Anaesthesia!

[kosmo14]

Been awhile since I have had a chance to post so I will answer as many questions as I can here:

 

Satsuma: I am extemely satisfied with my patient contact. I believe I make a real difference in every patients life I encounter. It begins with the patients I see in the Pre assessment unit (the place people come to see the various specialists a few days before thier surgery, these are usually the patients with more complex medical issues). I do a history and physical on these patients, order appropriate diagnostic tests, review them, develop a differential diagnosis, and then decide whether I can optimize that patients condition prior to surgery (if it will potentially make the outcome better) whether that is starting them on a medication or refer to a different specialist. In the OR I see each patient before thier surgery, do a focused history and physical and very quickly determine if they are appropriately optimized for surgery or need further workup and treatment. That means my knowledge of medicine has to span virtually all aspects of medicine (surgery, internal medicine and its subspecialties, pediatrics, obstetrics, even dentistry). While seeing the patient pre-operatively I have to quickly gain the trust of the patient plus try to address thier worries and concerns. Intraoperatively the ability to quickly develop a differential diagnosis for various problems and to treat it appropriately is something we do everyday (for example a patient is hypotensive intraoperatively- big differential diagnosis and I have to quickly using my clinical exam and analytical skills determine the most likely cause and how to treat it appropriately otherwise that patient will die). Other aspects of our job depend on our ability to diagnose and treat in an acute manner. For example when you are involved in a trauma or code or acute airway emergency an anesthesiologist is frequently involved. I hope that answers your questions. We certainly don't diagnose and treat chronic conditions like an internist or family doctor, but we do diagnose acute conditions and are involved in knowing whether a patient is appropriatley treated in chronic conditions.

 

Mob1liz: Sorry so late, hopefully you weren't interviewing this year for carms. But there are certainly lots of ethical situations that can be asked. The drug addicted surgeon/anethetist, the intoxicated surgeon, the intoxicated attending anesthesiologist, the transfusion of a JW, the very elderly sick patient requiring a hip replacement (resource allocation) etc.. Remember there frequently is no right answer to these questions just the ability to understand both sides an determine what you feel is more right and having a good reason for that.

 

 

flying kumquat: It is not unusual for people to find anesthesia late and have fewer than normal electives. As long as you explain that you should be fine. You will be asked about it. I know many people will even address it in thier personal letter. Just show the people that you know what is involved in a career in anesthesia the good the bad and the ugly and explain your reasons for wanting to do anesthesia and most programs will not penalize you.

 

I can't comment on what UWO wants (I am not sure they even know haha just kidding Timmy) but to be a strong applicant for gas you need:

-to show interest in it (at least some elective time but don't need it all refer above)

-knowledge of the pros and cons of anesthesia

-academic ability (need to know a lot about a lot don't need to be superstar but need to show that you can learn)

-ability to handle stress and remain calm in stressful situations (when sh*t hits the fan you need to be the one to clean it up)

-showing ability to work well in a team environment (this is where extracurricular activities shine)

-able to pay attention to detail.

by doing electives in anesthesia and ICU you will be able to demonstrate those to those that will write your ref. letters.

-research is always helpful but not required

 

Anesthesia is a great career, it is intellectually stimulating, fulfilling, and has just enough crisis' to keep the adrenaline junkie in you satisfied.

[gumgum]

Hi kosmo14,

Could you please comment on the job prospect and the average income? Thanks.

[kosmo14]

Job prospects are excellent. Currently there is a massive shortage, such that many people don't do fellowships because they can find work without.

 

Tough for me to comment on money as I am only a resident, but anesthesiologists are one of the better paid specialties out there especially when you take into consideration that there is almost no overhead.

[leviathan]

Anyone heard updates on the future of nurse anaesthesiologists and/or anaesthesiology assistants? I've seen AA post-baccalaureate programs for respiratory therapists, but I'm not sure if the resultant scope of practice for these programs is the same as what the US programs are offering.

[UBCmed09]

Hi kosmo14,

Could you please comment on the job prospect and the average income? Thanks.

 

Here is a link to a recent post by a Canadian anesthesia resident who did a 2 week GP anesthesia locum at a peripheral hospital. He/she lays out the exact billing details for each day/case. Total earnings over 10 days + 1 Saturday call was: $18,171

 

http://forums.studentdoctor.net/showthread.php?t=486812&highlight=canada

 

Cheers,

UBCmed09

[gumgum]

Thank you for all the info guys. The link UBC Med 09 posted is very informative.

[UBCmed09]

Word around the country is that Anesthesia is VERY popular amongst 2009 graduates....I'm already scared about what this year's match is going to look like!

[ploughboy]

Word around the country is that Anesthesia is VERY popular amongst 2009 graduates....I'm already scared about what this year's match is going to look like!

 

I heard a rumor that there are 30 people from UBC Meds '09 interested in anaesthesia. That can't possibly be right, can it?

[NLengr]

What's Ortho looking like? The number coming out of MUN this year trying to match to it is completely insane. 12 people. Basically 1/6th of the total class from what I hear.

[UBCmed09]

I heard a rumor that there are 30 people from UBC Meds '09 interested in anaesthesia. That can't possibly be right, can it?

 

We're a big class so it's hard to keep track of everyone but most of us anesthesia hopefuls have done a rough tally and there's certainly ~20 or so for whom Gas is #1! On top of that you have people for whom it falls in their top 2 or 3....So yeah, I'm sure 30 is in the ballpark.

[ploughboy]

We're a big class so it's hard to keep track of everyone but most of us anesthesia hopefuls have done a rough tally and there's certainly ~20 or so for whom Gas is #1! On top of that you have people for whom it falls in their top 2 or 3....So yeah, I'm sure 30 is in the ballpark.

 

Wow, that's intense. I only know of 5/133 in UWO Meds '09 who have anaesthesia as their #1, but since I've been kind of out of the loop for the last while I expect there are more lurking.

 

Good luck!

[TwinTurbo]

We're a big class so it's hard to keep track of everyone but most of us anesthesia hopefuls have done a rough tally and there's certainly ~20 or so for whom Gas is #1! On top of that you have people for whom it falls in their top 2 or 3....So yeah, I'm sure 30 is in the ballpark.

 

wow that is a lot !! i remember interviewing at UBC and the class size was close to 230 but still. i think in general, there is a strong shift towards lifestyle specialties but i see it a lot in my own class and some of my friends' too.

 

one of my friend's at harvard said that there are 19 ppl applying into derm this year and i think there are 15 applying into rad onc at stanford !!!!!! i don't think many of them are going to be participating in caRMs though .... phew hehe.

[UBCmed09]

Yes, I believe UBC anaesthesia allows you the opportunity to obtain a general license after 2 years.

 

Just thought I would update for anyone interested in information on the UBC anesthesia program. After a couple of years of rumours, it's official, the option of getting a license after 2 years in a specialty program no longer exists here in BC as per a recent College communication.

[Orchid]

Hi all

 

Can anyone in anesthesia comment on the litigations / lawsuits in this specialty? Does it cost a lot for malpractice insurance?

 

It seems to be an appealing specialty to me, but because so much can go wrong, I am wondering if the lawsuits are still an issue. I know we should think we'll be competent and things will work out, but it's hard not to think of that in this specialty. The 99% routine 1% sheer terror thing... etc.

 

I heard in OB GYN they have decreased over the past decade, yet that specialty is also higher for litigation.

 

any comments would be appreciated.

 

thanks

[Laika]

Can anyone in anesthesia comment on the litigations / lawsuits in this specialty? Does it cost a lot for malpractice insurance?

 

Anaesthesia is getting safer and safer... malpractice insurance (in Ontario, at least) now costs less than it did in 1985, without taking inflation into account!

[kosmo14]

Anesthesia has one of the lowest CMPA (malpractice insurance fee) fees of all the specialties. Things have gottens safer over the years. I think what you will find in anesthesia is that we always plan for the worst no matter how remote that is, not all specialties do that. For example if we are called to the ward/emergency/ICU for an intubation you don't see us just blasting a bunch of drugs in without thought and then realizing that it is difficult, we always plan for the possibility that things can go wrong. It sometimes drives surgeons nuts, but ultimately we are looking out for the best interest of the patient.

[xylem29]

How flexible is the field in terms of hours - are you able to choose to work less during the week or is this not common practice?

[kosmo14]

Depends where you work. Some places give you all the flexibility you want, others not so much.

[ploughboy]

Does it cost a lot for malpractice insurance?

 

Here's the current cmpa premium schedule:

 

http://www.cmpa-acpm.ca/cmpapd04/docs/membership/fees/2009cal-e.pdf

 

Anaesthesia is code 90

[J.P.87]

 

So my very general question is....do anesthesiologists tend to be those who really love pharmacology? It seems to be such a drug oriented specialty. And to be honest I don`t love pharmacology. And I can't stomach most pain research I have read about.

 

Thanks!

 

 

Hi guys,

 

Love the thread, great questions and even better answers. Thanks for those who contributed.

 

I wanted to come back to this question that was asked on the first page of this thread but didn't seem to get much attention. It does seem like its very drug oriented specialty (obviously, right?). Personally I enjoy learning about physiology but not as much about specific mechanisms of actions of certain drugs (ie. their chemical structure, cellular mechanism of action etc...). Is it imperative to enjoy learning about drugs in order to go into anesthesia?

 

PS. I just finished my first year of med school and did a 12-hour elective with an awesome preceptor who let me do some procedures and was a fantastic teacher. This experience, in large part, is what has sparked my interest in the specialty. Thanks in advance for any help!

[kosmo14]

In short, anesthesia is all about applied pharmacology. It is the interesting side of pharmacology. You have to know almost everything about pharmacodynamics, and a fair amount about the pharmacokenetics of the drugs you use. If you don't you are a technition and nothing more. Does that mean you have to know the specific chemical structure of the drugs you use? Not really. I doubt many could draw out the structure of thier drugs. Some of the basics are important that relate to the pharmacokenetics and dynamics such as type of linkages (ester linkages confer some advantages in some of our drugs, s-enantiomer form of bupivacaine has some advantages over the r form, cis-atracurium vs. atracurium etc...). These become relatively easy concepts quite quickly during residency that actually make all that mumbo jumbo you may have learned a long time ago make sense.

 

You also certainly learn a lot about the cellular mechanism of many of the drugs you use, as well as many you use less frequently. Again these become relatively easy concepts as you move through residency. It actually becomes quite fascinating, something I never thought I would ever say.

 

So a long story short, yes you do have to know a fair bit about pharmacology, but it is not tedious, rather interesting. The neat part of anesthesia is the applied physiology in association with the applied pharmacology, something we get very good at. It sure makes learning physiology and pharmacology much easier and interesting.

[J.P.87]

Thanks for that kosmo!

 

I didn't think someone would respond so quickly given that the last post was a year ago! But we should keep this thread near the top for sure.

[leviathan]

So is anyone else doing anesthesiology on this forum? I love the input, keep it coming. I've started to shy away from doing gas, simply because I want to have more patient contact. I still love physio, pharm, and doing procedures, so maybe I will do IM + critical care or something. I shadowed with a couple anesthesiologists in a community hospital and didn't enjoy it too much. Maybe there are more complicated and interesting cases in larger hospitals, but at this hospital every patient was just: propofol, sux, tube, surf YouTube + Facebook for rest of case.

[A-Stark]

There was a time when I considered it, but after doing a four-weeks of anesthesia elective in Austria last summer, I've pretty much ruled it out. I probably would've enjoyed it more had I actually understood what everyone was saying. Maybe. I did get to do some interesting procedures (IVs, intubations, bag ventilation, ABGs, prepping propofol and remifentanil for the infuser) and see some interesting surgeries (lung resections of various sizes, brochoscopy with brush biopsy, renal transplant, bowel resections, some shoulder stuff).

 

In the end, though, I was typically more interested in what was happening on the other side of the drape, and unlike the resident I was with sometimes, I didn't have an iPhone to use during the case. They tended to follow fairly set protocols there, and I can't remember any "drama" or anything remotely exciting happening (better for the patient, of course).

[silverjelly]

In the end, though, I was typically more interested in what was happening on the other side of the drape, and unlike the resident I was with sometimes, I didn't have an iPhone to use during the case. They tended to follow fairly set protocols there, and I can't remember any "drama" or anything remotely exciting happening (better for the patient, of course).

 

Ha! That's exactly how I knew I wanted to do surgery.