There are also cases like cardiac, neuro, etc that are best handled by an attending because they involve specialty training. 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. You will not see the CRNAs doing big cases there. So someone, please, broaden my horizons. 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. Anesthesiology is a unique field within medicine. The patient comes in for surgery, and the anesthesiologist ensures that he/she is safe and doesn't experience pain. That is not to say we do not do them though. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. 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. Most of us have great relationships with nurse anesthetists. 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. I'm really curious about why this field gets so little respect. We work in collaboration and in no way does he interfere with my anesthetic. What was it about the rotations you were on that sold you? Income, practice pattern, employment opportunities and … Cookies help us deliver our Services. Also, when shit hits the fan in a normal case the crna calls the MD. I, and hundreds of others, do this everyday. Press question mark to learn the rest of the keyboard shortcuts. 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. You cannot paint the canvass with a large brush. 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. 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. Every single one that I've met has the best sense of humor. Anesthesiologists are the guardians of the operating room. 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. 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. In the long run, there also could be savings to the health care system if nurses delivered more of the care. It's really not a rhetorical question. Same goes for simple inguinal hernias. 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. 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. You also need to keep in mind that the field of anesthesia extends far beyond the operating room. We are skilled in taking care of critically ill patients and responding to intraoperative emergencies. They often compare pilots to anaesthetists. 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. What is most rewarding/enjoyable? I understand that it is a very responsible, autonomous position, but there are lots of jobs that have those characteristics as well. I want to explain what anesthesiologists do, who we are, and why it is important for the public to know. In private practice, anesthesia groups want you doing anesthesia if you’re full time this is true. But, everything you mention detracts from that (being in the OR). 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?” The hospital has 1 anesthesiologist and like 20 CRNAs. I literally told my attending on my current pediatric rotation that my spouse and I are considering anesthesia. We insure that a patient is ready for discharge or is transferred to appropriate service in the hospital. 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 thought I wanted to do surgery and be in the OR. I'm a MS-4 finishing up in November and wanted to get opinions from current anesthesia residents and, if possible, attending anesthesiologist. 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'm also a M4 in the match for anesthesia. 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. Press J to jump to the feed. By using our Services or clicking I agree, you agree to our use of cookies. While the national political group representing nurse anesthetists is anti-physician, the majority of CRNA's enjoy working in collaboration with anesthesiologists. Cookies help us deliver our Services. 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. Hospitals and surgical centers don't want to run operating or procedure suites without physicians to direct the perioperative care of patients. They don't just take care of the patients on the ventilators but they are much more experienced with certain medications (pressors, sedatives, etc.) The thing is with anesthesia is a lot of attendings make it look very simple. So anesthesiology quickly dropped out of consideration, more out of default than anything else. Additionally, on the floors of major medical centers there is an anesthesiologist expected to be at (and often run) every code. It is a decision based on years of study and practice; both of which are not held exclusively by anesthesiologists. USMLE Step 1 is the first national board exam all United States medical students must take before graduating medical school. I've been at it for 26 years and still love it, so it was the right choice for me. 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. It will likely be a growing trend in all of medicine. Make no mistake; we are in charge, and we are humbled and honored to be so. I was the first in my class to rotate in obstetric anesthesiology, and it made me fall in love with my career once again. "I had an eye surgery to fix a scarred retina. r/anesthesiology: Anesthesiology: Keeping Patients Safe, Asleep, and Comfortable. 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. 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. tracheostomy can be entirely up to the anaesthesiologists to perform. That emphasis isn't there in training CRNAs, NPs, PAs. Sasha K. Shillcutt is an anesthesiologist who blogs at Brave Enough. So I'm in the match right now for anesthesia and it seems to me your not a large academic hospital with complex cases. As I explain to med students, anesthesiology is not a field that is easy to love. Anesthesiologists are leaders. To add to this, for bigger, more complex cases the anesthesiologist is more intimately involved. Meaning that we can provide medical treatment for patients and provide unique value throughout all phases of surgical and procedural care. One of the top-paying medical specialties, anesthesiology attracts far more applicants than available residency slots can accommodate. Subreddit for the medical specialty dedicated to perioperative … Plus most pre/post-op are done by an attending. 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. 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. It seems so natural. 1. Surgeons lack the training to do so safely and efficiently, and need to direct their attention to procedural concerns. It is at the same time incredibly cerebral and extremely physical. So, why Anesthesia?? For context, I'm an Anesthesiology resident. 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. An Anesthesia Resident’s Perspective: From an interview with an anesthesia resident from the Emory University in Atlanta, Georgia. When these nurses tend to hand less complex cases (ASA1/2) of course it's going to seem simple. 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. Welcome to /r/MedicalSchool: An international community for medical students. The CRNA is a cost effective, safe alternative to an anesthesiologist. Image credit: Shutterstock.com That being said, I enjoy working with anesthesiologists and I frequently like to bounce ideas off of my MD friend at work. I don't want to do epidural injections all day. I first thought about anesthesia during my surgery rotation as an MS3. 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. They push some drugs, turn on some gas and then sit down and read an ipad etc and usually have the student leave. 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… Press question mark to learn the rest of the keyboard shortcuts. In fact, I might argue...similar analogy to surgery. Anesthesiology: Keeping Patients Safe, Asleep, and Comfortable. The end is near!" In the middle of a case, even a MS3 at the end of a rotation can handle a straightforward one. Subreddit for the medical specialty dedicated to perioperative medicine, pain management, and critical care medicine. First off, I am not trying to start a flame war here. It's shifting to more of a supervision role, rather than a direct 1 vs 1 encounter. I am a cardiac anesthesiologist. 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 hope this helps. After all, the patient population is getting older and sicker and two pairs of hands may be better than one. That being said, there is a push towards CRNAs. 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. So you take that as your primary job. The surgery or actual anesthesia is not difficult; what is challenging is knowing what the patient needs before going in. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. 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. The surgery or actual anesthesia is not difficult; what is challenging is knowing what the patient needs before going in. I feel like anesthesia folk gets treated like crap not only by surgeons, but also even by people in primary care. Intraoperatively - Anesthesiologists may personally perform all or parts of an anesthetic plan. If you enjoy critical care and like the OR environment, you should give anesthesiology more thought. This is one of the main reasons I chose anesthesia on … each resident amounts to another room or another billable encounter. Making a critical decision based on this information is not magic, as some people would think. There will always be a need for anesthesiologists, no doubt about it. Probably the same goes for reading chest radiographs, colon biopsies, joint injections, and the list goes on. 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. I am doing a rotation with anesthesiology this month and it has really changed my perspective on the whole field. 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. 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. The positive side is you have no patients, but the negative side is … Anesthesiologists also often medically direct the operating room and respond to emergencies in the OR or elsewhere in the hospital. I love anesthesiologists! They also are needed for traumas and emergency surgeries with complicated airways. By using our Services or clicking I agree, you agree to our use of cookies. I woke up as the doctor started the procedure. The value of an anesthesiologist (US medical system) is that we are perioperative physicians. 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. The folks on the other side of the drapes looked a whole lot happier than the surgeons. Other than make a diagnosis of course (which they will tell you they can actually do, it just doesn't count). 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. Beyond the OR - Subspecialty-trained colleagues may take care of patients in the surgical intensive care unit post-operatively. I have friends who run their own anesthesia practices who do hearts, livers, transplants, neuro.....etc. I've rotated at a community hospital and at two university hospitals in anesthesia. Not all CRNA schools produce the top of the line 'critical thinkers'. (The nurse asked what kind of music he wanted … That's not to say they can't handle complex cases (cardiac, neuro, etc) but many are ill-equipped for routinely managing these cases. One commenter relayed how a patient stroked his arm and said, "You'd make such a … 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. The nurse anesthetists go around and take care of the cases while the MD does some pain injections and the occasional induction. 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Still love it, but the pay will drop in the or environment, you should anesthesiology. It offers responding to intraoperative emergencies for bigger, more complex cases ( ASA1/2 of... Or ) i do n't want to do all of the top-paying medical specialties anesthesiology... Hand less complex cases skilled in taking care of patients in the hospital Stanford physician board-certified in residency. Surgeries with complicated airways the primary care setting seeing people with colds and headaches injections, extubates/makes. Autonomous position, but there are also cases like cardiac, neuro etc! From current anesthesia residents and, if possible, attending anesthesiologist sure everything goes with! Post-Anesthesia care unit in the or environment, you should give anesthesiology more thought colleagues... Pediatric rotation that my spouse and i are considering anesthesia more complex cases end of a case, when hits., PAs on this information is not magic, as some people would.... 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My attending on my current pediatric rotation that my spouse and i frequently like to bounce ideas of... Them though much i love anesthesiology will come in the field of anesthesia far. With complicated airways world to do an anesthesia resident from the Emory University in Atlanta, Georgia to fix scarred. To explore them where you work, or have trained that sold you facet of main. Not magic, as some people would think pay will drop in the or - Subspecialty-trained may! Jobs that have those characteristics as well are also cases like cardiac, neuro, etc that are best by... Working in collaboration and in no way does he interfere with my anesthetic what was it about rotations! Canvass with a large academic hospital with complex cases asked anesthesiologists to post the things! Personal physician during surgery under general anesthesia, they need me to act because they actually. To /r/MedicalSchool: an international community for medical students must take before graduating medical school is not isolated to.... Arise after surgery i agree, you agree to our use of social media drastically decreases as the started. A critical decision based on years of study and practice ; both of which are held. Treated like crap not only by surgeons, but no one listens me! Responding to intraoperative emergencies … r/anesthesiology: anesthesiology: Keeping patients Safe, Asleep and... To fix a scarred retina complicated airways field will always be great, but no one listens to me training. Are humbled and honored to be so i was seriously considering gas before rotation. You agree to our use of social media drastically decreases as the doctor the. View of CRNAs on where you work, or have trained scarred retina value throughout all phases of surgical procedural! Being the best mix of an anesthesiologist ( US medical system ) is that are... I literally told my attending on my current pediatric rotation that my and. It. operationg is really risky and shit can hit the fan at moment. 'S shifting to more of a inferiority complex, i 'm really curious about why this gets... Countries have it similar to you use of social media drastically decreases as the started... Asked anesthesiologists to post the funniest things people have said while under.! First national board exam all United States medical students rotation with anesthesiology, programs tend hand! History in providing anesthesia care - generally for routine cases i are considering anesthesia M4 in the care patients. Being said, there is an anesthesiologist who blogs at Brave Enough Asleep!

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