12 THINGS TO KNOW AS YOU NEAR THE END OF YOUR ANESTHESIA TRAINING

The most difficult challenge for any anesthesiologist is the transition from the end of anesthesia residency into the beginning of your first job. You’re on your at the hospital, sometimes on weekend nights, and sometimes at 3 a.m.

In “Subterranean Homesick Blues” Bob Dylan wrote, Twenty years of schoolin’ and they put you on the day shift. 

For anesthesiologists, it’s more like twenty-five years of training and they put you on the night shift. Alone.

Every anesthesiologist walks a long road before they finish their education. This includes thirteen years to finish high school, four years of college, four years of medical school, a year of internship, three years of anesthesia residency training, and possibly an extra year of a subspecialty fellowship.

When I finished my training I was naïve about what was around the corner. I had no physicians in my family and no older physicians as close friends. I learned my lessons in real time on the front lines. As you near the end of that twenty-fifth year of education, here’s a list of twelve things you should know before you leave the cocoon of academia and venture out into the job market as an anesthesiologist:

1. Your professors won’t find you a job. Their role is to teach anesthesia, to take care of patients, and to do research. They are not guidance counselors. Most of them are academics who either enjoy teaching or who enjoy the university faculty lifestyle. If they knew of or coveted a private practice job themselves, they would have taken one themselves long ago. You’ll likely have to find a job yourself. Your professors are of significant value when you are being considered for a specific job, because they can give your prospective employer a positive evaluation of you.
2. You’ll find job listings on the Internet. Apply for jobs you have interest in. Don’t be surprised if most of these posted jobs have a problem such as low pay, an undesirable location, a dead end career track, or (let me say it again) low pay. The more jobs you look into, the better you’ll understand the marketplace. You’ll learn from every unsuccessful inquiry. Why are jobs posted on Internet sites usually inferior jobs? See #4 below.
3. The best job opportunities are communicated by word of mouth. For example, imagine that an excellent group needs a new anesthesiologist with an emphasis in regional anesthesia. Members of that group will communicate with acquaintances at local university training programs or with top national university training programs, and ask for the names of recommended candidates. You want people to recommend you. It’s an old boy’s club of sorts (except that it includes men and women). You’ll get called up when the old boys agree that you’re the one they want.
4. If there’s a hospital location or an anesthesia group you’re particularly interested in, but they are not advertising a job opening. don’t waste your time writing them a letter with your curriculum vitae attached. The letter will be discarded. Instead, make phone calls. Find out who the leader of the group is, and call the operating room or the anesthesia company’s phone number. If they are unavailable, leave a message. Repeat in a week or so until you make contact. If they never call you back, so be it. But if you apply this strategy to multiple different jobs, you will connect with a real human voice, and you’ll have the opportunity to sell yourself over the phone.
5. Make as many personal contacts as you can with anesthesiologists who are already in private or community practice. Ask them questions when you can, and once you’ve landed a new job, connect with one of your new colleagues so they can serve as your mentor for the early career years. You’ll need to transition from a trainee mentored by professors to a graduated anesthesiologist mentored by a doctor who’s already out there in anesthesia practice.
6. Retain at least one close contact with a former faculty member, so you can ask questions of them as well after you are out in community practice. The theme here is build bridges with new colleagues, and never burn bridges with your old teachers.
7. You’ll have to pass your board examinations. My advice is to read every word of Miller’s Anesthesia prior to your oral boards. It’s a terrific book, and this is the one time in your career that you’ll be motivated to have encyclopedic knowledge of your specialty.
8. Along with book learning, find opportunities to take mock oral exams from faculty at your training program. Stanford conducts twice-yearly mock oral exams, using the identical format that the American Board of Anesthesiology uses. See my column ADVICE FOR PASSING THE ORAL BOARD EXAMS IN ANESTHESIOLOGY. If you read Miller’s Anesthesia and undergo mock oral training, you’ll pass the board exams and you’ll become board-certified in anesthesiology—a requirement for all top shelf jobs.
9. Think “Airway – Airway – Airway.” Airway –Breathing – Circulation, or A – B – C, describes the core management of critical care situations in the operating room, the emergency room, or the ICU. Of these three, the one that can get a new graduate (or any anesthesiologist) in a heap of trouble in less than five minutes is a botched airway. Be extremely careful and vigilant regarding all issues of airway management, both at times of intubation and extubation. Faulty judgment which leads to three minutes of hypoxia for your patient could severely harm your patient and change your life. Learn the ASA Difficult Airway Algorithm, and read AVOIDING AIRWAY DISASTERS IN ANESTHESIA. Avoid an airway disaster at all costs.
10. Find a reliable recipe for each common type of anesthetic, hone it, and stick to it. The early career years are not about doing “interesting” anesthetics, they are about doing safe, predictable anesthetics with safe outcomes.
11. Private practice surgeons are fast. Avoid the high doses of narcotics and muscle relaxants you used on those tediously long university cases. These will be overdoses in private practice, and your patients will be slow to wake up.
12. Learn how anesthesia billing is done. Learn how money is distributed to new anesthesiologists in a prospective job, and how your income will change over the years at that job. A quality job will have a path to partnership, where you will earn as much as the senior members of the group do at this point in time.

Good luck, happy job searching, and may your patients all be safe!

The most popular posts for laypeople on The Anesthesia Consultant include:

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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.

KIRKUS REVIEW

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: