5 Things I Wish I Knew Before I Became an Anesthesiologist

5 Things I Wish I Knew Before I Became an Anesthesiologist

By #LifeofaMedStudent

I’ve talked about How I Became an Anesthesiologist before, but now that I’m several years into the career some of those points may have changed a bit. In fact, until your really into a career it’s hard to REALLY know what you are getting into, regardless of which specialty you choose.

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 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 3 pm – but an extra add on or a slow surgeon can unexpectantly turn that into 5 or 6 o’clock quickly. Even better, a cancelation around the same time and I’m suddenly out at noon. A slow day in the OR at my current job, I might not have to come in at all depending on my numbered spot in the schedule. Being in a high paying salaried position allows me to happily stay at home when not needed.

I love the hours I work, but flexibility is key – both personally and with family. My wife, Cassey, knows that the time I can be home may vary greatly with little notice. BUT in day-to-day practice, it can sure be a frustrating occurrence if you let it bother you. I tell all medical students or residents interested in anesthesia 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, 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 week-long 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!

Anesthesia is not always known as a “people person” specialty, and in fact, many believe anesthesiologist going 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 much of our care, anesthesia 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 neurosurgical, from OB to pediatrics, critical care to outpatient orthopedics – using a breath of physiology, anatomy, pharmacology – I help navigate patients through a great deal of different surgical procedures. Whether a healthy 2-year-old for a quick abscess I&D 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. This broad knowledge base is both challenging, yet rewarding to have acquired, and something I think is often under-appreciated in anesthesia.

5.  CRNAs and AAs are changing the field of Anesthesia.

For (often) better or (occasionally) worse, CRNAs (Certified Registered Nurse Anesthetists) and AAs (Anesthesiologist Assistants) are changing the landscape of anesthesia. For me, I have benefited greatly from their team based integration into our practice. At our small to medium sized hospital, I get to take back-up call, and only get woken up at night for the “big” cases. This means fewer hours and a better lifestyle than I could have had otherwise. There is certainly an argument more anesthesia providers can increase patient access to care and increase surgery availability.

On the contrary, 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 anesthesia and TEE experience.

If I was going into anesthesia in the future, I would suggest strongly considering a fellowship. Personally, I’d go into a cardiac fellowship as the demand there seems greatest at the moment. Luckily, my first job was a great spot to learn cardiac anesthesia 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 resume 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 anesthesia 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 anesthesia is right for them as well!

This post first appeared on The Scope of Practice blog by Dr. Brent Lacey. 

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