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Anesthesiology’s allure: High pay, flexibility, intellectual stimulation

Discussion in 'Anesthesia' started by Egyptian Doctor, Aug 16, 2014.

  1. Egyptian Doctor

    Egyptian Doctor Moderator Verified Doctor

    Mar 21, 2011
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    Anesthesiologists like to joke, “We put people to sleep.” But in fact, the specialty is anything but dull. DOs who specialize in anesthesia describe their field as fast-paced and intellectually demanding, yet amenable to family life, with intense high-pressure workdays offset by ample personal time.

    One of the top-paying medical specialties, anesthesiology attracts far more applicants than available graduate medical education positions. To be competitive for residencies, osteopathic medical students need stellar scores on the Comprehensive Osteopathic Medical Licensing Examination—USA (COMLEX-USA) or the United States Medical Licensing Examination (USMLE).

    Many DO students who are interested in anesthesiology take the USMLE because it carries more weight with ACGME-accredited residency programs, which outnumber AOA-approved programs in the specialty 10-to-1. However, students need to select their residency route with an eye to the future because certain administrative positions within osteopathic medical education are closed to those who are not AOA board certified.

    Normally, osteopathic medical students have limited formal exposure to anesthesiology until the fourth year of med school, when it is offered as an elective rotation. But students contemplating an anesthesiology career need to lay a strong foundation in Year 1 by mastering the basic sciences. Such students should also find opportunities to learn more about and demonstrate interest in the science and technology of anesthesia.

    Long career, balanced life
    Experienced hospital-based anesthesiologists often make more than $350,000 a year. Compared with other medical specialties, the pay for anesthesiologists is in the top 5%, says Dennis E. Kane, DO, the president of the American Osteopathic College of Anesthesiologists.

    Although attending anesthesiologists frequently work 12-hour days and are on in-house call for 24-hour shifts, they typically receive several weeks of paid vacation time per year and they aren’t expected to be accessible on their days off.

    “One of the things that was appealing to me about anesthesia was that when I was at the hospital I was at work and when I was on call, I was on call. But when I was not at work or on call, they weren’t calling me,” says Barbara D. Dougherty, DO, a Sewell, N.J., anesthesiologist who raised three children and has been in practice for 32 years. “It was my time when I was at home.”

    A former chair of a hospital anesthesia department, Dr. Dougherty is winding down her career by practicing at an outpatient surgical center, which means shorter, more consistent hours.

    Today, anesthesiologists have many practice options, with varying hours and flexibility, notes Allan R. Escher, DO, the vice chairman of the American Osteopathic Board of Anesthesiology. “By practicing at a surgery center or with a group administering office-based anesthesia, or by practicing pain management in an office setting, it is possible to have a career in anesthesiology in which you have set hours or work part time,” he says.

    Given this flexibility, it is not usual for anesthesiologists to practice well into their 70s, and more and more women are entering the specialty, Dr. Escher points out. Although anesthesiologists sometimes experience career burnout because of daily pressures, it less likely than in emergency medicine and surgical specialties, he says.

    Nevertheless, due in part to their easy access to narcotics, anesthesiologists have a higher rate of opiate abuse than do most other medical specialists, warns Dr. Escher, who serves on the Florida Board of Osteopathic Medicine.

    What it takes
    Despite the adaptability of an anesthesiology career, the requirements to enter the field are strict. Only those with specific interests, aptitudes and personality traits should consider the specialty, anesthesiologists say.

    “As anesthesiologists, we essentially are doing applied clinical pharmacology,” observes Mike Green, DO, the director of the anesthesiology residency program at the Drexel University College of Medicine in Philadelphia. “We’re giving patients medications and watching the changes in realtime as they are occurring in the operating room. That’s what makes it exciting.”

    The specialty, thus, draws medical students who excel in the basic sciences and pharmacology, Dr. Green says. And it appeals to results-driven individuals, who like to see the fruits of their labors immediately. With patients’ lives hanging in the balance, anesthesiologists must be extremely observant and able to think and act very fast. They must detail-minded and always well-prepared should something go awry.

    “Anesthesiology is also a specialty for people who want to work with their hands,” Dr. Green says. “Whether it be vascular access or airway management, we are doing procedures to some degree on every patient we see.”

    Hospital-based anesthesiologists constitute a major component of critical care medicine, so individuals considering anesthesiology need to have an aptitude, as well as passion, for caring for patients with life-threatening conditions, Dr. Green notes. “We assess people when they enter the hospital. We assess them preoperatively and develop and anesthetic plan. We take care of them in the operating room. And we take care of them during the postoperative period,” he says.

    “The most desirable trait for an anesthesiologist is reliability, followed by honesty, functionality under stress, punctuality and discipline,” says Dr. Escher, who is an attending anesthesiologist at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla. “The patients are very dependent on you, and the surgeries don’t happen without your presence. This is the kind of field where if you are having a bad day, you still have to perform at your best.”

    Anesthesiologists need to be team players who work well with surgeons and surgical residents, and they need to have the management skills to supervise anesthesiology assistants and nurse anesthetists effectively, Dr. Kane says.

    “Contrary to what many people think, anesthesiologists need to have good interpersonal skills because this is a field in which you must be able to connect with patients very, very quickly,” Dr. Escher observes. “A lot of patients are quite scared before having an operation. A good anesthesiologist answers patients’ questions, puts them at ease, makes that personal connection and does everything he or she can to ensure a good outcome.”

    Getting there
    The right personality traits and interest in the field are not enough, however. Academic achievement and high board scores are important for anyone considering an anesthesiology residency.

    The immediate past chairman of Drexel’s anesthesiology department, George Mychaskiw II, DO, notes that each year Drexel’s ACGME-accredited residency program receives more than 800 applications for eight positions. To land an interview at Drexel, osteopathic medical students need to score at least 200 on the USMLE or at least 500 on the first attempt for Level 1 of COMLEX-USA. The COMLEX scores for Drexel’s ranked candidates average around 570.

    What’s more, says Dr. Mychaskiw, many of the more than 130 ACGME-accredited anesthesiology programs do not accept the COMLEX-USA and have higher cut-off scores for the USMLE.

    Excellent academic credentials are essential for anesthesiology program candidates, concurs Dr. Kane, the director of an eight-position AOA-approved anesthesiology residency program at South Pointe Hospital in Warrensville Heights, Ohio. “We only look at students whose COMLEX or USMLE scores are in the top 10% or top 15% nationally,” he says.

    But overall the 13 AOA-approved anesthesiology residencies will consider candidates with a broader range of scores, depending on the competition in a given year, according to data published by the American Association of Colleges of Osteopathic Medicine. The association reported that those matching into AOA-approved anesthesiology residencies in a recent year had average COMLEX scores of 501 for Level 1 and 518 for Level 2.

    Osteopathic medical students who hope to pursue an anesthesiology career should consider taking both the USMLE and COMLEX to expand their prospects, Dr. Kane suggests.

    Because anesthesiologists frequently engage in research on everything from pain modulation to postoperative cognitive function, residency candidates with research experience have an edge, Drexel’s Dr. Green says.

    Dr. Green also favors candidates who demonstrate interest in anesthesiology before their fourth-year anesthesiology elective. Students can shadow anesthesiologists, spend time with anesthesiologists when they are on surgery rotations, and attend anesthesiology conferences. “Face time is very valuable,” Dr. Green says. “Try to get to know people in the field.”

    Board certification and beyond
    The road to becoming an anesthesiologist is a long one, requiring a four-year residency or an osteopathic rotating internship followed by a three-year residency. Those training in AOA-approved programs need to become AOA board certified, a process requiring written, oral and clinical examinations that can take four years to complete. Those training in ACGME-accredited programs take part in a similar examination process to become certified by the American Board of Anesthesiology (ABA).

    Anesthesiologists have the option of furthering their education by serving a one-year fellowship or obtaining a certificate of added qualification in pain management, critical care, pediatric anesthesia or some other subspecialty.

    Because of the greater availability of ACGME anesthesiology residencies and fellowships, today most DO anesthesiologists become ABA certified. But DOs in certain key administrative positions in the profession, such as osteopathic medical school deans and osteopathic residency program directors, must be AOA board certified. Consequently, students who hope to become to become leaders in osteopathic medical education should carefully weigh the long-term pros and cons of serving an ACGME-accredited versus an AOA-approved anesthesiology residency.

    The AOA does, however, have a mechanism called “Resolution 56” that allows DOs who are certified through the American Board of Medical Specialties to take part in the AOA board-certification process.

    The DO difference
    During his time at Drexel, Dr. Mychaskiw observed that DO residents tend to be more mature overall than MD residents. “Most of Drexel’s chief residents are DOs. Many are somewhat older because osteopathic medicine is their second career. They tend to have more experience in the real world outside of school,” says Dr. Mychaskiw, who recently was appointed chairman of the anesthesiology department at the Nemours Children’s Hospital under construction in Orlando, Fla. “DO residents work hard, and they take their responsibilities seriously.”

    Outside of pain management practices, most DO anesthesiologists do not perform osteopathic manipulative treatment on patients, but their osteopathic approach to care shines through, according to Dr. Escher. “I think our interpersonal skills set us apart from a lot of MDs,” he says. “And our ability to look at the whole patient brings another dimension to our preoperative assessment and postoperative care of patients.”

    Patients don’t expect to remember their anesthesiologists. Anesthesiology is not a field in which physicians establish long-term relationships with patients. “But my patients usually do remember me because I talk with them and I joke with them,” Dr. Dougherty says. “This interaction has only a positive impact on patient outcomes, and it makes the work more fun.”



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