. What I do will ALWAYS be in the best interest of the patient. If the surgeon politely REQUESTS that I do a particular anesthetic technique (i.e. regional vs. general anesthesia) AND it is in the patients best interest, I will be more than happy to accomodate them. If however, it is not in the patient's best interest, then I WILL DECIDE WHAT THEIR ANESTHETIC care plan will entail. Believe me, I have stepped up to a few bullying surgeons who have tried to dictate a patients anesthetic care (laughable) and told them, "Fine, you can do the case, I just won't be involved." 100% OF THE TIME, my judgement has been accepted.

Hope this helps!

 

[Chemguync]

On one hand, the surgeon has to deal with all the calls from the patients and their family w/ questions about the case and recovery, and deal with the "my cat knocked my vicoden down the sink, and I need a refill right now" goodness. On the other hand, in pvt practice, the surgeon has a dutiful RN who handles all that crap for him while he's off playin w/ the wife and kids.

Pvt practice Gas in my local hospital = 2 weeks on 1 week off.. that sounds mighty nice.

 

[ALTorGT]

hey...when i said theres no respect..i dont really give a shyte about being the man who is followed around by dork medical students and feelign all important because he is professor of surgery..i meant from the point of view that your product/service is not a commodity but something unique...i know youre gonna say 10000 other poeple can do whipples and your not the only one..so theres nothing really special about it..but stil...a whole lot more special than just the other anesthetist ..who can be replaced..should the need arise..you know....from a business sense...isnt surgery more secure as a career choice???
appreciate your thoughts.

 

[ALTorGT]

what about all the time spent seein patients preop working them up to make sure theyre safe for anesthesia..theres none of that BS in Rads..basically..rads seems to be clinical work (and thus ...BS time free where u have to get never ending borng historys from patients)....

 

[Catfish John]

what about all the time spent seein patients preop working them up to make sure theyre safe for anesthesia..theres none of that BS in Rads..basically..rads seems to be clinical work (and thus ...BS time free where u have to get never ending borng historys from patients)....

if you think that preop prep with a patient to make sure they're safe for anesthesia is "BS" then it might be best to look to another field in medicine...



just a thought.

 

[chillindrdude]

Dude......first of all, as a Godfather of Gas, I must totally disagree. I never have been, nor will I EVER be a surgeon's beyatch. What I do will ALWAYS be in the best interest of the patient. If the surgeon politely REQUESTS that I do a particular anesthetic technique (i.e. regional vs. general anesthesia) AND it is in the patients best interest, I will be more than happy to accomodate them. If however, it is not in the patient's best interest, then I WILL DECIDE WHAT THEIR ANESTHETIC care plan will entail. Believe me, I have stepped up to a few bullying surgeons who have tried to dictate a patients anesthetic care (laughable) and told them, "Fine, you can do the case, I just won't be involved." 100% OF THE TIME, my judgement has been accepted.

Hope this helps!

my thoughts EXACTLY! as a lowly medical student, stupid surgery or ob/gyn attendings crack jokes at anesthesiology sometimes. i just grin and bear it. but just below my humble visage, i'm smirking. smirking that i'll have a better life, deal with less BS and malpractice, and making more money, than most of you suckas. i could give a rat's arse about "respectability"...that is a sign of vanity.

 

[VentdependenT]

my thoughts EXACTLY! as a lowly medical student, stupid surgery or ob/gyn attendings crack jokes at anesthesiology sometimes. i just grin and bear it. but just below my humble visage, i'm smirking. smirking that i'll have a better life, deal with less BS and malpractice, and making more money, than most of you suckas. i could give a rat's arse about "respectability"...that is a sign of vanity.

Post of the year man. Dead on. On top of that it is a fantastic field. You can take it to any level you want.

 

[apma77]

why do surgery when in anesthesia you have better hours, great procedures, good personalities (in general) and can double your salary if you know how to play the stock market!!

yes..i do know an anesthetist you drives a Lambo..ofcourse his stock market genius helped him get it

 

[gaseous]

I get the feeling that you become the surgeons beyatch...you know.the left hand man...

I've got buddies that are going into surgery that question my logic about Anesthesia.

They say things like, "man...your going to be my beyatch in the OR...When I say raise the bed, you raise the bed. When I say lower the bed, you lower the bed, etc..."

My response with a smirk is, "thats Ok, becuase when I leave the hospital ~2pm , I will go home and take care of my wife then I heading over to your house and take care of your wife since you will still be rounding at the hospital or in clinic. So you see, I may his beyatch in the OR but his wife is my beyatch when I'm at home."

 

[Tenesma]

when i don't feel like lowering or raising the table - i just tell them i am too busy to focus on that... oh well...

 

[ALTorGT]

what happens in pvt practice.....how can anesthetics be better than surgery as far as time spent is concerned if in the OR u have to be there longer than the surgeon. What I dont get is how the lifestyle can be better than that of a surgeon given that if someone needed surgery, the anesthetist has to be present..so if a surgeon is on call and someone comes in overnight with subdural haemmorhage, and the neurosurgeon is paged, then you literally are his bitch because hes going to call you and you have to come too..right?

 

[Tenesma]

ALTorGT:

let me clarify your point about an emergent crani for SDH - you are coming in for the patient, and the surgeon can't do squat without you being there...
you are nobody's bitch.

the hours: you are absolutely wrong if you think attendings have better hours than residents - in fact, with the 80 hour work week imposed on the residents, the attendings have incurred increasing hours. Plus you are forgetting about the obligations of a surgeon - there is a lot more to do then just OR stuff. The surgeon needs to recruit patients in a clinic, sees surgical consults in the ER or on the floor that can be time consuming (and some of those consults might not even go to the OR), has to dictate charts, has to deal with post-operative issues of the patient (patient is at home and has discharge from the wound, is in too much pain, has coughed and eviscerated through the fascial closure), etc... so while the average surgeon may have 40-50 hours of OR time, i think it is safe to assume that you have to add another 15 to 25 hours on clinic/consults/paperwork/charts/insurance, etc...
these are issues that the anesthesiologist is not burdened with.

and ALTorGT - i find it hard to believe that you are a 5th year med student when all of your other posts seem so clueless about what goes on inside the hospital....

 

[apma77]

you are only someone BIATCH if you wanna be that
but otherwise you are there to do what is in the best interest of the patient..if that is raise the table then so be it!


no point in fighting with surgeons,,,if you do your job which is to take care of the patient to the best extent then thats all that matters

if the surgeon is an azzzhole just ignore him and do your job , impolite azzholes use to get it their way 10 yrs ago but now thats usually not the case

 

[BassDominator]

They say things like, "man...your going to be my beyatch in the OR...When I say raise the bed, you raise the bed. When I say lower the bed, you lower the bed, etc..."

My response with a smirk is, "thats Ok, becuase when I leave the hospital ~2pm , I will go home and take care of my wife then I heading over to your house and take care of your wife since you will still be rounding at the hospital or in clinic. So you see, I may his beyatch in the OR but his wife is my beyatch when I'm at home."

Too funny (no, I don't support infidelity)

 

[JP2005]

im rich biotch !!! (honk, honk)

 

[ALTorGT]

I am not concerned about being the surgeons bitch in an egotistical sense. I meant from the point of view of having no control over when and how you work. I have been told on many occassions that as an anesthetist in pvt practice (which is more lucrative than public work), cultivating business relationships with the surgeons who use your services is very important. So, if a surgeon dictates that he wishes to do his surgery from 6-9pm after seeing 50 patients in his clinic from 9-5pm, then you have to suck it up and do so..or else he stops working with you and finds himself some other chump..SO...lets stop this talk about who gets to swush their dick in the OR more and talk about the logistics of whos in control of what gets done when and how that impacts on the anesthetists business case....

 

[NaeBlis]

I am not concerned about being the surgeons bitch in an egotistical sense. I meant from the point of view of having no control over when and how you work. I have been told on many occassions that as an anesthetist in pvt practice (which is more lucrative than public work), cultivating business relationships with the surgeons who use your services is very important. So, if a surgeon dictates that he wishes to do his surgery from 6-9pm after seeing 50 patients in his clinic from 9-5pm, then you have to suck it up and do so..or else he stops working with you and finds himself some other chump..SO...lets stop this talk about who gets to swush their dick in the OR more and talk about the logistics of whos in control of what gets done when and how that impacts on the anesthetists business case....

It doesn't really work that way. Who do you get your info from? Pre-meds?

 

[apma77]

ya dude where do you get your info from?

or are you here just stirring up shi# for no reason

 

[ALTorGT]

how DOES it work then smart ass...if the anesthetist doesnt wanna do an elective procedure when the surgeon wants to do it coz hed rather be home in bed with his woman or the golf clubs, then can he afford not to do it and risk some other anesthetist taking over that list. My point is, in pvt. practice, as an anesthetist, do you do most of your work for a select few surgeons with whom you've developed a business relationship? Because I hear stories of how some surgeons will only operate with a particular anesthetist and no one else..in which case, should you piss a particular surgeon off, wouldnt you lose a large chunk of your business.

 

[NaeBlis]

how DOES it work then smart ass...if the anesthetist doesnt wanna do an elective procedure when the surgeon wants to do it coz hed rather be home in bed with his woman or the golf clubs, then can he afford not to do it and risk some other anesthetist taking over that list. My point is, in pvt. practice, as an anesthetist, do you do most of your work for a select few surgeons with whom you've developed a business relationship? Because I hear stories of how some surgeons will only operate with a particular anesthetist and no one else..in which case, should you piss a particular surgeon off, wouldnt you lose a large chunk of your business.

Not even sure where to start explaining that your whole understanding seems off. Basicly, Anesthesiologists form groups and contract with prvt hospitals or surgi centers to provide services. Since there is such a shortage of providers right now, negociations usually go rather well. Then surgeons who have privilages st these places contact the hospitals and schedules surguries in available time slots. Surgeons can't create time slots, and they can't pick there provider in most cases. That is decided by the Anesthesia group. There is usually one anesthesiologist who is running the OR that day and assigns the providers and can affect schedules. I've seen the anesthesiologist bump the surgeries of surgeons he didn't like to the end of the day. Not very professional, but I have seen that happen more that once.

Even if things did happen in tha warped way u seem to think they do there is a huge shortage of providers right now and the surgeons can't just find anohter provider with any ease.

 

[ALTorGT]

that clarifies it...goodo...

 

[apma77]

dude it seems your more worried about becoming some1s biatch than an anesthesiologist....you should go into surgery ..that way you wont regret it for the rest of your life

 

[chillindrdude]

dude it seems your more worried about becoming some1s biatch than an anesthesiologist....you should go into surgery ..that way you wont regret it for the rest of your life

i concur...you should be on the other side of the drape.

the anesthesiology group at the prvt hospital i'm doing my rotations at make BANK! and thats just the surgical anesthesia portion. they get along well with most of the surgeons, cracking jokes and the like. they're never stressed and enthusiastic about teaching.

 

[ortholsu]

I myself am torn between surgery (specifically ortho) and gas, but i hope to make that decision based on what i enjoy and not the fear of being a bitch. In this world of medicine a doctor is always gonna be someone's bitch if you really think about it. we will always have insurance companies and hospital ceo's who will try to control and dictate the medicine we want to practice. can't forget about the law makers who will throw more crap at us with even less knowledge about medicine. lastly, a doctor is always going to be answering to patients because we are providing a service to them and we know deep down that they can take their buisness elsewhere. so why worry about all that b.s?
why not just try to find something you are happy with and do that. it seems that deep down you wanna do surgery. well do it. if i pick gas, then i'll need you to operate so that i can do my work and make my money. if you wanna do gas, then do gas, but do gas to the best of your abilities and you will never have to worry about all this bitchiness.
i hope to rotate through both fields in the next few months, and then i hope i either love one or the other, or hate both and find my true love somewhere else. and no matter what field i pick i will always make sure i got time for all the lovin' my wife needs.

word!