5 Things I Wish I Knew Before I Became an Anesthesiologist
Editor’s note: Dr. Charles Cochran is an anesthesiologist who writes the highly useful and popular blog Life of a Med Student. I’ve posted a couple of articles on his site, and he offered to share some of his wisdom in return. If you’re thinking of a career in anesthesiology, you definitely will get some inspiration here!
How did I become an Anesthesiologist?
The clinical years of medical school are kind of like a bad middle school dance. There are specialties you want to dance with but are out of your league.
There are specialties that like you, but you just can’t like them back. Throughout the year, people and their desired specialties are pairing up, and you’re wondering if you’ll be left out. And all that is before the horrific process that is THE MATCH.
I always thought I wanted to do either primary care or chronic pain (father was a small town chiropractor and always referring patients to PCPs and pain docs). I had an entire part of my life believing I would end up a rural primary care doctor, but as medical school started I had leaned toward chronic pain, and maybe even anesthesiology.
There are a couple of paths to get board certified in chronic pain – neurology, psych, anesthesiology – and anesthesiology seemed to pay the best with the best lifestyle as a backup.
Ok, simple enough!
I’ll finish medical school, do an anesthesiology residency, and then chronic pain fellowship. THEN, I actually went to medical school.
Two types of medical students
There seem to be two types of medical students on clinical rotations: those who like everything, and those who like nothing. I liked none of it. Sure, I didn’t mind a few rotations here and there, but for the most part I couldn’t imagine doing any of them for more than a few weeks.
I HATED ROUNDING (still do). Clinic hours bored me. Chronic pain was quickly ruled out as was all primary care. Surgery was cool in short bursts, but the residency is anything but short bursts.
I had the vanity but not the board scores for plastic surgery. I wanted a good lifestyle but didn’t have the board scores for derm or ophthalmology either. And of course, I had way too good of a tan for radiology.
So what’s left?
Basically down to anesthesiology and emergency medicine.
- No rounding.
- Acute care for potentially very sick patients.
- Hands-on care, with procedural over academic treatment.
- Shift work with a good lifestyle and good or even great pay.
Why did anesthesiology win out for me? Well, unfortunately with current healthcare delivery I felt emergency medicine was about 80% primary care and 20% acute lifesaving care (and maybe that’s generous). You may do a procedure or two per shift or none at all.
You may save a life or you may simply treat dental pain. With anesthesiology, you do procedural work every single day, and any case is an emergency if you don’t do a good enough job.
Here are the top 5 things I wish I knew before I became an Anesthesiologist!
1. You never know when you’ll go home.
If you just look at total hours worked, I think the hours of an anesthesiologist are probably less than a lot of, maybe even most, specialties. BUT, they can be extremely sporadic and often unpredictable. I take call a 1-2 times a week, and the difference between a great call and a horrible call can be just one phone call.
Likewise, on an average day I probably will go home around 3pm – but an extra add on or a slow surgeon can unexpectantly turn that into 5 or 6 o’clock quickly. Likewise, a cancelation around the same time and I’m out at noon. On a slow day in the OR at my current job, I might not have to come in at all depending on my spot in the schedule.
I love the hours I work, but flexibility is key – both personally and with family. My wife knows that the time I can be home may vary greatly with little notice, but in practice, it can be a frustrating occurrence if you let it bother you. I tell all medical students or residents interested in anesthesiology this simple fact – you might not always know when you’ll be home in this specialty!
2. There can be a lot of pressure.
Trauma, cardiac emergencies, sudden OB needs – the pressure can be on!
You take care of critical care patients long enough, bad things happen. Codes happen. Surgeons get into bleeding. Sometimes patients come to you crashing, and sometimes their pathology or surgical course lead them to an emergent situation.
I love the fact that what I consider a routine part of my job description might downright terrify a large number of docs out there. When it counts, an anesthesiologist is simply expected to be cool and calm in the OR and the leader under crisis – running toward the patient in need, never from it.
While much of my job can appear very “calm” and “routine” to a medical student on a 3-4 day rotation, that can change any second, and being able to respond to pressure is a very key part of this job I probably didn’t truly appreciate until after I was already in it.
3. First impressions count!
Anesthesiology is not always known as a “people person” specialty, and in fact, many believe an anesthesiologist goes into the specialty because they “prefer their patients asleep.” NO WAY!
I love the fact I often get just minutes to make a great impression on a patient. A few moments to ease tension, crack a joke, and hopefully make a patient trust that I’m going to see them through a vulnerable period with success.
Patients are NERVOUS for surgery and sometimes act out in various ways because of that. The people skills to understand and diminish some of these fears are of utmost importance.
While other physicians may get years to develop trust with a patient, I enjoy the fact I need to do it in just a few minutes. So yes, even though our patients are asleep for much of our care, anesthesiology is very much a people-person specialty!
4. Your knowledge base is going to stay much wider than you expect.
I know a little (and often a lot) about a variety of medicine – it’s not just “putting patients to sleep!”
From cardiac cases to neurosurgery, from OB to pediatrics, critical care to outpatient orthopedics – using a breadth of physiology, anatomy, pharmacology – I help navigate patients through a great deal of different surgical procedures.
Whether a healthy 2-year-old with a quick abscess debridement or a critically ill emergent cardiac window, I need to have the knowledge and skill to take care of whoever ends up in the operating room.
It means knowing how each of the various surgical specialties operates, the kinds of patients they’ll take care of, what the surgeons will want, and expecting ahead of time what the patients will need. The required broad knowledge base is challenging yet rewarding to have acquired, and something I think many people under-appreciate about anesthesiology.
5. CRNAs and AAs are changing the field of anesthesiology.
For (often) better or (occasionally) worse, CRNAs (Certified Registered Nurse Anesthetists) and AAs (Anesthesiologist Assistants) are changing the landscape of anesthesiology. For me, I have benefited greatly from their care team-based integration into our practice.
I take back-up call, and only get woken up at night for the “real” cases. This means fewer hours and a better lifestyle than I could have had otherwise. There is certainly an argument that more anesthesiology providers can increase patient access to care and increase surgery availability.
On the other hand, I do believe CRNAs are filling jobs that traditionally have been held by physicians. In Indiana, this hasn’t seemed to affect the job market at all, as there are pages and pages of “wanted” ads on sites like gaswork.com looking for board-certified anesthesiologists. BUT, I see more and more of these requesting higher-level care, especially with cardiac anesthesiology experience.
If I was going into anesthesiology in the future, I would suggest strongly considering a fellowship.
Personally, I’d go into a cardiac fellowship as the demand there seems greatest. Luckily, my first job was a great spot to learn cardiac anesthesiology from excellent mentors. While I’ll never be at an academic fellowship level, I’m very proud to be able to safely care for a variety of cardiac-based operations – something I’ll always have on my résumé if my job were to change.
And that is what I wish I’d known – that the changing landscape will push physicians into more difficult cases and more specialization within anesthesiology as the role of CRNAs/AAs continues to grow.
I love my job as an anesthesiologist and I’m so thankful for the lifestyle and income it provides. I truly believe it is THE best specialty out there. If you are considering the field, these are the things I wish I would have known. Hopefully, they help medical students and residents decide if anesthesiology is right for them as well!
Dr. Charles Cochran is an anesthesiologist and the founder of LifeofaMedStudent.com – a social media movement to amplify the voice of all those in medical training! Contact him by email at Lifeofamedstudent@yahoo.com or on Twitter at https://twitter.com/LifeofMedstudnt.
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