Not that my choices should profoundly affect the choices each of you will eventually make, but I thought if I were to somehow put down some of the factors that played in my decision, it might help you to make your own informed decisions.
What do I want from my medical career?
I knew before I entered medical school that I loved and function very well in high acuity environments [for those of you who do not know, “high acuity” is a $0.50 term for sick & complex patients]. ICUs have been my home for many years and I love the feeling of satisfaction from helping someone at a very critical juncture in their life. No, you cannot save them all, and believe me – there are fates far worse than death. But, working in the critical care arena enables you to help both patients and their families during a time when they are frequently unable to do so themselves.
Sometimes it is the adrenalin & ecstacy of snatching victory from the jaws of defeat. Sometimes it is assisting a patient in having a good death instead of a long & messy one. Sometimes it is just being there to help those they left behind to cope. It requires that you give of yourself on a very fundamental level while simultaneously preserving your own sense of “self”. In a matter of a short walk, you can encounter families on the ultimate high and those enduring immense suffering. And they look to you for help…and you do what you can.
So, I knew what I wanted in my professional life - complex problem solving in a high-acuity environment, lots of procedures and a minimum of ‘chronic’ in my patient population. In my mind, the three that best suit my needs are: anesthesiology, surgery & emergergency medicine.
But, critical to my own survival, I must have a personal life outside of my professional one. Many many physicians get so enraptured with their position/career that they no longer have an identity outside of “physician”. They try to be a Doc above all else – this is a prime contributor to physicians exceeding all other professions in the areas of substance abuse, suicide, divorce and many other wonderful attributes (sarcasm intended).
To honor this need within myself and my committment to be an excellent husband & father (one day), I needed to choose something that afforded the luxury of self-guidance in my professional committments.
Surgery - sure I could do the residency and I know I’d make a strong surgeon. However, I don’t feel that I could manage to be as active in the husband & father roles as a surgeon. This and other factors [surgeons tend to have high malpractice premiums & practice overhead expenses] lead me to exclude this option.
Emergency Medicine - worked many an hour in ER/Trauma! The time spent caring for the severely & critically injured were awesome! And, Lord knows that ER Docs have an excellent lifestyle & work hours. They are well-paid, frequently considered hospital employees with nice benefit packages and often their malpractice is covered by the hosp, since they’re a hosp employee.
But, the reality of ER and managed care has become that many folks who simply wish to avoid their meager co-pay attempt to use ERs as their family doc. Meaning, depending on the ER, at least 70% [usually more] of your patients could just as easily gone to a regular doc and not the ER. ER docs spent the preponderance of their time doing Fam Practice stuff – if I wanted that, I’d have chosen FP.
Anesthesiology - fulfills all of my requirements. There is substantial capacity to customize your professional demands in the context of lifestyle. The field pays well…and, unless you’re in an outpatient pain clinic setting, there is minimal to zero overhead [no staff, no office, no billing people]. Fairly often, the anesthesiologist’s malpractice is covered by the hosp, although not as often as for ER docs.
With zero overhead, the effective earning potential for an anesthesiologist exceeds many specialties. No, I am not choosing based on cash flow. However, as with many of you, I will come out of this deeply in debt and with minimal retirement savings intact. So, a huge benefit to choosing anesthesiology is the capability to make up for lost time.
Most importantly, it feels right. I feel at home doing anesthesiology – you know sometimes you can just tell, it is a perfect fit. And, there are multiple & varied career options for anesthesiology: pain management, critical care medicine and several surgical anesthesia subdisciplines: cardiothoracic anes, peds anes, peds cardiothoracic anes, neuro anes, OB/Gyn anes…
I hope this disclosure doesn’t just bore you, but helps you think your choices through from many different perspectives.
Dave,
That wasn’t boring at all. Even though I’m far from med school, and even further from having to choose a specialty, anesthesiology ranks at the top of my list of potentials. I’m interested in it for many of the reasons you list, but I would like to know what a “day in the life” is like for an anesthesiologist.
If you wouldn’t mind expanding on this, I’m sure there are others besides me who would like to know what their job function entails. I’m more interested in a hospital based anesthesiologist. I know two doctors in private practice doing pain management and they have recommended not going in that direction. Their practices are doing well, but they complain about the patient population (I know that sounds callus), as well as the typical Medicaid, Medicare, Worker’s Comp, and HMO complaints.
Thanks.
First, I must preface my “day in the life” description with the fact that I am not yet an anesthesiologist & have only experienced it as a clerk. And, I suspect, like many other specialties, the reality can vary substantially by practice and geography.
Due to the nasty habits of surgeons, cases start EARLY most mornings…as in 0700 early. Which means that if they want to begin cutting by 0730, then you, the anesthesiologist, must start even earlier to stay on schedule.
It is most wise & prudent to have seen, visited with and examined your patients prior to surgery. If the opportunity arises, as in an inpatient, or the patient has significant co-morbidities, a visit with your patient a day or two prior to the actual surgery may be a smart play, but is not often necessary. However, you would always examine & interview every patient immediately pre-operatively to determine co-morbids, assess their potential risk of anesthesia and determine anesthetic & airway management strategies. Once the patient is in the surgical suite, you implement those plans…and alter them as is necessary.
The content, involvement & amount of time this all takes is, again, highly variable - dependent upon the patient and what their procedure is to be. For a young healthy guy having knee arthroscopy - not too much pre-op in the way of intravenous access…most likely a spinal. But a sickly middle-aged immediate post-MI needing multiple bypass grafting - there is a TON of pre-op procedures to be done to maximize safety & subsequent patient management.
Essentially, this begins around 0600/0630. The process is repeated, case by case, until all of the cases for the day are done. One nice habit of surgeons is that they prefer to not only start early, but finish as early as is possible as well…of course, that may mean 1400, 1500, 2000, 2200 or 0000. But that is the way it goes.
In between cases, you check in on your recovering patients in post-op. And, if you also manage surgical ICU patients, check in on them as well. Many anesthesiologists, at least the ones I’ve worked with, also visit their patients in the general care areas at least a couple of times post-op or post-ICU to ensure their continued positive progress.
Call is another highly variable component that will depend upon the structure of the group to which you belong and what areas of anesthesia you have privileges for. The group I was with, they did overnight call (with the assistance of 1 CRNA) 1x per week. And, had to cover two weekends out of every 8 - one w/e on cardiovascular call and the other on general surg/trauma call. Every 4th week, they were scheduled off Mon ~ Fri, if they wished to take it. However, virtually all of them came in for at least half days during their week off.
If this does not satisfy your curiosity, please reply with more specific questions.
Thanks for the reply Dave.
I do have a couple of specific questions, and forgive my naiveness. Do anesthesiologists have patients that they call their own? Meaning are there patients they are responsible for that they admit, care for, and then discharge?
The reason I ask is that it seems that if someone comes in for surgery, the surgeon is responsible for the pre and post-operative care, right? Or in the case of a woman in labor, even if an anesthesiologist is used for an epidural or for a c-section, it’s the OB/GYN who is ultimately responsible for the patient.
You mentioned that they check on recovering patients in post-op, and manage surgical ICU patients. I’m assuming this is done in addition to the care the patients are receiving from the surgeon or other doc?
I kind of fumbled around trying to get that out. I hope you’re able to discern what I’m asking out of my ramblings. 
Dave,
That was very interesting information. If you don't mind my asking, what is a comorbity (sp.) in a patient?
Kristen
OMD,
Your post on “Why Anesthesiology” was very insightful to me personally since I’m leaning towards either a specialty in Cardiology/CHF Management or Critical Care Medicine. When Nat replied to one of my posts about her surgical residency she said that surgeons manage the trauma/surgical ICU patients with an anestheiologist occasionally roataing through the service. So, a question for you, if someone was comtemplating wanting to deal with the management of trauma/surgical ICU patients, do you feel that an IM residency w/fellowship in Critical Care Medicine or an Anesthesiology resideny w/fellowship in Critical Care Medicine? I asked Nat the same question and look forward to reading both of your responses! 