Teaching attendings: How often do they work alone?

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15+ Year Member
Dec 1, 2005
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My experience is that those in teaching jobs uncommonly run cases without a resident, especially in cardiac rooms. Is this what others have seen as well?

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At my institution, the younger attendings get stuck by themselves in the GI/Litho/ unless theres enough residents to go around that day (week of christmas/nye ect.)
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The answer is that it is totally institution dependent. I looked at academic jobs at Children's Hospitals where it was >50% direct care and others where it was maybe 1%. The difference is usually related to the presence of CRNAs and who takes call. We don't have any CRNAs on call with us. Faculty may do their own cases if things are busy in the evening, and we usually have a few rooms/locations that are direct care every day. Our ASC locations are also all direct care. On nights/weekends when I have to call in the 2nd call faculty from home (very uncommon) they usually have to work alone, but not always. Sometimes it's a relatively straight forward case, but urgent and off the floor from the main OR, so I can't go myself while doing other cases. Other times it's a wreck of a case (NICU disaster, trauma, etc) and the Fellow is already tied up with me in a transplant or some other wreck. You never know, that's part of the fun.:eek: I would not recommend taking a 100% supervision job right out of training. That's a bad idea. You need time to develop your skills and judgement.
Where I trained, there is never any situation ever where an attending would be sitting a case by themselves. One time during my CA-3 year, one of my attendings offered to send me to lunch during circ arrest (without a resident or CRNA to break me) and I totally laughed at him. He had to spend like 5 minutes convincing me it was "legal" for him to be in there alone. I went to lunch, and when I came back he had neglected to ice the patient's head (which was our practice at the time) and hadn't charted anything because he didn't know how to use the computerized charting system. Thanks buddy!
Maine. ~10 cardiac attendings. 2-3 rooms per day. Typically one resident assigned to one room. All echos done by anesthesia, with exception to post-repair valves (Cardiology). No fellows (CT surg or anesthesia). Pedi hearts by a great surgeon. Two cardiac attendings are ABA examiners.

I got 40 pump runs in 2 months as a CA-2. That was with one slow month of only one heart a day. Attendings generally stand back by your second month.

If you like hearts, I really couldn't think of a better place to train. The attendings like working alone, too. They actually get a little upset sometimes when we come in and steal lines during non-OR rotations.