Perhaps the single most important advance in the history of institutional surgery was the first administration of ether an as anesthetic. Without it, many surgeries were rough and difficult, and had as much chance of damaging the patient as the condition that led him/her to the surgical table in the first place. Most surgeries were simply impossible prior to its implementation.
Despite playing such an important role in modern medicine, anesthesiology remains a subspecialty that few know much about, even incoming medical students. Many of those who have chosen the anesthesiology specialty did not enter medical school intending to select that particular field of study. Despite its position as the ultimate in perioperative care, it is frequently overlooked as a potential career path.
CHOOSING ANESTHESIOLOGY
Anesthesiology is one of the more misunderstood specialties. Part of the problem comes from the common misconceptions about anesthesiologists. Many regard the anesthesiologist as a medical technician as opposed to a doctor. This couldn't be further from the truth. The lack of understanding about the intricacies of this specialty translates to a shortage of anesthesiologists, making this a profession that is in high demand.
"Vigilance" is the motto of the American Society of Anesthesiologists, and it is very much the keyword of this specialty. The anesthesiologist is responsible for considerably more than just administering anesthesia. This doctor essentially acts as the guardian of the patient's life. It is the anesthesiologist's job to maintain the optimum condition of the patient's vitals while undergoing a surgery that can create unusual new conditions or aggravate existing ones. The essential processes of the human body, breathing and circulation, are entirely in this physician's hands throughout the entire surgical process. A sharp mind and the ability to think on the fly are imperative, as emergencies can appear with little warning and life or death can be determined in a matter of seconds.
TRAINING IN THE SPECIALTY
An anesthesiology residency consists of four years of postgraduate training. An internship year in fields such as general surgery or internal medicine is common. The other three years are devoted to clinical anesthesiology.
The first two months of the residency are spent in the company of one attending, providing a solid consistency of training. The American Board of Anesthesiologists mandates that residents cannot work more than 24 hours consecutively. That means residents are released at 7 a.m. following a night on call. Most surgeries are scheduled for early in the day on weekdays, leaving weekends free. Long nights, however, are not out of the question.
Residents will also go through monthly rotations in a wide variety of areas. This is not to be confused with anesthesiology subspecialty training. As the medical field meets increasingly advanced needs, several subspecialties have developed in such areas as pediatric, obstetric, cardiac, and neuro-anesthesia, among others. Fellowships in these areas require an additional year of training. While the American Board of Anesthesiology does not certify these subspecialties, the expertise that can be gained in these specific areas can be beneficial in expanding career options.
A one to two year fellowship in Pain Management can prove a profitable investment. The ABA does offer board certification for this subspecialty. As chronic or acute pain is a complaint of most patients, the field is wide open. Pain management specialists generally only see patients in clinical settings. An anesthesiologist in this setting may seek to relieve pain though methods ranging from simple medication to advanced techniques such as spinal cord stimulators. However, in the pain management field, one may face challenges such as patients who fake pain in order to acquire drugs, or problems that fail to respond to treatment.
Critical Care fellowships often consist of one additional year of training, and the ABA offers board certification in this specialty as well. Many of the qualities that an anesthesiologist will develop in residency are ideally suited toward becoming an intensivist. Expertise in high-tech life support and airway management is highly sought after in Critical Care facilities. Working in an intensive care facility is a natural extension of an anesthesiologist’s responsibilities. While this is a very small subspecialty, encompassing a fraction of all practicing anesthesiologists, demand is expected to rise with the aging of the baby boomer generation.
LIFESTYLE & PRACTICE
Anesthesiologists are frequently the most relaxed and happy of all specialty physicians. This comes from a combination of personal satisfaction, immediate results in their work, and a consistency in the availability of free time.
As most of the anesthesiologist's work is scheduled during daytime weekday hours, only the occasional on-call period is likely to provide any sort of interruption to off-duty hours. This serves as a welcome reward to the sometimes highly stressful hours in the surgical theatre, carefully monitoring complex vital signs.
The financial rewards are significant as well. Over four-fifths of anesthesiologists surveyed by the American Medical Association said that their compensation has met or exceeded their expectations. Salaries can range from the low 200's for critical care medicine to the upper 200's for pain management specialists.
Options for practice are diverse. While perioperative care is the most common and widely known choice, there are many other employment options available. Those with an administrative aptitude may elect to become medical directors in an operating room or intensive care environment. Some act as leaders of anesthesia care teams consisting of residents and Certified Registered Nurse Anesthetists (CRNA).
Academically, many anesthesiologists involve themselves in clinical pharmacology research or in a teaching role, working with new residents.
The subspecialty of pain management provides for a longer period of interaction with specific patients and ensures a more cohesive continuity of care. Private clinics specializing in palliative care draw upon this subspecialty heavily.
BREATHING DEEP
The fast pace and quick decision-making involved in anesthesiology, along with the opportunity to utilize cutting-edge pharmacological and technological advances, make the specialty very professionally rewarding. The gratification of seeing one's work have an immediate effect, the solemn responsibility of guarding human life, and the financial and schedule benefits serve to make the personal rewards incomparable as well.
For the physician looking for the best life has to offer--and seeking to offer his or her best to life--the anesthesiology specialty is the perfect choice.
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