Things to be aware of as a student:
1. If you have an ego and enjoy people recognizing you on a regular basis as a physician, this is not for you.
2. In residency and med school, you think of an anesthesiologist being solo in a room on a good first name basis with all the surgeons who respect you or supervising by dictating a plan to the anesthetist who follows every word you say while you are there for induction, extubation, or any emergencies. The reality is, often the surgeon just sees you as the thing that delays him/her from operating with needless questions or rigmarole. Some won't bother to learn your name. The general trend is this generation of workers (not just nurses, everyone) are more entitled and overconfident than ever and will not treat you with respect by helping you with basic stuff (i.e. turn on bair hugger, start an IV, pull stylet, get a drug you need, etc.) when you are solo. "You make the big bucks and that's not my job!" When you are supervising, you are not involved in patient care as much as you would think. You are more of the H&P monkey seeing patients, doing blocks, and managing PACU issues. You are hardly in the OR and are completely at the mercy of whoever is the primary in the room that you are supervising. Some anesthetists listen, more and more don't and feel that they can do whatever they want and not tell you when things go awry (remember, you are ultimately responsible for their bad choices). I suspect that collaborative models will essentially take over everywhere with higher and higher ratios of supervision once the market cools. Look into QZ billing. I can see places have you medically direct 4 rooms while doing QZ billing for another couple of off site places like endo.
3. People do not understand anesthesia and are quick to blame you for anything. You are constantly on the defensive. It was cute at first but now is annoying. Many people promising patients "You won't remember anything!" who aren't involved in anesthesia at all for a case done mostly under local or "the patient is in pain! Do something!" when they are actually having an anxiety attack with a perfectly functioning spinal anesthetic. I have seen anesthesiologists get blamed for lumbar radiculopathy because they got a perfectly placed epidural (no, ma'am, you were pushing for delivery which caused a disc herniation), a bilateral vocal cord paresis resulting in an ICU stay after aspiration and need for long-term tube feeds (no, sir, you were intubated for 22 hours in the OR because your surgeon took 22 hours to do what a competent one can do in 4 hours. We extubated you within 5 minutes of the surgery being done), and a median nerve palsy in a 16yo undergoing shoulder surgery because of "anesthesia's interscalene block (sorry, that block can't do that, it was the surgeon's positioning of some instrument or pressure on the nerve in the surgical field that did it). It is perfectly acceptable for other services to tell patients it was "anesthesia's fault" that you had a poor outcome but if you explain what actually happened to patients, everyone is mad at you and thinks you're the bad guy or unnecessarily casting blame on others.
4. Empty Foley catheters and push beds. Can you name any other physician who is expected to routinely do this?
5. You exist to serve the surgeons. They don't want to start cases till 2PM and their cases will go to 8PM? Guess you better cancel your dinner plans. Patient took Warfarin and the case is elective so you want to cancel? Too bad, surgeon wants you to give FFP because he is going out of town for two weeks starting tomorrow and he doesn't want to make his patients mad. You want to do a lower extremity nerve block BEFORE the case? Sorry, surgeon says it interferes with his post-op neuro exam so you have to wait till he gives the "OK" when the patient is about to leave Phase I of PACU so you do the block while he goes home (don't worry, he rounded after the case was done to kill time before getting that neuro exam!). With anesthesia heading more and more towards a hospital employed model, it is becoming harder and harder to fight these ridiculous requests. Have done at least 2-3 ELECTIVE open-heart cases on the weekend because the "surgeon doesn't have time during the week." Absolutely bonkers
6. Holidays, nights, and weekends. They become more valuable as you get older. Now, it just interferes with my life to be at the hospital during these times. Also, in-house call at some places. Very few specialties have attendings that do this.
7. SRNAs introducing themselves as anesthesia residents now. Huge slap in the face to anesthesia training.
8. I realize billing is getting cut for every specialty but in anesthesia it is quite severe. Private groups are now dependent on supplement payments from the hospitals they cover which I think is the fast road to being employed by the health system. An anesthesiologist has some of the most leverage to lose from being hospital employed compared to other physician specialties. I imagine a lot of anesthetics actually lose money or break even. I suspect this to get worse with the No Surprises Act. Someone in the c-suite is going to notice this and cut compensation eventually. Not now or soon, I think, but eventually.
These are things I wish someone mentioned to me as a med student. Overall, I am clearly on the more pessimistic side. I really love giving anesthesia, doing regional blocks, and taking care of really sick patients. I get enjoyment from a perfectly balanced anesthetic that leads to a quick wake-up and recovery. But, boy, do the politics suck!
