view the surgeon as a client?

[AngryBird69]

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A couple of med students were discussing the dynamics of the surgeon/anesthesiologist dynamic and when the topic of bossy surgeons came up, one of them said: don't think of the surgeon as a bossy colleague, look at him as a client or customer you are trying to please.

This resounded with me because indeed the gas doc is providing a highly skilled service to the surgeon.

My question: is that a healthy way of defining your relationship to surgeons? I.e. You are a service provider and you`re trying to keep the customer happy.

 

[countingdays]

A couple of med students were discussing the dynamics of the surgeon/anesthesiologist dynamic and when the topic of bossy surgeons came up, one of them said: don't think of the surgeon as a bossy colleague, look at him as a client or customer you are trying to please.

This resounded with me because indeed the gas doc is providing a highly skilled service to the surgeon.

My question: is that a healthy way of defining your relationship to surgeons? I.e. You are a service provider and you`re trying to keep the customer happy.

It's probably the worst thing about being an anesthesiologist.

 

[Precedex]

A couple of med students were discussing the dynamics of the surgeon/anesthesiologist dynamic and when the topic of bossy surgeons came up, one of them said: don't think of the surgeon as a bossy colleague, look at him as a client or customer you are trying to please.

This resounded with me because indeed the gas doc is providing a highly skilled service to the surgeon.

My question: is that a healthy way of defining your relationship to surgeons? I.e. You are a service provider and you`re trying to keep the customer happy.

That's fd up man. Find another place to work if that is what it takes to get through the day.

 

[deleted126335]

A couple of med students were discussing the dynamics of the surgeon/anesthesiologist dynamic and when the topic of bossy surgeons came up, one of them said: don't think of the surgeon as a bossy colleague, look at him as a client or customer you are trying to please.

This resounded with me because indeed the gas doc is providing a highly skilled service to the surgeon.

My question: is that a healthy way of defining your relationship to surgeons? I.e. You are a service provider and you`re trying to keep the customer happy.

It is not a healthy way of defining our relationship. In many weak departments and settings, particularly surgeon owned centers, it is an accurate way of defining our relationship.

 

[MD Dreams]

People will treat you the way you allow them to. If you are doing your job well and are assertive and let them know up front that you are not their bitch they will learn quickly that your not one to walk over. Furthermore, with the shift towards more anesthesiologists becoming hospital employees this type of mentality will be less prevalent. I prefer to think that I'm providing a service to the patient, not the surgeon. If I am working with a respectful surgeon I will certainly try to accommodate their needs as much as possible. If I'm working with a jerk, I can make their life very unpleasant. We should not forget that we hold a lot of power. My situation may be different than some who have posted here in that I am a hospital employee. I, for one, will never work in a setting where the surgeon tries to run the show. It should be a professional, collaborative environment.

 

[pgg]

My question: is that a healthy way of defining your relationship to surgeons? I.e. You are a service provider and you`re trying to keep the customer happy.

No, but it pays to remember that
- patients come to the hospital for surgery, not anesthesia
- surgeons bring patients to the hospital, not anesthesia
And keep in mind that there are varying shades and different tones to interactions with other physicians in other specialties. Don't be eager to take offense when some guy who's doing his job just expects you to do your job without accolades or genuflections.

We aren't the only specialty that sometimes perceives being looked down on by others. Ask the ER doc if he ever gets shat upon by a surgeon, or an FP doc if he ever gets attitude from a cardiologist, or a radiologist or pathologist if he ever feels like he's an unappreciated cog in someone else's machine.

At least surgeons SEE what we do as we're doing it, and the smart ones can tell the difference between a good, no-drama, elegant anesthetic and a hamhanded moving-patient, bucking-extubation, puking-PACU ordeal.


We ARE providing a service, and one of the parties we need to take care of is the surgeon. That doesn't mean we have to be subservient or obsequious, and it doesn't mean we need to put up with any abuse.

It does mean that in most cases, we need to be willing and able to provide good care when and where the surgeon decides a patient needs surgery, and according to the level of urgency that they feel is necessary. Obviously if something is amiss one of our jobs is to put the brakes on things. Still, usually the correct answer to a surgeon who says he has a case to do is "OK, when do you want to go to the OR?"

Usually there's mutual respect, even if most surgeons probably feel like they're in charge, or at least first among equals.

There aren't a lot of fields of medicine where easily bruised egos will be coddled. If "taking **** from surgeons" is your reason to avoid anesthesia, you're in for a rough ride whatever field you choose. 🙂

 

[MD Dreams]

No, but it pays to remember that
- patients come to the hospital for surgery, not anesthesia
- surgeons bring patients to the hospital, not anesthesia
And keep in mind that there are varying shades and different tones to interactions with other physicians in other specialties. Don't be eager to take offense when some guy who's doing his job just expects you to do your job without accolades or genuflections.

We aren't the only specialty that sometimes perceives being looked down on by others. Ask the ER doc if he ever gets shat upon by a surgeon, or an FP doc if he ever gets attitude from a cardiologist, or a radiologist or pathologist if he ever feels like he's an unappreciated cog in someone else's machine.

At least surgeons SEE what we do as we're doing it, and the smart ones can tell the difference between a good, no-drama, elegant anesthetic and a hamhanded moving-patient, bucking-extubation, puking-PACU ordeal.


We ARE providing a service, and one of the parties we need to take care of is the surgeon. That doesn't mean we have to be subservient or obsequious, and it doesn't mean we need to put up with any abuse.

It does mean that in most cases, we need to be willing and able to provide good care when and where the surgeon decides a patient needs surgery, and according to the level of urgency that they feel is necessary. Obviously if something is amiss one of our jobs is to put the brakes on things. Still, usually the correct answer to a surgeon who says he has a case to do is "OK, when do you want to go to the OR?"

Usually there's mutual respect, even if most surgeons probably feel like they're in charge, or at least first among equals.

There aren't a lot of fields of medicine where easily bruised egos will be coddled. If "taking **** from surgeons" is your reason to avoid anesthesia, you're in for a rough ride whatever field you choose. 🙂

Nice post!

 

[AngryBird69]

It's probably the worst thing about being an anesthesiologist.

Yeah surgeons can be surgeons but in the end you're making more $ per hour than they are lol

That's fd up man. Find another place to work if that is what it takes to get through the day.

Nah I didn't mean it like that. I pretty set on anesthesia at this point and surgeons don't scare me. The ones that need to be d*cks are just sour pusses that thrive on misery.

It is not a healthy way of defining our relationship. In many weak departments and settings, particularly surgeon owned centers, it is an accurate way of defining our relationship.

Thanks for chiming in. Yeah it doesn't seem all that healthy from a personal or financial POV when I really think about it.

People will treat you the way you allow them to. If you are doing your job well and are assertive and let them know up front that you are not their bitch they will learn quickly that your not one to walk over. Furthermore, with the shift towards more anesthesiologists becoming hospital employees this type of mentality will be less prevalent. I prefer to think that I'm providing a service to the patient, not the surgeon. If I am working with a respectful surgeon I will certainly try to accommodate their needs as much as possible. If I'm working with a jerk, I can make their life very unpleasant. We should not forget that we hold a lot of power. My situation may be different than some who have posted here in that I am a hospital employee. I, for one, will never work in a setting where the surgeon tries to run the show. It should be a professional, collaborative environment.

Speaking of being a hospital employee, if one gets an offer from one's own residency hospital upon graduation, is it likely to be a good gig? It can be quite tempting I imagine.

No, but it pays to remember that
- patients come to the hospital for surgery, not anesthesia
- surgeons bring patients to the hospital, not anesthesia
And keep in mind that there are varying shades and different tones to interactions with other physicians in other specialties. Don't be eager to take offense when some guy who's doing his job just expects you to do your job without accolades or genuflections.

We aren't the only specialty that sometimes perceives being looked down on by others. Ask the ER doc if he ever gets shat upon by a surgeon, or an FP doc if he ever gets attitude from a cardiologist, or a radiologist or pathologist if he ever feels like he's an unappreciated cog in someone else's machine.

At least surgeons SEE what we do as we're doing it, and the smart ones can tell the difference between a good, no-drama, elegant anesthetic and a hamhanded moving-patient, bucking-extubation, puking-PACU ordeal.


We ARE providing a service, and one of the parties we need to take care of is the surgeon. That doesn't mean we have to be subservient or obsequious, and it doesn't mean we need to put up with any abuse.

It does mean that in most cases, we need to be willing and able to provide good care when and where the surgeon decides a patient needs surgery, and according to the level of urgency that they feel is necessary. Obviously if something is amiss one of our jobs is to put the brakes on things. Still, usually the correct answer to a surgeon who says he has a case to do is "OK, when do you want to go to the OR?"

Usually there's mutual respect, even if most surgeons probably feel like they're in charge, or at least first among equals.

There aren't a lot of fields of medicine where easily bruised egos will be coddled. If "taking **** from surgeons" is your reason to avoid anesthesia, you're in for a rough ride whatever field you choose. 🙂

thanks PGG, very well said. No as I said above, surgeons don't scare me. I was genuinely curious as to how some of you guys would interpret my friend's "customer service" view of the anesthesiologist.

 

[gasattack3]

A couple of med students were discussing the dynamics of the surgeon/anesthesiologist dynamic and when the topic of bossy surgeons came up, one of them said: don't think of the surgeon as a bossy colleague, look at him as a client or customer you are trying to please.

This resounded with me because indeed the gas doc is providing a highly skilled service to the surgeon.

My question: is that a healthy way of defining your relationship to surgeons? I.e. You are a service provider and you`re trying to keep the customer happy.

I never fully understood WHY (not how) some people in our "biz" are so reluctant to see that for what it is.

They are our internal customers. Surely, we have professional responsibilities of our own, and we have an obligation to do what's best, and safest, for the patient.


Nobody is saying, "dude, you need to grovel with your tail between your legs and bow down to the master". Not it at all, but taking away problems is a great way to add value and solidify your position and worth within an organization. Anything we can do to effect those things will benefit us.
But, that doesn't in any way preclude us from cultivating those "business" relationships. Providing good, safe, effective, expedient service to our internal customers, surgeons. I just don't see what the problem with that is.

Actually, I would bet that those who AREN'T reluctant to embrace that fact of life, are probably more successful and even enjoy their jobs more.

Just my 2 cents.

 

[deleted126335]

Some people are bastards and like the feeling of intimidating others and moving somebody like a chess piece. A disproportionate number of surgeons fit this description as compared to the general population. Consequence of their training I suspect.
In a previous job I worked occasionally at a surgeon owned surgicenter where one of the surgeons reallly liked the feeling of "owning" other people. The overall anesthesia department in this job was weak, The anesthesiologits got pushed around alot. The chairman was spineless and couldn't be counted on to back you. One anesthesiologist didn't get his contract renewed bcause of refusing to take any crap.

 

[JSBMD]

I've been in the private world for 15 years. Here's my take: yes, we are independent physicians, who don't need to take anyone's crap. Also, the surgeons most definitely can tell good from mediocre anesthesia when they see it (bad just doesn't survive long).

BUT, if you want to last, and yes, enjoy your job, you DO need to remember that many facilities are "surgeon request". Meaning, pick your battles. You may be right, but that's not worth much as you are being eliminated from a group because not many surgeons will work with you ("too difficult"). Also, remember that you don't start out with infinite respect when you start working with a new group of surgeons/nurses/etc. That is earned in time. Cop an attitude early, and you can find yourself labelled a malcontent.

 

[Osteoimperfecta]

I've been in the private world for 15 years. Here's my take: yes, we are independent physicians, who don't need to take anyone's crap. Also, the surgeons most definitely can tell good from mediocre anesthesia when they see it (bad just doesn't survive long).

BUT, if you want to last, and yes, enjoy your job, you DO need to remember that many facilities are "surgeon request". Meaning, pick your battles. You may be right, but that's not worth much as you are being eliminated from a group because not many surgeons will work with you ("too difficult"). Also, remember that you don't start out with infinite respect when you start working with a new group of surgeons/nurses/etc. That is earned in time. Cop an attitude early, and you can find yourself labelled a malcontent.

Well this is the issue at hand, because as a group we do not hold our ground. So now we are just another thing that gets requested in the OR. In an environment where posture determines respect, we have chosen a weak posture, and it is not good for our survival.

 

[pgg]

Well this is the issue at hand, because as a group we do not hold our ground. So now we are just another thing that gets requested in the OR. In an environment where posture determines respect, we have chosen a weak posture, and it is not good for our survival.

As opposed to radiologists? Or the internist who's just another thing for the orthopod to request to manage the insulin for his TKA?

Not good for our survival? Who's going to replace us because we're (as a group) too subserviant, CRNAs? As a group they're even more willing to kowtow to surgeons than even the most spineless anesthesiologists.

I still think this is a non issue.

 

[Osteoimperfecta]

As opposed to radiologists? Or the internist who's just another thing for the orthopod to request to manage the insulin for his TKA?

Not good for our survival? Who's going to replace us because we're (as a group) too subserviant, CRNAs? As a group they're even more willing to kowtow to surgeons than even the most spineless anesthesiologists.

I still think this is a non issue.

Of the 3 specialties you mention we are in the worst position. When was the last time you heard a radiologist kicked off a group because some other physicians refuse to work with him/her? Possible, but surely not the norm in their business. All I am saying is collectively we are assuming a poor posture. We are feeding the beast, and it keeps wanting more. I have seen anesthesiologist do wierd stuff to make the surgeon happy. We are not circulators, we are physicians. I just think we sell ourselves short as a group, and maybe it's just good business but I think we need a little bit more control of our destinies to survive.

 

[countingdays]

Where I am, having surgeons try to tell you what do do isn't an issue. What sucks is that they can post a case and show up 2-3 hours late and nothing happens, you and the OR staff are stuck waiting there. Then they show up 3 hours late and get pissed if they have to wait 5 minutes cause you are putting in an epidural or the nurse is in the bathroom or whatever. If you showed up 20 minutes late and they were on time, you'd be fired. They show up very late and nothing happens. It's just a complete lack of common courtesy that you may be subject to in anesthesia.

 

[MD Dreams]

It's all about how you let others treat you. Making change is not easy and it's not pleasant. But it can be done. Anesthesia is changing as a specialty, for the better I believe, as the lazy, spineless, incompetent anesthesiologists who compromised our specialty become replaced with a new generation of folks who take pride in their profession. In time, perhaps more surgeons will come to see us in a different light. Work hard, do a good job and stand your ground, even if it has unpleasant consequences.

 

[jetproppilot]

A couple of med students were discussing the dynamics of the surgeon/anesthesiologist dynamic and when the topic of bossy surgeons came up, one of them said: don't think of the surgeon as a bossy colleague, look at him as a client or customer you are trying to please.

This resounded with me because indeed the gas doc is providing a highly skilled service to the surgeon.

My question: is that a healthy way of defining your relationship to surgeons? I.e. You are a service provider and you`re trying to keep the customer happy.

INDEED. SURGEONS ARE CLIENTS.

What many residents and attendings fail to recognize is as an anesthesiologist, it
doesn't take away from you if you treat a surgeon as a client.

UNLESS YOU ARE A PRIMARY CARE DOCTOR, YOUR GRAVY TRAIN COMES FROM SOMEONE ELSE.

Where do you think surgeons get their cases?

Most are

REFERRED to them from a primary care doctor.

Where do you think heart surgeons get their cases?

REFERRED from cardiologist colleagues.

For some reason this thought process that anesthesiologists have to act like bullies in order to protect our specialty from surgeons is propagated and it is

COMPLETE BUL S H IT.

Even heart surgeons have clients.

It doesn't make you a vagina if you treat a surgeon like a client.

 

[pgg]

When was the last time you heard a radiologist kicked off a group because some other physicians refuse to work with him/her?

When was the last time you heard of a good anesthesiologist kicked off a group because a surgeon refused to work with him/her? It's got to be a vanishingly rare occurrence.


Very occasionally I'll witness or catch wind of one of our surgeons declaring he won't work with X anesthesiologist or Y CRNA. You know what? Every time, if I know Dr X and nurse Y, all I can do is shrug because the elephant in the room is that we all know Dr X and nurse Y suck.

 

[climbingak]

Jet has it exactly right. The surgeon is our client and treating them as such does not mean you have to bow down to them. In my world (anesthesia and medical director for an asc) the main way I treat the surgeon as a clent is to keep the ORs physician friendly. No BS nursing or admin posturing that makes mine and their lives more difficult. This separates us 180 degrees from the hospital which has become physician hostile.

Maybe Ive been out of the academic world to long, but the surgeons I work with are super busy guys who just want to navigate their day and get home to their families. For them that includes clinic (blah!) Emtala call, OR with all its potential delays, calls from patients and floor nurses. They are pulled a thousand directions and have to jump over physician hostile obstacles at every point because some NWC thought it might be a good idea. The thing I can offer them is that when they walk in to our ASC, everything is designed to get them in and out as quickly as possible and for their patients to feel like it was the best experience ever.

If we can control the ORs and give them that kind of "service" do you think they are going to piss all over you? Absolutely not. They'll call you when they run into an obstacle and grow to depend on your service. Having the contract for this asc, all I can do is try to make myself as invaluable as possible and try to keep it as long as I can. The more invaluable you are, the longer you stay. I admit this is easier for me because I am at a physician owned surgery center, where it is easy to set up physician friendly policies.

 

[ssmallz]

Where I am, having surgeons try to tell you what do do isn't an issue. What sucks is that they can post a case and show up 2-3 hours late and nothing happens, you and the OR staff are stuck waiting there. Then they show up 3 hours late and get pissed if they have to wait 5 minutes cause you are putting in an epidural or the nurse is in the bathroom or whatever. If you showed up 20 minutes late and they were on time, you'd be fired. They show up very late and nothing happens. It's just a complete lack of common courtesy that you may be subject to in anesthesia.

This is probably my single biggest pet peeve in the OR. At one of the hospitals I work out at it's almost customary for a surgeon to show up at 8am for 730 case. I see this as a total lack of respect for myself, but also the nursing team, or techs, and anyone else involved in the case. This should be unacceptable in any professional environment. Unfortunately, politics being what they are, surgeons may get spoken to but nothing ever gets done.

My other big pet peeve is the to follow case that gets booked at 3am because it's convenient for the surgeon but no one else. Was on call last Friday when surgeon books a 4am appy cause there's 4 cases scheduled and he doesn't wanna wait till 3pm the next day to do the case. Fine no big deal, do the appy and be home in my bed by 4:30. Get to the hospital find the surgeon who wants to do his scheduled 8am case to follow because now it's more convenient for him🙄. Totally selfish, no respect for the surgical staff, anesthesia staff, or anyone else for that matter because if an actual emergency comes in your staff is now tied up (which ironically is exactly what happened the last time he tried to pull this when I was on call w/him).👎.

 

[cpants]

This is probably my single biggest pet peeve in the OR. At one of the hospitals I work out at it's almost customary for a surgeon to show up at 8am for 730 case. I see this as a total lack of respect for myself, but also the nursing team, or techs, and anyone else involved in the case. This should be unacceptable in any professional environment. Unfortunately, politics being what they are, surgeons may get spoken to but nothing ever gets done.

My other big pet peeve is the to follow case that gets booked at 3am because it's convenient for the surgeon but no one else. Was on call last Friday when surgeon books a 4am appy cause there's 4 cases scheduled and he doesn't wanna wait till 3pm the next day to do the case. Fine no big deal, do the appy and be home in my bed by 4:30. Get to the hospital find the surgeon who wants to do his scheduled 8am case to follow because now it's more convenient for him🙄. Totally selfish, no respect for the surgical staff, anesthesia staff, or anyone else for that matter because if an actual emergency comes in your staff is now tied up (which ironically is exactly what happened the last time he tried to pull this when I was on call w/him).👎.

That's an institutional issue. An appy is arguably an emergent case. If he wants to do his inguinal hernia repair at 0430, someone should be telling him to go screw. If the OR staff isn't telling him that for some reason, I think you would be well within your rights to tell him you don't do middle of the night anesthesia for routine cases. There's good reason not to, as the OR and ICU is skeleton staffed, ancillary services aren't available, and it's generally not as safe as daytime surgery. Not saying this happens every time in the real world, but if you let yourself get walked on, you shouldn't be blaming the surgeon.

 

[countingdays]

That's an institutional issue. An appy is arguably an emergent case. If he wants to do his inguinal hernia repair at 0430, someone should be telling him to go screw. If the OR staff isn't telling him that for some reason, I think you would be well within your rights to tell him you don't do middle of the night anesthesia for routine cases. There's good reason not to, as the OR and ICU is skeleton staffed, ancillary services aren't available, and it's generally not as safe as daytime surgery. Not saying this happens every time in the real world, but if you let yourself get walked on, you shouldn't be blaming the surgeon.

That's untrue. The problem is hospital administration. If they want to bend over for surgeons, you can go along with it or lose the contract. Weak hospitals with patchy o r schedules are going to get walked all over by surgeons, obstetricians, etc, because they are desperate for business. There is little if anything you can do about it. There are plenty of groups who would gladly take your contract at a weak hospital if you don't go along with whatever it.

 

[jwk]

Of the 3 specialties you mention we are in the worst position. When was the last time you heard a radiologist kicked off a group because some other physicians refuse to work with him/her? Possible, but surely not the norm in their business. All I am saying is collectively we are assuming a poor posture. We are feeding the beast, and it keeps wanting more. I have seen anesthesiologist do wierd stuff to make the surgeon happy. We are not circulators, we are physicians. I just think we sell ourselves short as a group, and maybe it's just good business but I think we need a little bit more control of our destinies to survive.

It's definitely cliche', but the concept that "respect is earned and not bestowed by title" always holds true. There are always problem surgeons and physicians in every hospital (TJC now has guidelines to deal with the worst ones) but most are decent folks who just want to take good care of their patients, just like you do.

I think there are other threads that have touched on this, but do you simply show up and do OR and OB cases at the hospital, or do you actually participate in the overall management and running of the hospital? Do you serve on committees / hospital boards / medical staff leadership? Do you offer inservice lectures to the nursing and/or medical staff? Do you participate in the hospital's PR programs? Our group actually DOES bring patients to the hospital through participation in a joint anesthesia/neurosurgery spine center. We're offering an ever-increasing number and types of blocks for post-op pain across a variety of surgical specialties besides orthopedics, increasing patient satisfaction (which surgeons WILL notice).

Anesthesiologists can certainly get booted from groups. It usually happens for two main reasons - lack of clinical competency (which I rarely see in our group) and "inability to play well with others", whether that be surgeons, staff, or anesthesia staff. We do not kiss butt by any stretch of the imagination, and we will cancel cases as indicated (not a common thing). Developing mutual respect between the surgeons and anesthesia will go a long way - just as the surgeon has to earn your respect (after all, you can refer patients too, right?) so too you have to earn their respect by showing that your interested, engaged, and will work to get the job done while still protecting the patient's well-being.

 

[ssmallz]

That's an institutional issue. An appy is arguably an emergent case. If he wants to do his inguinal hernia repair at 0430, someone should be telling him to go screw. If the OR staff isn't telling him that for some reason, I think you would be well within your rights to tell him you don't do middle of the night anesthesia for routine cases. There's good reason not to, as the OR and ICU is skeleton staffed, ancillary services aren't available, and it's generally not as safe as daytime surgery. Not saying this happens every time in the real world, but if you let yourself get walked on, you shouldn't be blaming the surgeon.

As Gypsy mentioned, this isn't a black and white situation. I voiced my opinion on the matter and made it known to the surgeon that this was a non emergent case and he should wait untill 8am for the reasons outlined by others. He understood and still wished to proceed. Being the new guy to the group, this can be a very touchy situation. The case ultimately got cancelled because the nursing staff said they had shift change at 7am and by the time the case finished they would have to call in others and it would be easier for everyone to just wait till 8am because we really wouldn't start much earlier. If nursing had said yes, I would have done the case and brought it up to my director the next day. This is they type of thing that needs to be handled by the more senior members in the group because as others in this thread have mentioned, respect is earned, not given and I haven't been there long enough for my opinions on this matter to change things.

I think it's really important for the residents out there to understand that when you're the new guy your job is to not rock the boat too much. This doesn't mean proceeding with cases that should be cancelled or putting a pt in harms way. It means learning to pick and choose your battles and realizing that even if you're right, there's a right and wrong way to handle the situation. The more senior members of the group have been there much longer than you have. They understand the hospital dynamics and understand which battles they can fight and which will lead to contract dismissal. Disagreements with surgeons and nursing staff are battles that you need your more senior partners to fight for you because you just don't have the clout yet to pull this off. It's a very tricky thing to learn but if you think you can walk into a group as the new guy and act like you own the place you'll very quickly find out how easily you can replaced.

 

[deleted126335]

I have had greatly varying experiences in the way that anesthesia is conducted and viewed.
Plain and simple, there is a wide range of institutional and local perceptions of the medical specialty of anesthesia out there. Changing an institutional perception is something that is a tall order and not always an attainable goal.

My first job: the anesthesia department the CRNAs ran the show, there was an abundance of FMGs and nonboarded docs and others with problems on their CVs. Their job was to bless the CRNAs anesthetic plan and to be the fire department when things didn't go well. As a new grad trying to earn "respect" in this type of culture was a tall order. Eventually I did for clinical skill, but it did not translate into anything substantive-like the ability to say "NO" to a purely elective case at midnight for the surgeon's convenience. Plain and simple my job would have been at risk.
Even though this was technically against department policy.

My current position is in a desirable practice where the anesthesiologists are extremely well trained and credentialed and involved in med staff politics and several are leaders within the hospital.

My point is that sometimes you can't win a poorly dealt hand. Some departments are poorly dealt hands where even the Jets and Blades of the world would have a very hard time changing the culture if they were alone.

 

[jetproppilot]

I have had greatly varying experiences in the way that anesthesia is conducted and viewed.
Plain and simple, there is a wide range of institutional and local perceptions of the medical specialty of anesthesia out there. Changing an institutional perception is something that is a tall order and not always an attainable goal.

My first job: the anesthesia department the CRNAs ran the show, there was an abundance of FMGs and nonboarded docs and others with problems on their CVs. Their job was to bless the CRNAs anesthetic plan and to be the fire department when things didn't go well. As a new grad trying to earn "respect" in this type of culture was a tall order. Eventually I did for clinical skill, but it did not translate into anything substantive-like the ability to say "NO" to a purely elective case at midnight for the surgeon's convenience. Plain and simple my job would have been at risk.
Even though this was technically against department policy.

My current position is in a desirable practice where the anesthesiologists are extremely well trained and credentialed and involved in med staff politics and several are leaders within the hospital.

My point is that sometimes you can't win a poorly dealt hand. Some departments are poorly dealt hands where even the Jets and Blades of the world would have a very hard time changing the culture if they were alone.

Your point is accurate and respected.

 

[urge]

A couple of med students were discussing the dynamics of the surgeon/anesthesiologist dynamic and when the topic of bossy surgeons came up, one of them said: don't think of the surgeon as a bossy colleague, look at him as a client or customer you are trying to please.

It's a matter of supply and demand. If you cannot find a better job, you have to put up with crap. Lack of leadership in the department leads to these situations. Sometimes the damage is so deep that it is not worth it to try to fix. It's better to find another job.

No job is perfect. Only you can tell what amount of crap you can take in a given job.

 

[pmichaelmd]

INDEED. SURGEONS ARE CLIENTS.
It doesn't make you a vagina if you treat a surgeon like a client.

Very true. Thankfully, we have some of our physicians in leadership positions within the hospital and have been able to better cement our position with our colleagues in other specialties. Definitely a good move.