You’ve found The Anesthesia Consultant website, so you have some interest in anesthesiology. Perhaps you’ve heard that anesthesiologists earn a comfortable living. Per wikiprofessionals.org: “According to figures from the U.S. Department of Labor, the lowest 10% of anesthesiologists earn under $135,110 per year, whereas the top 10% earn up to $408,000 per year. The median annual earnings, defined as that figure where half the experienced anesthesiologists earn less than that amount and half earn more, is $292,000. Anesthesiologists’ salaries are among the highest of all U.S. professions.”
Perhaps you’re wondering if anesthesiology is a potential vocation for you, your child, your cousin, or your niece. The truth is: a career in anesthesia involves unique demands that most people would not seek, tolerate, or ever grow accustomed to.
Nonetheless, I believe no medical specialty is more fascinating than anesthesiology. Based on thirty years as an anesthesiologist, here’s my checklist of ten qualities necessary to succeed in this profession.
You must have:
- Calmness under intense pressure. I’ve experience countless emergency moments where patients dropped their heart rate or blood pressure dangerously low, increased their heart rate or blood pressure dangerously high, hemorrhaged from an artery, lost their airway, or in some other unexpected way sustained a life-threatening event. An anesthesiologist must remain focused and decisive at these moments. An anesthesiologist must choose the correct diagnostic and therapeutic moves to save the patient’s life. An operating room emergency is not a time for screaming, temper tantrums, or freezing. An operating room emergency is a time for calm, assertive action.
- Vigilance during long periods of quasi-boredom. In between those emergency occurrences, an anesthesiologist must remain attentive without becoming bored or distracted. The motto of the American Society of Anesthesiologists is one word: Vigilance. During surgery, much of our job is to observe. One day I brought my 15-year-old son into the operating room with me to observe surgery, hoping he would respect the complex nature of my job. Instead his impression afterward was, “Dad, most of the time you don’t really do much of anything. You watch monitor screens, talk to the surgeon and the nurses, and listen to music.” One of my partners overheard this analysis and remarked, “If you see an anesthesiologist working hard, then you’ve really got a problem!”
- Superior skills with your hands. There are no tests during college pre-med classes or medical school clerkships to quantify an individual’s fine motor skills. Many doctors with superior manual dexterity migrate toward operative specialties like surgery or anesthesia. But not all anesthesiologists are equal. Some resident anesthesia doctors are less skillful than others at various anesthesia procedures such as placing breathing tubes into windpipes, inserting catheters into veins and arteries, injecting nerve blocks near peripheral nerves, or injecting spinals and epidurals into the lumbar spine. Residents have dropped out of our specialty altogether because they were not confident with the required procedural skills.
- The patience and motivation to persist through 25-27 years of training. In the song Subterranean Homesick Blues, Bob Dylan wrote, “Twenty years of schooling and they put you on the day shift.” In anesthesiology, twenty years of schooling earns you both the dayshift and the night shift. Your education will consist of thirteen years through high school, four years of college, four years of medical school, one year of internship, three years of anesthesia residency, and probably an extra one or two years of fellowship specialization. This cascade of years stretches your education past the age of thirty. You must to be accepting of delayed gratification. During the last of those twenty-five years, when you owe $250,000 in educational debt and are roaming hospital hallways at three a.m., your college classmates who chose business careers are at home sleeping in a house they’ve already purchased.
- A tolerance for sleeplessness. You must have the ability to thrive during early mornings and late nights. Scheduled surgeries start early in the morning, usually at 0730. Prior to that hour, anesthesiologists meet, evaluate, and obtain consent from their first patient, and then bring the patient to the operating room and safely render them unconscious. Not all cases start at sunrise—surgical patients get sick around the clock. Emergency surgeries may start at midnight or three o’clock in the morning. Anesthesiologists must be tolerant of fatigue and still be able to work unimpaired.
- Compulsive attention to detail. All aspects of anesthesia care, including a) the review of a patient’s medical condition prior to surgery, b) the planning and conduct of the anesthetic, and the management of medical conditions and c) complications immediately after surgery, require the anesthesiologist to avoid mistakes of any kind and to strive for near-perfection. Psychiatrists often diagnose OCD (obsessive-compulsive disorder) in patients. It’s probable that most anesthesiologists have a least a touch of OCD.
- Thick skin. You cannot be too hard on yourself, even though anesthesiologists are not allowed to have a bad day. A bad day in this career could mean a dead patient, a comatose patient, or a patient who was supposed to be discharged home instead lying in an intensive care unit on a ventilator. You’re human, and you may make a mistake. That mistake may have no consequence or it may cost a patient dearly. If a patient suffers a bad outcome secondary to a mistake you make, you’ll have to endure the emotional toll. There are stories of anesthesiologists who quit the specialty, become addicts, or commit suicide because a patient suffered a bad outcome. You can’t succumb.
- Excellent communication skills. You must be someone who can sell yourself to a patient in ten minutes. Anesthesiologists typically have ten minutes before surgery to interview a patient, examine them, obtain their consent, and gain their trust. The patient will be anxious. You need to assess and manage both their medical and their emotional needs at this demanding moment. An anesthesiologist’s patients are unconscious most of the time, but not all the time. If you want a medical career with zero awake hours of patient contact, consider pathology instead of anesthesiology. A successful anesthesiologist must also cooperate with different teams of surgeons, nurses, and medical techs every day. Surgeon personalities come in all varieties—some are demanding, some are condescending, and some are bullies. You have to work effectively with all types of surgeons, whether you admire that individual’s personality or not.
- Intelligence. Admission to anesthesia residency positions is very competitive. In 2014 there were only 1,049 anesthesia PG-1 (Post-Graduate Year 1) residency positions in the United States and 1,836 individuals who applied for these positions. Nearly 50% of applicants—all of them medical school seniors or medical school graduates—failed to land a position in anesthesia. (Ref: Results and Data, National Resident Matching Program 2014 http://www.nrmp.org/wp-content/uploads/2014/04/Main-Match-Results-and-Data-2014.pdf)
- A love for helping people. Every physician must have this. We spend years memorizing facts about physiology, disease, and pharmacology, but a successful doctor must care about each patient as an individual. Empathy for patients before, during, and after the day of their surgery and anesthesia is essential.
These are ten qualities I look for in an outstanding anesthesiologist. The next time you need surgery, I’d advise you to look for and expect the same qualities in the man or woman who will anesthetize you.
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.
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