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  • So you want to be an anesthesiologist.

  • You like the idea of being in the operating room, being the patient's guardian angel,

  • and having a laidback lifestyle.

  • Let's debunk the public perception myths of what it means to be an anesthesiologist,

  • and give it to you straight.

  • This is the reality of anesthesiology.

  • Dr. Jubbal, MedSchoolInsiders.com.

  • Welcome to our next installment in So You Want to Be.

  • In this series, we highlight a specific specialty within medicine, such as anesthesiology, and

  • help you decide if it's a good fit for you.

  • You can find the other specialties on our So You Want to Be playlist.

  • A lot of you asked for anesthesiology, so that's what we're covering here.

  • If you want to vote in upcoming polls to decide what future specialties we cover, make sure

  • you're subscribed.

  • If you'd like to see what being an anesthesiologist looks like, check out my second channel, Kevin

  • Jubbal, M.D., where I do a second series in parallel called a Day in the Life.

  • Once the world is back to a more normal baseline, we'll be doing a Day in the Life of an Anesthesiologist.

  • Anesthesiology is the specialty dealing with taking care of patients before, during, and

  • after surgery, or pre-op, intra-op, and post-op.

  • Think of them as the patient's “guardian angel”, or the one responsible for making

  • sure the patient gets through surgery safely.

  • In addition to ensuring patients are properly sedated and comfortable throughout the operation,

  • they also maintain stable vitals, hemodynamic status, meaning their blood circulation, and

  • an open airway to ensure adequate breathing.

  • Surgery can be incredibly traumatic to a patient's body, resulting in violent swings in their

  • hemodynamic status.

  • Without an anesthesiologist, patients would have dangerous shifts in their heart rate

  • and blood pressure.

  • Anesthesiologists administer drugs and make adjustments to maintain vitals in a stable

  • and consistent mannerwhat they callrailroad tracks”.

  • Patients are also unable to breathe on their own during surgery so an anesthesiologist

  • places a breathing tube, called an endotracheal tube, connected to a ventilator.

  • Pre-op, the anesthesiologist will see the patient to make sure they are safe to proceed

  • with the surgery, ensuring their medical conditions are stable and they haven't recently smoked,

  • eaten, or drank anything since the previous day.

  • Otherwise, they could aspirate during surgery, meaning regurgitate and choke on their stomach

  • contents.

  • Intra-op, they'll be taking care of the patient.

  • And post-op, they'll ensure safe recovery and pain management.

  • Contrary to stereotypes, anesthesiology isn't just about putting people to sleep and then

  • doing crossword puzzles.

  • Sure, there are moments of down time as an anesthesiologist, but even when things are

  • calm and steady, it requires constant vigilance to anticipate any potential problems.

  • And when things go sideways, they really hit the fan and it's all hands on deck.

  • This isn't a specialty for those who aren't able to handle high intensity situations.

  • Anesthesiology is an active sport, and it's important to anticipate how the patient's

  • body will respond to what's happening in surgery.

  • For example, right before the surgeon makes the first incision, they administer a bolus

  • of pain medications to prevent an increase in the patient's heart rate.

  • Alternatively, if a patient is losing a high volume of blood during a procedure, which

  • often happens, they are responsible for maintaining stable hemodynamics, which may include fluids

  • like normal saline, blood transfusions, and even vasopressors.

  • This requires not only mastery of physiology and pharmacology, but also astute observation

  • and quick clinical judgement.

  • You can think of anesthesiology in a few different categories.

  • First, academic versus community versus private practice.

  • As an academic anesthesiologist, you'll be working at a large hospital associated

  • with a medical school.

  • In addition to your regular clinical duties, you'll also be responsible for teaching

  • medical students and residents.

  • You may also be involved with anesthesiology related research.

  • As a community anesthesiologist, you'll be working at a smaller hospital mostly dealing

  • with bread and butter cases, which often include general surgery and orthopedics.

  • As a private practice anesthesiologist, you'll be working at privately owned hospitals or

  • clinics where your day will also consist of more routine cases.

  • Private practice and community practice are strictly clinical OR work only and do not

  • include teaching and research.

  • It's usually higher compensation than academia, but some find it more monotonous.

  • Anesthesia isn't just inpatient as most expect.

  • Inpatient anesthesiologists work in a hospital operating room, usually in larger surgeries

  • that require general anesthesia.

  • General anesthesia is when someone is put under, meaning they are unconscious and require

  • assistance with breathing.

  • In comparison, sedation depresses one's awareness such that their response to external

  • stimuli is limited, and they usually have associated amnesia.

  • Anesthesiologists working in outpatient are generally administering sedation rather than

  • general anesthesia.

  • These procedures are smaller in magnitude than surgeries in the OR, and are performed

  • either in clinic or in outpatient procedure centers.

  • Sedation is used for procedures like cataract surgeries performed by ophthalmologists, which

  • we covered in a previous episode of So You Want to Be.

  • Sedation is also used in procedures like colonoscopies, where a camera is used to look at your intestines

  • and GI tract.

  • If you want to see my experience the day of my colonoscopy, I have a video on my personal

  • channel.

  • Link in the description.

  • Anesthesiologists are typically in the operating room, or OR, but depending on your type of

  • practice, you may be working in other parts of the hospital.

  • For example, critical care anesthesiologists manage patients in the intensive care unit,

  • or ICU.

  • Chronic pain anesthesiologists see patients in clinic, rather than the hospital, who suffer

  • from chronic pain.

  • This involves prescribing various pain medications or administering injections.

  • After completing medical school, anesthesiology residency is an additional 4 years.

  • The first year, or intern year, is a standard intern year where you rotate through a variety

  • of specialties.

  • Your actual anesthesia training begins during your second year of residency, or PGY-2, meaning

  • postgraduate year 2.

  • We call this second year of residency, which is the first year of anesthesiology training,

  • as CA-1, standing for clinical anesthesia year.

  • So as a PGY-2, you'll be a CA-1.

  • There are two types of programs: categorical and advanced.

  • For categorical programs, you'll do all 4 years at the same institution in an integrated

  • program.

  • The first year, or intern year, can be either a medicine year or surgical year, or even

  • a mix of the two, depending on the program.

  • Medicine intern years generally provide lighter hours than surgical intern years, and this

  • experience provides valuable insight for managing a patient's cardiopulmonary status, pain,

  • and glucose levels, which will come in handy in the operating room.

  • However, since anesthesiologists will mostly be working closely with surgeons during the

  • rest of their training and their career, surgical intern years also offer valuable insight.

  • For advanced residency programs, the intern year and clinical anesthesia years are done

  • at separate programs.

  • In this instance, we call the intern year a transitional year, or TY.

  • TY's occur in other specialties too, such as dermatology, radiology, and ophthalmology.

  • Transition years consist of a mix of medicine, surgery, electives, and research, and are

  • overall considered an easier intern year with lighter hours.

  • In terms of competitiveness, anesthesiology used to be highly competitive two decades

  • ago.

  • These days, it's one of the least competitive specialties, second only to family medicine,

  • as we've outlined in our 6 least competitive specialties video.

  • The average Step 1 score is 232, and average Step 2CK score is 244, but the high number

  • of programs and positions means there are several unfilled positions each year.

  • In terms of the rigor of anesthesiology residency, it's generally more laid back with predictable

  • hours and generally 55-65 hour work weeks, which is on the lower end compared to many

  • other specialties.

  • And as an attending, 40-50 hours a week is the norm.

  • It's no surprise that the students applying to anesthesia are more easygoing and understand

  • the importance of work-life balance.

  • But don't let the stereotypes confuse you.

  • Anesthesiologists still work hard and have a great deal of pressure to perform and ensure

  • patient safety.

  • After anesthesiology residency, you can subspecialize further with any number of fellowships.

  • And good news, each fellowship is only 1 year in length.

  • Regional Anesthesiology and Acute Pain Medicine Go into regional anesthesiology and acute

  • pain medicine if you enjoy doing light procedures, like ultrasound guided regional nerve blocks.

  • You'll see lots of patients pre-op, doing epidurals before labor or managing pain in

  • post-operative patients.

  • When we say regional anesthesia, we refer to blocking pain in a specific area of the

  • body, such as doing a knee block for an ACL repair.

  • This way, the patient doesn't feel anything from the knee down.

  • Alternatively, median nerve blocks are done in the wrist when operating in certain regions

  • of the hand.

  • Cardiac anesthesiology is for those who are hardcore, intense, and somewhat of adrenaline

  • junkies.

  • You'll be assisting with big cardiothoracic cases, such as open heart surgery, and may

  • be involved in more sophisticated and nuanced techniques.

  • For example, single lung ventilation is sometimes used to allow the surgeon to operate on the

  • heart without interference from the lung.

  • This is the second highest compensated anesthesiology subspecialty, second only to chronic pain.

  • Chronic pain anesthesiologists see patients in clinic and prescribe analgesics or administer

  • injections.

  • You can also become a chronic pain physician by pursuing 4 years of PM&R residency followed

  • by a 1 year chronic pain fellowship.

  • Compensation for chronic pain specialists is quite high.

  • After all, you're prescribing medications and performing injections and procedures on

  • patients who are highly dependent on your care, and they'll be coming back for additional

  • treatment.

  • Neuroanesthesiology is for the brainiacs who are into the esoteric and weird stuff.

  • You'll assist neurosurgeons who need their patient to be awake during the middle of the

  • case to test brain functions.

  • This subspecialty requires a great deal of planning to execute successfully.

  • OB anesthesiology is strongly female dominated.

  • These are often anesthesiologists who enjoyed obstetrics but didn't necessarily want to

  • be the person delivering the baby.

  • You'll be leading mothers through C sections, and it's ultimately very rewarding, because

  • at the end of each case you'll generally have a healthy baby and a happy mom.

  • Pediatric anesthesiology is not surprisingly best for those anesthesiologists who love

  • working with kids.

  • Oftentimes, they had surgeries themselves when they were younger and were inspired to

  • help kids because they remember how terrifying it was.

  • There certainly are big cases in pediatrics, but it's also not uncommon to be assisting

  • with minor procedures.

  • Young children, after all, are generally less tolerant of certain procedures and may require

  • anesthesia for their own comfort and safety.

  • Remember, kids are not just little adults, and not only do they have unique physiology,

  • but also require special equipment, like smaller endotracheal tubes and Macintosh or Miller

  • blades.

  • Critical care anesthesiologists care for patients who are admitted to the ICU.

  • This includes patients who have had major surgery or who suffer from severe infections

  • or trauma.

  • As a critical care anesthesiologist, you will not be working in the OR.

  • Instead, you will be managing the ICU.

  • Another way to become a critical care physician is 3 years of internal medicine residency

  • followed by a 3 year critical care fellowship.

  • This path will take 6 years, whereas going the anesthesia route will be 5 years.

  • Four years for anesthesia residency, and only a 1 year critical care fellowship.

  • There's a lot to love about the field of anesthesiology.

  • It's one of the ROAD lifestyle specialties, standing for radiology, ophthalmology, anesthesiology,

  • and dermatology.

  • These are specialties with great lifestyles, meaning high compensation and a good work-life

  • balance.

  • Speaking of work-life balance, you can expect to work regular 9 to 5 hours.

  • And when you're off, you're completely off.

  • There's no need to carry a pager home and be called in during the middle of the night.

  • If you don't enjoy clinic, which is a common sentiment, particularly amongst surgeons,

  • know that as an anesthesiologist you won't have to do clinic at all, unless you want

  • to pursue something like chronic pain.

  • If you love the OR but don't want to necessarily be a surgeon, anesthesiology is your best

  • bet.

  • The operating room is a great place to be, where you'll have an intimate sense of camaraderie

  • with the rest of the surgical team.

  • While anesthesiology is great, it isn't perfect.

  • Anesthesiologists are unsung heroes often not receiving the recognition they deserve.

  • Patients will rarely thank you as the doctor.

  • That gratitude gets directed to the surgeon.

  • And oftentimes, others will consider you the sidekick to the surgeon, Robin to their Batman.

  • If you're not fond of high stress situations requiring quick decision making, then steer

  • clear of anesthesiology.

  • While it's often calm and relaxed, things can and will go wrong, and a patient's life

  • will be in your hands.

  • And lastly, mid-level encroachment into the field of anesthesiology is a growing concern.

  • Mid-level providers, such as CRNA's, are lobbying for independent practice rights,

  • although this is controversial and is something I will explore in a future video.

  • Many hospitals are now adopting an anesthesia care team model whereby an MD anesthesiologist

  • simultaneously supervises several CRNA's, each of whom are in an operating room.

  • This has raised concerns of decreasing employment opportunities for anesthesiologists.

  • However, there are still many opportunities to work in the OR 1-on-1 with the patient,

  • particularly in larger and more complicated cases that require a physician's expertise.

  • If you were the student in medical school that loved physiology and pharmacology, enjoyed

  • working with their hands, gravitated toward high stress situations, and values the importance

  • of work-life balance, then anesthesiology may be a good fit for you.

  • If you love the OR and want to make it the focus of your life, become a surgeon.

  • But if you like the OR, become an anesthesiologist.

  • At the end of the day, the operating room is the surgeon's domain, and you have to

  • be ok with that.

  • Those who crave the spotlight and want to be the person in charge would not be happy

  • working in the background as an anesthesiologist.

  • As my anesthesiologist friend says, “if you do your job right, the patient shouldn't

  • remember you.”

  • And finally, while anesthesiology is less competitive than some other specialties, it's

  • still extremely challenging to get into a strong and desirable residency program.