Anesthesia - Hours As Resident And Staff

[mononoke]

So I was shadowing in emerg the other day when I asked the physician why she also liked anesthesia and she said "well..the hours are pretty good...". This wasn't the first time I heard this since plastic surgeons, urologists, and some other ER staff have also said the exact same phrase.

 

This was curious to me because anesthesia residents I've talked to feel that the residency is quite tough especially with 1:4 call and some also mentioned the in-house call being very tiring as well. They also talk about getting up at 6am and going home at 6/7pm 

 

So what is call actually like as an anesthesia resident vs staff? Why do people say the hours are good while others don't agree?

 

 

[Fresh fry]

Anesthesia is a "lifestyle" specialty. As staff they tend to work shifts with dedicated start and stop times. Plus they belong to large call groups so don't do a lot of mandatory call. For example most ORs in the country start around 0730 and go until 4 or 5 at the latest (Western is an exception). If cases can't be finished by that time then they don't get started and if they do go late for unforeseen circumstances then the on call anesthesiologist takes over. Life is very predictable as you know what days you work, when you will be home, and you can take as much time off as you want (within reason). The pay is great, there are no inpatients to round on, no clinics (unless you want them) and it is a gateway to critical care. Fellowships are available in CV anesthesia or pain med if you want to subspecialize. The only down side is at the end of the day you are an anesthesiologist.

 

Residency sucks for everyone (except EM) and anesthesia doesn't get off the hook. I wouldn't base my future career options solely on the difficulty or ease of residency because it is such a short time relatively speaking compared to the rest of your career. 

[LittleDaisy]

Em residents do surgery rotation, critical care and internal medicine rotations throughout their residency.

They often take the night shifts and evening shifts. Residency does not have a typical 8-5 schedule for everyone

Anesthesia is a "lifestyle" specialty. As staff they tend to work shifts with dedicated start and stop times. Plus they belong to large call groups so don't do a lot of mandatory call. For example most ORs in the country start around 0730 and go until 4 or 5 at the latest (Western is an exception). If cases can't be finished by that time then they don't get started and if they do go late for unforeseen circumstances then the on call anesthesiologist takes over. Life is very predictable as you know what days you work, when you will be home, and you can take as much time off as you want (within reason). The pay is great, there are no inpatients to round on, no clinics (unless you want them) and it is a gateway to critical care. Fellowships are available in CV anesthesia or pain med if you want to subspecialize. The only down side is at the end of the day you are an anesthesiologist.

 

Residency sucks for everyone (except EM) and anesthesia doesn't get off the hook. I wouldn't base my future career options solely on the difficulty or ease of residency because it is such a short time relatively speaking compared to the rest of your career. 

[mononoke]

Anesthesia is a "lifestyle" specialty. As staff they tend to work shifts with dedicated start and stop times. Plus they belong to large call groups so don't do a lot of mandatory call. For example most ORs in the country start around 0730 and go until 4 or 5 at the latest (Western is an exception). If cases can't be finished by that time then they don't get started and if they do go late for unforeseen circumstances then the on call anesthesiologist takes over. Life is very predictable as you know what days you work, when you will be home, and you can take as much time off as you want (within reason). The pay is great, there are no inpatients to round on, no clinics (unless you want them) and it is a gateway to critical care. Fellowships are available in CV anesthesia or pain med if you want to subspecialize. The only down side is at the end of the day you are an anesthesiologist.

 

Residency sucks for everyone (except EM) and anesthesia doesn't get off the hook. I wouldn't base my future career options solely on the difficulty or ease of residency because it is such a short time relatively speaking compared to the rest of your career. 

I'm not understanding...why doesn't it suck for EM? Aren't there 18 shifts/month, which based on what residents told me can be difficult, the days blending together and feeling tired all the time

[rmorelan]

I'm not understanding...why doesn't it suck for EM? Aren't there 18 shifts/month, which based on what residents told me can be difficult, the days blending together and feeling tired all the time

 

sucks is a relative term - you have EM doing night shifts which can be disorientating for sure and are roughly 8-9 hours long. You have other specialties doing night shifts as well in effect but they were proceeded by a 16 hour day, and often follow with a further 2-4 hour shift.  They work 16-18 shifts a month of which say 1/3 are nights (really it is less because you need more doctors during the day than at night). That is roughly 5-6 shifts say overnight. On call other fields will often have 5-7 call shifts per month (or rather every 28 days). Emerg residents are often quite busy during their shifts - depending on the specialty other fields may actually be there overnight but not always working (perhaps even get some sleep ha ). Some people (right or wrong) question the volume of material needed to learn relative to other fields (arguments - US is 4 years for emerg, you can here get a 2+1, so why does it take 5 years for emerg? What is taking so long, blah, blah. Often part of the final year becomes a fellowship like experience).

 

No one has it easy - but most people would say EM has it relatively easier. Total number of hours is a lot less, total number of days is less, and call vs an overnight shift often isn't much of a contest in many fields. 

[Fresh fry]

I don't want to get way off topic as the point of this thread was originally about anesthesia residency/staff lifestyles. I'm also notorious for taking fun pokes at all specialties so please take my jab at EM in the lighthearted way it was intended. 

 

I started off medicine as an emerge gunner, spent the first two years shadowing 3-4 shifts month and my 1st year summer getting dirty as much as possible. But as rmorelan has mentioned their residency is controversial. Yes, no one has it easy during residency, but of all of the college programs EM generally puts in less hours. Yes they do off service rotations, but so does everyone else. Most programs have an ICU bid, a CCU bid, or both. I guess if you want to judge a program on its intensity ask the residents if they are looking forward to their ICU time so they can have a break from their home service or whether they are dreading having to live by the beeper. 

 

None of this really matters, it is all a means to an end. The only thing that matters is that your residency prepares you for the specialty you want to do. Everyone has it harder than someone else one way or another, we are all in this together. 

[chromeboker]

I also thought I was destined for the ER when I started medical school. I've since moved into a surgical specialty. The biggest deterrent for me was the shift work. I found the hours were wildly unpredictable - even though you worked less. In surgery, yes I work more but at least I have a set schedule.

[mononoke]

So just to clarify and getting back to my original question - if an anesthesia resident doing call on internal is 1:4, what is call like on the anesthesia rotation? 1:7?

[NLengr]

I also thought I was destined for the ER when I started medical school. I've since moved into a surgical specialty. The biggest deterrent for me was the shift work. I found the hours were wildly unpredictable - even though you worked less. In surgery, yes I work more but at least I have a set schedule.

I suppose constantly is a kind of schedule.

[Tacrolimus]

So just to clarify and getting back to my original question - if an anesthesia resident doing call on internal is 1:4, what is call like on the anesthesia rotation? 1:7?

It probably depends on the program, but I'm pretty sure anesthesia rotations can require 1:4 call too. I have shadowed anesthesia several times (including late night/overnight on call in OR), and the general sense I got was that residency is challenging in terms of schedule and 1:4 is standard when it comes to PGY1 & PGY2. I was also told that call for staff is extremely lax, and that lifestyle post-residency is pretty good. I will admit that I (still) wonder about this though. Hopefully, I can get more answers in the next couple years. 

 

(I'm just a first year med student though, so take it for what it's worth) 

[CharmingHedgehog]

I can only speak to my experience, but hopefully it'll shed light on your question a little bit. Some institutions the anesthesia service is 16 hr call (ie. 4pm-8am, 8am-4pm shifts of call) If you are on night call, then you have the day of call off until 4pm, then day post call off starting from 8am (or whenever you handover). Other institutions is 24 hr call like most other specialties. The amount of call you take depends on how many residents are on service at the same time, usually it varies between 6-7 calls per 28 days. 

 

A resident's day can start any time between 6am - 7:30am, depending on teaching (have to set up room before teaching), and what areas/rooms you are booked in (less complex = less set up time). Usually the cases are done at around 4-ish, but if you are booked in a late room, or the OR run late, then you stay. On call degree of busy-ness is system dependent. If there is only one resident on call for a hospital, then you cover OR, consults, OB, acute pain service, difficult intubations, difficult IV starts, and PACU, +/- trauma. This usually means minimal to no sleep. But, if your hospital has two residents on call, one for OR + PACU, one for everything else, then usually the OR + PACU resident has a higher chance of getting some sleep once the ORs are done. The other resident is usually busy. For anesthesia, there is usually no senior resident you report to when you are on call. Since staff is always in house, if you are uncertain about something, you talk it over with the staff. 

 

If the hospital doesn't have OB service, then anesthesia staff is home call. If they have OB, staff is in-house (in case of crash C sections). Staff usually starts the day at around 7:30, and goes home when cases are done (either 3:30/4 or 6/7-8/9, if late room, or providing "late" coverage). When on night call, staff goes to sleep when OR on call cases are done, which can range from 7pm, to 4am. If you are second call staff, you stay until whenever they are down to 1 OR running, which is usually before midnight, but sometimes can go for longer. If you are second call, you also can get called back if the first call staff needs help. It's worth noting that OB and anesthesia are probably the only two specialties where you have to stay in house on call as staff. The call group in an academic centre is usually large enough that you are on call once every 2-4 weeks.