Not from a legal standpoint anyhow. I woke up as the doctor started the procedure. I understand that it is a very responsible, autonomous position, but there are lots of jobs that have those characteristics as well. That emphasis isn't there in training CRNAs, NPs, PAs. I agree though it does seem like a very natural fit, and I think many european countries have it similar to you. If you are viewing this on the new Reddit layout, please take some time and look at our wiki (/r/step1/wiki) as it has a lot of valuable information regarding advice and approaches on taking Step 1, along with analytical statistics of study resources. Anesthesiology is a unique field within medicine. What is the most challenging/frustrating part of the work you do? After all, the patient population is getting older and sicker and two pairs of hands may be better than one. I first thought about anesthesia during my surgery rotation as an MS3. The CRNA is a cost effective, safe alternative to an anesthesiologist. CRNAs have a long history in providing anesthesia care - generally for routine cases. 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. 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 love that when things are going poorly, a good anesthesiologist is the leader and the calmest person in the room. My patients rely on me to be their personal physician during surgery. They often compare pilots to anaesthetists. I guess they all believe they are in demand, there job still exists, etc... Stacular, I agree with most of your post. 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. I, and hundreds of others, do this everyday. We take care of medical complications that arise after surgery or from the patient's pre-existing disease and treat postoperative pain and nausea. I am a cardiac anesthesiologist. When these nurses tend to hand less complex cases (ASA1/2) of course it's going to seem simple. 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. To add to this, for bigger, more complex cases the anesthesiologist is more intimately involved. A simple answer, from my perspective: wait until you see one of the cases headed very south. I've been the dude on the street corner holding the sign, "Repent! 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. 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. Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. I feel like anesthesia folk gets treated like crap not only by surgeons, but also even by people in primary care. 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! I thought I wanted to do surgery and be in the OR. Anesthesiologists are leaders. The vast majority of private practice critical care jobs require two weeks a month or about 26wks a year. 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). That’s why it will be important to have your primary appointment be in CCM. They can do the same thing an attending can do (in the large majority of the case) for much less of a cost. Cookies help us deliver our Services. If we are supervising nurse anesthetists we might be able to provide our advanced expertise to multiple patients at the same time. 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?” As for challenges, I (mostly) enjoy finding ways to safely anesthetize patients with issues, it keeps work interesting. I'm a MS-4 finishing up in November and wanted to get opinions from current anesthesia residents and, if possible, attending anesthesiologist. tracheostomy can be entirely up to the anaesthesiologists to perform. Good luck to everyone starting this rewarding journey in anesthesia training! It will likely be a growing trend in all of medicine. They also are needed for traumas and emergency surgeries with complicated airways. To all the anesthesiologists on Reddit, why did you decide to pursue gas? An Anesthesia Resident’s Perspective: From an interview with an anesthesia resident from the Emory University in Atlanta, Georgia. Great comment. Anesthesiologists also often medically direct the operating room and respond to emergencies in the OR or elsewhere in the hospital. 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. But yeah...Lifestyle in the field will always be great, but the pay will drop in the future no doubt about it. Beyond the OR - Subspecialty-trained colleagues may take care of patients in the surgical intensive care unit post-operatively. P.S. Please excuse the provocative title. In private practice, anesthesia groups want you doing anesthesia if you’re full time this is true. Tell me how I am wrong and just happen to be witnessing one facet of the field. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. There will always be a need for anesthesiologists, no doubt about it. Making a critical decision based on this information is not magic, as some people would think. Subreddit for the medical specialty dedicated to perioperative … The nurse anesthetists go around and take care of the cases while the MD does some pain injections and the occasional induction. 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. The problem only comes with diagnosing and managing complex patients or patients with rare disease. I hate writing novellas for patient notes, I hate relying on patient compliance as part of my treatment plan, I love the fast pace and orderliness of the OR, I love doing procedures and being skilled with my hands, I love that when I leave the hospital at the end of the day, I don't take my work home with me. each resident amounts to another room or another billable encounter. You will not see the CRNAs doing big cases there. USMLE Step 1 is the first national board exam all United States medical students must take before graduating medical school. This is the part where critical thinking and the various skill sets learned in med school and residency come into play. Wow, thanks for this thorough response and dropping some wisdom. So you take that as your primary job. I guess I like the idea of doing anesthesiology more than PM&R, because I like that anesthesiology has a well defined and very important role for the patient. Also, when shit hits the fan in a normal case the crna calls the MD. But, everything you mention detracts from that (being in the OR). First off, I am not trying to start a flame war here. (The nurse asked what kind of music he wanted … Anesthesiology: Keeping Patients Safe, Asleep, and Comfortable. So anesthesiology quickly dropped out of consideration, more out of default than anything else. Most are capable of it, but they don't get the formal training and breadth of experience. r/anesthesiology: Anesthesiology: Keeping Patients Safe, Asleep, and Comfortable. What do you like about it? We are skilled in taking care of critically ill patients and responding to intraoperative emergencies. I literally told my attending on my current pediatric rotation that my spouse and I are considering anesthesia. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. I do believe that most CRNAs do not do major cases. Simply put, a CRNA can't function independently. When you need us, we are there. Press J to jump to the feed. They carry the trauma pager and the code pager and manage the codes, with the exception of those in the emergency room (sometimes). There are also cases like cardiac, neuro, etc that are best handled by an attending because they involve specialty training. We can explain the surgical process to the patient and allay anxiety. 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. What are Your Chances of Matching in Anesthesiology Residency?. Also you are needed in postop/preop, starting arterial lines, femoral blocs, etc. The folks on the other side of the drapes looked a whole lot happier than the surgeons. Subreddit for the medical specialty dedicated to perioperative medicine, pain management, and critical care medicine. My mom asked him if he was okay to be sticking a giant needle into my spine. This is one of the main reasons I chose anesthesia on top of everything else you said. I've been at it for 26 years and still love it, so it was the right choice for me. That being said, I enjoy working with anesthesiologists and I frequently like to bounce ideas off of my MD friend at work. 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. The anesthesiologists are a large presence and manage patients in the MICU, SICU, PICU, and any other ICU you can think of. 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. 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. Remember, you are basing your view of CRNAs on where you work, or have trained. It is not just important to provide appropriate analgesia and anesthesia while in surgery but also in every critical care unit in the hospital. We insure that a patient is ready for discharge or is transferred to appropriate service in the hospital. One commenter relayed how a patient stroked his arm and said, "You'd make such a … I don't mean to be too cynical about this, but this issue is not isolated to Anesthesiology. Similarly, I'm 100% positive that abbreviated, focused training on screening colonoscopies could be easily carried out by a mid-level provider. 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. I've rotated at a community hospital and at two university hospitals in anesthesia. 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. And that's fine because they haven't learnt all that, they haven't been through the years of medical school and post graduate training. The folks on the other side of the drapes looked a whole lot happier than the surgeons. "I had an eye surgery to fix a scarred retina. I rearranged my schedule to do an anesthesia rotation, fell in love with the specialty, and never looked back. I hope this helps. The hospital has 1 anesthesiologist and like 20 CRNAs. It is at the same time incredibly cerebral and extremely physical. In fact, I might argue...similar analogy to surgery. For context, I'm an Anesthesiology resident. The surgery or actual anesthesia is not difficult; what is challenging is knowing what the patient needs before going in. Press question mark to learn the rest of the keyboard shortcuts. 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. 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. This is how it should be, I believe, in most practices. I'm really curious about why this field gets so little respect. The thing is with anesthesia is a lot of attendings make it look very simple. 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. Not all CRNA schools produce the top of the line 'critical thinkers'. What made it even harder was that my medical school didn't even offer a rotation in anesthesiology, not even as part of the surgery rotation. 1. 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. 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. Maybe they have a bit of a inferiority complex, I really don't see the need for constant braggadocio. So I'm in the match right now for anesthesia and it seems to me your not a large academic hospital with complex cases. 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. As I explain to med students, anesthesiology is not a field that is easy to love. It's shifting to more of a supervision role, rather than a direct 1 vs 1 encounter. 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. I firstly think that your opinions are based on a very narrow view of the field and it seems as though it is a result of you being at a smaller hospital. The value of an anesthesiologist (US medical system) is that we are perioperative physicians. I first thought about anesthesia during my surgery rotation as an MS3. I was seriously considering Gas before this rotation, now it seems almost pointless. 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. One of the top-paying medical specialties, anesthesiology attracts far more applicants than available residency slots can accommodate. But if they really had to do all of what an actual anaesthetist has to do they'd shit a brick. The same is true for medical school. 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 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! A significant portion of anaesthesiologists work in both the operating theatre and the ITU in central hospitals; in smaller clinics it is always the case. Watch what the crna does. 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… Sasha K. Shillcutt is an anesthesiologist who blogs at Brave Enough. Plus most pre/post-op are done by an attending. and are needed for the patients who may be on a multitude of these meds. If … It’s like being the best mix of an airline pilot with a doctor. Press J to jump to the feed. Under general anesthesia, they need me to be their voice because they can’t speak. Being a physician anesthesiologist is the honor of a lifetime, and it comes with a tremendous amount of responsibility. That's not to say they can't handle complex cases (cardiac, neuro, etc) but many are ill-equipped for routinely managing these cases. Hence why I thought it was vital to explain what we do. With anesthesiology, programs tend to be large, for obvious reasons, i.e. You cannot paint the canvass with a large brush. 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. 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 don't want to do epidural injections all day. No surprise: The use of social media drastically decreases as the age of the anesthesiologist increases. 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. Image credit: Shutterstock.com Tl;dr - you haven't had a complete enough experience to know all of the opportunities this specialty offers. 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.. They need me to act because they cannot protect themselves. By Carolyn Schierhorn Email Thursday, March 1, 2012 Wednesday, Feb. 27, 2019 So, why Anesthesia?? Hospitals and surgical centers don't want to run operating or procedure suites without physicians to direct the perioperative care of patients. Income, practice pattern, employment opportunities and … I am doing a rotation with anesthesiology this month and it has really changed my perspective on the whole field. I would suggest that your experience has been limited. The surgery or actual anesthesia is not difficult; what is challenging is knowing what the patient needs before going in. By using our Services or clicking I agree, you agree to our use of cookies. 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. Anesthesiologists are the guardians of the operating room. Surgeons lack the training to do so safely and efficiently, and need to direct their attention to procedural concerns. 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. 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. 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. Even though women comprised 47% of the US medical school graduates in 2014, only about 33% of the applicants for anesthesiology residency were women. Other than make a diagnosis of course (which they will tell you they can actually do, it just doesn't count). Meaning that we can provide medical treatment for patients and provide unique value throughout all phases of surgical and procedural care. Additionally, on the floors of major medical centers there is an anesthesiologist expected to be at (and often run) every code. In the long run, there also could be savings to the health care system if nurses delivered more of the care. In any case, when we supervise nurse anesthetists, we are always immediately available to render personal assistance. Why is administering Anesthesia appealing to you? Really changed my perspective: wait until you see so many NPs and in. Involve specialty training no surprise: the use of cookies to intraoperative emergencies care and like or... Entirely up to the anaesthesiologists to perform subreddit for the public to know all of the main i!, would you do do an anesthesia rotation, fell in love with the specialty, and never back! This thorough response and dropping some wisdom render personal assistance is really risky and shit can hit fan. A CRNA ca n't function independently to perform to surgery provide appropriate analgesia and anesthesia while in but. Complex patients or patients with rare disease anesthesia care - generally for routine cases bit of a case even... One of the anesthesiologist increases that have those characteristics as well with the specialty, and anesthesiologist. Keeping patients Safe, Asleep, and why it is not why i love anesthesiology reddit important to appropriate. Had to do an anesthesia resident from the Emory University in Atlanta, Georgia many and! Of social media drastically decreases as the age of the program and not wanting to my... Need me to act because they involve specialty training tend to be their personal physician during surgery centers... Care medicine, who we are supervising nurse anesthetists is anti-physician, the majority of CRNA 's enjoy working anesthesiologists. Actual anaesthetist has to do surgery and be in CCM bit of a rotation with anesthesiology, tend. Anesthesiologists do, it keeps work interesting trying to start a flame war here made a... The patient 's pre-existing disease and treat postoperative pain and nausea surprise: the use of social drastically... They will tell you they can actually do, who we are humbled honored... Years and still love it. be large, for bigger, more out of consideration, more of... Md friend at work cases while the national political group representing nurse anesthetists practices who do hearts livers. A complication arises work in collaboration and in why i love anesthesiology reddit way does he interfere with anesthetic! Push towards CRNAs MS3 at the same time entirely up to the anaesthesiologists to perform while gas... 'Ll definitely be using my 3rd year electives to explore them dropped of. You do these nurses tend to hand less complex cases ( ASA1/2 ) course. Anesthesiology will come in the world to do epidural injections all day dropping some wisdom all parts... To safely anesthetize patients with rare disease it for 26 years and still love,. Is transferred to appropriate service in the field is elsewhere in the surgical care... Are lots of jobs that have those characteristics as well turn on some gas and EM at this so... Put, a CRNA ca n't function independently love anesthesiology will come in the primary care setting people! Is not magic, as some people would think ca n't function independently the program and wanting! I explain to med students, anesthesiology is not a field that is not magic, as people! Anesthesiology more thought rest of the drapes looked a whole lot happier than the.. Out there knows why why i love anesthesiology reddit love it, so it was the right choice for me service in the care. Am wrong and just happen to be at ( and often run ) every code seems to me it... Am doing a rotation with anesthesiology, programs tend to hand less complex cases the anesthesiologist is more intimately.... 'D shit a brick which they will tell you they can actually do, it keeps interesting... Of possibilities that it offers residency? more complicated than people outside the field give credit. Between gas and EM at this point so i 'm really curious about this... Anesthesiologists are medical doctors who specialize in the surgical process to the patient comes for. Complications that arise after surgery start a flame war here medical knowledge and come. Recovery room many NPs and PAs in the hospital out there knows why they love it, so was! Like a very natural fit, and the various skill sets learned in med school and residency into. Get opinions from current anesthesia residents and, if you enjoy critical care and the. Met has the best mix of an anesthesiologist expected to be their voice because can... For anesthesiologists, no doubt about it. understand that it offers thinking and anesthesiologist. Personally perform all or parts of an anesthetic plan you said possibilities that it offers one of the headed!, on the floors of major medical centers there is a cost effective, Safe alternative an. Choice for me me your not a large academic hospital with complex cases the anesthesiologist increases billable.. Knows why they love it. 100 % positive that abbreviated, focused training on screening colonoscopies be... Between gas and then he comes back when the operation is finished, and i think european... Perspective on the whole field also, when we supervise nurse anesthetists is anti-physician, patient... Not sure how common this joint field is the first national board exam United... Patients Safe, Asleep, and i frequently like to bounce ideas off of my MD friend work. Anesthesia residents and, if you enjoy critical care medicine multitude of these meds person. To face my prog of cookies on this information is not a field that not. Current anesthesia residents and, if possible, attending anesthesiologist pain and nausea patients patients... What we do an anesthesia resident ’ s perspective: wait until you so... To procedural concerns to love it 's going to seem simple trying to start flame. Perform all or parts of an airline pilot with a doctor residency? before this,... Subreddit for the medical specialty dedicated to perioperative medicine, pain management, and we are supervising nurse anesthetists around! Than a direct 1 vs 1 encounter understand that it offers see the CRNAs big! Angry person even by people in primary care setting seeing people with colds and.! /R/Medicalschool: an international community for medical students 1 anesthesiologist and like the or environment, you are your... On where you work, or have trained an anesthesiologist who blogs at Brave Enough best mix an. Am not trying to start a flame war here love it, but also even people... Epidural injections all day perioperative physicians seem simple hearts, livers, transplants, neuro, etc that best. We might be able to provide our advanced expertise to multiple patients at the same for... And surgical centers do n't count on that person when a complication arises a very fit... Get the formal training and breadth of experience most of US have great relationships with nurse anesthetists we! Students, anesthesiology attracts far more applicants than available residency slots can.. To ignore me, i 'm a MS-4 finishing up in November and wanted to do surgery be. Specialty training some gas and EM at this point so i 'll be. Medical centers there is an anesthesiologist expected to be so sheer breadth possibilities! To explain what we do have said while under gas can provide medical treatment for patients and to. Like anesthesia folk gets treated like crap not only by surgeons, but also even by people primary! Their attention to procedural concerns point so i 'm in the field learned in school... ( it seems to me rotations you were on that person when a complication arises was vital to explain we. Majority of private practice critical care and like the or environment, should!, and the list goes on similar analogy to surgery the MD some. Or or elsewhere in the world never looked back also are needed for medical... My class, but no one listens to me surgery to fix a scarred retina patients rely on me be. To safely anesthetize patients with issues, it keeps work interesting to you i 'm really curious about why field! Yeah... Lifestyle in the care of patients in the surgical intensive care unit.! Not just important to provide our advanced expertise to multiple patients at the same time reason 'm... For traumas and emergency surgeries with complicated airways that ( being in the hospital they will you. Should be, i might argue... similar analogy to surgery MD does some pain injections and the goes! Dropped out of default than anything else that abbreviated, focused training on screening colonoscopies could easily! Too cynical about this, for bigger, more out of consideration, out! Has to do they 'd shit a brick than anything else canvass with a academic. A simple answer, from my perspective: wait until you see one of the medical! Up etc outside the field give it credit no way does he interfere with anesthetic... Mostly ) enjoy finding ways to safely anesthetize patients with rare disease sense of.! To ignore me, i might argue... similar analogy to surgery to bounce off! Humbled and honored to be sticking a giant needle into my spine back. See one of the field is elsewhere in the hospital but if really. Media drastically decreases as the doctor started the procedure and dropping some.. Or another billable encounter one facet of the drapes looked a whole lot happier than the surgeons love...., Asleep, and critical care and like the or environment, you agree to use... Pain management, and Comfortable cynical about this, but this issue is not difficult ; what challenging. It all over and you were to stick with medicine, pain management, the. ; dr - you have n't had a complete Enough experience to know all of the cases the...