"What it’s like ... to be the forgotten physician"

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http://www.theglobeandmail.com/life...o-be-the-forgotten-physician/article27960917/

"Every patient knows who did that cutting. “Oh, Dr. So and So was my surgeon, she’s the best …” No one remembers his or her anesthesiologist’s name. “So when will I see the doctor?” they ask, after I explain, carefully and thoroughly, everything I will be doing to bring them to the brink of death and then back again. Far away are the days when I would launch into my, “Well, I am your anesthetic doctor …” speech."

 

[NontradCA]

Tool.

Savage/10

 

[DokterMom]

Tool.

How so? Dr. is a "tool" for noting her job is largely thankless?

 

[PL198]

what about pathologists, radiologists and to some degree ICU docs

 

[Pacna]

what about pathologists, radiologists and to some degree ICU docs

We can address those, as well as the starving children in Africa, in their own thread, maybe?

 

[Psai]

Part of the reason I like anesthesia is because I'm not really a spotlight kind of person.

 

[Dave89]

I think that the salary compensates for the lack of patient validation 😉

 

[witzelsucht]

i heard the new drager's are shipping with minecraft pre-installed

 

[SnozzBerry]

what about "the forgotten CRNA"?

 

[ACSurgeon]

Part of the reason I like anesthesia is because I'm not really a spotlight kind of person.

Exactly. I bet most anesthsiologists LOVE not being remembered. They went into anesthesia for a reason.

On a similar note, ER doctors and even trauma/acute care surgeons by in large "nameless". You don't have long-term follow up with your patients. You don't manage a chronic problem.

And no, most patients do NOT remember anything about anything. It's a miracle if they can tell you the rough decade and hospital in which they had their operations. To be able to name their doctors would be impressive.

 

[Low Flow]

Exactly. I bet most anesthsiologists LOVE not being remembered. They went into anesthesia for a reason.

On a similar note, ER doctors and even trauma/acute care surgeons by in large "nameless". You don't have long-term follow up with your patients. You don't manage a chronic problem.

And no, most patients do NOT remember anything about anything. It's a miracle if they can tell you the rough decade and hospital in which they had their operations. To be able to name their doctors would be impressive.

I actually shadowed an anesthesiologist as a pre med and this is exactly what he said. That and the money.

 

[Psai]

I actually shadowed an anesthesiologist as a pre med and this is exactly what he said. That and the money.

Man every time I tell people I'm going into anesthesiology
"Isn't it boring?"
"They make good money right?"

 

[Wordead]

Man every time I tell people I'm going into anesthesiology
"Isn't it boring?"
"They make good money right?"

I thought you were doing ENT bro, dafuq

 

[Psai]

I thought you were doing ENT bro, dafuq

Me too but then I didn't like it. I thought the big cases were cool but I couldn't see myself doing the bread and butter all the time. I wonder if I'm going to end up regretting the wasted step 1 score. I have a friend who did a few ent aways but also switched to anesthesia before eras opened

 

[alpinism]

Me too but then I didn't like it. I thought the big cases were cool but I couldn't see myself doing the bread and butter all the time. I wonder if I'm going to end up regretting the wasted step 1 score. I have a friend who did a few ent aways but also switched to anesthesia before eras opened

Honestly if you don't like the bread and butter cases now it would only get worse during residency.

 

[jthedestroyr]

This is exactly why I like anesthesia and NOT having to deal with floor nurse beyond a very limited interaction.

I'd rather be forgotten then remembered when it's 2am and the patient is like I have a brillant idea, "I have problem xzy that's absolutely not urgent/critical, none the less, let's call my doctor now and ask them about it."

 

[ChillDawg]

Part of the reason I like anesthesia is because I'm not really a spotlight kind of person.

What's the other part? Besides compensation... I'm genuinely curious about what exactly it is about the work that anesthesiologists do that attracts med students. Seems even more mundane than any bread and butter surgical case...

 

[Mad Jack]

what about pathologists, radiologists and to some degree ICU docs

Trust me, people get to know the docs in the ICU. It's a thankless job in the end because you often never see the patients again (God willing), but they certainly know who you are and the hard work you do while you're doing it. Some of the best days were when we'd get gifts and cards in the ICU or a visit from a former patient or their families, and got to see them healthy and walking. Hell, even in my thankless former field of respiratory therapy, we'd get a few cards here and there from patients and their loved ones, and it was always really nice.

Radiologists and pathologists though- man do I feel bad for them. They do incredibly important work, but often get little recognition for it. Then again, many people enter those fields to avoid patient interactions, so maybe they don't really mind the lack of recognition from people they'd rather never see face-to-face in the first place...

 

[Hangry]

Exactly. I bet most anesthsiologists LOVE not being remembered. They went into anesthesia for a reason.

The only time I can remember a patient asking about their anesthesiologist was when they thought they had gotten their tooth chipped during an operation. If a patient remembers an anesthesiologist's work in the OR they've probably got a problem on their hands.

 

[Hangry]

Me too but then I didn't like it. I thought the big cases were cool but I couldn't see myself doing the bread and butter all the time. I wonder if I'm going to end up regretting the wasted step 1 score. I have a friend who did a few ent aways but also switched to anesthesia before eras opened

I can understand your concerns about ENT bread and butter (freakin tubes and tonsils), but why the switch from surgical things all the way to anesthesia? I get that you're still in the OR, but 😴. Unless you figure that CRNAs are going to be doing all the sitting in the OR time in the future and you just get to do the more intense airways, extubations, procedures, etc?

And about the step 1 thing, I don't think it's wasted. A high score should do big things to get you to the residency of your choice (be that prestige, location, etc), regardless of the competitiveness of your specific specialty. Although I do understand the feeling. When so many other people who have their pick of specialty choose to do one thing (be that derm, ent, plastics, etc) and you don't it feels like you must be missing something..

 

[Tenk]

I get a lot of thank yous but not once to this day have I ever had someone who was on the brink of death come back to me later and say: thank you for saving my life.

Doesn't bother me, just saying it's not unique to any field.

 

[ACSurgeon]

Me too but then I didn't like it. I thought the big cases were cool but I couldn't see myself doing the bread and butter all the time. I wonder if I'm going to end up regretting the wasted step 1 score. I have a friend who did a few ent aways but also switched to anesthesia before eras opened

The Step 1 score is to get you where you wanna go. It's not wasted if you accomplished your goal.

Also, your step 2/3 and inservice exams will all be solid because of your strong foundation. Never regret working hard

 

[Sailor Senshi Dermystify]

Me too but then I didn't like it. I thought the big cases were cool but I couldn't see myself doing the bread and butter all the time. I wonder if I'm going to end up regretting the wasted step 1 score. I have a friend who did a few ent aways but also switched to anesthesia before eras opened

What was your step 1 score?

 

[Wordead]

Me too but then I didn't like it. I thought the big cases were cool but I couldn't see myself doing the bread and butter all the time. I wonder if I'm going to end up regretting the wasted step 1 score. I have a friend who did a few ent aways but also switched to anesthesia before eras opened

Bummer. Well if you wanted to do big whacks all day the head and neck fellowships are not competitive (too late now, obviously).

I think it happens to a lot of people for whatever reason. Several of the people I did aways with ended up switching to radiology or gas before ERAS opened.

 

[Hangry]

Bummer. Well if you wanted to do big whacks all day the head and neck fellowships are not competitive (too late now, obviously).

I think it happens to a lot of people for whatever reason. Several of the people I did aways with ended up switching to radiology or gas before ERAS opened.

Sounds like some people were in it for the "lifestyle surgical subspecialty" then ran after they found out ENT is a true surgical residency intensity-wise during their fourth year rotations. Especially if they switched to rads or gas.

 

[ACSurgeon]

Sounds like some people were in it for the "lifestyle surgical subspecialty" then ran after they found out ENT is a true surgical residency intensity-wise during their fourth year rotations. Especially if they switched to rads or gas.

That and head and neck anatomy is very difficult. You can like the concept of good work life balance as a surgeon, but you have to have enough interest and be able to learn the skillset required, which isn't easy

 

[Psai]

I enjoyed my time on surgery and long hours aren't a big deal to me although it would be nice to have some time to myself. But on ent we just had a day where we had 10 tonsils and adenoids in a row and I'm like there's no way I can do this. I'm sure that doing it is different from watching. I liked anesthesia before I thought about surgery. Anesthesia seems like it is in decline though with constant crna encroachment (their online presence is pure insanity and many of them are incredibly unpleasant in real life) and more importantly, the fact that the majority will be working as hospital employed or an employee of a management company. The real winners will be the people who own their patients. So surgeons, primary care, derm, allergy, gi, etc. are some of those who will continue to do well. But I do like the intense interactions before surgery, the fact that you are generally dealing with acute issues, little time wasted on placement, and the feeling that you are making a difference in people's lives. They are true generalists and have a wide knowledge base, especially in physiology. It's a shame how superspecialized things are getting nowadays because it makes medicine seem fragmented.

The main issue is the loss of autonomy. All of these quality measures are thoughtless, poorly implemented and negatively affect patient care. What difference does it make if a patient gets into the or at 731 instead of 729? Beta blockers are not always indicated in cardiac patients and are sometimes harmful. Bureaucrats and administrators are turning into everything they can into checklist medicine which is great for nurses who are married to their protocols but terrible for doctors and patients.

 

[giantswing]

What its like to go home at three everyday.

 

[DocVapor]

What its like to go home at three everyday.

Aaaaaaaahhhhmazing.

 

[mimelim]

Me too but then I didn't like it. I thought the big cases were cool but I couldn't see myself doing the bread and butter all the time. I wonder if I'm going to end up regretting the wasted step 1 score. I have a friend who did a few ent aways but also switched to anesthesia before eras opened

No such thing as a wasted step 1 score. High score improves your chances of getting into the program that you want. Personal philosophy, but, purpose in life is to be happy, a higher score helps do that, thus not wasted. A high Step 1 score gives you more options and more importantly for most people, less worry. 🙂

 

[VisionaryTics]

I'm in the 250s. I enjoyed my time on surgery and long hours aren't a big deal to me although it would be nice to have some time to myself. But on ent we just had a day where we had 10 tonsils and adenoids in a row and I'm like there's no way I can do this. I'm sure that doing it is different from watching.

The least exciting thing in the world is watching people operate. The second most exciting thing in the world is operating.

Also, T&As were agony as a med student. At least with sinus and otology you got to see something if you weren't doing anything.

And I'm sure your rank list appreciates your high step score.

 

[IlDestriero]

What's the other part? Besides compensation... I'm genuinely curious about what exactly it is about the work that anesthesiologists do that attracts med students. Seems even more mundane than any bread and butter surgical case...

It has variety. Healthy outpatient one day, then ortho regional day, craniotomy for big tumor the next, call train wrecks, GI sedation, cardiac/vascular, then off to OB land, repeat.
Don't want to do one or more of those things? Just go somewhere that doesn't do them.
Reasonably predictable hours.
Reasonable call burden.
No clinic, outside of occasional phone consults with the pre op clinic run by NPs for some periop questions.
No long term follow up, unless you count the follow up of a diabetic vasculopath smoker progressing from non healing ulcer debridements, to fem-pop bypass, to BKA, to AKA.
No after hours stuff when not on call. I like my family time, and I like it undisturbed.
You can subspecilaize and sub-sub specialize. You can even leave anesthesia behind (Pain, critical care, sleep)
Flexible schedule possible to suit your lifestyle and income goals. You can find any arrangement you want in anesthesia if you are willing to relocate. Want to work 1/2 the year 1 month on 1 month off split with another person? -Rare, but I've actually seen it in a group where I interviewed. Want to work 3 days a week? Mommy track? Nights and weekends only? Want to make big bank giving up vacations and run all day covering 4 CRNAs? Want extra vacation? 6, 8, 10, 12 weeks? Outpatient ambulatory surgery only? Dental only?
It's also applied critical care. When the stool hits the fan, you're the one who's getting it done. Most cases are fairly routine, particularly with proper prior planning, but some are not. That's why you make the big bucks.
It works for me.

 

[NontradCA]

The least exciting thing in the world is watching people operate. The second most exciting thing in the world is operating.

Also, T&As were agony as a med student. At least with sinus and otology you got to see something if you weren't doing anything.

And I'm sure your rank list appreciates your high step score.

Most exciting is managing chronic diabetes?

 

[Shipping News]

Radiologists and pathologists though- man do I feel bad for them. They do incredibly important work, but often get little recognition for it. Then again, many people enter those fields to avoid patient interactions, so maybe they don't really mind the lack of recognition from people they'd rather never see face-to-face in the first place...

Anesthesiologists are forgotten doctors, but they were known at one point before the drugs started kicking in. Patients don't even know pathology or radiology are a thing. "I'm a radiology resident." "Oh, so you're the guy who comes in and shoots the xrays for my doctor?" "No, I'm a doctor." "Really?"

Not that I care, one of the beautifully appealing reasons for me to go into radiology was to avoid talking to patients as much as possible. Intern year was enough full-on patient interaction for my career.

 

[Shipping News]

I'm in the 250s. I enjoyed my time on surgery and long hours aren't a big deal to me although it would be nice to have some time to myself. But on ent we just had a day where we had 10 tonsils and adenoids in a row and I'm like there's no way I can do this. I'm sure that doing it is different from watching. I liked anesthesia before I thought about surgery. Anesthesia seems like it is in decline though with constant crna encroachment (their online presence is pure insanity and many of them are incredibly unpleasant in real life) and more importantly, the fact that the majority will be working as hospital employed or an employee of a management company. The real winners will be the people who own their patients. So surgeons, primary care, derm, allergy, gi, etc. are some of those who will continue to do well. But I do like the intense interactions before surgery, the fact that you are generally dealing with acute issues, little time wasted on placement, and the feeling that you are making a difference in people's lives. They are true generalists and have a wide knowledge base, especially in physiology. It's a shame how superspecialized things are getting nowadays because it makes medicine seem fragmented.

The main issue is the loss of autonomy. All of these quality measures are thoughtless, poorly implemented and negatively affect patient care. What difference does it make if a patient gets into the or at 731 instead of 729? Beta blockers are not always indicated in cardiac patients and are sometimes harmful. Bureaucrats and administrators are turning into everything they can into checklist medicine which is great for nurses who are married to their protocols but terrible for doctors and patients.

pffft what a pleb

come back when you have a 280

 

[ChillDawg]

It has variety. Healthy outpatient one day, then ortho regional day, craniotomy for big tumor the next, call train wrecks, GI sedation, cardiac/vascular, then off to OB land, repeat.
Don't want to do one or more of those things? Just go somewhere that doesn't do them.
Reasonably predictable hours.
Reasonable call burden.
No clinic, outside of occasional phone consults with the pre op clinic run by NPs for some periop questions.
No long term follow up, unless you count the follow up of a diabetic vasculopath smoker progressing from non healing ulcer debridements, to fem-pop bypass, to BKA, to AKA.
No after hours stuff when not on call. I like my family time, and I like it undisturbed.
You can subspecilaize and sub-sub specialize. You can even leave anesthesia behind (Pain, critical care, sleep)
Flexible schedule possible to suit your lifestyle and income goals. You can find any arrangement you want in anesthesia if you are willing to relocate. Want to work 1/2 the year 1 month on 1 month off split with another person? -Rare, but I've actually seen it in a group where I interviewed. Want to work 3 days a week? Mommy track? Nights and weekends only? Want to make big bank giving up vacations and run all day covering 4 CRNAs? Want extra vacation? 6, 8, 10, 12 weeks? Outpatient ambulatory surgery only? Dental only?
It's also applied critical care. When the stool hits the fan, you're the one who's getting it done. Most cases are fairly routine, particularly with proper prior planning, but some are not. That's why you make the big bucks.
It works for me.

Informative post, thanks!
You mention the various types of surgical cases that you participate on as an anesthesiologist, but aren't you always just sedating and bringing patients back, regardless of type of surgery? No disrespect or anything intended, I was just always curious about this.

 

[IlDestriero]

Informative post, thanks!
You mention the various types of surgical cases that you participate on as an anesthesiologist, but aren't you always just sedating and bringing patients back, regardless of type of surgery? No disrespect or anything intended, I was just always curious about this.

Well, there's more to it than push a stick of the white stuff and turn the yellow dial to 3%. Though if we're doing a good job it may not look like it.
Some days are quite routine, some are not, and the flow of the day in the neuro room is quite different than GI, OB, etc.

 

[bc65]

I'm not an anesthesiologist, but I would emphasize some of the points made above. A field like anesthesia offers great flexibility in terms of working schedule, which will be great when you want to slow down. One drawback is that lots of jobs require you to work night shifts, but you might be able to find jobs that suit you. But don't do it if you won't enjoy giving anesthetics. Make sure you like what you will be doing. I have met many anesthesiologists who spend all day, every day, being terrified. Others were always cool and calm, no matter what. Make sure it suits your personality.

As far as not getting remembered: Trust me, you don't want to be remembered. The satisfaction comes from a job well done. I don't care what the patient thinks, as long as they don't sue me.

 

[Yadster101]

Hell, even in my thankless former field of respiratory therapy

Did you go to resp therapy school knowing you'd want to go to med school? Man I wish I had done that back in the day so I could've made some money. Are the typical pre-med classes part of the resp therapy curriculum? How long did you take off to work as a resp therapist before med school?

Im guessing RT school is typically easier than a bio major?

 

[Mad Jack]

Did you go to resp therapy school knowing you'd want to go to med school? Man I wish I had done that back in the day so I could've made some money. Are the typical pre-med classes part of the resp therapy curriculum? How long did you take off to work as a resp therapist before med school?

Im guessing RT school is typically easier than a bio major?

No, I didn't. I started off at community college and really had no clue what I wanted to do, aside from get a job that paid me something when I finished my A.S. Respiratory therapy fit the bill. I could have worked in the medical school prereqs, but I was too lazy at the time, so I did the gimped prereqs for allied health majors that aren't applicable for medical school admissions. The four year RT programs have them already integrated for the most part. I was an RT for five years when I submitted my app, had like, 10k hours of experience.

As to the difficulty of the degree, when I went back for my BS there were a few courses that were different between bio and RT, aside from the obvious RT courses lol. Bio majors had to take comparative anatomy, ecology, calc I, calc II, and genetics lab, with one of the following three being optional: immunology, biochem, or microbiology. RTs were required to take microbiology, anatomy and physiology I and II, genetics, statistics, statistics, precalc, and either immunology OR biochem. All other prereq courses (chem, organic chem, bio, genetics) were the same. Plus, as an RT all of the fluff was cut out of my curriculum, so there was no time for research or anything like that- I was spending 24 hours a week in the hospital and another 16 physically in class every week while my peers were cruising by with their 12-15 hours of total commitment time. Plus the actual coursework you learn to become an RT isn't exactly easy- hemodynamics, pulmonary function tests, cardiopulmonary anatomy and physiology, the science of mechanical ventilation, etc. A lot of physicians couldn't interpret a PFT or run a vent for the life of them without making a few calls, and you've got to know it all cold and be able to do all of the equations by hand come test time.

Another interesting thing about becoming an RT is the testing process- you have to sit for this lovely thing called the Clinical Simulation Exam, which is a real pain in the ass. You've got 22 patient cases that are 8-14 questions long, that will actually change down a question stem depending on whether you initially managed the patient appropriately or inappropriately. Screw up too badly and the patient can up and die, resulting in you losing credit for the remainder of the case. It's also arranged in a multiple-multiple choice format, with some questions having fifteen tests for you to pick from, for instance. They don't say pick a certain number, you have to know when to stop. Here's a couple of the easy practice problems if anyone on here is wondering what the CSE is like lol, just enter your name to give being an RT a shot: https://prod1.lxr.com/webtest/Secure/login.aspx

 

[Yadster101]

@Mad Jack

Wow seems legit. Man I really think that doing something like that would be better prep for med school compared to the typical bio degree. Since so many ppl take gap years, they could actually gain valuable experience and save money. Its hard to do either of those things for bio majors.

 

[Mad Jack]

@Mad Jack

Wow seems legit. Man I really think that doing something like that would be better prep for med school compared to the typical bio degree. Since so many ppl take gap years, they could actually gain valuable experience and save money. Its hard to do either of those things for bio majors.

Bio is honestly one of the worst majors, I don't know why so many premeds love it so much. It has no utility in the career world, little additional utility over other science majors, and is much more difficult and less enjoyable than the majority of lib arts majors. Few other majors have that poor of a level of effort to reward.

RT did weaken my application in a lot of ways though- I lost a lot of the fluffy stuff (volunteering and the like) that I just didn't have time for, and really couldn't fit in research with a full-time job (nor did any professor want to have a volunteer researcher for any serious projects, as ones that are working for a grade the generally have by the balls). Will say it made cardio and respiratory in year one easy as hell- didn't even study and landed an 86%+ in both tests. Also I do way better in my standardized patient exams than a lot of my peers, care of actually knowing what to do when working with a patient.