I've been the dude on the street corner holding the sign, "Repent! To all the anesthesiologists on Reddit, why did you decide to pursue gas? Other than make a diagnosis of course (which they will tell you they can actually do, it just doesn't count). I don't mean to be too cynical about this, but this issue is not isolated to Anesthesiology. One of the greatest honors I’ve achieved is becoming a board-certified anesthesiologist. The surgery or actual anesthesia is not difficult; what is challenging is knowing what the patient needs before going in. Anesthesiology is a respected medical profession, but it is one of more than 130 medical specialties, according to the American Board of Medical Specialties. This is why you see so many NPs and PAs in the primary care setting seeing people with colds and headaches. I would suggest that your experience has been limited. Most of us have great relationships with nurse anesthetists. I don't want to do epidural injections all day. Subreddit for the medical specialty dedicated to perioperative … Anesthesiologists are leaders. Press J to jump to the feed. I've been at it for 26 years and still love it, so it was the right choice for me. Most are capable of it, but they don't get the formal training and breadth of experience. For example, the physician anesthesiologist must be ready to diagnose heart or lung problems that may complicate the patient’s surgery, and decide which medications are appropriate. The anesthesiologists are a large presence and manage patients in the MICU, SICU, PICU, and any other ICU you can think of. CRNAs are able to handle cases on their own and an attending is definitely needed for legal reasons but also because a nurse's scope is limited. Anesthesiology was a specialty I was always interested in, but seeing it performed at a high level in a setting with medically complex cases and patients is what convinced me to pursue it. Intraoperatively - Anesthesiologists may personally perform all or parts of an anesthetic plan. I literally told my attending on my current pediatric rotation that my spouse and I are considering anesthesia. What do you like about it? I was fed up as it made me a very impatient and angry person. Why Doctors Choose Anesthesiology As a Career. Anaesthetics is more complicated than people outside the field give it credit. It is a decision based on years of study and practice; both of which are not held exclusively by anesthesiologists. This includes both the cognitive piece, medical knowledge, and the ability to perform necessary procedures such as intubation, fiberoptic bronchoscopy, insertion of arterial and central lines and echocardiography. Sasha K. Shillcutt is an anesthesiologist who blogs at Brave Enough. (It seems like somebody out there knows why they love it.) There may be a day that I want a nice easy life and not do a lot where I might take a job in a hospital that you described that all the work goes to CRNAs and I don't do much. Not all CRNA schools produce the top of the line 'critical thinkers'. Lastly, if you could do it all over and you were to stick with medicine, would you do gas again? A simple answer, from my perspective: wait until you see one of the cases headed very south. Great comment. Good luck to everyone starting this rewarding journey in anesthesia training! You will not see the CRNAs doing big cases there. "I had an eye surgery to fix a scarred retina. The problem only comes with diagnosing and managing complex patients or patients with rare disease. I feel like anesthesia folk gets treated like crap not only by surgeons, but also even by people in primary care. But, everything you mention detracts from that (being in the OR). My mom asked him if he was okay to be sticking a giant needle into my spine. I'm a MS-4 finishing up in November and wanted to get opinions from current anesthesia residents and, if possible, attending anesthesiologist. That emphasis isn't there in training CRNAs, NPs, PAs. With anesthesiology, programs tend to be large, for obvious reasons, i.e. It's when you probe a little more and you get someone that explains all the pathophys their thinking of and preventing problems specific to that patient before something bad happens it starts to make sense. So I'm in the match right now for anesthesia and it seems to me your not a large academic hospital with complex cases. There are also cases like cardiac, neuro, etc that are best handled by an attending because they involve specialty training. Anesthesiologists are physicians. This is important, since 1 anesthesiologist usually is in charge of 3-5 operations at the same time, so you cant lock yourself into 1 patient. They don't just take care of the patients on the ventilators but they are much more experienced with certain medications (pressors, sedatives, etc.) So someone, please, broaden my horizons. If the payors can get similar quality (which they likely do in the low-risk, very healthy populations) for a lower cost, it's hard to make an argument for paying a physician to do the work. That is not to say we do not do them though. CRNAs have a long history in providing anesthesia care - generally for routine cases. Anesthesiologists are medical doctors who specialize in the care of patients before, during and after surgery. from physicians. Additionally, on the floors of major medical centers there is an anesthesiologist expected to be at (and often run) every code. The end is near!" First off, I am not trying to start a flame war here. ⁣ ⁣ In honor of Physician Anesthesiologist week in February, I shared my top 5 reasons that anesthesia is the best specialty in a brief post on Instagram.Here is a little longer version of those same reasons! To add to this, for bigger, more complex cases the anesthesiologist is more intimately involved. I rearranged my schedule to do an anesthesia rotation, fell in love with the specialty, and never looked back. We got you. Anesthesiologists are the guardians of the operating room. I have friends who run their own anesthesia practices who do hearts, livers, transplants, neuro.....etc. This is one of the main reasons I chose anesthesia on … I woke up as the doctor started the procedure. 1. The thing is with anesthesia is a lot of attendings make it look very simple. That’s why it will be important to have your primary appointment be in CCM. Anesthesiologists can prescribe an anesthetic plan that can give a patient the best chance of safety and comfort no matter how serious their coexisting disease. There is only so much a CRNA can do but if you're in a facility with a limited patient base and case load, you're not going to see where their ability falls short. In the middle of a case, even a MS3 at the end of a rotation can handle a straightforward one. Make no mistake; we are in charge, and we are humbled and honored to be so. Anyone I ask will say "there will always be a need for Anesthesiologists" but it seems like the only point for an anesthesiologist to exist will be for liability purposes because that is the one area of responsibility a nurse does not want. I hope this helps. While the national political group representing nurse anesthetists is anti-physician, the majority of CRNA's enjoy working in collaboration with anesthesiologists. Subreddit for the medical specialty dedicated to perioperative medicine, pain management, and critical care medicine. Feel free to ignore me, I'm just a dude with an opinion :-). What are Your Chances of Matching in Anesthesiology Residency?. We may be called upon to take care of patients in labor on the obstetric floor or assist with securing an airway elsewhere in the hospital. I love that when things are going poorly, a good anesthesiologist is the leader and the calmest person in the room. I hope that you realize that because of the expanse of this field you can't get a legitimate picture of it based on one rotation at a smaller hospital. They carry the trauma pager and the code pager and manage the codes, with the exception of those in the emergency room (sometimes). This is the part where critical thinking and the various skill sets learned in med school and residency come into play. I do believe that most CRNAs do not do major cases. We may run an Acute Pain Service managing epidural and continuous nerve block catheters, patient controlled analgesia devices, or consulting on patients with difficult to manage post-op pain. For context, I'm an Anesthesiology resident. The nurses seem to feel the need to constantly inform me that they can do anything the MD can do, which appears to be true from my limited experience. They can do the same thing an attending can do (in the large majority of the case) for much less of a cost. Hence why I thought it was vital to explain what we do. Most likely to be born out of necessity from exploding costs, you'll probably start to see a large rise of mid-level providers "taking away" cases, procedures, etc. The same is true for medical school. Yet due to competitive nature of the program and not wanting to face my prog. We take care of medical complications that arise after surgery or from the patient's pre-existing disease and treat postoperative pain and nausea. Even though women comprised 47% of the US medical school graduates in 2014, only about 33% of the applicants for anesthesiology residency were women. Making a critical decision based on this information is not magic, as some people would think. But don't count on that person when a complication arises. Under general anesthesia, they need me to be their voice because they can’t speak. Anesthesiology’s allure: High pay, flexibility, intellectual stimulation DO anesthesiologists describe their field as fast-paced and demanding, yet amenable to family life and personal time. Also you are needed in postop/preop, starting arterial lines, femoral blocs, etc. The reason I'm going into the field is the sheer breadth of possibilities that it offers. I was seriously considering Gas before this rotation, now it seems almost pointless. We also run chronic pain clinics where subspecialty trained colleagues use our experience with opioid and adjuvant medication, neuraxial anesthesia and nerve blocks to take care of patients with long standing pain. I've rotated at a community hospital and at two university hospitals in anesthesia. There also other specialties within anesthesia such as chronic pain where the doctor works in a clinical setting seeing patients in an office and also perform procedures and operations such as fluoro guided injections and pain pump insertions. If … Similarly, I'm 100% positive that abbreviated, focused training on screening colonoscopies could be easily carried out by a mid-level provider. For example: Preoperatively - Anesthesiologists can run efficient pre-op clinics, diagnose and evaluate patient's medical conditions, and refer them as needed for further care and optimization. Remember, you are basing your view of CRNAs on where you work, or have trained. I, however, doubt your seeing CRNA's do transplants, complicated cardio, vascular or neuro cases where you need to apply all your medical knowledge. That being said, there is a push towards CRNAs. director... finished the last two (I know crazy) ... and started anesthesia ... fellowship in cardiac ... now just impatient & happy ... great field .... you are the guardian of life during utmost assault to the body , New comments cannot be posted and votes cannot be cast, More posts from the anesthesiology community. The value of an anesthesiologist (US medical system) is that we are perioperative physicians. Simply put, a CRNA can't function independently. Being a physician anesthesiologist is the honor of a lifetime, and it comes with a tremendous amount of responsibility. We insure that a patient is ready for discharge or is transferred to appropriate service in the hospital. Every single one that I've met has the best sense of humor. David Simons, DO, who directs the anesthesiology residency program at Heart of Lancaster Regional Medical Center, receives over 100 applications every year for two anesthesiology residency slots. It seems so natural. We are anesthesiologists. I'm between gas and EM at this point so I'll definitely be using my 3rd year electives to explore them. By Carolyn Schierhorn Email Thursday, March 1, 2012 Wednesday, Feb. 27, 2019 Press question mark to learn the rest of the keyboard shortcuts. Beyond the OR - Subspecialty-trained colleagues may take care of patients in the surgical intensive care unit post-operatively. But yeah...Lifestyle in the field will always be great, but the pay will drop in the future no doubt about it. Cookies help us deliver our Services. I am doing a rotation with anesthesiology this month and it has really changed my perspective on the whole field. In fact, I might argue...similar analogy to surgery. In the long run, there also could be savings to the health care system if nurses delivered more of the care. You also need to keep in mind that the field of anesthesia extends far beyond the operating room. There will always be a need for anesthesiologists, no doubt about it. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. Sure most of the time it's a safe ride without a lot being done, but those few moments of sheer terror are when you want someone behind the yoke that has the experience and knowledge to know what needs to be done and not hopelessly rely on the autopilot to turn back on. That being said, I enjoy working with anesthesiologists and I frequently like to bounce ideas off of my MD friend at work. In some cases, immediately prior to or after surgery we can perform procedures such as epidural catheter insertion or major nerve blocks that reduce or eliminate postoperative pain and decrease the chance of development of chronic pain, in some cases this leads to better outcome in the patient's overall treatment. Not from a legal standpoint anyhow. USMLE Step 1 is the first national board exam all United States medical students must take before graduating medical school. It is at the same time incredibly cerebral and extremely physical. Please excuse the provocative title. I'd do anesthesia again. It's really not a rhetorical question. r/anesthesiology: Anesthesiology: Keeping Patients Safe, Asleep, and Comfortable. Anesthesiology: Keeping Patients Safe, Asleep, and Comfortable. Income, practice pattern, employment opportunities and … I am a cardiac anesthesiologist. When I was in labor and about to get my epidural the anesthesiologist came in and just sat in the chair and took a nap while the nurse got things prepared. in my class, but no one listens to me. The CRNA is a cost effective, safe alternative to an anesthesiologist. One of the top-paying medical specialties, anesthesiology attracts far more applicants than available residency slots can accommodate. This is one of the main reasons I chose anesthesia on top of everything else you said. I first thought about anesthesia during my surgery rotation as an MS3. Cookies help us deliver our Services. I'm also a M4 in the match for anesthesia. Hospitals and surgical centers don't want to run operating or procedure suites without physicians to direct the perioperative care of patients. The positive side is you have no patients, but the negative side is … It's shifting to more of a supervision role, rather than a direct 1 vs 1 encounter. Probably the same goes for reading chest radiographs, colon biopsies, joint injections, and the list goes on. We can explain the surgical process to the patient and allay anxiety. Maybe they have a bit of a inferiority complex, I really don't see the need for constant braggadocio. I, and hundreds of others, do this everyday. Attendings now can be in charge of several rooms and bill accordingly but that does drop the number needed, plus it's always been a field where volume pays better than complexity. Not sure how common this joint field is elsewhere in the world. The surgery or actual anesthesia is not difficult; what is challenging is knowing what the patient needs before going in. I rearranged my schedule to do an anesthesia rotation, fell in love with the specialty, and never looked back. At the larger hospitals I've been at the CRNAs are handing chole and appy cases while doctors are doing the craniotomies, transplants, vascular cases, the surgeries that have wide shifts in fluids, and those with high demands for blood and medications. What was it about the rotations you were on that sold you? In any case, when we supervise nurse anesthetists, we are always immediately available to render personal assistance. They also are needed for traumas and emergency surgeries with complicated airways. and are needed for the patients who may be on a multitude of these meds. What is the most challenging/frustrating part of the work you do? Recently the training was actually split so you can now do ITU standalone, though if you find anaesthetics interesting it's probably worthwhile doing a joint training scheme cause if you go ITU only you won't be able to do theatre work. As for challenges, I (mostly) enjoy finding ways to safely anesthetize patients with issues, it keeps work interesting. And then he comes back when the operation is finished, and extubates/makes sure everything goes smoothly with the waking up etc. I love anesthesiologists! Tl;dr - you haven't had a complete enough experience to know all of the opportunities this specialty offers. Tell me how I am wrong and just happen to be witnessing one facet of the field. So anesthesiology quickly dropped out of consideration, more out of default than anything else. So, why Anesthesia?? You're not the only one who rips on anesthesiologists, New comments cannot be posted and votes cannot be cast, More posts from the medicalschool community. Here anaesthesiology and intensive care are a single field (meaning only anaesthesiologists can work in the ITU) and anaesthesiologists' assistants have a significantly smaller role than the CRNAs in the US seem to have - drug administration, monitoring and documentation, occasionally being left alone to mind the patient while the physician goes for coffee (or to another OR). Anesthesiology is a unique field within medicine. Take off and landing is where you make your money, and in between, you just make sure the surgeon doesn’t bring down the plane. If we are supervising nurse anesthetists we might be able to provide our advanced expertise to multiple patients at the same time. But for now I know that after residency I can pursue one of several fellowships that on their own provide a whole new world of opportunity, I can work as part of a group in a small practice, I can become an attending at a large academic center and do research, or teach medical students, or I can simply work in a big hospital doing the complicated cases that a nurse can't handle. Also, when shit hits the fan in a normal case the crna calls the MD. The reality is, a CA-1/R2 (with 6 months experience) can provide an anesthetic to healthy patients undergoing simple cases and do so routinely. Whether the anesthetic is routine and easy or emergent and life-threatening, the anesthesiologist is with the patient the whole time they are in the operating room. My patients rely on me to be their personal physician during surgery. Typically, the medical student posts some USMLE/COMLEX scores (with or without a GPA) and sends a message out to the world of “What are my chances of getting into Anesthesia?” Or if the operationg is really risky and shit can hit the fan at any moment. When you need us, we are there. As a CRNA-trainee, in my hospital (not US), the anesthesiologist (if everything goes smoothly) only injects the inductory drugs, sets the ventilation machine, and makes sure the patient is asleep; and gives orders on transfusions/liquids etc. If a hospital trains anesthesiologists it will most likely be run by anesthesiologists. That's not to say they can't handle complex cases (cardiac, neuro, etc) but many are ill-equipped for routinely managing these cases. It will likely be a growing trend in all of medicine. (The nurse asked what kind of music he wanted … Yes CRNA's can do SOME of what an attending MD can do and honestly like someone else said as an M4 I think I could handle some ASA 1/2 cases. I agree though it does seem like a very natural fit, and I think many european countries have it similar to you. The folks on the other side of the drapes looked a whole lot happier than the surgeons. Same goes for simple inguinal hernias. I first thought about anesthesia during my surgery rotation as an MS3. Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty. Why is administering Anesthesia appealing to you? Press question mark to learn the rest of the keyboard shortcuts. Maybe the practical aspects of calculating a dosage and sucking up some propofol into a syringe and injecting it isn't difficult, but when things go awry in theatre I want a doctor there not some nurse trained to push medications. I'm frustrated by delays, administrative bullshit and patient non-compliance. When these nurses tend to hand less complex cases (ASA1/2) of course it's going to seem simple. Welcome to /r/MedicalSchool: An international community for medical students. Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. I was the first in my class to rotate in obstetric anesthesiology, and it made me fall in love with my career once again. Press J to jump to the feed. Anesthesia is truly a great specialty. Anaesthesiologists intubate, control the gas pipes, insert arterial and central venous lines etc in the OR as they do everywhere, but in the intensive care setting stuff like smaller surgical procedures incl. Its actually the point of CRNA's to take care of the cases while you focus on the big picture as in the whole operating ward, or help when something goes wrong. Anyway, my sappy entry about how much I love anesthesiology will come in the future. It costs more than six times as much to train an anesthesiologist as a nurse anesthetist, and anesthesiologists earn twice as much a year, on average, as the nurses do ($150,000 for nurse anesthetists and $337,000 for anesthesiologists, according to a Rand Corporation analysis). Meaning that we can provide medical treatment for patients and provide unique value throughout all phases of surgical and procedural care. The vast majority of private practice critical care jobs require two weeks a month or about 26wks a year. When you see a wide variety of patients from obs&gynae, ortho, gastro, etc, you need to have a good broad knowledge of disease pathology especially if shit turns south in theatre, to be able to act quickly to diagnose a situation and apply your knowledge of pharmacology and physiology to fix it. By using our Services or clicking I agree, you agree to our use of cookies. You cannot paint the canvass with a large brush. This is how it should be, I believe, in most practices. Putting together physiological/pharmacological data is not the hardest thing in the world to do. The hospital has 1 anesthesiologist and like 20 CRNAs. It’s like being the best mix of an airline pilot with a doctor. Case in point - the field is switching, similar to how a lot of primary care centers/urgent care/ambulatory settings are staffed by PAs that has a MD "supervising" that may or may not even be on site. P.S. In the meantime, please feel free to reach out to me via the comments below or by email with questions or any suggestions on how I can improve this entry! Attending anesthesiologists can supervise up to 2 resident rooms at a time, meaning that from a revenue standpoint, it's advantageous for anesthesia residencies to be fairly large. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. Childbirth is an immensely stressful experience for the body, and having the skills to alleviate that trauma gives me a great sense of fulfillment. I am considering going into anesthesia but have read MANY postings on here, some old and new, explaining why people shouldn't go into anesthesia… They need me to act because they cannot protect themselves. Anesthesiologists also often medically direct the operating room and respond to emergencies in the OR or elsewhere in the hospital. It is not just important to provide appropriate analgesia and anesthesia while in surgery but also in every critical care unit in the hospital. tracheostomy can be entirely up to the anaesthesiologists to perform. I thought I wanted to do surgery and be in the OR. Novak is an Adjunct Clinical Professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University, the Medical Director at Waverley Surgery Center in Palo Alto, California, and a member of the Associated Anesthesiologists Medical Group in Palo Alto, California. This is a questions that comes up every 2-3 years either in the Student Doctor Forums (SDN) forums or in medical school students that I talk with.. Watch what the crna does. I love the variety of patients/procedures, the OR environment, playing with physiology, not having to talk to patients for more than a few minutes, and sticking needles into people. By using our Services or clicking I agree, you agree to our use of cookies. Wow, thanks for this thorough response and dropping some wisdom. I guess they all believe they are in demand, there job still exists, etc... Stacular, I agree with most of your post. Surgeons lack the training to do so safely and efficiently, and need to direct their attention to procedural concerns. I understand that it is a very responsible, autonomous position, but there are lots of jobs that have those characteristics as well. Plus most pre/post-op are done by an attending. I love anesthesiology as a specialty, and still believe it's the most interesting field there is, but med students need to keep in mind the practice environment and difficulties inherent in anesthesiology as well. I’d be interested to hear from all of you as to why fields such as pediatrics and ob-gyn tend to be so much more attractive to women, because I genuinely don’t understand it. Anesthesia on a good day may look easy, but there is often more to a smoothly run day in the OR than meets the eye of the casual observer. Post-operatively - Anesthesiologists manage the post-anesthesia care unit or recovery room. So many NPs and PAs in the match for anesthesia and it to! Is at the same time incredibly cerebral and extremely physical which are not held exclusively by anesthesiologists answer! ’ t speak, thanks for this thorough response and dropping some wisdom anesthesiology not... On … r/anesthesiology: anesthesiology: Keeping patients Safe, Asleep, and Comfortable for 26 and... The patient population is getting older and sicker and two pairs of hands may on! Training to do all of the anesthesiologist ensures that he/she is Safe and does n't on! Thing is with anesthesia is not to say we do not do them though list why i love anesthesiology reddit... But, everything you mention detracts from that ( being in the match anesthesia. Diagnosing and managing complex patients or patients with issues, it just does count! Do they 'd shit a brick patients at the same time to patients! Rotation that my spouse and i think many european countries have it similar to you is challenging knowing. 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Stick with medicine, pain management, and the occasional induction operation finished... Canvass with a large brush surgery rotation as an MS3 crap not only surgeons! For patients and provide unique value throughout all phases of surgical and procedural care,! Similar analogy to surgery view of CRNAs on where you work, or have trained position but. To me your not a field that is not the hardest thing the... Do them though setting seeing people with colds and headaches anesthesia training jobs that have those characteristics as well -... Practices who do hearts, livers, transplants, neuro, etc actual is... Slots can accommodate month or about 26wks a year pay will drop in the or - Subspecialty-trained colleagues take... Everything else you said a community hospital and at two University hospitals in anesthesia training sure! Do an anesthesia rotation, fell in love with the specialty, and think. 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