5 Things I Wish I Knew Before I Became an Anesthesiologist

5 thing I wish I knew before I became an anesthesiologist
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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.

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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.

I’m biased, but I think I picked the greatest specialty of them all. That said, there are things I wish I knew before going into the specialty.

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!

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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.

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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.

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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.

Final Thoughts:

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!

 

anesthesiologist

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.

 

Are you interested in contributing an article to The Specialist Series?  It’s a great opportunity to share your wisdom with current and future members of your specialty, as well as get some free promotion for your blog, podcast, or business.  You can check out The Specialist Series home page here, or email editor@TheScopeOfPractice.com for more information.

 

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Comments (40)

  • I just read this and I love it ! I’m only 15 but, i’m interested in learning about an anesthesiologist and is something i’m looking forward to, I don’t know exactly why i’m replying to this but I just had a gut feeling. Hope you continue having an amazing life and your family looks really happy ! Have an amazing night/or day 🙂

  • Are you able to work per diem or part-time as an anesthesiologist? How flexible would you say your specialty is compared to other specialties?
    Also, I’ve noticed that many physicians spend a lot of time charting, do anesthesiologist also spend a lot of hours doing charts?

    Great article by the way!

    • Anya-

      You bet! There are TONS of opportunities to work part-time or per diem as an anesthesiologist. The opportunities are a lot higher than for many other specialties, which is actually one of the things that attracts people to anesthesiology more. Also, yes, anesthesiologists do a lot of charting, just like all other physicians. Learning to master your electronic medical record system is a must if you’re going to be maximally efficient, but you can definitely figure out ways to streamline things.

      -brent

  • Heyy! Thank you so much for taking the time to list all these great tips! I now feel more cautious and interested in considering a field in anesthesiology. How would you suggest I go about becoming an Anesthesiologist? I’m a freshman in college right now and I’m planning on becoming one, but I don’t know how to start. Which classes should I take and which medical school is the best to apply for it? Which fellowship should I consider and how do I apply for one?
    Are there different fields in Anesthesiology? Or is it just one field?
    Thank you for all the tips!

    • There are several different fields in anesthesiology such as “regional anesthesiology,” “critical care,” and “interventional radiology.” In order to become an anesthesiologist, your first step is to become a physician. The typical path is college, then medical school, then anesthesiology residency, then a subspecialty fellowship afterwards if you want.

      The best thing to do to see if anesthesiology is something you’d want do is to actually go work with an anesthesiologist. We typically call that “shadowing.” It’s something I recommend to anyone considering a career in medicine. If you’re serious about heading that way, you should also seek out your college pre-professional/pre-medical advisor and ask for help in getting set up for your pre-med classes so you are eligible to apply to medical school in a few years.

      This would be a great discussion to have over the phone. There’s a lot to unpack. Send me an email at editor@thescopeofpractice.com, and let’s set something up! Looking forward to it!!

  • Hey! I want to be come an anesthesiologist and I have to sign up for classes in 2 months I was wondering what would be the right classes to start off with?

    • If you’re in college, check with your pre-medical advisor and find out what classes you need to take to be ready for medical school. Typical required classes include: basic chemistry, organic chemistry, physics, biology, math, and writing. If you’re in medical school, all of your classes during the first two years are pretty much decided for you. Once you get to third and fourth year, you may be able to take anesthesiology as an elective.

  • Hey Brent, any suggestions for things I can do in the early years to get a leg up (research, etc)? I am starting this fall and anesthesia has always been my vision of where I’ll end up. I am 100% open to gravitating toward what appeals to me once I’m exposed to it, but as of now would love to lock in on anesthesia. Also to the comment above, being a part time anesthesia doc sounds like my dream. My brother is a dentist and only works a few days a week.

    • Hans-

      Great questions! If there’s a medical school in your time, see if you can get a meeting with their department head and ask them directly. Just getting some face time with them would be huge by way of signaling your interest. The Dean of Students at the medical school could also be helpful. The bigger issue than research is actually connections. Start befriending the anesthesiology residents and fellows in your medical school. Maybe there’s even an anesthesiology student interest club you can join. The best thing you can do is get a great recommendation letter from an anesthesiology leader at your school. Hope that helps!!

  • Do you suggest a pre-Med degree for the first four years of the path?

    Which colleges do you personally think are the best option for Med school?

    • Anne-

      Great questions! A pre-med degree is helpful, but honestly, after about the first 2 months, everyone’s pretty much on a level playing field, regardless of undergraduate major. I did a pre-med degree, and I think it was helpful, but you’d do just fine without it. The downside of the pre-med degree is that if you don’t get into medical school, you really haven’t been prepared for anything else.

      As for colleges, it really doesn’t matter too much. I went to a good public school in my home state and did very well there. The quality of your education is much more dependent on you than on your school. Here’s an article I wrote on the subject, if you’d like to read more. Thanks!

      https://www.thescopeofpractice.com/almost-no-one-cares-where-you-went-to-school/

      -Brent

  • Thanks for posting this! Like you, I’m very interested in chronic pain, pharmacology, and like procedures so I am considering anesthesiology. However, I don’t enjoy critical care/emergency situations. Is anesthesiology still the right path for me?

    • Grace-

      Great question! Anesthesiologists deal with a LOT of emergency and critical care situations on a near-daily basis. But, you may find you’re actually very well suited to it. Have you had a chance to spend any time with anesthesiologists during actual clinical situations? The best way to find out if you like it is to shadow some anesthesiologists for a couple of weeks and see what their life is really like.

      Other great specialties you might consider would be gastroenterology and interventional radiology. We do some emergency stuff, but a lot of it’s routine. Those could be great options too!

      -Brent

  • I am only 17, I’m in my 12th grade right now.As I’m an indian , so as a medical aspirant I will give NEET exam next year.And I want to be an anesthesiologist. And my question to you is , how many days(on average)in a week an anesthesiologist works?Does they get days off in the week?how many on average they works in a day?Does they get vacations in every year to do a tour with friends and family?Does anesthesiologist get enough time for themselves,family and social life?Everyone has passion in painting,singing, dancing etc.I love dancing.will I get enough to do it if I become anesthesiologist?I also have a youtube channel. Will I get time to continue my channel after becoming an anesthesiologist? please answer

    • Shilpa-

      Thanks for reaching out! It’s good that you’re thinking about this stuff so early! Anesthesiologist’s work schedules can vary widely, but they typically work 4-5 days per week. They tend to think (in many cases, such as hospital settings) in terms of number of shifts per month instead of days per week. 18 shifts a month would be fairly typical, but again it can vary. Days worked are highly variable too, often with erratic schedules between weekdays, weekends, nights and days. Shift lengths are typically 8-12 hours. Yes, they do get vacation days. Actually, anesthesiology is one of the most flexible professions in terms of scheduling, which is one reason many people are drawn to it. Yes, you can have time for your YouTube channel! Regardless of your specialty, you should always make time for your hobbies and spending time with family.

      All the best!

      -Brent

  • Hey I am 14 I will be going to high school and I am very interested In being an anesthesiologist I want to start early so I have a good idea of what im getting into, what are some ideas to study for now.

    • Luke-

      It’s great that you’re thinking about this early!! The best thing you can do is find some time to go work side by side with an anesthesiologist for a couple of weeks and see if you really like it. The idea and the reality of any job are often very different. If you or your parents know someone who is an anesthesiologist, reach out to them and ask to shadow them for a week or two.

      The other thing you can do is get an oustanding GPA in high school and crush your SAT/ACT tests. Get into a decent college, study hard, and that’ll set you up for med school.

      Thanks!

      -Brent

  • Hi! I’m interested in a career switch and have a BS and an MS but in non-medically related fields. Where should I start? This was a great and informative article, thanks!

    • DP-

      What career are you working in now? Switching to medicine is a big move. Lots of requirements, depending on what you’re doing now.

      -Brent

  • hi! I am in grade ten in Australia, and am having to choose my subjects for my senior years. I am torn between law and medicine at the moment, but know that I am very interested in anesthesiology. do you think chemistry is a necessary subject in senior school, or do you think it is something you learn in university? Also, do you think it is okay to chop and change your choice throughout university?
    I think what you’re doing is great, a true role model!!

    Thank you! 🙂

    • Lily-

      I’m so glad that you’re thinking critically about these decisions! So many people wait for years before they start to consider their future. So, you’re WAY ahead of the game.

      As to your question about chemistry, I don’t think it’s critically necessary to take it in high school. I think it’ll probably make university-level chemistry a little easier, but if you don’t take it until college, that’s fine. On a side note, chemistry was one of my favorite classes in high school, so I’m a little biased in favor of it, but you’re not going to be too far behind the curve if you wait until university.

      As for changing your choices throughout college, you should DEFINITELY feel the freedom to do that. I started out in college as a business major, with plans to go into marketing/advertising. Then I felt God calling me into medicine towards the end of the first year and I switched to pre-medical studies. Yes, be prepared to change, and I think that’s totally ok!

      -Brent

  • thank you so much!!! i have decided to choose chemistry, and i think it will be enjoyable.

    best of luck with everything.

  • I would like to comment on your words concerning CRNAs. Thank you for the respect! I have been a CRNA for 18 years, and have had nothing but excellent relationships with anesthesiologists. Too often the conversation goes south, and the politics win out. I went to school for almost 10 years of you include the 2 years i was in a CVICU. My advice to those considering any healthcare specialty is burnout. Please be AWARE. It is scary, and i believe anesthesiology is one of the worst. It is all fun and games while you are learning. It is all fine until you have seen most all of it, and then you are haunted because you know it is not a matter of if but when you will see it again.

    • Matthew-

      Thanks for reading! You’ve got a great attitude! Joy is a choice, as I always say. I’m glad you’re not letting anyone else steal yours. All the best!

      -Brent

  • Great Post, Especially the part where you have talked about the Brand value. Getting Internships in Big Brands does add weight to the resume. Thank you for sharing this.

  • Hi! I’m super impressed with this article and it really helped me a lot. I know I want to go into anesthesiology but I’m not sure if I should go through med school and be an anesthesiologist or going the nursing route to be a CRNA. So my question is, is being an anesthesiologist and going through med school worth the debt?

    • It’s worth it if you feel called to the profession. But, I always caution people to make sure they are living well beneath their means so they can pay off that debt as quickly as possible.

  • Hello, I am currently a junior in highschool and I have been taking all of the medical classes that my school. I have taken a liking to anesthesiology I have been talking to my aunt about it as she is a CNO in maine but I wanted to find a more professional approach so I wanted to know what i should do as im halfway through my year currently
    -Nathan

    • The best thing you can do is find an anesthesiologist to shadow. If you know someone, or if you know someone who knows someone who is currently an anesthesiologist, reach out to them and ask if you can follow them around for a week or two (or however long they’ll let you) and see what it’s really like.

      As far as getting into medical school goes, just make sure to ace your freshman year in college. Poor freshman grades are the number one killer of medical school applications.

      You’re taking a really smart approach!

  • Hi! Thank you so much for this article. I am a second year in medical school right now, and I have been torn between different specialties. Your article really clarified things for me! How much research experience is recommended to have under your belt for anesthesiology residency applications? (Number of publications, presentations, abstracts)? Also, I was hoping to see if you could speak a little more about anesthesiologists’ roles in the ICU – is there a separate fellowship for this? Thank you!

    • Monica-

      Interesting question! Actually, in some hospitals, the anesthesiology teams run the ICU. There is a pathway to critical care fellowship from anesthesiology. Not every residency program has this option. So, if you’re seriously thinking about doing a critical care fellowship, make sure to look at residencies that have that option for you.

      -Brent

  • Thank you so much! In regards to research experience before residency, how many publications or presentations are considered adequate for interviewing for anesthesiology residency positions? I appreciate your help!

    • Good question! Every residency program is different. If you don’t have any, you can still be competitive. Having your name on one or two would be valuable. If you’re going for a more research-heavy residency, the more papers you have, the better you’ll do.

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