Anesthesia: 2+1 option?

[Orchid]

hi.

 

I was at a talk by a family med doc the other night who works as a 2+1 family med + anesthesiology. i was surprised to learn about this... didn't even know it existed.

 

Could anyone comment on this option as opposed to the 5 year specialty option, and how one goes to do 2+1... and what salary / skill set differences may be?

 

This doc was working in local hospitals in the niagara region. (no big academic centre)

[White-Tiger]

Im also interested in this, do you happen to remember the name of the doctor?

[blinknoodle]

There is a GP in Wawa who goes to the Sault once a week per month to do anesthesia. I did more spinals with him in one week, than I saw in London. I think the option is really only open for smaller centres.

 

As far as I know, you simply apply for the extra year after a 2-year family med residency.

 

Not sure about pay differences (doubt it). There didn't seem to be a stratification of cases for the GP-anesthetist, but I can't say for sure.. we were doing spinals, nasotracheal intubations, etc

[mbene085]

I have also been told that this is restricted to smaller centres. It's a very attractive (not to mention lucrative) option for those who see themselves in smaller cities for the bulk of their careers.

[Calgarymed]

GP anes...

 

They can do "easy" cases as much as they want, this generally would occur in smaller centres. They are paid the same as a 5 yr for doing those cases, all the provinces i know of anyways. If you do gp anes work in northern areas, such as inuvik, you make a killing.........

 

Generally GP anes cant do anyone with an ASA class greater than 2 i believe...which means no one with poorly controlled dm, htn, etc or any complicated medical issues....and they dont do big emergency cases except when they have no other option. So yeah they would do spinals, nasotracheal intubations...but on "easy" cases...they would also do epidurals etc as well if they were trained in that.

 

I know quite a few family docs in rural bc that do this, and like it a lot. 2 of them have gone back to specialize completely and returned to "medium" size centres.

[kosmo14]

GP Anesthetists typically do only ASA I and II patients and for basic surgical procedures. In most places they get the same rate as the FRCP Anesthesiologists (but not quite the truth as the billing rates are typically higher for either greater ASA patients or more complicated surgery).

 

GP Anesthetists would not do any neurosurgical, vascular, thoracics, high risk obstetrics, cardiovascular, very minimal peds, major abdominal, or high risk emergencies. What they would do would be low risk obstetrics (epidurals), low risk gen. surg (lap choles, hernias), some ortho, some gyne.

 

It really depends what you want as a practice profile. If you like the low risk, relatively easy anesthesia stuff in a non-academic setting then that is definately a good option. If you want to be in an academic center doing the more difficult anethetics and higher risk patients/procedures then the FRCP route is definately the way to go.

[UBCmed09]

I worked with a GP-anesthetist last year in rural BC and can share a few comments. I'm not sure if this is always the case but he was only in the OR for 2 "days" a week - each "day" comprised 2 very basic cases. Some locations may be able to offer higher volume. This meant that the other days were spent doing family med - not my cup of tea. As well, this GP-A mentioned that when he did the R3 year he thought this would open up many opportunities for him but he found that in today's system, there are relatively few hospitals doing enough low-risk surgeries to keep your skills up and hire GP-A's rather than FRCP anesthetists. So in the end, he actually felt he significantly limited his overall options for practice (presuming he wanted to maintain his gas skills).

[Orchid]

thanks for the replies guys. that helps.

[MDWork.com]

This was originally known as GP-Anesthesia. With the move to a 2 year family medicine residency it is now more properly called FP-Anesthesia.

 

After 2 years of a family medicine residency there are several additional 3rd year programs (called R3 Enhanced Skills Programs).

 

Such programs include:

Academic Fellowship in Education Research

2.Anaesthesia

Care of the Elderly

Emergency Medicine

H.I.V.

Obstetrics

Palliative Care

Self-Designed Enhanced Skills Program

Sports Medicine

 

You can find some more info:

http://fammedmcmaster.ca/postgrad/pgy3

and

http://www.familymed.ubc.ca/Residency/R3_Enhanced_Skills_Programs.htm

among others.

 

A PYG3 in Anesthesia is not offered at every program. Training is geneally 9 months adult anesthesia, 2 months pediatric anesthesia and 1 month ICU.

 

FP-Anesthesia exists in most provinces with the exception of Quebec. Their roles are generally limited to smaller, more peripheral hospitals. Most rural hospitals are staffed by FP-A's. Most only do anesthesia 2-3 days a week with clinic or ER work on the other days though some do full time anesthesia.

 

In general your work is limited compared to FRCPC anaesthetists (no neurosurgery, thorasics, vascular, ect). But generally these are not done at these smaller centers anyways. You do mostly bread and butter work. Simple General surgery (hernias, appy's, lap choles, ect), Gyn (D&C, laparoscopy, C/S's), ect.

 

Pay is generally the same fee schedule as the Royal college trained guys.

 

If you want to work in a smaller/rural area, this can be a good option. It is a nice way to stay sane in Family medicine as well as it adds diversity. You generally end up doing some critical care/ICU coverage as well. If you want to be in a big center you will need to go the Royal college route.

 

Hope this helps.