Why do you think current M4s aren’t heeding the warnings of Anesthesia being “dead”?

[slippery_when_wet]

the advantage of radiology is that they dont have nursethesits that think they can do a better job than them.

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[CidHighwind]

We aren't heeding washed up old crusty anesthesiologists' garbage opinion on this because we don't listen to the HATERS AND LOSERS!

I feel like this applies to most of the attendings on this forum. Ol “I have more seniority than you so whatever you have to say/think is worthless and whatever I say is right” people.

the advantage of radiology is that they dont have nursethesits that think they can do a better job than them.

I feel like anesthesiologists have to use more politics in their daily workday. Navigating all the personalities in the OR, PACU, ICU, and families. Radiologists just deal with the occasional doc that wants a stat read or likes to come to the room directly.

 

[abolt18]

I feel like this applies to most of the attendings on this forum. Ol “I have more seniority than you so whatever you have to say/think is worthless and whatever I say is right” people.



I feel like anesthesiologists have to use more politics in their daily workday. Navigating all the personalities in the OR, PACU, ICU, and families. Radiologists just deal with the occasional doc that wants a stat read or likes to come to the room directly.

The attendings on this forum spend a lot of time sharing their personal experiences and opinions in a way to help residents, med students, and other attendings. They are a phenomenal resource. Much of what they have to say IS right, based on their own experiences. And "experience" is something they have a lot more of than you or me. So take what you find valuable and leave the rest behind.

 

[CidHighwind]

The attendings on this forum spend a lot of time sharing their personal experiences and opinions in a way to help residents, med students, and other attendings. They are a phenomenal resource. Much of what they have to say IS right, based on their own experiences. And "experience" is something they have a lot more of than you or me. So take what you find valuable and leave the rest behind.

I agree, it’s just that SOMETIMES, some posters can be a little condescending with the delivery of said experiences. Sometimes warranted, sometimes not.

 

[abolt18]

I agree, it’s just that SOMETIMES, some posters can be a little condescending with the delivery of said experiences. Sometimes warranted, sometimes not.

Indeed. Thick skin required in the anesthesia subforum.

 

[PieOHmy]

Anesthesia seemed to fluctuate alot year to year in terms of MS4 interest. Medicine in general sucks but I mean if youre gonna do it you might as well do something that isnt going to kill your soul in the process.

oh believe you me anesthesia day in and day out is soul crushing.......

 

[nimbus]

For some anesthesia is the funnest specialty in all of medicine.

 

[nimbus]

Indeed. Thick skin required in the anesthesia subforum.

Yep. SDN anesthesia is a much sketchier neighborhood than real life.

 

[BLADEMDA]

We aren't heeding washed up old crusty anesthesiologists' garbage opinion on this because we don't listen to the HATERS AND LOSERS!

How ironic that this post is an example of exactly what you accuse the senior/Experienced anesthesiologists of doing on SDN: hateful and non productive posts.

How do you define a loser? Is that someone who hasn’t been successful in his or her career? Success being defined by money or rank ?

The whole point of discussion is to get a variety of opinions on the subject exposing a range of people’s viewpoints.

So, I’d rather have Med students question the underlying argument or viewpoint than the character of the poster. I believe that makes for a better discussion.

 

[tennessee2244]

How ironic that this post is an example of exactly what you accuse the senior/Experienced anesthesiologists of doing on SDN: hateful and non productive posts.

How do you define a loser? Is that someone who hasn’t been successful in his or her career? Success being defined by money or rank ?

The whole point of discussion is to get a variety of opinions on the subject exposing a range of people’s viewpoints.

So, I’d rather have Med students question the underlying argument or viewpoint than the character of the poster. I believe that makes for a better discussion.

I define the HATERS and LOSERS as someone who always notices the negatives, always notices the problems, and never brings a positive mindset or solutions to problems. Anesthesia is not dead. When all someone has to offer in a profession is negativity and problem recognition then it's time to hang it up.

 

[deleted171991]

Yep. SDN anesthesia is a much sketchier neighborhood than real life.

Real life is politically correct and conflict avoiding.

As I have said before: I don't even bother to tell The Truth to trainees anymore. It's like telling them that there is no Santa Claus. Last time I made that mistake was during fellowship.

 

[AdmiralChz]

Yep. SDN anesthesia is a much sketchier neighborhood than real life.

“Where did you grow up?”

“The mean streets of SDN!”

 

[BLADEMDA]

I define the HATERS and LOSERS as someone who always notices the negatives, always notices the problems, and never brings a positive mindset or solutions to problems. Anesthesia is not dead. When all someone has to offer in a profession is negativity and problem recognition then it's time to hang it up.

If all the poster has to offer is mean spirited hateful posts or non stop negativity on the profession I can agree that he/she may have little to offer in terms of advice.

But, some of these people do add to our clinical discussions and reflect a percentage of practicing anesthesiologists. Like in all fields there will be viewpoints across the spectrum. I can see how a Med student or resident can have trouble seeing the mainstream opinion when a few of the most negative posters are also very vocal.

I still object to your terminology of “ haters and losers” because you have not defined those terms well. I prefer disillusioned and less successful to describe these same posters.

This field has changed dramatically during my career but it is certainly not dead.

 

[AdmiralChz]

Real life is politically correct and conflict avoiding.

As I have said before: I don't even bother to tell The Truth to trainees anymore. It's like telling them that there is no Santa Claus. Last time I made that mistake was during fellowship.

 

[BLADEMDA]

I want to add that if a Med student (Anesthesiology bound) or resident is willing to live anywhere in the USA there are still many opportunities out there for a highly lucrative and successful career. But, the key is to be very flexible on geographic location.

Second, as many of you know I firmly believe in doing a fellowship for enhanced job security and academic options post fellowship. I know some disagree with me but that extra year may (I stress may) really open up some doors for you in better locations.

 

[Twiggidy]

I define the HATERS and LOSERS as someone who always notices the negatives, always notices the problems, and never brings a positive mindset or solutions to problems. Anesthesia is not dead. When all someone has to offer in a profession is negativity and problem recognition then it's time to hang it up.

What a thread like this offers is "perspective" even if it tends to be mostly negative. I strongly believe that when MS4s choose anesthesiology it's one of the least informed decisions that make in med school. I'm not being a downer. I'm just speaking the truth. The rotation is almost nothing like you experience in real life or even residency so then people head into that CA-1 year and they are shocked. Even still, when people get over the shock of residency the become more shocked of what REAL LIFE anesthesiology practice is like. I don't think what even some of the biggest "haters and losers" on this forum post are necessarily too far from the truth. This forum just gives people tough love and as others have said you have to have some thick skin.

 

[vector2]

I assumed when he used the phrase "haters and losers" he was referencing this....... :

 

[deleted171991]

What a thread like this offers is "perspective" even if it tends to be mostly negative. I strongly believe that when MS4s choose anesthesiology it's one of the least informed decisions that make in med school. I'm not being a downer. I'm just speaking the truth. The rotation is almost nothing like you experience in real life or even residency so then people head into that CA-1 year and they are shocked. Even still, when people get over the shock of residency the become more shocked of what REAL LIFE anesthesiology practice is like. I don't think what even some of the biggest "haters and losers" on this forum post are necessarily too far from the truth. This forum just gives people tough love and as others have said you have to have some thick skin.

If they don't have thick skin for OUR tough love, they should wait till they meet the surgeons.

People who call others losers are usually pots calling the kettle black.

 

[Consigliere]

We aren't heeding washed up old crusty anesthesiologists' garbage opinion on this because we don't listen to the HATERS AND LOSERS!

Your funeral pal.....just remember - when the 62 y.o. CRNA TELLS you they'll perform the anesthetic the way they want "because I'll be in the room the entire time, you won't" and "I've been doing this for 35 years" and the hairs on the back of your neck stand up and your hand is now a fist......remember - I told you so.

 

[MoMoGesiologist]

Real life is politically correct and conflict avoiding.

As I have said before: I don't even bother to tell The Truth to trainees anymore. It's like telling them that there is no Santa Claus. Last time I made that mistake was during fellowship.

There is a way to give people feedback and “The Truth” without crushing their spirit. I haven’t figured it out yet personally, but I did have one or two attendings in residency who could tell me what I’m doing wrong and I would walk away thinking I am doing a good job and can and will be better. Having the right personality helps, but surely there’s a way for the rest of us to teach and encourage trainees, right!?

 

[BLADEMDA]

There is a way to give people feedback and “The Truth” without crushing their spirit. I haven’t figured it out yet personally, but I did have one or two attendings in residency who could tell me what I’m doing wrong and I would walk away thinking I am doing a good job and can and will be better. Having the right personality helps, but surely there’s a way for the rest of us to teach and encourage trainees, right!?

Since I’m my harshest critic in the real world I understand it takes a lifetime or more to be the best+ if one can ever truly achieve such a thing. This means constant criticism in a constructive way to do it better next time. No matter how good you think you are there is always room to get better.

This same philosophy applies when criticizing others a lot less experienced in the field. As long as the person is receptive to feedback the dialogue can work in a positive fashion. The few times I have lost my temper (briefly) and raised my voice at an inexperienced provider I came to regret it later. There is simply a better way to interact with people than by focusing on the negatives. I find stressing the positive areas first ( some kind words) before diving into what needs to be improved upon and why seems to be a good approach.

To this day I still remember those mentors who trained me in the field decades ago. I can look back and clearly see those individuals who I admired and respected vs the few I disliked. I hope over time I am much more like the former than the latter to those I’ve interacted with over the years.

I totally agree we can discuss subjects or this specialty without “crushing your spirit/soul” in the process. Being on SDN for over 12 years I’ve learned a lot from even those I Disagree with. Most importantly, I have learned to ignore some posts and take some posters with a huge grain of salt. I’m sure there are many that feel that way about me for example.

If all else fails there is always the ignore feature which is better than getting into a pissing match on. SDN. I certainly have learned that over the years here on this board.

 

[MirrorTodd]

What a thread like this offers is "perspective" even if it tends to be mostly negative. I strongly believe that when MS4s choose anesthesiology it's one of the least informed decisions that make in med school. I'm not being a downer. I'm just speaking the truth. The rotation is almost nothing like you experience in real life or even residency so then people head into that CA-1 year and they are shocked. Even still, when people get over the shock of residency the become more shocked of what REAL LIFE anesthesiology practice is like. I don't think what even some of the biggest "haters and losers" on this forum post are necessarily too far from the truth. This forum just gives people tough love and as others have said you have to have some thick skin.

That's true of every medical student choosing any of their chosen specialties. There is no way in hell ANYONE is prepared to truly decide if their specialty is gonna be "good enough" prior to making that decision. Hell, I was able to do 5 months of anesthesia during 3rd and 4th year and I STILL didn't scratch the surface of what this specialty truly entails. I just knew what I DIDN'T want to do...which helped me narrow things down and yet I still made the decision two weeks into my first rotation.

 

[nimbus]

That's true of every medical student choosing any of their chosen specialties. There is no way in hell ANYONE is prepared to truly decide if their specialty is gonna be "good enough" prior to making that decision. Hell, I was able to do 5 months of anesthesia during 3rd and 4th year and I STILL didn't scratch the surface of what this specialty truly entails. I just knew what I DIDN'T want to do...which helped me narrow things down and yet I still made the decision two weeks into my first rotation.

1000%. No clinic.

 

[hununuh]

Your funeral pal.....just remember - when the 62 y.o. CRNA TELLS you they'll perform the anesthetic the way they want "because I'll be in the room the entire time, you won't" and "I've been doing this for 35 years" and the hairs on the back of your neck stand up and your hand is now a fist......remember - I told you so.

How do these CRNAs not get fired or get in trouble for this?

 

[Mikkel]

How do these CRNAs not get fired or get in trouble for this?

You're the one who's gonna get canned if you keep trying to hurt their feelings, you disruptive physician.

 

[IMGASMD]

How do these CRNAs not get fired or get in trouble for this?

I’ve had one of the nicest CRNA claims that she doesn’t understand why the military will send CRNA/mid level/RN out in the front line, before MDs. (Not sure if that’s a real policy, but certainly a well circulated rumor).

Translation: we and physicians do the same thing, why would they send us to die first.... *can’t* comprehend that the physicians have more trainings and the military invested more in physicians.

In some CRNAs eyes, they’re the real “providers” we are just there to sign their chart. In PP at least the physicians are the “owners” and they’re employees.

In AMC setting, I’ve seen “Chief CRNA” deemed to be equal as the medical director in the corporate structure. Now we are all employees, what makes you more special than me?!

 

[deleted171991]

How do these CRNAs not get fired or get in trouble for this?

Because there is such a "shortage" of anesthesiologists (buuuuuuuuuuuuuuuuuuuuuuuuuuuuuull feces), that the management would rather fire an anesthesiologist than a CRNA. And getting the reputation that one is not able to work with CRNAs is the kiss of death.

 

[deleted171991]

There is a way to give people feedback and “The Truth” without crushing their spirit. I haven’t figured it out yet personally, but I did have one or two attendings in residency who could tell me what I’m doing wrong and I would walk away thinking I am doing a good job and can and will be better. Having the right personality helps, but surely there’s a way for the rest of us to teach and encourage trainees, right!?

I don't remember ONE thing those people taught me. But I do remember a lot of the mistakes when my attending didn't choose her words. Memories need to be attached to strong emotions, otherwise they don't last long. Encouraging trainees is nice and PC, but, if one wants to create a lasting impression, consider making them feel bad. You may save a life.

The problem nowadays is that academic promotions are based on trainee reviews, instead of trainee performance. So everybody tip-toes around their "feelings", while training another generation of mediocrities.

 

[hununuh]

I’ve had one of the nicest CRNA claims that she doesn’t understand why the military will send CRNA/mid level/RN out in the front line, before MDs. (Not sure if that’s a real policy, but certainly a well circulated rumor).

Translation: we and physicians do the same thing, why would they send us to die first.... *can’t* comprehend that the physicians have more trainings and the military invested more in physicians.

In some CRNAs eyes, they’re the real “providers” we are just there to sign their chart. In PP at least the physicians are the “owners” and they’re employees.

In AMC setting, I’ve seen “Chief CRNA” deemed to be equal as the medical director in the corporate structure. Now we are all employees, what makes you more special than me?!

Wow... I am only a CA-1, but thank god I don't have any geographical ties to any region and I will move to wherever there is a PP gig. Hopefully I never have to work for an AMC.

 

[Arch Guillotti]

In some CRNAs eyes, they’re the real “providers” we are just there to sign their chart. In PP at least the physicians are the “owners” and they’re employees

Agree with sentiment but CRNA’s are not always employed by a group.

 

[IMGASMD]

Agree with sentiment but CRNA’s are not always employed by a group.

For those who are in training or still students, I think that the nurses are employed by the group is generally true.

I certainly didn’t know about other arrangements until very recently, some from here, some around where I am now.

 

[B-Bone]

For those who are in training or still students, I think that the nurses are employed by the group is generally true.

I certainly didn’t know about other arrangements until very recently, some from here, some around where I am now.

CRNAs employed by the hospital is relatively common, though that's a crappy situation to work with (no hiring/firing/quality control ability).

Also, there are private CRNA groups that MD anesthesia PP groups contract with. All depends how your market is set up.

 

[Twiggidy]

1000%. No clinic.

TBH if I could've tolerated just 50% of clinic I probably would be doing something else. I think if you a very specialized surgeon with good PAs/NPs it's probably not as bad as we think. I had one bad day of radiology that turned me off from the field but there are definitely days I wished I gave it a second look. I love doing anesthesia but that's where practice choice is a big factor in this field.

 

[Neopolymath]

TBH if I could've tolerated just 50% of clinic I probably would be doing something else. I think if you a very specialized surgeon with good PAs/NPs it's probably not as bad as we think. I had one bad day of radiology that turned me off from the field but there are definitely days I wished I gave it a second look. I love doing anesthesia but that's where practice choice is a back factor in this field.

Can you explain what went wrong in radiology for you? I loved surgery but the clinic killed it for me. It's bizarre because I am a legitimate people person. So many of the patients in these clinics are grating though and I just felt like a hamster on a wheel wishing away time to get back to actual work instead of baby sitting some little old lady who felt that she got discharged too early.

Anesthesiology is an awesome field in a vacuum but suffers from the need to be in strong PP group with a bunch of stipulations to really be ideal.

I feel like I can't pick a field solely based on the medicine because each of them have such flaws these days.

 

[chudat]

I feel like radiology is much safer from midlevel encroachment than anesthesia. Even if surgeons think they know how to read ct abd/pel they only look at areas of chief complaint and miss incidentals that radiologists pick up. Additionally, radiologists still bill for the ct and interpretation.

 

[Arch Guillotti]

CRNAs employed by the hospital is relatively common, though that's a crappy situation to work with (no hiring/firing/quality control ability).

Also no financial headaches, no recruiting headaches, no staffing headaches, no human resources headaches, no dependence on subsidy, etc.

 

[B-Bone]

Also no financial headaches, no recruiting headaches, no staffing headaches, no human resources headaches, no dependence on subsidy, etc.

I've done it both ways (and was very skeptical about employing CRNAs based on the concerns you cite), and it is waaaaaaaaaaaaaaaay better to employ them. Being able to select the CRNAs you work with is invaluable. Don't like militant, anti-doc CRNAs? Don't hire them. Don't like incompetent people who don't know what they don't know? Don't hire them. One of the above sneaks past your vetting procedures? Fire them. Also, CRNAs are a lot less likely to argue/deviate from the plan/etc when they know you're the one signing their paychecks.

 

[Arch Guillotti]

I've done it both ways (and was very skeptical about employing CRNAs based on the concerns you cite), and it is waaaaaaaaaaaaaaaay better to employ them. Being able to select the CRNAs you work with is invaluable. Don't like militant, anti-doc CRNAs? Don't hire them. Don't like incompetent people who don't know what they don't know? Don't hire them. One of the above sneaks past your vetting procedures? Fire them. Also, CRNAs are a lot less likely to argue/deviate from the plan/etc when they know you're the one signing their paychecks.

Can’t argue much. But the grass is always greener on the other side.

 

[CidHighwind]

You're the one who's gonna get canned if you keep trying to hurt their feelings, you disruptive physician.

Doesn’t this dynamic exist anywhere where there are headstrong nurses? Floor and ED nurses can be brutal, snarky, lazy, arrogant, unpleasant people, but if they’re employed by the hospital, there’s really nothing the doc can do, and you can forget it if you’re a resident or student.

 

[dannyboy1]

Your funeral pal.....just remember - when the 62 y.o. CRNA TELLS you they'll perform the anesthetic the way they want "because I'll be in the room the entire time, you won't" and "I've been doing this for 35 years" and the hairs on the back of your neck stand up and your hand is now a fist......remember - I told you so.

You just have to be able not to give a $hit about these things. As I’ve said before, when working with a CRNA the only thing I care about is that the patient wakes up alive and neurologically intact. And that my paycheck arrives on time. It’s a JOB. that’s it

 

[Mikkel]

Doesn’t this dynamic exist anywhere where there are headstrong nurses? Floor and ED nurses can be brutal, snarky, lazy, arrogant, unpleasant people, but if they’re employed by the hospital, there’s really nothing the doc can do, and you can forget it if you’re a resident or student.

You can order a floor nurse something nicely and you won't get in trouble.

You can order a CRNA something nicely and you'll get 10 years of pain in the ass.

 

[Mman]

You can order a floor nurse something nicely and you won't get in trouble.

You can order a CRNA something nicely and you'll get 10 years of pain in the ass.

the CRNAs job is to help enact my anesthetic plan. Ours do that well. If they didn't, they wouldn't be working for us.

 

[9blade]

I’ve heard from the PD at my school that significantly more students are applying to anesthesia than in previous years, and that they’re a lot more 250s/AOA caliber students applying as well. It seems like no matter how many rights midlevels get, or how many times people here try to warn students not to go into anesthesia, more and more people are gunning for it.

because everywhere else in medicine sucks. So anesthesia is still a pretty good gig

 

[hununuh]

the CRNAs job is to help enact my anesthetic plan. Ours do that well. If they didn't, they wouldn't be working FOR us.

I guess that's the key part of the deal.

 

[PieOHmy]

because everywhere else in medicine sucks. So anesthesia is still a pretty good gig

at least the others dont have to get up at the ass crack of dawn every day to put up with whining crnas who think you are better than you are , dingus surgeons who think you are useless and get paid too much, passive aggressive holding room nurses who think you create work for them, hospital administration who are trying to replace you with someone cheaper constantly, every single page that is not answered within 25 secs is reported. All the while trying to get a moment of peace to take a dump is a struggle. That is the day in the life of an anesthesiologist.

 

[Twiggidy]

You just have to be able not to give a $hit about these things. As I’ve said before, when working with a CRNA the only thing I care about is that the patient wakes up alive and neurologically intact. And that my paycheck arrives on time. It’s a JOB. that’s it

This 100%. A CRNA can tell me she's the MIchael Jordan of CRNAs and my anesthetic is trash......well, I fresh out of you know whats. Keep the patient alive and pass me my check.

 

[Twiggidy]

Can you explain what went wrong in radiology for you? I loved surgery but the clinic killed it for me. It's bizarre because I am a legitimate people person. So many of the patients in these clinics are grating though and I just felt like a hamster on a wheel wishing away time to get back to actual work instead of baby sitting some little old lady who felt that she got discharged too early.

Anesthesiology is an awesome field in a vacuum but suffers from the need to be in strong PP group with a bunch of stipulations to really be ideal.

I feel like I can't pick a field solely based on the medicine because each of them have such flaws these days.

Literally one day we had one of the worst attendings in the program teaching and of the rare times there is patient interaction in radiology it went bad. I still think it was a rash decision given how much I enjoy medicine/anatomy but also enjoy computers and tech. It really does come down to picking the lesser of all evils because all fields have their BS it's just the BS we tend to deal with in this field can be bothersome because, let's be real, in a lot aspects anesthesiologist get treated like second rate citizens in the hospital until we're need and then we're super heroes. Most of us in this field simply HATED clinic and found radiology too boring (or didn't have the credentials to match the field).

 

[Mman]

at least the others dont have to get up at the ass crack of dawn every day to put up with whining crnas who think you are better than you are , dingus surgeons who think you are useless and get paid too much, passive aggressive holding room nurses who think you create work for them, hospital administration who are trying to replace you with someone cheaper constantly, every single page that is not answered within 25 secs is reported. All the while trying to get a moment of peace to take a dump is a struggle. That is the day in the life of an anesthesiologist.

when I retire 10-20 years before them I will chuckle

 

[tennessee2244]

at least the others dont have to get up at the ass crack of dawn every day to put up with whining crnas who think you are better than you are , dingus surgeons who think you are useless and get paid too much, passive aggressive holding room nurses who think you create work for them, hospital administration who are trying to replace you with someone cheaper constantly, every single page that is not answered within 25 secs is reported. All the while trying to get a moment of peace to take a dump is a struggle. That is the day in the life of an anesthesiologist.

Damn you whine alot.

 

[tennessee2244]

This thread is toxic and not helpful to the anesthesia specialty at all. A moderator should close it.