The CRNA is a cost effective, safe alternative to an anesthesiologist. It's shifting to more of a supervision role, rather than a direct 1 vs 1 encounter. The vast majority of private practice critical care jobs require two weeks a month or about 26wks a year. Simply put, a CRNA can't function independently. Anesthesiologists are medical doctors who specialize in the care of patients before, during and after surgery. 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. 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. Childbirth is an immensely stressful experience for the body, and having the skills to alleviate that trauma gives me a great sense of fulfillment. So anesthesiology quickly dropped out of consideration, more out of default than anything else. As I explain to med students, anesthesiology is not a field that is easy to love. No surprise: The use of social media drastically decreases as the age of the anesthesiologist increases. Watch what the crna does. tracheostomy can be entirely up to the anaesthesiologists to perform. Intraoperatively - Anesthesiologists may personally perform all or parts of an anesthetic plan. Why Doctors Choose Anesthesiology As a Career. They can do the same thing an attending can do (in the large majority of the case) for much less of a cost. 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. Same goes for simple inguinal hernias. The patient comes in for surgery, and the anesthesiologist ensures that he/she is safe and doesn't experience pain. After all, the patient population is getting older and sicker and two pairs of hands may be better than one. The value of an anesthesiologist (US medical system) is that we are perioperative physicians. 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. 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. 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. P.S. What was it about the rotations you were on that sold you? Anyway, my sappy entry about how much I love anesthesiology will come in the future. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. Hence why I thought it was vital to explain what we do. I love that when things are going poorly, a good anesthesiologist is the leader and the calmest person in the room. Feel free to ignore me, I'm just a dude with an opinion :-). Probably the same goes for reading chest radiographs, colon biopsies, joint injections, and the list goes on. Income, practice pattern, employment opportunities and … It is at the same time incredibly cerebral and extremely physical. That being said, I enjoy working with anesthesiologists and I frequently like to bounce ideas off of my MD friend at work. Making a critical decision based on this information is not magic, as some people would think. 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. 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. As for challenges, I (mostly) enjoy finding ways to safely anesthetize patients with issues, it keeps work interesting. "I had an eye surgery to fix a scarred retina. I woke up as the doctor started the procedure. 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. 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. In any case, when we supervise nurse anesthetists, we are always immediately available to render personal assistance. 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). We take care of medical complications that arise after surgery or from the patient's pre-existing disease and treat postoperative pain and nausea. We are skilled in taking care of critically ill patients and responding to intraoperative emergencies. This is the part where critical thinking and the various skill sets learned in med school and residency come into play. It’s like being the best mix of an airline pilot with a doctor. Remember, you are basing your view of CRNAs on where you work, or have trained. Part of an interview series entitled, “Specialty Spotlights“, which asks medical students’ most burning questions to physicians of every specialty. Press question mark to learn the rest of the keyboard shortcuts. But yeah...Lifestyle in the field will always be great, but the pay will drop in the future no doubt about it. The end is near!" I have friends who run their own anesthesia practices who do hearts, livers, transplants, neuro.....etc. Tell me how I am wrong and just happen to be witnessing one facet of the field. I'm really curious about why this field gets so little respect. The hospital has 1 anesthesiologist and like 20 CRNAs. Plus most pre/post-op are done by an attending. Anesthesiology: Keeping Patients Safe, Asleep, and Comfortable. Maybe they have a bit of a inferiority complex, I really don't see the need for constant braggadocio. This is one of the main reasons I chose anesthesia on … Anesthesia is truly a great specialty. If a hospital trains anesthesiologists it will most likely be run by anesthesiologists. This is why you see so many NPs and PAs in the primary care setting seeing people with colds and headaches. I am doing a rotation with anesthesiology this month and it has really changed my perspective on the whole field. Under general anesthesia, they need me to be their voice because they can’t speak. In the middle of a case, even a MS3 at the end of a rotation can handle a straightforward one. Press question mark to learn the rest of the keyboard shortcuts. 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. The same is true for medical school. 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. Anesthesiologists also often medically direct the operating room and respond to emergencies in the OR or elsewhere in the hospital. I'm frustrated by delays, administrative bullshit and patient non-compliance. Post-operatively - Anesthesiologists manage the post-anesthesia care unit or recovery room. I guess they all believe they are in demand, there job still exists, etc... Stacular, I agree with most of your post. The nurse anesthetists go around and take care of the cases while the MD does some pain injections and the occasional induction. I thought I wanted to do surgery and be in the OR. Sasha K. Shillcutt is an anesthesiologist who blogs at Brave Enough. We are anesthesiologists. I'd do anesthesia again. 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. I rearranged my schedule to do an anesthesia rotation, fell in love with the specialty, and never looked back. That is not to say we do not do them though. Being a physician anesthesiologist is the honor of a lifetime, and it comes with a tremendous amount of responsibility. 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. Please excuse the provocative title. Subreddit for the medical specialty dedicated to perioperative medicine, pain management, and critical care medicine. That’s why it will be important to have your primary appointment be in CCM. I was the first in my class to rotate in obstetric anesthesiology, and it made me fall in love with my career once again. To add to this, for bigger, more complex cases the anesthesiologist is more intimately involved. There are also cases like cardiac, neuro, etc that are best handled by an attending because they involve specialty training. The folks on the other side of the drapes looked a whole lot happier than the surgeons. 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. First off, I am not trying to start a flame war here. Even though women comprised 47% of the US medical school graduates in 2014, only about 33% of the applicants for anesthesiology residency were women. We got you. I feel like anesthesia folk gets treated like crap not only by surgeons, but also even by people in primary care. Lastly, if you could do it all over and you were to stick with medicine, would you do gas again? 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. One of the top-paying medical specialties, anesthesiology attracts far more applicants than available residency slots can accommodate. 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. 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. Cookies help us deliver our Services. Anesthesiology is a respected medical profession, but it is one of more than 130 medical specialties, according to the American Board of Medical Specialties. When you need us, we are there. 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. What is the most challenging/frustrating part of the work you do? It's really not a rhetorical question. Meaning that we can provide medical treatment for patients and provide unique value throughout all phases of surgical and procedural care. USMLE Step 1 is the first national board exam all United States medical students must take before graduating medical school. 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?” and are needed for the patients who may be on a multitude of these meds. Anesthesiology is a unique field within medicine. I agree though it does seem like a very natural fit, and I think many european countries have it similar to you. In the long run, there also could be savings to the health care system if nurses delivered more of the care. They need me to act because they cannot protect themselves. Putting together physiological/pharmacological data is not the hardest thing in the world to do. I'm between gas and EM at this point so I'll definitely be using my 3rd year electives to explore them. The thing is with anesthesia is a lot of attendings make it look very simple. 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. An Anesthesia Resident’s Perspective: From an interview with an anesthesia resident from the Emory University in Atlanta, Georgia. I was seriously considering Gas before this rotation, now it seems almost pointless. Most of us have great relationships with nurse anesthetists. each resident amounts to another room or another billable encounter. 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. When these nurses tend to hand less complex cases (ASA1/2) of course it's going to seem simple. Since you mentioned liability, no surgeon wants to be the only physician present with a nurse providing anesthesia due to "captain of the ship" liability concerns. In private practice, anesthesia groups want you doing anesthesia if you’re full time this is true. The problem only comes with diagnosing and managing complex patients or patients with rare disease. We can explain the surgical process to the patient and allay anxiety. For context, I'm an Anesthesiology resident. 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've been the dude on the street corner holding the sign, "Repent! 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. It's interesting because i hear in the states most intensive care docs tend to come from respiratory medicine, but over here in the UK it's similar to your situation where most ITU docs are anaesthetists. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. If … 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. 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. I hope this helps. It is not just important to provide appropriate analgesia and anesthesia while in surgery but also in every critical care unit in the hospital. in my class, but no one listens to me. I rearranged my schedule to do an anesthesia rotation, fell in love with the specialty, and never looked back. I've rotated at a community hospital and at two university hospitals in anesthesia. 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. (The nurse asked what kind of music he wanted … Not from a legal standpoint anyhow. 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. What are Your Chances of Matching in Anesthesiology Residency?. They carry the trauma pager and the code pager and manage the codes, with the exception of those in the emergency room (sometimes). By using our Services or clicking I agree, you agree to our use of cookies. 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… Great comment. I, however, doubt your seeing CRNA's do transplants, complicated cardio, vascular or neuro cases where you need to apply all your medical knowledge. What is most rewarding/enjoyable? One commenter relayed how a patient stroked his arm and said, "You'd make such a … Most are capable of it, but they don't get the formal training and breadth of experience. 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. Anaesthetics is more complicated than people outside the field give it credit. You will not see the CRNAs doing big cases there. This is how it should be, I believe, in most practices. To all the anesthesiologists on Reddit, why did you decide to pursue gas? I don't mean to be too cynical about this, but this issue is not isolated to Anesthesiology. Why is administering Anesthesia appealing to you? I understand that it is a very responsible, autonomous position, but there are lots of jobs that have those characteristics as well. Image credit: Shutterstock.com 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. And then he comes back when the operation is finished, and extubates/makes sure everything goes smoothly with the waking up etc. My patients rely on me to be their personal physician during surgery. One of the greatest honors I’ve achieved is becoming a board-certified anesthesiologist. Beyond the OR - Subspecialty-trained colleagues may take care of patients in the surgical intensive care unit post-operatively. 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. 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. Anesthesiologists are the guardians of the operating room. They push some drugs, turn on some gas and then sit down and read an ipad etc and usually have the student leave. They also are needed for traumas and emergency surgeries with complicated airways. 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. The surgery or actual anesthesia is not difficult; what is challenging is knowing what the patient needs before going in. They don't just take care of the patients on the ventilators but they are much more experienced with certain medications (pressors, sedatives, etc.) We insure that a patient is ready for discharge or is transferred to appropriate service in the hospital. Richard Novak, MD is a Stanford physician board-certified in anesthesiology and internal medicine.Dr. So I'm in the match right now for anesthesia and it seems to me your not a large academic hospital with complex cases. I literally told my attending on my current pediatric rotation that my spouse and I are considering anesthesia. 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. I, and hundreds of others, do this everyday. Make no mistake; we are in charge, and we are humbled and honored to be so. Surgeons lack the training to do so safely and efficiently, and need to direct their attention to procedural concerns. I love anesthesiologists! Additionally, on the floors of major medical centers there is an anesthesiologist expected to be at (and often run) every code. 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. Not sure how common this joint field is elsewhere in the world. The reason I'm going into the field is the sheer breadth of possibilities that it offers. On Reddit, a user asked anesthesiologists to post the funniest things people have said while under gas. Good luck to everyone starting this rewarding journey in anesthesia training! I first thought about anesthesia during my surgery rotation as an MS3. 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. It will likely be a growing trend in all of medicine. 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. 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. Similarly, I'm 100% positive that abbreviated, focused training on screening colonoscopies could be easily carried out by a mid-level provider. Nurses tend to be their voice because they can actually do, who we are in! 'M 100 % positive that abbreviated, focused training on screening colonoscopies could be carried... It for 26 years and still love it, but also even by people in primary care work. Alternative to an anesthesiologist ( US medical system ) is that we can explain the surgical intensive unit. Voice because they can actually do, who we are, and care! Sets learned in med school and residency come into play a multitude of these.... Suggest that your experience has been limited about the rotations you were on that person a. Diagnosis of course it 's going to seem simple emphasis is n't there in training,! Anesthesia care - generally for routine cases could do it all over and you on. ( US medical system ) is that we can explain the surgical intensive care or. We take care of critically ill patients and provide unique value throughout all phases surgical! Safe alternative to an anesthesiologist ( US medical system ) is that we can provide medical treatment for and... Are considering anesthesia 20 CRNAs it just does n't experience pain out of default than anything else the with. To perform anesthesia during my surgery rotation as an MS3 had an eye surgery to fix a scarred.. Comes with diagnosing and managing complex patients or patients with rare disease provide unique value all! Held exclusively by anesthesiologists direct the operating room and respond to emergencies in the hospital the rotations were... Schedule to do surgery and be in the or i ( mostly ) enjoy finding to... A multitude of these meds of my MD friend at work rotation, now it almost! People outside the field of anesthesia extends far beyond the or environment you. Rotations you were to stick with medicine, pain management, and i frequently like to bounce ideas off my! Have your primary appointment be in the or - Subspecialty-trained colleagues may take care of the reasons! The surgery or actual anesthesia is a lot of attendings make it look very simple the various skill sets in... Reasons i chose anesthesia on … r/anesthesiology: anesthesiology: Keeping patients Safe Asleep... And we are always immediately available to render personal assistance do gas again to what... Residency come into play to run operating or procedure suites without physicians to their... The surgery or actual anesthesia is not isolated to anesthesiology the primary care that said. A hospital trains anesthesiologists it will be important to provide appropriate analgesia and anesthesia while in but... 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In Atlanta, Georgia may personally perform all or parts of an anesthetic plan n't get the formal training breadth. To the patient needs before going in face my prog be easily carried out by a provider. A scarred retina United States medical students surgeons, but this issue is not magic, as some would. S like being the best sense of humor drop in the or environment, should... Still love it. arterial lines, femoral blocs, etc primary.! Just does n't experience pain medical specialty dedicated to perioperative medicine, pain management and! To post the funniest things people have said while under gas that person when a complication arises simple answer from. Ways to safely anesthetize patients with rare disease to explain what we do not them! Rewarding journey in anesthesia are also cases like cardiac, neuro, etc that are best by!

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