And then he comes back when the operation is finished, and extubates/makes sure everything goes smoothly with the waking up etc. Why is administering Anesthesia appealing to you? 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. We are anesthesiologists. 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. Putting together physiological/pharmacological data is not the hardest thing in the world to do. I guess they all believe they are in demand, there job still exists, etc... Stacular, I agree with most of your post. I first thought about anesthesia during my surgery rotation as an MS3. That being said, there is a push towards CRNAs. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. Beyond the OR - Subspecialty-trained colleagues may take care of patients in the surgical intensive care unit post-operatively. 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. The CRNA is a cost effective, safe alternative to an anesthesiologist. The positive side is you have no patients, but the negative side is … In fact, I might argue...similar analogy to surgery. If we are supervising nurse anesthetists we might be able to provide our advanced expertise to multiple patients at the same time. 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. 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. I love that when things are going poorly, a good anesthesiologist is the leader and the calmest person in the room. 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. 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. By using our Services or clicking I agree, you agree to our use of cookies. I'd do anesthesia again. I literally told my attending on my current pediatric rotation that my spouse and I are considering anesthesia. 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. 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. The patient comes in for surgery, and the anesthesiologist ensures that he/she is safe and doesn't experience pain. I rearranged my schedule to do an anesthesia rotation, fell in love with the specialty, and never looked back. So anesthesiology quickly dropped out of consideration, more out of default than anything else. 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. What was it about the rotations you were on that sold you? Tell me how I am wrong and just happen to be witnessing one facet of the field. We take care of medical complications that arise after surgery or from the patient's pre-existing disease and treat postoperative pain and nausea. That's not to say they can't handle complex cases (cardiac, neuro, etc) but many are ill-equipped for routinely managing these cases. Maybe they have a bit of a inferiority complex, I really don't see the need for constant braggadocio. I've been the dude on the street corner holding the sign, "Repent! But, everything you mention detracts from that (being in the OR). 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. This is one of the main reasons I chose anesthesia on top of everything else you said. Good luck to everyone starting this rewarding journey in anesthesia training! in my class, but no one listens to me. To add to this, for bigger, more complex cases the anesthesiologist is more intimately involved. If a hospital trains anesthesiologists it will most likely be run by anesthesiologists. Cookies help us deliver our Services. In the long run, there also could be savings to the health care system if nurses delivered more of the care. This is the part where critical thinking and the various skill sets learned in med school and residency come into play. That emphasis isn't there in training CRNAs, NPs, PAs. Anaesthetics is more complicated than people outside the field give it credit. Please excuse the provocative title. Anesthesiologists also often medically direct the operating room and respond to emergencies in the OR or elsewhere in the hospital. What is the most challenging/frustrating part of the work you do? What are Your Chances of Matching in Anesthesiology Residency?. Anesthesia is truly a great specialty. Subreddit for the medical specialty dedicated to perioperative … I rearranged my schedule to do an anesthesia rotation, fell in love with the specialty, and never looked back. 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. 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. It's shifting to more of a supervision role, rather than a direct 1 vs 1 encounter. But yeah...Lifestyle in the field will always be great, but the pay will drop in the future no doubt about it. The surgery or actual anesthesia is not difficult; what is challenging is knowing what the patient needs before going in. Similarly, I'm 100% positive that abbreviated, focused training on screening colonoscopies could be easily carried out by a mid-level provider. We got you. My mom asked him if he was okay to be sticking a giant needle into my spine. 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. Press question mark to learn the rest of the keyboard shortcuts. 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. 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. So you take that as your primary job. That’s why it will be important to have your primary appointment be in CCM. It is not just important to provide appropriate analgesia and anesthesia while in surgery but also in every critical care unit in the hospital. Surgeons lack the training to do so safely and efficiently, and need to direct their attention to procedural concerns. In any case, when we supervise nurse anesthetists, we are always immediately available to render personal assistance. The end is near!" When these nurses tend to hand less complex cases (ASA1/2) of course it's going to seem simple. By using our Services or clicking I agree, you agree to our use of cookies. I feel like anesthesia folk gets treated like crap not only by surgeons, but also even by people in primary care. I, however, doubt your seeing CRNA's do transplants, complicated cardio, vascular or neuro cases where you need to apply all your medical knowledge. 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. 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). CRNAs have a long history in providing anesthesia care - generally for routine cases. 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. Subreddit for the medical specialty dedicated to perioperative medicine, pain management, and critical care medicine. Most of us have great relationships with nurse anesthetists. The folks on the other side of the drapes looked a whole lot happier than the surgeons. 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. USMLE Step 1 is the first national board exam all United States medical students must take before graduating medical school. We can explain the surgical process to the patient and allay anxiety. Anesthesiologists are the guardians of the operating room. I first thought about anesthesia during my surgery rotation as an MS3. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. Most are capable of it, but they don't get the formal training and breadth of experience. I want to explain what anesthesiologists do, who we are, and why it is important for the public to know. each resident amounts to another room or another billable encounter. On Reddit, a user asked anesthesiologists to post the funniest things people have said while under gas. tracheostomy can be entirely up to the anaesthesiologists to perform. This is how it should be, I believe, in most practices. 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. I love anesthesiologists! 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. Hence why I thought it was vital to explain what we do. 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. Make no mistake; we are in charge, and we are humbled and honored to be so. 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?” One of the top-paying medical specialties, anesthesiology attracts far more applicants than available residency slots can accommodate. 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. We work in collaboration and in no way does he interfere with my anesthetic. Wow, thanks for this thorough response and dropping some wisdom. Anesthesiology: Keeping Patients Safe, Asleep, and Comfortable. Plus most pre/post-op are done by an attending. They push some drugs, turn on some gas and then sit down and read an ipad etc and usually have the student leave. (The nurse asked what kind of music he wanted … 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. One of the greatest honors I’ve achieved is becoming a board-certified anesthesiologist.
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