1/5/2017 WhyOrWhyNotGoIntoAnesthesia,byKarenSibert,MDinTraining,theonlinemagazineformedicalstudents

WhyOrWhyNotGoIntoAnesthesia,byKarenSibert,MD
byEricDonahueatUniversityofWashingtonSchoolofMedicine

1137 SHARES

ArticlebyKarenSibert,MD|DoctorsOrderscuratedbyeditorEricDonahue

Incaseyouwerewondering:robotswontreplaceanesthesiologistsanytimesoon,regardlessofwhatThe
WashingtonPostmayhavetosay.Theresdefinitelyaplaceforfeedbackandclosedlooptechnology
applicationsinsedationandingeneralanesthesia,butfortheforeseeablefuturewewillstillneed
humans.

Ivebeenpracticinganesthesiologyfor30yearsnow,intheoperatingroomsofmajorhospitals.Since
1999IveworkedatCedarsSinaiMedicalCenter,alargetertiarycareprivatehospitalinLosAngeles.

SowhatdoIwanttotellyou,thenextgenerationofphysicians,aboutmyfield?

Alifestyleprofession?

Forstarters,IhavetolaughwhenIhearanesthesiologymentionedwithdermatologyandradiologyas
oneofthelifestyleprofessions.Certainlythereareoutpatientsurgerycenterswherethehoursare
predictableandtherearenonights,weekendsorholidaysonduty.Thedownside?Youregivingsedation
forlumps,bumpsandendoscopiesalotofthetime,whichcanbetedious.Youmaystarttoloseyour
skillsinlineplacement,intubationandemergencymanagement.

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Occasionally,though,ifyouworkinanoutpatientcenter,youllbeaskedtogiveanesthesiafor
inappropriatelyscheduledcasesonpatientswhoarereallytoohighrisktohavesurgerythere.These
patientsslipthroughthecracksandtheretheyare,inyourpreoperativearea.Cancelingthecasecosts
everyonemoneyandmakeseveryoneunhappy.Yetifyouproceedandsomethinggoeswrong,youcant
evengetyourhandsonaunitofbloodfortransfusion.Tome,workinginanoutpatientcenterislike
workingclosetoarealhospitalbutnotcloseenoughamixtureofboredomandpotentialdisaster.

ThepathIchoseistofocusonhighriskinpatientcases.Iespeciallyenjoythoracicsurgery,withthe
challengesofcomplexpatientsandonelungventilation.Youcanbringmethesickestpatientinthe
hospitalsettingwhereIhaveallthemonitoringtechniques,resuscitationdrugs,bloodproducts,
bronchoscopesandanythingelseImightneedandIllbeperfectlyhappy.Thedownside:apractice
likeminetendstobestressfulandtiring,andIneverknowtheexacttimethatthedaywillend.Hospitals
thatofferlevelItraumaandhighriskobstetriccarearerequiredtohaveanesthesiologistsinhouse24
hoursaday,365daysayear.Theresnoperfectworld.

Whattypeofpersonishappyasananesthesiologist?

Eventhoughwomencomprised47percentofU.S.medicalschoolgraduatesin2014,onlyabout33
percentoftheapplicantsforanesthesiologyresidencywerewomen.Idbeinterestedtohearfromallof
youastowhyfieldssuchaspediatricsandOB/GYNtendtobesomuchmoreattractivetowomen,
becauseIgenuinelydontunderstandit.ButIdohaveafewthoughtsastothetypeofpersonwhotends
tobehappyorunhappyasananesthesiologist.

Firstofall,youhavetoliketheoperatingroomenvironmentandbeabletohandleoccasional
emergencies.Ifyourethesortofpersonwholikesmakingrounds,consultingreferencesanddeliberating
inthecompanyofagroupbeforeyoumakeanydecision,thenanesthesiologyisntthejobforyou.Much
ofwhatwedoisroutineandpredictable.Butwhencrisesarise,decisionsmustbemaderapidlyandthe
anesthesiologistmustdirecttheeffortsofateamofnursesandtechnicians.Iveknownpeoplewhohave
doubleboardcertificationininternalmedicineandanesthesiologysomeareamongthesmartestand
mostcompetentpeopleIveevermet,andothersnevergetoverthewishtodeliberateatlengthbefore
takingaction.

Second,youhavetoenjoythecompanyofsurgeons.Manyjokesaremadeaboutsurgeons.Oftenwrong,
butneverunsureisoneofthemorerepeatableones.Someofthemoremalignantandabusivetraditions
ofpastsurgicaltrainingnolongerpersist,soweseelessarrogance.Butasurgeonstillneedstohavea
senseofconfidenceandacertainamountofnerve.Maleorfemale,theyoftenthinkofthemselvesasthe
captainoftheship.Ifyoucantdealwiththatsortofpersonalitywithgraceandabitofhumor,youwont
behappytryingtocoexistwiththem.Anesthesiologistsneedtodeveloptherightbalanceofbackboneand
flexibility.Mostofthetime,Isimplythinkofmyselfasthephysicianwhostakingcareoftheheart,lungs,

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andtherestofthepatientsneedswhilethesurgeontakescareofthesurgicalproblem.Weeachhaveour
jobs.

Third,youhavetomakeyourpeacewiththeideathatyourenotthepersonthatthepatientwillthinkof
ashisorherdoctor.Thatwillbethesurgeon,ortheobstetrician,ortheprimarycaredoctor.My
interactionswithpatientsareintensebutshortlived.Goodinterpersonalskillshelpagreatdeal,asIneed
tomakeeachpatientcomfortablewithputtinghisorherlifeinmyhandsafterjustafewminutesof
acquaintance.Oddsare,though,thatthepatientwontremembermuchaboutourinteraction.

Myworkintheoperatingroombecomesquitetechnicalafterthemomentthatthepatientloses
consciousness,whichyoumightseeasadisadvantage.Ontheotherhand,Iseldomneedtobetheperson
whodeliversthediagnosisofcancerorotherterriblenewstopatientsandfamilies.Anesthesiologistswho
specializeinobstetricanesthesiaorregionaltechniquesspendmoreoftheirtimewithawakepatients,
whileintensivecarespecialistsandchronicpainspecialistsoftenseepatientsrepeatedlyoveralengthy
courseoftreatment.Thatsachoiceyoumakeatthefellowshiplevel.

Howtodecideonaspecialty?

Forme,thebigdecisionpointinmedicalschoolwaswhethertogointointernalmedicineandspecialize
inpulmonarymedicine,orwhethertogointoanesthesiology.ThefactthatIgenuinelyenjoyedbeingin
theoperatingroomwasthecriticalfactor.WhenIgiveamedicationthroughthepatientsIV,ittakes
effectquickly,andIdonthavetowaituntilthenextvisittotheclinictofindoutifitworked.

Ilikemanagingairwaysandputtingneedlesinbloodvessels,andIenjoybeingintheanesthesia
cockpit,orchestratingapatientscoursethroughinduction,maintenanceandemergence.Imfortunate
toworkwithoutstandingteamsofsurgeons,nursesandtechnicians.Wegettoknoweachotherwellover
time,andtheresacomfortablesortoffamilycohesivenesstotheoperatingroomcommunity.Ihavethe
pleasureoffocusingononepatientandoneprocedureatatime,withouttheconstantpressureofan
officeappointmentschedule.

Therearesomedarkcloudsonthehorizonforanesthesiology,though.Mygrouppracticesinaphysician
onlymodel,morecommonontheWestCoast,whereeachpatienthashisorherpersonalanesthesiologist
forthedurationofthesurgery.Thatmodelprobablywontbefinanciallysustainableovertime.

Justasnursepractitionersareclamoringforindependentpractice,nurseanesthetistsclaimthattheycan
giveanesthesiajustaswellandmorecheaplythanIcan.Itslikelythatmoreandmoreanesthesiology
practiceswillmovetoacareteammodel,whereanesthesiologistssupervisenurseanesthetistsand
anesthesiologistassistants.Somehospitals,wherestatesallowit,alreadyallownurseanesthetiststo
practicewithnoanesthesiologistsupervisionatall.Bepreparedfordownwardpressureonpaymentrates
ifthesetrendscontinue.
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Manyanesthesiologistsareexpandingtheirfootprintoutsidetheoperatingroomandbecomingmore
involvedwithpatientcarebeforeandaftersurgery.Othersareactiveinoperatingroomandhospital
leadership,andaregoingbacktoschoolforMBAorMHAdegrees.Youmaywanttotakealookat
informationabouttheexpandingroleofanesthesiologistsinthePerioperativeSurgicalHomeinitiative,
ledbytheAmericanSocietyofAnesthesiologists.

Myson,asithappens,isamedicalstudentwhojustfinishedhissecondyear.Ihavenoideawhatfieldhe
willchoose.IvetoldhimthesamethingsIwouldtellanyothermedicalstudent:

1.Donttrytopickyourfieldtoosoon.Keepanopenmind,becauseyouwontreallyhaveanyidea
whatyoullfindmostinterestinguntilyoumakeyourwaythroughclinicalrotations.
2.Dontwastetoomuchtimethinkingaboutmoneyorlifestyle.Nolifestyleispleasantenoughifyou
stillhavetospendyourdaysdoingworkyoudontenjoy.Frankly,ifyouwantedtogetrich,you
shouldhavegoneintoinvestmentbanking.
3.Ifyoudontlikemedicinenow,youllneverlikeit.Quitbeforeyoustartaresidency,anddo
somethingyouwanttodo,notwhatyouthoughtwouldmakeyourparentshappy.
4.Ifyourelikemyhusbandandme,andbeingadoctoristheonlyjobyoueverwanted,bethankful!
Itsagreatandhonorableprofession,andoneofthefewwherematurityandexperienceare
valued.Ifeelatthepeakofmygamethesedays,whileinSiliconValleyorprosportstheyrepast
theirprimeat35.
5.Itsanhonorandaprivilegetotakecareofanotherhumanbeing.Alwaysrememberthat,
whateverfieldyoupursue,andpleaseacceptallmybestwishesforsuccessinyourfuture
endeavors.

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