Anesthesiology career quetions (2024)

I was considering anesthesiology as a field. But had a few questions...

1. What kind of procedures do cardiac anesthesiologists do?

2. Can you do double fellowship in cardiac anesthesiology and pain management and be able to practice both in an academic and private practice setting?

3. Are there a lot of jobs that allow cardiac and pain certified anesthesiologists to practice both?

4. Does anesthesiology procedures get repetitive? This is one of my major concerns.

5. In the OR, is there any kind of hierarchy established between surgeons and anesthesiologists? ie. surgeons not thinking as highly of anesthesiologists, etc. I heard of this. Just wondering how common it is.

drmedstudent said:

I was considering anesthesiology as a field. But had a few questions...

4. Does anesthesiology procedures get repetitive? This is one of my major concerns.

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Every specialty's procedures get repetitive. Don't go into Ortho unless you like doing shoulder/knee scopes. Don't be a general surgeon unless gallbladders and hernias excite you. Don't do ENT unless you like tonsillectomies. Don't be an anesthesiologist if you hate putting in epidurals and lines.

Every specialty has some interesting rare stuff that they see/do. But the bread and butter stuff is what pays the bills and what you will be doing 30 years from now.

You could do a cardiac fellowship and a pain fellowship; it's 2 fellowships rather than a double fellowship. You could practice both in theory. It is highly unlikely that you would actually want to do both when the time comes.

Cardiac and ICU are a more natural pairing, but you CAN do what you want. I've never heard of anyone doing pain and cardiac. They are so different that it is unlikely that anyone would like both equally.

Anyone know any pain/cardiac guys?

Most pain guys I know can barely do healthy general cases (and don't want to), much less cardiac. They were nearly 100% pain though. If you did 50/50 all along, you'd be fine in the OR but that's probably not very common.

GypsySongman said:

Cardiac and ICU are a more natural pairing,

See Also

How to Become an ASATT-Certified Anesthesia Technologist​Types of Careers in AnesthesiaSo, I finally got to shadow an anesthesiologist, and I must say...Ask Me Anything With An Anesthesiologist: Dr. Alex Tripp - SDN

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can u elaborate more on this......so there's a cardiac fellowship and an ICU fellowship? what does the latter entail?

im a med student and i havent yet done my anesthesiology rotation yet...but i was interested in either cardiac anesthesia or pain management

can someone provide pros/cons for both in terms of interest, demand/job saturation, pay scale, private practice scope, number of patients you see

also, how is cardiac anesthesia different from general anesthesia....ie. what extra procedures do you do?

as cardiac anesthesiologist, can you still work on general anesthesiology cases (non cardiac related)?

drmedstudent said:

can u elaborate more on this......so there's a cardiac fellowship and an ICU fellowship? what does the latter entail?

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The field of CCM (ICU) was established by anesthesiologists way back, and a lot of anesthesiologists liken their work in the ICU to the OR, where the ICU is an extension of what an Anesthesiologist does in the OR. So, it makes sense that Anesthesiologists can become Intensivists in the same way Pulmonary/CCM and Trauma/CCM have their fellowships. Ours is just 1 year. Generally, nowadays, Anesthesiologists would be found in the cardiac surgical ICUs and then the general surgical ICUs. So when GypsySongman said that Cardiac and ICU fellowships are a more natural pairing, it's because the units led by Anesthesiologists are usually cardiac surgical units where the patients are post-op major heart surgeries. Hope that helps.

drmedstudent said:

is cardiac anesthesia more hands on or is it also mostly monitoring patient like general anesthesia? i havent seen any cardiac anesthesia procedure so im just wondering

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There are others 1000% more qualified to answer this, but the cardiac cases I've been in are:
1) generally some sick patients
2) there's the hemodynamic monitoring with Swan Ganz catheters, which would be placed by the doc.
3) there's the TEE looking for a whole host of things, but specifically wall motion abnormalities, EF, in CABG's, as well as valvular function post valve repair/replacement. Ofcourse the CT anesthesiologist will take a gander at the atria for thrombi as well, with an especially critical look in pts with underlying A-fib....

2 and 3 are done/placed/interpreted by the anesthesiologist. I liked heart cases during my med student rotations. When the pt is on pump it seems that there's some down time, but frankly that downtime wasn't torture but rather kind of a nice reprieve.

Just my 2 cents. Perhaps the CT guys can elaborate further.

**I've noted many open hearts going "multiprocedural" these days. That is, a very sick, multivessel diseased heart is likely to have other abnormalities whether they be valvular or even underlying A-fib. So, during SICU, I'd see many CABG x3's WITH AVR, WITH MAZE, WITH left atrial appendage ligation/excision.

So, it seems that by the time the interventional cards guys are through with them, yet still need interventions, these surgical candidates are indeed rather sick folks.

Anecdotally, the CV surgeons I worked with really embraced me as an anesthesiology resident (PGY1 which they knew), and like I've mentioned, one elaborated on the value of an anesthesiology-CC oriented SICU. The major point I took from it is that these aforementioned sick patients need great ICU care to pull them through. Who better to take care of these people?

cf

drmedstudent said:

is cardiac anesthesia more hands on or is it also mostly monitoring patient like general anesthesia? i havent seen any cardiac anesthesia procedure so im just wondering

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Cardiac tends to be more hands-on than general because the patients are sicker, thus require more vigilance. More lines to place routinely. Also, the nation is moving towards an ACT model, meaning supervising anesthesiologist covering multiple rooms and CRNA in the OR. That pulls the anesthesiologist out of the OR and into the Pre-op unit. Cardiac is mostly immune to encroachment. You will be taking care of your patient alone for the duration. The obvious exception is academic practice.

That said, cardiac cases are punctuated by pump runs of 1-2 hrs (or more) when the anesthesiologist does nothing. You make your money getting the lines in, checking TEE, and coming off pump.

Bertelman said:

That said, cardiac cases are punctuated by pump runs of 1-2 hrs (or more) when the anesthesiologist does nothing. You make your money getting the lines in, checking TEE, and coming off pump.

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Not completely correct. I'm always monitoring the pressure, ensuring the pump oxygenator is working, that the perfusionist has turned on the volatile anesthestic (and it's filled), ensuring adequate anticoagulation etc. While it's normally a fairly chill time, there are plenty of catastrophes that happen on pump (like the aortic cannula falling out of minimally invasive valve replacement...ever crash off of pump?), or misplaced/kinked aortic and venous cannulas, dissections that occur on pump etc. It's just not a time to space out.

proman said:

Not completely correct. I'm always monitoring the pressure, ensuring the pump oxygenator is working, that the perfusionist has turned on the volatile anesthestic (and it's filled), ensuring adequate anticoagulation etc. While it's normally a fairly chill time, there are plenty of catastrophes that happen on pump (like the aortic cannula falling out of minimally invasive valve replacement...ever crash off of pump?), or misplaced/kinked aortic and venous cannulas, dissections that occur on pump etc. It's just not a time to space out.

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It was a bit of an overstatement.

Just trying to convey the general pattern of a cardiac case to a med student. Some of the tasks you describe are handled by the ...ummmm....perfusionists at other hospitals.

Bertelman said:

It was a bit of an overstatement.

Just trying to convey the general pattern of a cardiac case to a med student. Some of the tasks you describe are handled by the ...ummmm....perfusionists at other hospitals.

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I figured you were simplifying. But you shouldn't trust others so much. I've seen a perfusionist turn the iso dial to 1% and it was empty. Today I heard a story at a VA about how the venous drainage developed an air lock and neither the surgeon nor the perfusionist knew how to fix it. Lucky for the patient, the attending did.

GypsySongman said:

Anyone know any pain/cardiac guys?

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Yes, there was one at my fellowship. He was an awesome guy, a wonderfully skilled cardiac anesthesiologist, and one of my favorite attendings in the pain clinic. He is at Virginia Mason.

drmedstudent said:

do u guys think CRNAs r gonna take over the field from the looks of how the trend is?

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If you cannot take the effort to type 'you' and 'are,' why should someone take the time to answer your question?

Brachyury said:

If you cannot take the effort to type 'you' and 'are,' why should someone take the time to answer your question?

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lol anyways...anyone wanna answer the question about the trend?