What is the worst part of your job???

[A-non-y-mous]

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Sometimes I get so lost in all the bickering about CRNA's and reimbursements on this forum.

WHat are the day to day, non_CRNA, things that you hate about specifically anesthesiology...not just medicine as a whole...

I was reviewing some old threads...from 2001....and came across this...."3) I think the worst part of the job is the horrible stress. You are constantly vigilantly watching the monitors for arrthymias, hypotension, etc. You are responsible for every heartbeat, every blood pressure reading, and every breath. It is really frightening to suddenly look up, see a blood pressure of 60/30, look over the curtain and see blood everywhere. Even if the surgeon caused the problem, it is your responsibility to fix it so the patient can survive. Also, you might be thinking that if you are constantly watching what's happening this won't happen to you. But it will - a patient can loose 1 liter of blood in seconds...

4) I could go on with a huge list of negatives about this field, but I won't. I will just add that you will not be respected in this field. The surgeons have no idea what you do, and they don't care. They have no respect for you. Nor do many of the nurses in the room ( I think that's because they know that you are replaceable by a CRNA). (And it's not like you interact with these people for a few minutes and then you can let it go - you will be with these people the entire day and it can be very frustrating.) Even many patients have no idea the degree of risk they are assuming in undergoing anesthesia. I am frightened for them! "

 

[Noyac]

Politics

 

[pd4emergence]

Sometimes I get so lost in all the bickering about CRNA's and reimbursements on this forum.

WHat are the day to day, non_CRNA, things that you hate about specifically anesthesiology...not just medicine as a whole...

I was reviewing some old threads...from 2001....and came across this...."3) I think the worst part of the job is the horrible stress. You are constantly vigilantly watching the monitors for arrthymias, hypotension, etc. You are responsible for every heartbeat, every blood pressure reading, and every breath. It is really frightening to suddenly look up, see a blood pressure of 60/30, look over the curtain and see blood everywhere. Even if the surgeon caused the problem, it is your responsibility to fix it so the patient can survive. Also, you might be thinking that if you are constantly watching what's happening this won't happen to you. But it will - a patient can loose 1 liter of blood in seconds...

4) I could go on with a huge list of negatives about this field, but I won't. I will just add that you will not be respected in this field. The surgeons have no idea what you do, and they don't care. They have no respect for you. Nor do many of the nurses in the room ( I think that's because they know that you are replaceable by a CRNA). (And it's not like you interact with these people for a few minutes and then you can let it go - you will be with these people the entire day and it can be very frustrating.) Even many patients have no idea the degree of risk they are assuming in undergoing anesthesia. I am frightened for them! "

Not sure where you are going or want to go with this thread. You seem suspect especially after looking at your previous threads. I suggest you change careers if you are so truly so miserable. Also, if you don't like the content of this forum, don't bother looking at it. Good luck with your career change.

 

[Noyac]

4) I could go on with a huge list of negatives about this field, but I won't. I will just add that you will not be respected in this field. The surgeons have no idea what you do, and they don't care. They have no respect for you. Nor do many of the nurses in the room ( I think that's because they know that you are replaceable by a CRNA). (And it's not like you interact with these people for a few minutes and then you can let it go - you will be with these people the entire day and it can be very frustrating.) Even many patients have no idea the degree of risk they are assuming in undergoing anesthesia. I am frightened for them! "

Yeah, if you are one of those folks that needs to be idolized and have nurses falling all over you to help you then anesthesia is not for you. You will need to be more self sufficient.

As far as respect goes, well that is different. It is earned in anesthesia but it can be gained and it can be gained quite effectively. There will be times that you walk into the room and the atmosphere will change. Everyone will all of a sudden become much more at ease. A sigh of relief will be heard in the room. Now that is a good feeling and when you notice it, you will feel the confidence that people have in your skills. But if your skills are suspect then I can see how it can be frustrating.

 

[Trisomy13]

Orthopods.

 

[VentdependenT]

Orthopods.

So true that it burns. Like the herpes. And not the "good" herpes.

 

[AK_MD2BE]

I am not sure what a previous poster was getting at when they mentioned that a previous comment pertained to a change in career. I would like this thread continued b/c I am an MS2 that is seriously considering a career in Anesthesiology b/c I am fascinated by the physiological effects of the drugs administered, the lifestyle (i.e. you can leave your job at the hospital, and all of the procedures that you are able to perform. But, no field is perfect. So I would like to continue this thread and find out what the drawbacks are. Thanks for the insight. 🙂

 

[A-non-y-mous]

Not sure where you are going or want to go with this thread. You seem suspect especially after looking at your previous threads. I suggest you change careers if you are so truly so miserable. Also, if you don't like the content of this forum, don't bother looking at it. Good luck with your career change.

I'm not sure where your confusion is coming from. However, i asked a pretty simple question and would politely like it answerd.

Thanks in advance.

 

[A-non-y-mous]

I am not sure what a previous poster was getting at when they mentioned that a previous comment pertained to a change in career. I would like this thread continued b/c I am an MS2 that is seriously considering a career in Anesthesiology b/c I am fascinated by the physiological effects of the drugs administered, the lifestyle (i.e. you can leave your job at the hospital, and all of the procedures that you are able to perform. But, no field is perfect. So I would like to continue this thread and find out what the drawbacks are. Thanks for the insight. 🙂

That's all i'm looking for as well. I want to make an educated decision.

 

[InductionAgent]

There is a certain ego-deflation one has to undergo to in being an anesthesiologist, remembering that the patient is there primarily to undergo surgery, not anesthesia. However, what we do is extremely important, and without it, surgery could not be performed in the manner it is today.

It is a bit annoying to hear the PACU nurses use "doctors" as a synonym for surgeon. I've come to expect it from the circulators, so when I'm in the room and we're all waiting for the surgeons, and they say "the doctors haven't shown up yet," it no longer bothers me, although I occasionally say something like "Well, one of the doctors is here." If the PACU nurses ask me "Did the doctors...," I whimsically respond "you mean the surgeons?" and then answer their question.

The stress of anesthesiology can be a bit daunting, but that it is also where the excitement comes from, so it's truly a love/hate situation. It makes me appreciate the "boring" times when the patient is stable, and the surgeons are slow. Pre-ops are not the most fun in the world, but I remind myself that at least I don't have to do rounds.

 

[powermd]

So true that it burns. Like the herpes. And not the "good" herpes.

Too much info!

 

[deleted126335]

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[A-non-y-mous]

hot damn...

Thank you for the honest answers.

It looks like a lot of the problem is the disrespect you get from staff and fellow doctors....and I don't think much can be changed...

 

[Noyac]

WHat are the day to day, non_CRNA, things that you hate about specifically anesthesiology....


The continuous assault on one's self esteem.

The perception that we are an institutional service, not doctors whose work and time is just as valuable as the surgeons. In many departments, this is manifest on so many levels of what we do. e.g.

- The difficulty in saying no to the following situations:

The orthopod who comes to your hospital for a hip fracture at 8 pm when OR time was available all day after his dinner with the family and kids baseball pratice.

The urologist who wants to do a cysto for a stone at 3 am because he happens to be willing to do this case on short notice at this time when so many others have been postponed for 18 hours for his conveniance.

The OB who has been at the office all day shows up at 5 pm to see a laboring patient with a stable tracing who hasn't gone anywhere for hours, who now wants to do a C-sec right now in reality for failure to progress but claims a "bad tracing" so he can get it done and go home.

The general surgeon who shows up at the end of the day wanting to do his morbidly obese chole with multiple medical problems after spending all day at the surgicenter that he has part ownership of doing healthy better insured softball cases.

The incompetent and/or lazy and/or unavailable ER and ICU docs your hospital contracts with that expects you to do your scut for them.

The OB nurse who expects you to be at the bedside on a few minutes notice for an elective labor epidural now that she is finally ready, and that we now have an order for an epidural from the OB.

Working in the surgeon owned surgicenter, with dingus surgeons who like to feel that they own you.

The administration that demands that you open more elective time for surgeons evenings and weekends so that we don't turn away business. The administration that won't back you for saying "NO" to any or all of the above situations.

IMO, Those are the type of situations that are the worst day to day issues that anesthesiologists face (outside a department with virulent CRNAs or exploitive senior partners which I consider even worse than the above)

Politics

 

[Broken Ankles]

WHat are the day to day, non_CRNA, things that you hate about specifically anesthesiology....


The continuous assault on one's self esteem.

The perception that we are an institutional service, not doctors whose work and time is just as valuable as the surgeons. In many departments, this is manifest on so many levels of what we do. e.g.

- The difficulty in saying no to the following situations:

The orthopod who comes to your hospital for a hip fracture at 8 pm when OR time was available all day after his dinner with the family and kids baseball pratice.

The urologist who wants to do a cysto for a stone at 3 am because he happens to be willing to do this case on short notice at this time when so many others have been postponed for 18 hours for his conveniance.

The OB who has been at the office all day shows up at 5 pm to see a laboring patient with a stable tracing who hasn't gone anywhere for hours, who now wants to do a C-sec right now in reality for failure to progress but claims a "bad tracing" so he can get it done and go home.

The general surgeon who shows up at the end of the day wanting to do his morbidly obese chole with multiple medical problems after spending all day at the surgicenter that he has part ownership of doing healthy better insured softball cases.

The incompetent and/or lazy and/or unavailable ER and ICU docs your hospital contracts with that expects you to do your scut for them.

The OB nurse who expects you to be at the bedside on a few minutes notice for an elective labor epidural now that she is finally ready, and that we now have an order for an epidural from the OB.

Working in the surgeon owned surgicenter, with dingus surgeons who like to feel that they own you.

The administration that demands that you open more elective time for surgeons evenings and weekends so that we don't turn away business. The administration that won't back you for saying "NO" to any or all of the above situations.

IMO, Those are the type of situations that are the worst day to day issues that anesthesiologists face (outside a department with virulent CRNAs or exploitive senior partners which I consider even worse than the above)

i see most of these examples as more money in the bank. let the surgeons bring all the patients they want at all hours. if i'm on call, i won't mind.

 

[CremeSickle]

The change in the atmosphere i have noticed at my teaching facility since the impending medicare cuts were announced (and actually started to happen).

 

[Planktonmd]

There are many positive aspects to Anesthesiology:
1- You get to wear Pajamas to work.
2- You get to park next to rich doctors (like ophthalmologists).
3- You come so early to work you never have to deal with traffic.
4- Patients bowel movements are not your responsibility.
5- You never do rectal exams.

 

[CremeSickle]

To add

You never do pelvic exams
No calls in the middle of the night for "random orders"
Less running all over the hospital for pages
No list of patients to see

There are many positive aspects to Anesthesiology:
1- You get to wear Pajamas to work.
2- You get to park next to rich doctors (like ophthalmologists).
3- You come so early to work you never have to deal with traffic.
4- Patients bowel movements are not your responsibility.
5- You never do rectal exams.

 

[Noyac]

To add

No calls in the middle of the night for "random orders"
Less running all over the hospital for pages
No list of patients to see

I disagree with these three. Occassional epidurals calls, One can find themselves running all over the hospital from ICU to ER to OR to OB to the floor, and we have a list of acute pain pts to see. These examples are more from my previous job, however.

 

[A-non-y-mous]

To add

You never do pelvic exams
No calls in the middle of the night for "random orders"
Less running all over the hospital for pages
No list of patients to see

Do anesthesiologists do much code? I would assume the answer is yes...

 

[morpheus md]

There are many positive aspects to Anesthesiology:
1- You get to wear Pajamas to work.
2- You get to park next to rich doctors (like ophthalmologists).
3- You come so early to work you never have to deal with traffic.
4- Patients bowel movements are not your responsibility.
5- You never do rectal exams.

NO Clinic.

 

[kraphtymac]

70% of your job isn't paper work (i.e. internal medicine)... it's more like 20%, which is MUCH, MUCH more manageable.

 

[deleted126335]

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[johankriek]

WHat are the day to day, non_CRNA, things that you hate about specifically anesthesiology....


The continuous assault on one's self esteem.

The perception that we are an institutional service, not doctors whose work and time is just as valuable as the surgeons. In many departments, this is manifest on so many levels of what we do. e.g.

- The difficulty in saying no to the following situations:

The orthopod who comes to your hospital for a hip fracture at 8 pm when OR time was available all day after his dinner with the family and kids baseball pratice.

The urologist who wants to do a cysto for a stone at 3 am because he happens to be willing to do this case on short notice at this time when so many others have been postponed for 18 hours for his conveniance.

The OB who has been at the office all day shows up at 5 pm to see a laboring patient with a stable tracing who hasn't gone anywhere for hours, who now wants to do a C-sec right now in reality for failure to progress but claims a "bad tracing" so he can get it done and go home.

The general surgeon who shows up at the end of the day wanting to do his morbidly obese chole with multiple medical problems after spending all day at the surgicenter that he has part ownership of doing healthy better insured softball cases.

The incompetent and/or lazy and/or unavailable ER and ICU docs your hospital contracts with that expects you to do your scut for them.

The OB nurse who expects you to be at the bedside on a few minutes notice for an elective labor epidural now that she is finally ready, and that we now have an order for an epidural from the OB.

Working in the surgeon owned surgicenter, with dingus surgeons who like to feel that they own you.

The administration that demands that you open more elective time for surgeons evenings and weekends so that we don't turn away business. The administration that won't back you for saying "NO" to any or all of the above situations.

IMO, Those are the type of situations that are the worst day to day issues that anesthesiologists face (outside a department with virulent CRNAs or exploitive senior partners which I consider even worse than the above)

damn dude

you are on the money with above on many levels...

part of the problem is exclusive contracts... If you dont have exclusive contracts you can say.. guess what.. im not doing dr. xyz cases because... you dont even have to have a reason.... but with exclusive contracts comes the fact that you have to deal with all the bull**** that the hospital throws at you because... of .. your exclusive contract...

Just last week i was on call.. and we had a bunch of add ons.. and we all bill for ourselves.. so I ask one of the other guys.. hey many do you mind taking care of the pacemaker and the hip... i had a SBO and a ankle to do.. He said well let me check with my wife.. He went down and checked the insurance on those patients and called me back and said.. hey man my wife needs me home.. LOL.. hey i dont blame him. i had to do all four cases ... i was up til 3. thats the beauty of being on your own.. you can do that.. IF you have exclusive contract you have to eat crow..

 

[jetproppilot]

Sometimes I get so lost in all the bickering about CRNA's and reimbursements on this forum.

WHat are the day to day, non_CRNA, things that you hate about specifically anesthesiology...not just medicine as a whole...

I was reviewing some old threads...from 2001....and came across this...."3) I think the worst part of the job is the horrible stress. You are constantly vigilantly watching the monitors for arrthymias, hypotension, etc. You are responsible for every heartbeat, every blood pressure reading, and every breath. It is really frightening to suddenly look up, see a blood pressure of 60/30, look over the curtain and see blood everywhere. Even if the surgeon caused the problem, it is your responsibility to fix it so the patient can survive. Also, you might be thinking that if you are constantly watching what's happening this won't happen to you. But it will - a patient can loose 1 liter of blood in seconds...

4) I could go on with a huge list of negatives about this field, but I won't. I will just add that you will not be respected in this field. The surgeons have no idea what you do, and they don't care. They have no respect for you. Nor do many of the nurses in the room ( I think that's because they know that you are replaceable by a CRNA). (And it's not like you interact with these people for a few minutes and then you can let it go - you will be with these people the entire day and it can be very frustrating.) Even many patients have no idea the degree of risk they are assuming in undergoing anesthesia. I am frightened for them! "

NIGHT CALL. hands down.

 

[deleted126335]

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[johankriek]

NIGHT CALL. hands down.

thats a good one too.. If i was up at 230 am every time im on call.. I wo uld not be very happy for too long. it happens to me prolly twice a month... but if it became a habit I would ask for a serious raise or I would drop it like its hot.

 

[harryh]

[/size]

 

[mdjobexchange]

Remember there is always locum tenens. I did locums for 2 years and I didn't care what case I did. I was getting 150 an hour and 175 for OT.

I know of an anesthesia group in arizona that was getting crap reimbursement. they all quit and signed up with a locums company. The hospital had to contract with the locums company to get them back. They were able to eventually get a desirable contract from the hospital.

Exclusive contracts are not a panacea. If the hospital decides to attract business that pays anesthesia poorly, you are in trouble.

I think locums is going to be a significant equalizer for physicians. Ultimately I think we should go to billable hours like lawyers and locums is opening that door for us.

 

[Noyac]

Remember there is always locum tenens. I did locums for 2 years and I didn't care what case I did. I was getting 150 an hour and 175 for OT.

I know of an anesthesia group in arizona that was getting crap reimbursement. they all quit and signed up with a locums company. The hospital had to contract with the locums company to get them back. They were able to eventually get a desirable contract from the hospital.

Exclusive contracts are not a panacea. If the hospital decides to attract business that pays anesthesia poorly, you are in trouble.

I think locums is going to be a significant equalizer for physicians. Ultimately I think we should go to billable hours like lawyers and locums is opening that door for us.

This sure is an interesting way to look at it.

 

[me454555]

No discharging, you drop em off @ pacu and they're someone else's problem. No need to contact family or find a bed at a SNF or SAR. Can you tell which rotation I'm on now?

 

[harryh]

Remember there is always locum tenens. I did locums for 2 years and I didn't care what case I did. I was getting 150 an hour and 175 for OT.

I know of an anesthesia group in arizona that was getting crap reimbursement. they all quit and signed up with a locums company. The hospital had to contract with the locums company to get them back. They were able to eventually get a desirable contract from the hospital.

Exclusive contracts are not a panacea. If the hospital decides to attract business that pays anesthesia poorly, you are in trouble.

I think locums is going to be a significant equalizer for physicians. Ultimately I think we should go to billable hours like lawyers and locums is opening that door for us.

Unfortunately, The administration to often succumbs to the lies and money offered up by an Anesthesia management companies (AMC) who will promise anything to get the contract then maintain it with a steady stream of bribes to the administration. The AMC will initially employ locums to staff the facility but will eventual find weak or naive anesthesiologists to work for far less than the doctors who left. There are so many ways a physician can get screwed by an anesthesia management company, so their labor cost a much lower than a real anesthesia group.

 

[supercut]

The incompetent and/or lazy and/or unavailable ER and ICU docs your hospital contracts with that expects you to do your scut for them.

Can someone elaborate on this please? I can't imagine what kind of scut an ER doc would dump on an anesthesiologist?

 

[deleted126335]

.

 

[me454555]

One of the hospitals that our group covers, some of the ER docs call us for routine intubations, ALL central lines, and Art lines. Since some of us have started objecting that ER physicians are credentialed in these procedures, that they should be attempting to do these procedures on thier own without calling us. The response to this tactic is to immediately transfer the unstable septic patient in respiratory distress to the ICU, where upon arrival the ICU nurses page us STAT. Where upon we get asked to intubate, place central line and Aline. (The ICU docs only make rounds and see consults mornings and evenings. They are internists who are not even credentialed in invasive monitoring)

That's the kind of scut that they dump on us.

Still beats getting called @ 3am b/c "31d is c/o knee pain. Can you perscribe some morphine"

 

[zippy2u]

Boy, now this is a thread I can all psyched up about. Dr. Doze is spot on about what he says. You eliminate most of the BS by transitioning yourself to a surgery center. Look, big picture shiit; your 20s (the best part of your life) was wasted sitting behind an endless book while your buds were bangin' hot chicks and practicing porn star moves. Now ya want me to waste my 30s sittin' around doing BS 2AM labor epidurals, midnight knife and gun club, 4AM post CABG mediastinal bleeding take backs, 3AM organ harvesting and on and on... Not goin' to happen with this cat. I'll clap for ya and let you be the hero. So at 2AM when ya get that BS emergency call, had your smoke and cup of Joe to clear the cobwebs on your way to that stinkin' hospital, I want you to crank up Harry Chapin's song "Cats in the Cradle"... Regards, ----Zip

 

[deleted126335]

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[zippy2u]

The biggest negative of the surgery center is the atrophy of your skills. Why does this happen? Because you are working with CRNAs who are doing the cases. A new grad should not work in a surgery center. It's better to work in a big hospital where your group does everything. Do this for 5-10 years then never look back. Regards, ----Zip

 

[Noyac]

The biggest negative of the surgery center is the atrophy of your skills. Why does this happen? Because you are working with CRNAs who are doing the cases. A new grad should not work in a surgery center. It's better to work in a big hospital where your group does everything. Do this for 5-10 years then never look back. Regards, ----Zip

Absolutely right

 

[Planktonmd]

The biggest negative of the surgery center is the atrophy of your skills. Why does this happen? Because you are working with CRNAs who are doing the cases. A new grad should not work in a surgery center. It's better to work in a big hospital where your group does everything. Do this for 5-10 years then never look back. Regards, ----Zip

Skill atrophy can happen at any stage of your career, I know many senior anesthesiologists who can't start an IV anymore because all they do is surgi-center.
So, unless you are ready to retire, I think you should try to alternate between surgicenter and other places.

 

[johankriek]

Skill atrophy can happen at any stage of your career, I know many senior anesthesiologists who can't start an IV anymore because all they do is surgi-center.
.

yeah they dont use IVs in surgery centers at all...

 

[UTSouthwestern]

yeah they dont use IVs in surgery centers at all...

Most surgery centers have the preop nurses place the IV's to help speed turnover, especially with high volume surgeries.

 

[Planktonmd]

yeah they dont use IVs in surgery centers at all...

😕
Usually there is one Anesthesiologist supervising 4 CRNA's.
The anesthesiologist does not start IV's and rarely does anything hands on.
This is the situation I am referring to.

 

[swpm]

There are some real upsides to surgery center. No nights, weekends, or holidays. Better insured cases. Softball cases who are less likely to die or stroke on you.

It seems much of the financial advantage surgeons enjoy by working at a surgicenter is due to their partial ownership of the place.

Are there many anesthesiologists who are part owners of surgicenters? What does one have to do to create that opportunity?