What is anesthesia really like?

[FiremedicMike]

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I've read several threads on this forum and I am left with several different visions of what the life on an anesthesiologist like.

One thread talks about a medical issue during a case and goes on to describe the challenges the anesthesiologist had to evaluate and overcome. This leads me to have a vision of an anesthetist who is integral in the OR, thinking on his feet, and responsible for dealing with any non-surgical issue that may arise in the OR. This is quite appealing to me and my personality.

Other threads talk about anesthesiologists being faceless bodies in the corner, and give me a vision of starting an IV, sedating and intubating a patient, setting maintenance infusions, then playing brick-breaker in the corner. This sounds quite unappealing to me.

I really have no frame of reference as my only OR time was an 8 hour block in 1999 during paramedic school where I was stuck in the corner trying to watch between surgeons (and granted, not focused on anesthesiology at the time). So can someone give me some idea what it's like to work in anesthesia?

(on a side note, if there are any anesthesiologists here from Central Ohio and wouldn't mind having a firefighter/paramedic follow you around for a day or two, I'll buy you lunch)

 

[335230]

ok

 

[IlDestriero]

Your continued assertion that a physician making "only" $200k Obamacare loot can't afford to have a family remains as ridiculous now as the first time you said it. Your loans will be as low as 1000/month. I've had bigger car payments. What must you think about the other 98% of the population of the US making far less than your horrible 200k? What's the average family income? $53k, with 2 kids. They must be living in a box in the alley eating dogfood, right? Come on man. If you can't afford a modest clean secure home in a good neighborhood on $200K, you're doing something wrong. If you really feel that way, you'll look back and regret your decision later. Unless you don't want kids anyway, in which case it doesn't matter.
You know who really regrets their decision, those newly minted MBAs with 100k+ loans and no job offers, or the 50k "part time" no benefits consulting offer which is less than they were making before school. A stable secure job is good for families as well. I don't know any out of work physicians, do you?
Is it too late to go back to dental school?
😍
P.S. I'll remember to watch my head in the OR. WTF? I'm sorry your Mom thinks your career was a waste of time and money. Maybe you saw $$ and not a true calling. That's on you. It certainly seems that way from what you write. It's not too late to score with an investment banker, but you might have the better job now.
P.P.S. As long as we're being honest, heaven is a myth.😱

 

[FiremedicMike]

<sigh> can there just be 1 thread on SDN that doesn't revolve around how horrible it is to be a doctor..

Back to the original topic?

 

[bigeyedfish]

I hate it when I'm a faceless body. It really ruins my day.

Anesthesia is like flying a plane.....from the backseat of a car.....on a long trip.......with your bratty sister in the seat in front of you......driving through a tunnel.......with a cobra.......a great white shark.......and a rottweiler in the backseat with you.......while waiting to get bitten for hours.......and hoping if you do get bit, it's only the rottie. OK I'm out of metaphors.

 

[McBatCommander]

You just ripped that guy a new *******.

Your continued assertion that a physician making "only" $200k Obamacare loot can't afford to have a family remains as ridiculous now as the first time you said it. Your loans will be as low as 1000/month. I've had bigger car payments. What must you think about the other 98% of the population of the US making far less than your horrible 200k? What's the average family income? $53k, with 2 kids. They must be living in a box in the alley eating dogfood, right? Come on man. If you can't afford a modest clean secure home in a good neighborhood on $200K, you're doing something wrong. If you really feel that way, you'll look back and regret your decision later. Unless you don't want kids anyway, in which case it doesn't matter.
You know who really regrets their decision, those newly minted MBAs with 100k+ loans and no job offers, or the 50k "part time" no benefits consulting offer which is less than they were making before school. A stable secure job is good for families as well. I don't know any out of work physicians, do you?
Is it too late to go back to dental school?
😍
P.S. I'll remember to watch my head in the OR. WTF? I'm sorry your Mom thinks your career was a waste of time and money. Maybe you saw $$ and not a true calling. That's on you. It certainly seems that way from what you write. It's not too late to score with an investment banker, but you might have the better job now.
P.P.S. As long as we're being honest, heaven is a myth.😱

 

[FiremedicMike]

I must have come off slightly trollish in my OP, so I apologize. If there's anyone out there that wouldn't mind taking a few moments to give me a better depiction, I would greatly appreciate it.

 

[Coastie]

can be boring..to annoying..to exciting..to exhausting...to fun...

or all at the same time.

Big variety of cases, involved with a more diverse patient group than almost any other specialty.

Lots of intensive care, internal medicine (and subspecs), knowledge of surgical procedures...Pharmacology, physiology, anatomy need to be well known.

Big headaches: Some surgeons, some nurse anesthetists..

reality: you're the "short, fat bald dude on seinfeld"....you can do some cool stuff, make good money, but you'll never be the QB..you'll be the offensive lineman..or the field-goal kicker...

I've read several threads on this forum and I am left with several different visions of what the life on an anesthesiologist like.

One thread talks about a medical issue during a case and goes on to describe the challenges the anesthesiologist had to evaluate and overcome. This leads me to have a vision of an anesthetist who is integral in the OR, thinking on his feet, and responsible for dealing with any non-surgical issue that may arise in the OR. This is quite appealing to me and my personality.

Other threads talk about anesthesiologists being faceless bodies in the corner, and give me a vision of starting an IV, sedating and intubating a patient, setting maintenance infusions, then playing brick-breaker in the corner. This sounds quite unappealing to me.

I really have no frame of reference as my only OR time was an 8 hour block in 1999 during paramedic school where I was stuck in the corner trying to watch between surgeons (and granted, not focused on anesthesiology at the time). So can someone give me some idea what it's like to work in anesthesia?

(on a side note, if there are any anesthesiologists here from Central Ohio and wouldn't mind having a firefighter/paramedic follow you around for a day or two, I'll buy you lunch)

 

[igottaquestion]

Anesthesia is like flying a plane.....from the backseat of a car.....on a long trip.......with your bratty sister in the seat in front of you......driving through a tunnel.......with a cobra.......a great white shark.......and a rottweiler in the backseat with you.......while waiting to get bitten for hours.......and hoping if you do get bit, it's only the rottie. OK I'm out of metaphors.

brilliant.

 

[Planktonmd]

I hate it when I'm a faceless body. It really ruins my day.

Anesthesia is like flying a plane.....from the backseat of a car.....on a long trip.......with your bratty sister in the seat in front of you......driving through a tunnel.......with a cobra.......a great white shark.......and a rottweiler in the backseat with you.......while waiting to get bitten for hours.......and hoping if you do get bit, it's only the rottie. OK I'm out of metaphors.

 

[gaspasser2004]

Anesthesia varies greatly depending on your style of practice.

Anesthesia Resident
Get to hospital at 0615 to set up room. See patient. Try to find attending. Take lots of grief from attending about taping the tube right and other BS. Get 15 minute am break. Work some more. Get 30 minute lunch break. Work some more. Maybe get 15 minute afternoon break. Work some more. Finish your last case about 1600-1800. Go see in patient pre-ops. Go home. Call attending about the next day's cases.

Attending in Eat What You Kill Practice
Get to hospital at 0500 because ortho dude wants to do 2 hips before office hours. Hustle your ***** off to get patient in room, case started. After the two hips, get in your car and drive across town to another hospital to do general surgery cases. No breaks, no lunch. Just when you think your day is over at 1700, you have an add-on medicaid/medicare/no pay case to do. You can't say no because this surgeon gives you steady work during the daytime. Get home at 2100 and try to get some sleep to do it again tomorrow.

Attending in large CRNA Mill Group
Get to hospital at 0600. Pre-op 4 patients and start their IV's. Find some way to start all 4 of your rooms, because even though they are technically staggered starts, they all seem to start at the same time. Run from room to room inducing and emerging. Try to keep up with all your pre-ops. Not really any time for a break. Scarf down lunch in 5 minutes. Get relieved by other doc at 1400-1700. Go home.

Attending in Academic Department
Get to hospital at 0700. Review your residents' pre-ops and briefly talk to patient. Start your two resident rooms. Go to lounge/office. Give residents breaks (doesn't always happen by attending). Talk to next patients. Go back to lounge/office to do work/research. Give lunch breaks (maybe). Supervise some more. Go home around 1600.

 

[Gimlet]

Attending in Academic Department
Get to hospital at 0700. Review your residents' pre-ops and briefly talk to patient. Start your two resident rooms. Go to lounge/office. Give residents breaks (doesn't always happen by attending). Talk to next patients. Go back to lounge/office to do work/research. Give lunch breaks (maybe). Supervise some more. Go home around 1600.

Don't forget "Read about something in your office then go pimp your resident on the topic, making them feel stupid for not knowing the minute details you just brushed up on."

 

[FiremedicMike]

I guess what I was really after is what the anesthesiologist does after the tube goes in/verified and once the maintenance infusion is running, as a typical norm..

 

[Coastie]

I guess what I was really after is what the anesthesiologist does after the tube goes in/verified and once the maintenance infusion is running, as a typical norm..

did you not read my response?

yeah..its just a tube and maintenance infusion..I think we sleep...and make tons of money! 👍

 

[335230]

ok

 

[GoodmanBrown]

I guess what I was really after is what the anesthesiologist does after the tube goes in/verified and once the maintenance infusion is running, as a typical norm..

Mike, most of the other posters on this thread have literally thousands and thousands more hours of experience than I do. I've got like 24 hours of anesthesiology experience spaced over 3-4 days. So, take my experiences with those caveats in mind. The only reason I post is that it seems like you're still looking for some other thoughts.

I shadowed in entirely academic settings. One day was outpatient surg center, others were main OR.

In the SC, the anesthesiologist attending I shadowed was constantly on the move. She'd pre-op a patient, go off to give a block, be in to discuss anesthetic plan and induce with a CRNA, be back over to extubate and discuss PACU meds with a resident, etc. Always busy. I also hung out with a few residents during the OR time, and this was quite busy too. At a surg center, the cases are really rapid fire, so the anesthesiologist was constantly tweaking the gases and meds to keep the patient at a level where they obviously weren't waking up, but weren't really deep so that extubation wouldn't be delayed. So, they monitored heart rate, BP, BIS, etc. to make sure the patient was at an optimal level of anesthetic. Because it was such a fine line, it seemed to take a fair amount of concentration and work on their part.

The main OR was similar, but different. Two surgeries stick out in my mind as being notable. One was an on-pump bypass. There, the anesthesiologist was hella busy. Constantly giving meds, adjusting gas, checking the TEE, and working with the surgeon as the surgery progressed. At one point, while stabilized and out in the open, the patient's heart went into v-tach. The anesthesiologists made the surgeon un-clamp the heart, pushed meds, tweaked dials, and got everything stabilized before letting the surgeon continue. Otherwise he was constantly vigilant to vital signs and always adding a bit of this and that to optimize the HR and BP.

The other surgery was a liver resection (I think). This one was a lot slower and as an uneducated observer was a bit boring. The surgery was gonna take hours to complete, and the patient was pretty stable. So, the main job of the resident was to tweak meds to keep the BP in line and watch for blood loss and be prepared to deal with that. In the time I was there, the patient only required a few tweaks to raise his BP. I will say that it could've gone south very fast had something gone wrong. During that time, the resident and I chatted, and the resident went to check out the blood loss from the cell saver from time to time. By himself, I guess the resident would've charted, tweaked meds, checked blood loss, and maybe daydreamed a bit. Had things gone south with blood loss, the resident (and back-up) starts hanging blood products, adjusting meds to keep the BP and HR in line, and maybe resuscitating the patient.

So, yeah, that's one dude's totally uneducated peak at the OR. I highly recommend you do any shadowing possible because I'm sure my thoughts clearly betray my ignorance. Are you taking any classes right now? Being a student can get your foot in the door sometimes.

 

[fastosprintini]

well, if it's good it's really good and if it's bad it's awful....
sometimes you are in the flow, have physiology and pharmacology at your fingertips, stay cool in critical situations and still are able to go home in the afternoon with your pager switched off .
on other days you are surrounded by people who don't have the faintest clue about what you are doing (schedulers, nurses, surgeons,scrubtech, relatives etc. etc ) but feel compelled to meddle with your work....:-(
fasto

 

[Consigliere]

What is anesthesia really like?

It's like getting kicked in the nuts repetitively. Every day, you wake up, scream "F UCK" so loudly that they hear you in China, then proceed to the hospital where someone drops anvils on your nuts from a helicopter.

That's what it's like, friend.

 

[IlDestriero]

Your right Mr. Happy. My argument that a physician making $200 large+ over a 30+ year career, 4 times the average US family combined income, can in fact afford a family and crushing 1000 month of loan debt is completely invalidated by sarcasm. Perhaps we can use sarcasm to fix the economy? Everyone else having kids in the US is selfish and wrong. Procreating bastards.

 

[IlDestriero]

I won't post about this again as it is off topic, but in all seriousness just how much do you think you need to make to have a couple of kids? I know many people doing just fine at around 100k.

 

[durlvlbeacoo]

I won't post about this again as it is off topic, but in all seriousness just how much do you think you need to make to have a couple of kids? I know many people doing just fine at around 100k.

Why don't you tell Obama, Kobe Bryant, George Soros to live on $30,000 total (no savings)? If they end up doing that and you live on $30,000, then maybe you can tell me how much I can make. Otherwise, STFU.

 

[PharmaTope]

What is anesthesia really like?

It's like getting kicked in the nuts repetitively. Every day, you wake up, scream "F UCK" so loudly that they hear you in China, then proceed to the hospital where someone drops anvils on your nuts from a helicopter.

That's what it's like, friend.

boner

 

[IlDestriero]

Why don't you tell Obama, Kobe Bryant, George Soros to live on $30,000 total (no savings)? If they end up doing that and you live on $30,000, then maybe you can tell me how much I can make. Otherwise, STFU.

I think you misunderstand. This is carry over from another thread. Dr. happy is the one that thinks we'll all be on the gov't payroll/salary cap in a couple years, making $200g and not being able to afford anything, because that's so little.🙄 I disagree. We made more this year than ever, and business is booming. I expect that the real doom and gloom is still some time off. We'll have to see what happens over the next few years. One thing's for sure though, we don't have many friends in Congress.
Regards,

 

[Surfer]

What is anesthesia really like?

It's like getting kicked in the nuts repetitively. Every day, you wake up, scream "F UCK" so loudly that they hear you in China, then proceed to the hospital where someone drops anvils on your nuts from a helicopter.

That's what it's like, friend.

👍
what's sadder, that's its true, that i keep going to work every day... or that i kinda like it???

 

[proman]

Anesthesia varies greatly depending on your style of practice.

Anesthesia Resident
Get to hospital at 0615 to set up room. See patient. Try to find attending. Take lots of grief from attending about taping the tube right and other BS. Get 15 minute am break. Work some more. Get 30 minute lunch break. Work some more. Maybe get 15 minute afternoon break. Work some more. Finish your last case about 1600-1800. Go see in patient pre-ops. Go home. Call attending about the next day's cases.

I know for a fact your lunches were longer than 30 minutes

 

[WholeLottaGame7]

I know of some anesthesiologists that disagree with the analogy, but my impression is that it's somewhat like flying a plane. Takeoffs and landings are usually the trickiest, sometimes you can relax (but not lose focus/vigilance), and sometimes there are some dicey moments. Maybe there are a few more plane crashes than the airline industry, but hey, humans have more moving parts than airplanes do. Plus, if there is a catastrophe you can usually bring the plane in on one engine so that it can die in the ICU.

Anyway, those are my observations from a year of research in anesthesia and my one month of anesthesia in medical school.

Also of note, at least where I've been, I haven't really felt any tension between anesthesiologists and CRNAs or surgeons, so I think if you get all of your anesthesia knowledge from this forum those things might get blown up a little.

 

[GoodmanBrown]

boner

... 😕

 

[TenaciousGirl]

I hate it when I'm a faceless body. It really ruins my day.

Anesthesia is like flying a plane.....from the backseat of a car.....on a long trip.......with your bratty sister in the seat in front of you......driving through a tunnel.......with a cobra.......a great white shark.......and a rottweiler in the backseat with you.......while waiting to get bitten for hours.......and hoping if you do get bit, it's only the rottie. OK I'm out of metaphors.

 

[hoyden]

I know for a fact your lunches were longer than 30 minutes

What a cushy program 😉

 

[hoyden]

I hate it when I'm a faceless body. It really ruins my day.

Anesthesia is like flying a plane.....from the backseat of a car.....on a long trip.......with your bratty sister in the seat in front of you......driving through a tunnel.......with a cobra.......a great white shark.......and a rottweiler in the backseat with you.......while waiting to get bitten for hours.......and hoping if you do get bit, it's only the rottie. OK I'm out of metaphors.

👍

 

[hoyden]

...we'll all be on the gov't payroll/salary cap in a couple years, making $200g and not being able to afford anything, because that's so little.🙄

I generally disagree with a doom and gloom future, however, I also disagree with a figure of 200K on a government payroll if that will happen.
It is going to be much, much less - closer to our resident's/fellow's salary.
At least in terms of the real value of a dollar by that time.

 

[proman]

What a cushy program 😉

Our attendings never really watched the clock. I only had 1 attending who ever said anything when I came back 5 minutes late. I bet gaspasser could guess his initials.

 

[igottaquestion]

I generally disagree with a doom and gloom future, however, I also disagree with a figure of 200K on a government payroll if that will happen.
It is going to be much, much less - closer to our resident's/fellow's salary.
At least in terms of the real value of a dollar by that time.

in that case, our country would find out what it means to have a true shortage of doctors and nurses, with the resulting lack of medical care of any quality. the country would have to be in really bad shape for that to happen, as in waterworld bad . . .

 

[hoyden]

in that case, our country would find out what it means to have a true shortage of doctors and nurses, with the resulting lack of medical care of any quality. the country would have to be in really bad shape for that to happen, as in waterworld bad . . .

There is a already the shortage of doctors in this country.

With already existing shortage, adding additional pool of entitled patients will inevitably result in deterioration of quality and longer waiting time for anything. Plus mounting corruption on top of it.

 

[WholeLottaGame7]

There is a already the shortage of doctors in this country.

With already existing shortage, adding additional pool of entitled patients will inevitably result in deterioration of quality and longer waiting time for anything. Plus mounting corruption on top of it.

I think the shortage of doctors is as much a result of the AMA restricting the number of graduating doctors while the population continued to grow. It seems like only recently have a number of medical schools opened/class sizes increased. I think by artificially keeping the ratio of MD/population low, they were hoping to protect salaries or "elite" status of the title, but in reality, they just opened the door to mid-level providers.

 

[hoyden]

I think the shortage of doctors is as much a result of the AMA restricting the number of graduating doctors while the population continued to grow. It seems like only recently have a number of medical schools opened/class sizes increased. I think by artificially keeping the ratio of MD/population low, they were hoping to protect salaries or "elite" status of the title, but in reality, they just opened the door to mid-level providers.

and who is that evil mastermind? that mysterious they😉

It's much more simple - resident's salaries are paid by medicare/medicaid - and that is a government one-payer system. You are welcome to extend the conclusions further 😉

 

[Narcotized]

.

 

[WholeLottaGame7]

and who is that evil mastermind? that mysterious they😉

It's much more simple - resident's salaries are paid by medicare/medicaid - and that is a government one-payer system. You are welcome to extend the conclusions further 😉

Well, the AMA, unless you're proposing that the government is actually running the AMA. I guess that's not any more ridiculous a proposition than any other conspiracy theory, but if so, then it's a bipartisan conspiracy, as this has been going on for some time.

 

[hoyden]

Well, the AMA, unless you're proposing that the government is actually running the AMA. I guess that's not any more ridiculous a proposition than any other conspiracy theory, but if so, then it's a bipartisan conspiracy, as this has been going on for some time.

AMA is paying your salary? 😀
Learning something new everyday ))))


===============

Financing residency programs

The Department of Health and Human Services, primarily Medicare, funds the vast majority of residency training in the US. This tax-based financing covers resident salaries and benefits through payments called Direct Medical Education or DME payments. Medicare also uses taxes for Indirect Medical Education or IME payments, a subsidy paid to teaching hospitals that is tied to admissions of Medicare patients in exchange for training resident physicians.[3] Overall funding levels, however, have remained frozen over the last ten years, creating a bottleneck in the training of new physicians in the US, according to the AMA.[4] On the other hand, some argue that Medicare subsidies for training residents simply provide surplus revenue for hospitals which recoup their training costs by paying residents salaries (roughly $35,000 per year) that are far below the residents' market value.[5][6]. Nicholson's research suggests, in fact, that residency bottlenecks are not caused by a Medicare funding cap, but rather, by Residency Review Committees (which approve new residencies in each specialty) which seek to limit the number of specialists in their field to maintain high incomes[7]. In any case, hospitals trained residents long before Medicare provided additional subsidies for that purpose. A large number of teaching hospitals fund resident training to increase the supply of residency slots, leading to the modest 4% total growth in slots from 1998&#8211;2004.[4]

 

[WholeLottaGame7]

AMA is paying your salary? 😀
Learning something new everyday ))))


===============

Financing residency programs

The Department of Health and Human Services, primarily Medicare, funds the vast majority of residency training in the US. This tax-based financing covers resident salaries and benefits through payments called Direct Medical Education or DME payments. Medicare also uses taxes for Indirect Medical Education or IME payments, a subsidy paid to teaching hospitals that is tied to admissions of Medicare patients in exchange for training resident physicians.[3] Overall funding levels, however, have remained frozen over the last ten years, creating a bottleneck in the training of new physicians in the US, according to the AMA.[4] On the other hand, some argue that Medicare subsidies for training residents simply provide surplus revenue for hospitals which recoup their training costs by paying residents salaries (roughly $35,000 per year) that are far below the residents' market value.[5][6]. Nicholson's research suggests, in fact, that residency bottlenecks are not caused by a Medicare funding cap, but rather, by Residency Review Committees (which approve new residencies in each specialty) which seek to limit the number of specialists in their field to maintain high incomes[7]. In any case, hospitals trained residents long before Medicare provided additional subsidies for that purpose. A large number of teaching hospitals fund resident training to increase the supply of residency slots, leading to the modest 4% total growth in slots from 1998&#8211;2004.[4]

Ah, I see what you're saying: that the government controls Medicare, which provides resident salaries, which governs how many medical grads there are. That makes sense, except that the paper you quoted also argues against it. See bold.

So maybe it's a combination of both?

 

[hoyden]

Ah, I see what you're saying: that the government controls Medicare, which provides resident salaries, which governs how many medical grads there are. That makes sense, except that the paper you quoted also argues against it. See bold.

So maybe it's a combination of both?

Do you know an expression - cherchez la femme?

it's wrong - it should be - chercher de l'argent... 😉

Or plain old Cui bono...

 

[jetproppilot]

I was a firefighter/paramedic before I was an anesthesiologist.

 

[durlvlbeacoo]

Ah, I see what you're saying: that the government controls Medicare, which provides resident salaries, which governs how many medical grads there are. That makes sense, except that the paper you quoted also argues against it. See bold.

So maybe it's a combination of both?

Medicare controls the number of residency positions.

 

[Qex]

Medicare controls the number of residency positions.

The way I read it is Medicare simply pays for a certain number of residents in each program. I don't think Medicare would stop hospitals from adding more residents, it just won't give funding for them. Without funding, hospitals can't usually afford extra residents. So, no; Medicare doesn't control the number of residents, just the number it will pay for.

 

[hoyden]

The way I read it is Medicare simply pays for a certain number of residents in each program. I don't think Medicare would stop hospitals from adding more residents, it just won't give funding for them. Without funding, hospitals can't usually afford extra residents. So, no; Medicare doesn't control the number of residents, just the number it will pay for.

And now explain how it differs form the control over the number of residents.
Oh, I've got it - you mean there are going to be quite a bit of residents, working their butt off solely because of the love of art? Pardon me, medicine 😀

Whoever controls the $$$ is controlling everything else.

 

[badgas]

Government statistics show it takes a yearly income of about $500k to have just one child, about $200-300k to have 2 children, roughly $100,000 to have 3 children, $50,000 to have 4 children, and a completely uneducated unemployed income of zero dollars to have anywhere from 5 to 17 kids.