Session 4
In this episode, Ryan talks with Dr. Patrick Pickett, an anesthesiologist who practices in the community hospital in Oklahoma as he shares about his path to anesthesiology, his typical day at work, work-life balance, as well as the things that he like most and least about being an anesthesiologist. Finally, he gives his opinion on the future of anesthesiology specifically merging with CRNAs.
Here are the highlights of the conversation with Patrick: Choosing the kind of setting to practice in:
- Always thinking he wanted to do academics
- Realizing he didn't want to do academic setting after doing a fellowship in critical care medicine
- Started looking for jobs and happened to find a community job and realized it was a better fit for him
When he knew he wanted to be an anesthesiologist:
- Patrick majored in engineering and volunteered at a biomedical engineering department at a hospital and realized it wasn't something he wanted to do.
- Getting to watch surgeries and working with the anesthesia side of it
- Went through shadowing and didn't like it but after going through rotation and training, he had a turnaround
What caused him to like anesthesiology after rotation:
- Coming from a family with medical background, he knew what specialties he didn't like
- Thinking he wanted radiology coming into medical school
- Not liking clinic and liking hospital setting
- Liked being in the operating room but not liking to be a surgeon
- Choosing the specialty through the process of elimination
Traits that lead to being a good anesthesiologist:
- Flexibility in time and treatment options
- Thinking on your feet
- Being well-versed and liking different things
- Having broad knowledge
- Being able to change gears quickly
- Being able to get along with people and the team
- Being able to assume leadership role at times
A typical day in the say of an anesthesiologist:
- Starting before 7 am and ending the day 4-5 pm on average
- There is no one typical day since you will be working at different locations for different cases
- If in the operating room: 3-5 cases on average for 1-2 hours each
- If in the GI lab: 10-15 cases for 30 minutes each
- If in neurosurgery/spine surgery/cardiac: 1-2 cases for 4-8 hours each
If in general surgery:
- Meets with patients; talks about the plan, risks, and alternatives and then to the operating room
- Walks patients through the procedure to reduce anxiety; manages vital signs, making sure all things are in place
- At the end of the surgery, takes them to the recovery room
Taking calls:
Less frequent calls but more likely to go to the hospital to be there
Work-life balance:
- Yes.This is one of Patrick's pre-requisites in choosing a specialty because he wanted something that would give him some flexibility.
- 55-60 hours a week
- Some days are predictable so he gets to see his kids more.
- Being on call is part of the deal but it's manageable.
What makes a competitive applicant for anesthesia:
- It's almost like Emergency Medicine in terms of the board scores and the grades
- Intangible aspect: Being appropriately aggressive, knowing when to step back and when to step forward to help out
- Doing well in your rotations
- It's not a small field as there are many programs in anesthesiology (around 1500 spots)
What residency looks like:
- 4 years - Intern year (medicine, surgery, EM, ICU, etc.) + 3 years (general rotations)
- Most programs won't put you in the OR by yourself on day 1 of that 2nd year
- More independence and advanced rotations as you go along
- Pain management as a multidisciplinary field in anesthesiology similar to critical care
- Less calls than surgeons but more than some others and almost always in-house and they couple a senior and a junior on-call
Orals boards:
- 2 hours
- 2 rooms (an hour each room and with 2 examiners in each room)
- Each candidate has the same stem of the case but which direction each goes is up to the examiners.
- It probes the limits of your knowledge and the format can be intimidating.
- Written board exam first before taking the oral exams
- Not a question of content but about being able to think on your feet
Bias among DOs vs. MDs:
Any bias perceived is not deserved.
Sub-specialties:
- Pain management:
- Neurologist
- Psychiatrist
- PMnR
- Internal Medicine
- Critical Care:
- Other sub-specs:
- Pediatric anesthesia
- Cardiac anesthesia > echocardiography
- Obstetric anesthesia
- Liver transplant anesthesia
What he wished he knew going into anesthesiology that he knows now:
- Job opportunities available
- The business side of medicine
Other specialists he works the closest with:
- All surgical fields expanding to procedural fields such as:
- GI - endoscopy
- Cardiology
- Internal radiologist
- MRI (they may provide sedation for really young patients)
Special opportunities outside of clinical medicine:
- Expert witness testimony
- Research
- Quality improvement
- Expansion of training
- Quality management
What he wished other specialties knew about anesthesiologists:
- Their focus on safety particularly a combination of three:
- Patient and their medical problems
- The surgery and how it affects the body
- The anesthetic and how it affects the body
- They have different ways of looking at patients.
- Pre-anesthesia process to decide who's a good candidate and who's not and what they can do to make them a good candidate
- They try to get everybody on the same page.
What he likes most as an anesthesiologist:
- Variety of the things they do everyday
- They also have their share of excitements but he also likes the routine stuff
What he likes the least being an anesthesiologist:
Night calls
Would he still choose anesthesiology if he were to do it again?
Yes, it's the right fit for him. You have to go through it to find out what works for you.
The future of anesthesiology vs. CRNA's merging:
The Anesthesia Care Team is a very safe approach. Patrick finds that although the topic is controversial, most people working get along just fine.
For premeds, you should be prepared to supervise nurses and you should be prepared to do your own cases because you can do both.
Some pieces of advice for those considering anesthesiology for a specialty:
If you like the fast-paced hospital-based specialty, give it a try. Give it a rotation and if you don't like it, there are plenty other fields to choose from but if you do, it can be a great career.
Links and Other Resources:
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