Growing Number of Physicians Here

I am most pleased to see the number of residents & practicing physicians has steadily grown over the last couple of years. For those of you still in the pre-med game, we may not be able to provide you with current info on the MCAT, app process & stuff of that sort. But, we can certainly provide you with information pertinent to success both as a pre-med & as a med student. I think I can speak for all of us, or we would not have bothered to sign up, when I say we are here for the asking. So take a few moments to raise your head from the books & ask us questions about being a Doc. Ask the tough questions…when you are interviewing, they will want to know if you are really “in the know” so some degree about what you are seeking to enter. Actually living it gives you the best understanding, but asking those of us who live it can serve as an adequate proxy.
Furthermore, it is my hope that one day, OPM will be populated by the entire continuum, for pre-med to attending, in sufficient numbers that we can function as our own internal referral system. Say Jane Pre-Med is intrigued by subspecialty Y & old Doc Freddie-Mac does that for a living. It would only be a natural extension to form a mentoring pair…maybe even assist in lining up shadowing options.
One day…
Here we are. Take advantage of the opportunity.

Okay OMD, I’ll be the first to ask questions!!! Since I am particularily interested in Anesthesiology and Critical Care Medicine(leaning more towards Peds), what made you decide on a career in Anesthesiology? Was it your prior background in respiratory care(a background we both share) or was it more complicated than that? Why would someone go into the field of Anesthesiology and, playing “devil’s advocate”, why would someone “run and hide” from the “Field of Gas”? Besides getting into medical school, how would your suggest that someone interested in Anesthesiology prepare at the pre-med stage? What about family life during residency and beyond as an Anesthesiologist? I think that’s enough to keep you busy for a bit and thanks for the opportunity to ask these questions

WOW! Talk about an open invitation to prattle on! However, I need to & should be reading on my cases for tomorrow. Take a rain check on my marathon reply to be?

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Okay OMD, I’ll be the first to ask questions!!! Since I am particularily interested in Anesthesiology and Critical Care Medicine(leaning more towards Peds), what made you decide on a career in Anesthesiology? Was it your prior background in respiratory care(a background we both share) or was it more complicated than that? Why would someone go into the field of Anesthesiology and, playing “devil’s advocate”, why would someone “run and hide” from the “Field of Gas”? Besides getting into medical school, how would your suggest that someone interested in Anesthesiology prepare at the pre-med stage? What about family life during residency and beyond as an Anesthesiologist? I think that’s enough to keep you busy for a bit and thanks for the opportunity to ask these questions


OK…I finally have some time to tackle this question - the charge anesthesiologist walked in with me this a.m. (as I have mentioned, been home the last 2 days w/ a severe asthma exacerbation & probably a smoldering bronchitis). Fortuitous coincidence, as we reached the top of the stairs - one flight, mind you - I was very winded & coughing my head off. Dr. Beach told me I looked like [censored] & should go home. He felt all rooms were covered (pre-Christmas closed lots of rooms) & there was not reason or benefit to my sticking it out. One of the many things that impress me so much about Dartmouth - the folks truly care about their residents. We work hard, but when we have issues, they support us.
Anyhow, back to the topic…
Why did I choose anesthesiology? Better yet, let me tell you what I learned, through my clerkships, what I wanted from my medical career: complex problem solving in a high-acuity environment, heavy in procedures, heavy in resuscitative medicine requiring lots of brain power & an absolute MINIMUM of “chronic” in my pt population. This narrowed down my choices considerably. For me, it came down to anesth, EM & surg - in that order. You can’t get any less chronic than path or radiology, nor could it be, for me, any more boring!
Surg - many factors against it: too much chronic, mucho high overhead (from a business standpoint) & liability and, frankly, after 1 year in the OR as a surg resident (did a surgical internship), I found surgery becoming quite boring - sorry Nat.
EM: the 10% or less that was actually EMERGENCY med (codes, MIs, resuscitative med…) was great! However, 90% of it was high-volume, high-pace FP after hours on pt’s who did not care enough about themselves to go to the trouble of getting their own physician. You can only sew up so many drunk head-lacs & remained challenged/entertained.
Anesthesiology provided ample quantities of everything I sought AND I felt totally at home on my side of the blood-brain barrier. Plus, my personality melds very well with the “anesthesiologist” personna. For those of you in healthcare, RRTs are the mavericks of the allied health professions - never hurry about much, but if the RTs are running, the damned house is ON FIRE. RTs also tend to not get loads of credit, pts & families frequently do not remember us and we do not generally seek that sort of glory. For anesthesiology, it works much the same way. We are critically important, but tend to be “behind the scenes”. Surgeons get the credit for the cure, but we ALL know that surgeons would be close to useless w/o we gas-passers. OTOH, we could do our job w/o surgeons, but what would that do? Nothing! The party does not start until we arrive.
So yes, in many ways, my history as a resp terrorist was significant in shaping me for anesthesiology. However, my fundamental personality (or lack thereof) was also critical. In essence, it just fits!
Why run away? Many reasons. Most people enter medicine desiring long-temr, continuity of care - you will not get that passing gas. Furthermore, anesthesia involves long hours of watchful waiting interspersed with episodes of shear terror - if you do not like the feeling of flying by the seat of your pants OR, even worse, you cannot process masses of information objectively, make decisions rapidly and act decisively in critical dynamic situation, gas is not for you. You have to be able to keep a clear head under immense pressure (HR <25, BPs of 50/?? & SpO2 dropping like a stone - happened to me in a “bland” routine ortho case about a month ago - ortho res dislodged my airway on a pt who was over beta-blocked - MAJOR ASS CLINCHER)…time to get the shakes later.
For me, I thrive in this environment - but it is not for everyone!
As a pre med? Nothing really. I recommend to all pre meds - it is good to have an idea of what interests you. Even better if you can associate those items of interest to a selection of specialties. However, to go into your med school interviews declaring that you will be xyz indicates more a lack of maturity & naivite than anthing…even if you do have years of experience to support your claim, the negative is the more likely interp by the interviewer. I tell all med students & pre meds to enter clerkships with an open mind. Each rotation you should invest yourself into it as if that were going to be your career. Only then can you truly know if this is the specialty for you. Do not pidgeon hole yourself into anything too early. Everyone worries about not deciding until too late. I think the bigger danger is deciding too early - before you have all the facts you need to make this decision. I can tell you of many colleagues who netered specialties they swore up & down they’d never do and are happy as a pig in poop doing them. They approached med school with an open mind & were rewarded for it.
Family life during residency? Tough for all types of residency, even the “cushy” ones. For all relationships to survive under any circumstances it must possess honesty, communication, trust & respect. If you have those & are truly dedicated to your partner - you can make your relationship survive, if not come out stronger. But, it will require work, dedication & deligence. There are no tricks, magic or painless solutions. Of course, that is no different than it would be doing anything else for living either.

Dave,
Fist off, I hope you are feeling better somewhat by now. I found your synopsis of what you chose Anesthesiology very interesting, especially your insights to the particular personality traits that led you in that direction. I remember OR as a nursing student, and agree %100 with your perception of surgery! I know from my few unfortunate trips to ER that its NOTHING like the TV show. Do you have the info for that site that asks questions about your interests and rates what specialty you’d supposed be best at? I know its somewhere in the archives but don’t know where. It was a medical school site if I remember correctly.
Kathy

I found that specialty recommendation site to be as closed to useless as was feasible. A number of my classmates & I took it and it did not even come close to our interests or what we ended up doing, in most cases. For me - the top 2 were Psych & OB/Gyn. Can you even envision 2 more incongruent matches for me?!?!?!?!?!

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I found that specialty recommendation site to be as closed to useless as was feasible. A number of my classmates & I took it and it did not even come close to our interests or what we ended up doing, in most cases. For me - the top 2 were Psych & OB/Gyn. Can you even envision 2 more incongruent matches for me?!?!?!?!?!


WOW!! That’s scary!

Hi there,
The URL for The Specialty Aptitude Test site is The Specialty Aptitude Test. This test generally compares your answers to 130 questions with those of practicing physicians in various specialties. These questions tend follow along certain personality traits and are meant to be a starting point for medical students who have no clue as to what career path to take.
As for Surgery: Either you ARE a surgeon or you ARE NOT a surgeon. It is definitely not the specialty for everyone. I generally do not fit the stereotypical surgeon but on the other hand, I don’t fit the stereotypical physician either. So much for that.
I took the Specialty Aptitude Test at the end of my second year of medical school and at the end of my third year of medical school as I was interviewing for residency slots in Anesthesia. All of my top ten specialties by this test were surgical except #10 which was Radiation Oncology. Anesthesia was never on my list which should have been an indication that it was not the specialty for me.
I cannot imagine doing anything except Vascular Surgery. I marvel at the ease that I can open a chest and cross clamp the aorta, the largest artery in the body. I can methodically examine the most severly injured patient, take him to the operating room and get him home.
When I was a PGY-1 or Surgical Intern, I found doing most of the ward work fairly tedious but time in the operating room was golden. I scrubbed on every case that I could get my hands into. My faculty members would take me through cases from skin to skin and I would thrive. There is great satisfaction in putting 100% into every ligature and every stroke of the scalpel. My concentration is unwavering and totally focused on every case. I spend hours perfecting every tie, stitch, mobilization and dissection. I practice many hours outside the OR memorizing every step of the 100s of operations that will become second-nature to me by the time I am done with my training. Every hernia is different and every appendectomy presents a new challenge. I can open a chest or abdomen faster than most people can open a package.
I like having a new and constant challenge everytime that I walk into the operating room. The best part is when I finish a case and go into the waiting room to speak with the family. There is no feeling like telling a family member that the case went well and that they will be able to see their loved one in the recovery room shortly. It is pure gold.
While anesthesia enables me to do my job, I would not want to trade places. Everyone has different likes and dislikes that make them excel at their chosen field. I am one of the fortunate few to be able to do what I love. I work very hard to stay on top of my skills. Medical school was the means that got me here but surgery keeps me here. As soon as I step in the OR, the rest of the world stops and my concentrations hones in on the task at hand. It is totally a blast at every turn and the ultimate adrenalin rush. I can totally understand why people jump out of airplanes now.
Natalie

A beautiful description Nat…I feel the same way on the other side of the ether tent. I just feels right & I am totally stoked every time I get to do it. You walk into the OR and it is home - not just feels like it, it is!

Dave,
Do you REALLY want the answer of whether I can picture you face deep between a woman’s knees most of the day??? LOL

Whatever specialty I end up choosing, I want to feel the same enthusiasm that I read in your guys posts. WOW. Ironically, after doing the test, my top pick was surgeon??
Kathy

Hi there,
I would caution anyone who had never attended medical school about taking the specialty aptitude test. The results are pretty meaningless until you have some medical clinical experience. You may find (as most people in medical schools) that you HATE surgery and hate that lifestyle not matter what that test shows.
Natalie

Having rotated through nursing school and knowing how I felt while I was in each rotation, I pretty much take it all with a grain of salt. It’ll take a lot to pull me away from kids though.

OMD,
Thanks for your insight!!! You are right about respiratory terrorists not getting the glory but, man, do we run the show in our own way when “[censored]” hits the fan. No one except a “terrorist…RT, that is” or very insightful anesthesiologist can manage a vent patient in crisis, Anesthesiology is definately the area of interest for me because it beings together all aspects of critical care medicine in an ever-changin environment. I love the challenges being a RT brings to the table when you have to manage a critically ill cardiopulmonary patient that does not respond to conventional treatment modalities. When I shadowed Nat, I met one of her collegues that is doing a surgery internship prior to an anesthesiology residency and, it just seems like the right thing to do to understand what happens on both sides of the curtain and how both specialities need each other to make things work. It’s pretty cool to have mentors on both sides of the curtain(OMD and Nat) that just happen to be respiratory therapists…life is definately good!!!

OMD, I have a question about Anesthesiology. Having finished my surgical rotation a few weeks ago, I found that I have little interest in being a surgeon. Although it was fun to assist on the surgery’s, I found I enjoyed the time out of the OR on the ICU floor much more. I did however find myself interested in what the “gas passers” were doing. I also am considering EM, or IM with an eye to a fellowship in pulmonology/intensive care medicine. I didn’t realize that anesthesiologists do that. Could you tell me a little more about the non-surgical/critical care role of the anesthesiologists? I am at a rural hospital, a tertiary care center, but still fairly small, and I haven’t really seen them doing that here-- the pulmonologists seemed to do it. I have scheduled an anesthesiology elective, but it was scheduled late in my fourth year. Now I’m thinking of moving it forward, and possibly doing it as an away elective, so I get a better feel for the specialty then I would here. But anything you can tell me about that aspect of anesthesiology would be appreciated.
Thanks, Epidoc

To be perfectly frank, the concept of “intensivist” & “intensive care medicine” are born from the discipline of anesthesiology, namely from the programs at UPitt, U FL & MD Shock Trauma - those are the original cornerstones institutions of the whole subspecialty of critical care medicine.





Now, you ask “Why is the specialty so dominated by IM intensivists & Pulm/CCM Docs?” Folks could wax poetic on this for quite some time, but I (WARNING - impending opinion coming) personally feel it has more to do with economics from both the physician & hospital perspectives. First, you must understand that counterintuitively, the higher the acuity of the pt population, the lower the profit margin. The highest acuity scenarios are typically money loosers, frequently large loosers. But, in the “old days”, when the medical institutions felt that monetary subsidies were an infinite resource, it became the vest role of the tertiary centers to build large, high-acuity intensive care programs because they had the financial base to absorb the losses. As such, as “money” progressed into a larger role in healthcare admin, beginning w/ DRGs in the early 80s, the fact the ICUs were $$ loosers became more & more significant. In that context, reimbursement, both hosp & physician, have commensurately eroded as well. This is beginning to change…just beginning - more on that later.





Physician perspective: getting down to brass tacks, a pulmonologist or an IM doc can greatly increase their expected salaries by undertaking an ICU fellowship. A general internist usually starts around $120s/year…don’t know about pulm. An intensivist starts more in the range of $175, give or take, as most often these slots are in teaching insitutions and they are paid commensurately. I cannot comment on private practice ICU docs, as this is a whole other kettle of fish. (Private ICUs are generally much lower actuity levels & frequently staffed by non-ICU trained physicians). OTOH, an anesthesiologist, straight out of residency, can easily find a private practice job starting $250k/yr and w/ some willingness to live more rurally, can easily crest $350k/yr. So, it is hard to justify an extra year of training for a substantial paycut & a much less lifestyle friendly profression. This is why there is such a puacity of anesth training in ICU med - last year, there were less than 50 anesthesiologists in ICU fellowships.





For Pulm/ICU - it is 4 years post-residency (IM) to be credential-eligible in both. For IM, it is 2 years post-residency. For anesth, it is 1 year post-residency. The justification being that what anesthesiologists do all day long in the OR is resuscitative medicine in a controlled environment.





Now, regarding the potential of change - more & more data is coming out that that even though intensivists command much higher salaries than non-intensivists to staff ICUs that this extra salary is more than offset by decreased overall costs of pt care. Studies are demonstrating that pt’s in ICUs have lower morbidity & mortality rates & shorter lengths of stay when cared for by fellowship-trained intensivists. (remember above where I stated that frequently ICUs are staffed by non-intensivists: FP, IM…, esp in the private practice arenas) But, to attract talented docs sufficiently to entice them to undertake a fellowship in ICU med, the $$ must be there to justify it. We’re not talking $$ to make them rich, but enough to offset the downside of an extra year or more of training where you make a resident’s salary & your burgeoning student loans cont to bloat on interest.





So, things are slowly starting to possibly change towards improving intensivist salaries to attract more physicians into the ICU, including anesthesiologists.





Whew…outta breath!

Wow! Thanks for the info! I’m going to have to look into this all very carefully, as I really do enjoy the intensivist side of medicine very much.
Thanks
Epidoc