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Anaesthesia!


Guest TimmyMax

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In unrelated news, I just wanted to share with everyone that I was fortunate enough to pass my Royal College FRCP examination, so now I am a full-fledged anaesthesia consultant! :) How the time flies!

 

 

Congrats! What I wouldn't do to be done already!! You must be so relieved it's over!!

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  • 2 weeks later...

TimmyMax:

 

1. Thanks for this thread. Just awesome. And super. All at the same time.

 

2. Congrats on passing the Royal College Exam!

 

3. My question: I see the lack of a long(er)-term relationship with patients to be the one big thing about anaesthesia that I'd have a problem with. It's obviously extremely important to establish rapport with the patient at pre-op assessment, and morning of surgery, after all, you have the fun job of keeping them alive during surgery! Do you find that relationship is enough?

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Hey Quackster,

 

My question: I see the lack of a long(er)-term relationship with patients to be the one big thing about anaesthesia that I'd have a problem with. It's obviously extremely important to establish rapport with the patient at pre-op assessment, and morning of surgery, after all, you have the fun job of keeping them alive during surgery! Do you find that relationship is enough?

 

In all honesty, I really don't have a problem with the lack of a long-term relationship with patients, so that aspect of anaesthesia works out great for me. I do take great pride in the requirement of my job that in the brief 2-5 minute period that you do spend with your routine surgical patients immediately preoperatively, you have to both establish rapport and put the patient at ease for their coming surgery. Most times, I would say that I am successful with respect to these goals, but there are times when, for whatever reason, I am not entirely successful. Usually, those are the patients that I am thankful for the fact that I won't have to see them again- you know, the ones with 5+ subjective food/environmental allergies and otherwise give me the distinct impression that they would be annoying to have to deal with day in and day out. Patients like that make me thankful that I won't have to have a long-term relationship with them. That's not to say that having long-term relationships with your patients isn't important- it is- but part of the allure of the field of anaesthesia to me was that distinct lack of follow-up and continuity. Otherwise, if having long-term relationships with patients was important to me, I may have gone into another field, such as family medicine, psychiatry or what have you.

 

So in answer to your question, I find that yes, the relationship that I have with patients during that quick 2-5 minute interval before surgery (assuming that they are relatively healthy, of course!) is enough. Anytime that I start to have thoughts that it might not be satisfying enough for me, it only usually takes one truly annoying patient to knock that thought out of my head for a long, long time! ;)

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Hey,

 

Actually, I'm okay with it. I knew that taking call for the rest of my career came with the territory when I got into this (as is the case with most of the other surgical disciplines, as well as many on the medical side), so it's not like that is a surprise. The difference is that since I am going to work in the community, I am not confined "in house", which to me makes all the difference (whereas in academic centres, although you are technically not confined "in house" while on call, most nights you might as well be). Nothing is better than the opportunity to go home, even if it is just for an hour or two so that you can "unwind" a bit or even hop out somewhere for a quick bite to eat (that isn't craptacular cafeteria food) before going back in. Although it is tough to go back in once you've gotten home, there are worse things in life.

 

As for the remuneration side of things, it can't be beat. As a resident, making my $4.25 an hour while on call, no matter how much (or little) I worked, I grumbled about pretty much everything I had to do on call (especially this past year!) while the consultants slept. And even when the consultants had to get up, they were always so freaking cheery and chipper. Now I understand why- something about a 75% premium for procedures/cases done after midnight. A cool couple hundred for an epidural after midnight??? Sign me up! Someone need their appendix out at 3 AM? Let's do it! Someone in the unit perfed their colon? Cha-ching!

 

Needless to say, a significant proportion of your income will come from cases on call. So if you aren't too big into taking call, then anaesthesia likely won't be a good match for you. If, however, you don't mind getting those requests for epidurals at 3 AM (I'm told that instead of hearing "Epidural in 4!" as you do as a resident, as a fee-for-service provider, you hear something along the lines of "Would you like to make $400?"), then anaesthesia might have a place for you.

 

During my third last call ever, I made a cool $2500 (by my count) in epidurals alone for my consultant while he slept, to add to an epidural I did between 1700 and midnight, a GA section and a GA for retained placenta- all done while he was off playing on his laptop somewhere. I still haven't done all the math for that night (too frustrating for me), but the whole time I was thinking- this would be such a sweet night, if only it was two weeks from now! I guess my turn will come.

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Hey Ian,

 

Thanks a lot! Long time, no see! Hope that life as a radiology consultant is treating you well after all of these years! :)

 

In answer to your question, quackster, yes, I will definitely check up on patients I have anesthetized to see how they have done, particularly the ones that were sicker to begin with or ones that I have some concern about.

 

I definitely check on the ICU ones- not so much by going to see them (since usually they will have been dropped off intubated, and usually remain intubated for the first night post-operatively), but mostly by logging in and checking their lab results and other post-operative imaging and generally following their clinical course from afar. The ICU guys are very well-skilled and take good care of the patients there, so they don't need extra people in there, second-guessing what they have done- they already get enough of that from the admitting medical and surgical services as it is! ;)

 

As for the ones that are admitted post-operatively and go to the floor, generally I don't really check up on them unless I have either a specific concern or I have performed some sort of regional procedure on them (ie: thoracic epidural for a thoracotomy case or peripheral nerve block).

 

Obviously, outpatients go home, so you can't check on them, unless you cruise by them in PACU (which I usually try and do with all of my patients, to make sure that they aren't in severe pain or suffering from severe nausea and/or vomiting), but if they received a peripheral nerve block, then you generally should follow up on them to make sure that all is well the next day, even if they went home the same day as their surgery. Besides, patients absolutely LOVE it when you call them at home, even if everything went completely normal (or awry) with their hospital procedure.

 

So yes, in answer to your question, I am interested in knowing how my patients did post-operatively, even though I know that I won't get a chance to follow up on all of them. It all kind of goes back to your pre-test probability- likely all will be good with your healthy 18-35 year olds coming for knee scopes, so I don't really feel a pressing need to follow up with those ones (other than to cruise by the PACU to rule out severe post-operative pain/PONV), but the big bowel cases from the unit, there's a bit more going on with those patients, so it's more fun (and interesting) to follow their post-operative course to see what's happened with them.

 

Of course, with the hospitals becoming more and more concerned with privacy and confidentiality of patient information, you kind of have to limit yourself in how much follow-up you do in terms of logging into the central computer to check on a patient, but following someone for the first 1-3 post-operative days seems a reasonable thing to do to me. Of course, the powers that be may not agree, so that's something else that you have to keep in the back of your mind.

 

Hope this answers your question!

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  • 2 weeks later...
Just wondering, as an anesthesiologist, what would you do if you are 55 or 60, and no longer have the physical capacity to stand for a long time? I'm interested in this specialty, but that's always been my worry. Internal medicine doctors can sit and stuff, what of the surgical doctors?

 

Pretty much every OR has a chair for the gas-passer. I mean, really, have you ever tried to do Sudoku for 8 hours while standing up? It's a hardship!!!

 

Ok, seriously, don't worry about having to stand up...worry about having to stick a needle into somebody at 04h00 when you're not young any more. All due respect to TMax, but your answer to "beep...Do you want make a few hundred bucks?" will at some point turn into "No thanks, I'd rather go back to sleep. Good luck!"

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Pretty much every OR has a chair for the gas-passer. I mean, really, have you ever tried to do Sudoku for 8 hours while standing up? It's a hardship!!!

 

Ok, seriously, don't worry about having to stand up...worry about having to stick a needle into somebody at 04h00 when you're not young any more. All due respect to TMax, but your answer to "beep...Do you want make a few hundred bucks?" will at some point turn into "No thanks, I'd rather go back to sleep. Good luck!"

 

Yeah, I can't remember ever having the "gas man" standing for any sort of extended time at all. The anesthesiologist isn't even in the sterile field.

 

Now if you were talking about the surgeon itself, that is a more interesting question :)

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Hi all,

 

Just wondering if any of you can shed some light on what the Anesthesiology program at McMaster is like?

 

- How open (or not open) is it to IMGs?

-Does anyone know of any IMGs who have matched there successfully?

- How competitive is it (how important are the MCCEE and QE I scores)?

- Any other aneth programs in Canada particularly IMG friendly?

- Or any other useful info for CaRMS and beyond!

 

I apologize if this question has already been posed earlier in this thread! Its just too long to sift through!

 

Thanks!

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Hey,

 

I will try to answer your questions, since we have a fair amount of interaction with the Mac residents at UWO...

 

- How open (or not open) is it to IMGs?

Yes, Mac anesthesia, like every other anaesthesia program in the country, is open to IMGs.

 

-Does anyone know of any IMGs who have matched there successfully?

Yes, IMGs have matched there successfully. I don't know them or know their names.

 

- How competitive is it (how important are the MCCEE and QE I scores)?

Beats me- residency admission criteria is a closely guarded secret and I have no idea how they incorporate LMCC scores into the mix. Mac is just as competitive as any other anaesthesia residency program in the country to get into- roughly 60-100 interview for 8-10 spots. Usually there are a couple (2-4) spots designated for IMGs and the IMGs will compete amongst themselves for these spots. No, I don't know how many IMGs apply- there aren't statistics posted for this by the individual programs.

 

- Any other aneth programs in Canada particularly IMG friendly?

Not sure what you mean by "IMG friendly". If you mean "friendly" in the sense that they accept IMGs, then every anaesthesia program in the country is "IMG friendly". If you mean "friendly" in the sense of accepting more IMGs than other programs, then likely Toronto would be the most "friendly"- since they have the most residency spots, they likely accept the most IMGs. Again, there aren't statistics posted for "IMG friendliness" by the individual programs.

 

- Or any other useful info for CaRMS and beyond!

My advice would be to find out how the CaRMS process works, figure out where you want to end up and then focus your energies and activities towards making it happen. Do electives there. Try to find out about the program and the city. Talk to current residents and staff there. Figure out how you would be a good match for their program and would do well in that particular program structure.

 

Easier said than done I know, but in the end, you need to convince this program that you are a better fit than the previous 50 people they interviewed (and the next 50 that they will interview after you) for their residency program. Who knows? You may end up surprised and be impressed by programs that weren't even on your radar to begin with. That's why they hold interviews and invite everyone to visit!

 

Hope this helps!

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Hi Timmy,

 

Thanks for your help....it is much appreciated.

 

Will doing research with a program that I'm interested in be helpful....obviously assuming I make a positive impression and get to know the faculty & residents? Will getting a LoR from this program be helpful even though it will be a 'research oriented' LoR and not a 'clinical experience' one?

 

Its too late for me to do electives with any programs, otherwise, that would've definitely the route I would've taken. Also, I DO want research experience.

 

Any insight on this would be much appreciated!

 

Thank you!

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Hey,

 

I'd say that yes, doing research in an area that you are genuinely interested in (it doesn't have to be related to anaesthesia) would be helpful and strong LoRs, whether they be "research oriented" or not, are never a bad thing. The bonus of getting to know the faculty and residents never hurts either, provided that you make a positive impression and aren't regarded as a screw-up.

 

This past year, we had a couple of applicants at UWO that had worked as research assistants with some of the staff come through the CaRMS pipeline. Although they ultimately didn't end up at UWO, they did end up successfully matching to other anaesthesia programs in the country, so good on them! They were also IMGs, in case you were wondering!

 

Hope this helps!

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  • 2 weeks later...
Hey,

 

I'd say that yes, doing research in an area that you are genuinely interested in (it doesn't have to be related to anaesthesia) would be helpful and strong LoRs, whether they be "research oriented" or not, are never a bad thing. The bonus of getting to know the faculty and residents never hurts either, provided that you make a positive impression and aren't regarded as a screw-up.

 

This past year, we had a couple of applicants at UWO that had worked as research assistants with some of the staff come through the CaRMS pipeline. Although they ultimately didn't end up at UWO, they did end up successfully matching to other anaesthesia programs in the country, so good on them! They were also IMGs, in case you were wondering!

 

Hope this helps!

 

Thanks very much!! That definitely is very encouraging!

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  • 3 weeks later...
  • 6 months later...
Anyone have any information regarding regional bias in Anesthesia? I would like to know if it is worthwhile to do rotations at Calgary, Alberta, Dalhousie or Saskatchewan - or do they typically pick their own and not out of province?

 

It's been a few years since I went through the match but at that time, places that had a reputation for interviewing/ranking mainly those who had done electives there were mainly Ottawa and UBC. If you're interested in Ottawa that's probably a place to try and do an elective. Otherwise, just getting out of town for at least one 'away' elective is probably sufficient to show interest/willingness to move for other programs. Of course, nothing beats getting your face out there for programs you are really interested in.

 

Hope that helps,

UBCmed09

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  • 1 month later...

Hey guys,

 

I've been meaning to do this for a long, long time, but haven't really had a chance so far- sorry! What I have in mind is a live anesthesia chat tomorrow night, 1 May 2012 @ 2000, featuring yours truly, a real FRCPC-certified anesthesiologist who is ready, willing and able to answer your questions about careers in anaesthesia, matching to anesthesia, residency in anaesthesia and consultant life in anaesthesia for once and for all! So if you are in the least bit interested in anaesthesia, log in to the Flash chat on this forum and fire away and I promise to do the best that I can to answer them! See y'all tomorrow night, y'all!

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Hey guys,

 

I've been meaning to do this for a long, long time, but haven't really had a chance so far- sorry! What I have in mind is a live anesthesia chat tomorrow night, 1 May 2012 @ 2000, featuring yours truly, a real FRCPC-certified anesthesiologist who is ready, willing and able to answer your questions about careers in anaesthesia, matching to anesthesia, residency in anaesthesia and consultant life in anaesthesia for once and for all! So if you are in the least bit interested in anaesthesia, log in to the Flash chat on this forum and fire away and I promise to do the best that I can to answer them! See y'all tomorrow night, y'all!

TimmyMax!! You are an inspiration for selflessness. I will do my best to log on at the time :)

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Hey guys,

 

I've been meaning to do this for a long, long time, but haven't really had a chance so far- sorry! What I have in mind is a live anesthesia chat tomorrow night, 1 May 2012 @ 2000, featuring yours truly, a real FRCPC-certified anesthesiologist who is ready, willing and able to answer your questions about careers in anaesthesia, matching to anesthesia, residency in anaesthesia and consultant life in anaesthesia for once and for all! So if you are in the least bit interested in anaesthesia, log in to the Flash chat on this forum and fire away and I promise to do the best that I can to answer them! See y'all tomorrow night, y'all!

 

Definitely!

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Hey guys,

 

I've been meaning to do this for a long, long time, but haven't really had a chance so far- sorry! What I have in mind is a live anesthesia chat tomorrow night, 1 May 2012 @ 2000, featuring yours truly, a real FRCPC-certified anesthesiologist who is ready, willing and able to answer your questions about careers in anaesthesia, matching to anesthesia, residency in anaesthesia and consultant life in anaesthesia for once and for all! So if you are in the least bit interested in anaesthesia, log in to the Flash chat on this forum and fire away and I promise to do the best that I can to answer them! See y'all tomorrow night, y'all!

 

Wow, thanks! 2000 EST?

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