A question anesthesiologists are commonly asked is, “Why did you decide on a career in anesthesiology?
Let’s assume a young man or woman has the discipline and intellect to attend medical school. Once that individual gains their M.D. degree, they will choose a specialty from a long line-up that includes multiple surgical specialties (general surgery, orthopedics, urology, neurosurgery, cardiac surgery, ophthalmology, plastic surgery, ear-nose-and-throat surgery), internal medicine, pediatrics, family practice, dermatology, radiology, invasive radiology, radiation oncology, allergy-immunology, emergency medicine, and anesthesiology.
Why choose anesthesiology? I offer up a list of the reasons individuals like myself chose this specialty:
- Anesthesiologists do acute care rather than clinic care or chronic care. Some doctors enjoy sitting in a clinic 40+ hours a week, talking to and listening to patients. Other doctors prefer acute care, where more exciting things happen moment to moment. It’s true that surgeons do acute care in the operating room, but most surgeons spend an equal amount of time in clinic, seeing patients before and after scheduled surgical procedures. Chronic care in clinics can be emotionally taxing. Ordering diagnostic studies and prescribing a variety of pills suits certain M.D.’s, but acute care in operating rooms and intensive care units is more stimulating. It’s exciting controlling a patient’s airway, breathing, and circulation. It’s exciting having a patient’s life in your hands. Time flies.
- Patients like and respect their anesthesiologist, and that feels good. Maybe it’s because we are about to take each patient’s life into our hands, but during those minutes prior to surgery, patients treat anesthesiologists very well. I tend to learn more about my patients’ personal lives, hobbies, and social history in those 10 minutes of conversation prior to surgery than I ever did in my internal medicine clinic.
- An anesthesiologist’s patients are unconscious the majority of time. Some anesthesiologists are attracted the this aspect. An unconscious patient is not complaining. In contrast, try to imagine a 50-hour-a-week clinic practice as an internal medicine doctor, in which every one of your patients has a list of medical problems they are eager to tell you about.
- There is tremendous variety in anesthesia practice. We take care of patients ranging in ages from newborns to 100-year-olds. We anesthetize patients for heart surgery, brain surgery, abdominal or chest surgeries, bone and joint surgeries, cosmetic surgery, eye surgery, urological surgery, trauma surgery, and organ transplantation surgery. Every mother for Cesarean section has an anesthetist, as do mothers for many vaginal deliveries for childbirth. Anesthesiologists run intensive care units and anesthesiologists are medical directors of operating rooms as well as pain clinics.
- Anesthesiologists work with a lot of cool gadgets and advanced technology. The modern anesthesia workstation is full of computers and computerized devices we use to monitor patients. The modern anesthesia workstation has parallels to a commercial aircraft cockpit.
- Lifestyle. We work hard, but if an anesthesiologist chooses to take a month off, he or she can be easily replaced during the absence. It’s very hard for an office doctor to take extended time away from their patients. Many patients will find a alternate doctor during a one month absence if the original physician is unavailable. This aspect of anesthesia is particularly attractive to some female physicians who have dual roles as mother and physician, and choose to work less than full-time as an anesthesiologist so they can attend to their children and family.
- Anesthesia is a procedural specialty. We work with our hands inserting IV’s, breathing tubes, central venous IV catheters, arterial catheters, spinal blocks, epidural blocks, and peripheral nerve blocks as needed. It’s fun to do these procedures. Historically, procedural specialties have been higher paid than non=procedural specialties.
What about problematic issues with a career in anesthesia? There are a few:
- We work hard. Surgical schedules commonly begin at 7:30 a.m., and anesthesiologists have to arrive well before that time to prepare equipment, evaluate the first patient, and get that patient asleep before any surgery can commence. After years of this, my internal alarm clock tends to wake me at 6:00 a.m. even on weekends.
- Crazy hours. Every emergency surgery—every automobile accident, gunshot wound, heart transplant, or urgent Cesarean section at 3 a.m. needs an anesthetist. Working around the clock can wear you out.
- The stakes are high if you make a serious mistake. In a clinic setting, an M.D. may commit malpractice by failing to recognize that a patient’s vague chest pain is really a heart attack, or an M.D. may fail to order or to check on an important lab test, leading to a missed diagnosis. But in an operating room, the malpractice risks to an anesthesiologist are dire. A failure in properly insert a breathing tube can lead to brain death in minutes. This level of tension isn’t for everyone. Some doctors are not emotionally suited for anesthesia practice.
- In the future, anesthesia doctors may gradually lose market share of their practice to nurse anesthetists. You can peruse other columns in this blog where I’ve discussed this issue.
- Anesthesiologists don’t bring any patients to a medical center. In medical politics, this can be problematic. Anesthesiologists have limited power in some negotiations, because we can be seen as service providers rather than as a source of new patient referrals for a hospital. Some hospital administrators see an anesthetist as easily replaced by the next anesthetist who walks through the door, or who offers to work for a lower wage.
The positive aspects of anesthesiology far outweigh these negatives.
Akin to the Dos Equis commercial that describes “The Most Interesting Man in the World,” I’d describe the profession of anesthesiology as “The Most Interesting Job in the World.”
And when you love your job, you’ll never work a day in your life.
Published in September 2017: The second edition of THE DOCTOR AND MR. DYLAN, Dr. Novak’s debut novel, a medical-legal mystery which blends the science and practice of anesthesiology with unforgettable characters, a page-turning plot, and the legacy of Nobel Prize winner Bob Dylan.
In this debut thriller, tragedies strike an anesthesiologist as he tries to start a new life with his son.
Dr. Nico Antone, an anesthesiologist at Stanford University, is married to Alexandra, a high-powered real estate agent obsessed with money. Their son, Johnny, an 11th-grader with immense potential, struggles to get the grades he’ll need to attend an Ivy League college. After a screaming match with Alexandra, Nico moves himself and Johnny from Palo Alto, California, to his frozen childhood home of Hibbing, Minnesota. The move should help Johnny improve his grades and thus seem more attractive to universities, but Nico loves the freedom from his wife, too. Hibbing also happens to be the hometown of music icon Bob Dylan. Joining the hospital staff, Nico runs afoul of a grouchy nurse anesthetist calling himself Bobby Dylan, who plays Dylan songs twice a week in a bar called Heaven’s Door. As Nico and Johnny settle in, their lives turn around; they even start dating the gorgeous mother/daughter pair of Lena and Echo Johnson. However, when Johnny accidentally impregnates Echo, the lives of the Hibbing transplants start to implode. In true page-turner fashion, first-time novelist Novak gets started by killing soulless Alexandra, which accelerates the downfall of his underdog protagonist now accused of murder. Dialogue is pitch-perfect, and the insults hurled between Nico and his wife are as hilarious as they are hurtful: “Are you my husband, Nico? Or my dependent?” The author’s medical expertise proves central to the plot, and there are a few grisly moments, as when “dark blood percolated” from a patient’s nostrils “like coffee grounds.” Bob Dylan details add quirkiness to what might otherwise be a chilly revenge tale; we’re told, for instance, that Dylan taught “every singer with a less-than-perfect voice…how to sneer and twist off syllables.” Courtroom scenes toward the end crackle with energy, though one scene involving a snowmobile ties up a certain plot thread too neatly. By the end, Nico has rolled with a great many punches.
Nuanced characterization and crafty details help this debut soar.
Click on the image below to reach the Amazon link to The Doctor and Mr. Dylan:
LEARN MORE ABOUT RICK NOVAK’S FICTION WRITING AT RICK NOVAK.COM BY CLICKING ON THE PICTURE BELOW: