SO YOU WANT TO BE AN ANESTHESIOLOGIST? TEN TRAITS OF ANESTHESIOLOGISTS

Anesthesiologists aren’t well known to most patients, but these specialty doctors have certain traits in common. Anesthesiologists are likely to have:

1. A preference for being in an operating room rather than in a clinic. The practice of anesthesiology is the practice of perioperative medicine. Perioperative medicine has three phases: prior to surgery, during surgery, and after surgery. While the preoperative process may involve a preoperative clinic in university settings, in most community practices the anesthesiologist evaluates the patient immediately prior to surgery. This may occur via a telephone call one day prior to surgery, or in the preanesthetic room on the day of surgery. Most of the time an anesthesiologist works in the operating room. Surgeons, by contrast, spend half their workdays in a clinic, seeing new patients who may need surgery or seeing post-operative patients in the days or weeks after surgery. A busy surgeon may work in the operating room two or three days per week. A busy anesthesiologist will be in the operating room five or more days per week.
2. An affinity for inserting tubes and needles into patients. It may sound barbaric, but the practice of anesthesia requires at least one needle placement (an intravenous line) through which anesthetics are injected into the patient’s bloodstream, and usually one airway tube (an endotracheal tube or a laryngeal mask airway) into the patients upper airway through the mouth. Other common anesthesia procedures include the placement of catheters into the radial artery at a patient’s wrist, placement of a central venous catheter into a patient’s internal jugular vein at the neck, placement of spinal or epidural needles into a patient’s back, placement of ultrasound-guided regional nerve block needles adjacent to major nerves in a patient’s body, nasogastric tubes through the nose into a patient’s stomach, transesophageal echocardiogram probe into a patient’s mouth into the esophagus, and the placement of temperature probes into a patient’s nose or esophagus. By contrast, a typical internal medicine or pediatric physician who works in an office will do few procedures at all.
3. A surgical personality, i.e. the desire to fix things now. One thing surgeons and anesthesiologists have in common is the desire to fix things as soon as possible. If a patient has appendicitis or a broken hip, in all likelihood the surgeon will schedule the surgery for that day, and the anesthesiologist will be there to render the patient free of pain. The pace of care in office medicine is slower. It may take days or weeks to make a diagnosis, and the prescription to remedy the problem may very well take days or weeks to treat the condition. Clinic medicine requires patience. Operating room medicine requires action.
4. An adrenaline-seeking personality. The operating room is a charged setting. Within minutes there is a loss of consciousness by the patient, a surgeon making an incision, a surgical treatment, the sewing up of the patient’s wounds, and a reawakening back to consciousness. Most of the time there are no complications, but complications can occur. When things go wrong, the anesthesiologist and the surgeon need to respond quickly. For the anesthesiologist, if the airway or breathing to the patient is impaired for even five minutes, permanent brain damage can occur. There is no time for mistakes in diagnosis, mistakes in judgment, or mistakes in treatment. It’s often said that anesthesiology is 99% boredom and 1% panic. Anesthesiologists are effective during that 1% of time. They have to be.
5. A disinclination to stand in one place all day. This relates to the difference between a surgeon’s work and an anesthesiologist’s work in the operating room. Surgeons stand beside the operating room table. Anesthesiologists stand at times, but during the stable durations of the surgery they can sit. When I was a 24-year-old medical student, I was certain I wanted to be a surgeon. I changed my mind when I finally did my surgical rotations, which involved holding a retractor and standing next to the attending surgeon watching procedures that often lasted four or more hours. Standing in one place all day isn’t for everyone. It wasn’t for me.
6. Limited interest in long term interaction/relationships with their patients. Anesthesiologists meet most of their patients minutes prior to the surgery, and never see them after the day of surgery. This is in contrast to my primary care internal medicine doctors and pediatricians, who often see their patients several times per year over decades of time. Internal medicine doctors and pediatricians get Christmas gifts from their patients. Anesthesiologists do not.
7. Interest in prolonged periods of time off or vacation. Anesthesiologists can work fulltime, but many choose to take numerous weeks off per year. In an anesthesia practice, because you don’t follow the same patients week to week, you have the potential for time off without disrupting patient care. Your duty to your anesthesia group is to do your contracted percentage of the workload, including a percentage of the on-call nights and on-call weekends. If you desire to travel to all the continents of the world, you’ll have that opportunity in many anesthesia practices.
8. An enjoyable time talking to a patient for ten minutes. In the preoperative meeting between the patient and the anesthesiologist, it’s our responsibility to learn all the pertinent medical details about the patient, to examine them, to review all relevant laboratory and scan results, and then to explain the anesthetic plan. It’s our job to discuss risks and alternatives to that anesthetic plan, and then to gain the patient’s informed consent to proceed. Once the medical review and consent are completed, I have ten minutes with that patient while I start the intravenous line, administer the initial antianxiety drug, and transport the patient’s gurney down the hallway to the operating room with the circulating nurse’s assistance. During these ten minutes an anesthesiologist can have all sorts of interesting conversations with the patient. I commonly learn where the patient grew up, what kind of work they do, how big their family is, what their hobbies are, if they have pets, and where they would like to go on vacation. It’s an enjoyable exchange, until I inject propofol into their IV and they become unconscious.
9. A contemplative nature. During my first month of anesthesia residency training, I was in the operating room with an anesthesia faculty member caring for a surgical patient. Once we injected the sodium pentothal (propofol wasn’t available yet) and placed the endotracheal breathing tube, the nursing staff prepped and draped the patient, and the 6-hour proposed surgery began. It was a prolonged teaching case involving junior surgery residents doing much of the work. After 30 minutes of teaching, with 5 hours and 30 minutes remaining, my anesthesia attending sighed and said, “in anesthesiology, it helps if you have a contemplative nature.” In the years to come I learned what he meant. The 99% boredom 1% panic ratio means there can be a multitude of minutes of steady-state stability, in which little is changing in the anesthesia management. The anesthesiologist has ample time to ponder whatever is on his or her mind. This sort of workplace characteristic isn’t for everyone, but it’s a part of daily life for most anesthesiologists.
10. A desire to be well paid for their time. Physicians earn more for doing procedures than they do sitting in an office talking to patients. The workday in the operating room is a series of hands-on procedures, and most anesthesiologists are better compensated per unit of time when compared to internal medicine doctors or pediatricians who are in clinics talking and listening. Is this fair? I believe so. I was an internal medicine doctor before I trained in anesthesiology. I had a lot of knowledge, but I was never put in a situation in which a patient could become brain dead in five minutes if I made a mistake. I believe the operating room practice of anesthesiology is a more demanding and dangerous specialty than office medicine.