What is an Anesthesiologist?
If you think that you'd like the operating room environment versus doing rounds, and would be ok handling the occasional emergency, anesthesiology might be for you.
An anesthesiologist is a medical doctor who keeps a patient comfortable, safe and pain-free during surgery by administering local or general anesthetic. Once the patient enters the operating room, an anesthesiologist will be by their side throughout the surgery, making sure they are stable right through to the post-anesthesia care unit.
Anesthesiology is a prestigious and lucrative field of medicine, but requires a great deal of education and expertise.
What does an Anesthesiologist do?
An anesthesiologist will meet with the patient prior to surgery to make sure they are suitably prepared and medically fit to endure the proposed surgery as well as the related anesthetic. Once they have done this, just before the surgery, the anesthesiologist will administer either a general or local anesthetic to the patient.
During the surgery, the anesthesiologist will monitor the patient's blood pressure, heart rhythm, temperature, level of consciousness, and amount of oxygen in the blood. For a general anesthetic, the anesthesiologist will monitor each breath. This is done by measuring the volume of breath exhaled and the amount of carbon dioxide in each breath. They may also measure the amount of blood the heart is pumping and blood pressure inside the lung vessels.
After putting the patient to sleep, the anesthesiologist will adjust the patient's position if necessary, depending on the surgery being performed. For example, a back operation will require a different position than a stomach operation. Also checking to make sure a patient doesn't have his legs crossed is important, as the patient can potentially sustain nerve damage if the legs are crossed for the duration of a long operation.
Some of the anesthesiologist's duties during surgery include:
- Continuous monitoring of vital signs
- Monitoring of the level and depth of anesthesia
- Making adjustments if necessary
- Recognition of any potentially life threatening emergencies and timely intervention
- Ensuring the safety of the patient at all times
They may also work with patients who need pain management for other issues outside of the operating room and delivery room. They provide after care for patients who have had surgery and still require some sort of pain management. They may also work in emergency rooms, and help with patients who need immediate pain relief or sedation.
Anesthesiology, like all medical disciplines, is sufficiently complex that it is divided into several subspecialties. While initially trained in anesthesiology as a whole, as they move through residency training, anesthesiologists choose to specialize in a particular area.
The following are some subspecialties within anesthesiology and a brief outline of the responsibilities involved for each:
This type of anesthesiologist has advanced training specifically dedicated to cardiac and thoracic anesthesia involving the heart and lungs, and whose responsibility it is to make the perioperative period both safe and comfortable for the patient.
Cardiothoracic anesthesiologists provide anesthesia for operations of the human chest, which may include bypass surgery (includes supervision of the bypass heart-lung machine), robotic surgery, minimally invasive surgery, and complex aortic surgery. They also keep an eye on the patient's bodily reactions to drugs during surgery.
Cardiothoracic anesthesiologists may also work with non-cardiac procedures, like performing ultrasound assessments for cardiac health, electrophysiology consulting for the reprogramming of pacemakers and implantable cardioverter-defibrillators (ICD), esophageal resection, and various types of video-assisted thoracoscopic surgery.
They often conduct research to help improve anesthesia and patient care during surgery and study medicines and ways for caring for heart patients before, during, and after an operation.
Critical Care Anesthesiologist
Some anesthesiologists pursue advanced training to subspecialize in critical care medicine in both adult and pediatric hospitals. Because of their comprehensive training in resuscitation and in clinical physiology and pharmacology, anesthesiologists are particularly suited to administering to patients in the intensive care unit.
Critical care anesthesiologists are able to coordinate the medical assessment, diagnosis, respiratory/cardiovascular support, and pain control needed by ICU patients - as well as provide airway management, advanced life support, and cardiac and pulmonary resuscitation in many emergency and trauma situations. They also play a vital role in stabilizing and preparing patients for emergency surgery.
Like other anesthesiologists, neurosurgical anesthesiologists provide anesthesia in the operating room, but specialize in the anesthetic management of patients with various conditions of the central nervous system, the brain, and the spine.
Anesthetic management is needed for aneurysms, head injuries, pediatric neurosurgery, spine surgery, arteriovenous malformations, intracranial tumors, stereotactic procedures, and neuroradiological procedures.
These types of procedures not only require having a solid understanding of neuroanatomy and neurophysiology, but require the knowledge base to measure intracranial pressure, cerebral blood flow, and cerebral metabolic rate.
An obstetric anesthesiologist works closely with obstetricians, perinatologists, midwives, neonatologists and labor and delivery nurses in order to give quality care for pregnant women and their babies.
Obstetric anesthesiologists serve in labor and delivery, ready to assist in the management of pain of labor and delivery, to administer anesthesia for cesarean section, and to manage emergencies that may arise.
They discuss pain management options with the mother, and administer an epidural anesthetic if the mother decides that she wants it. They watch over the mother and if the labor is long, or the epidural wears off, they provide another dose.
Children are not small adults and no child is exactly the same. Pediatric anesthesiologists focus on providing an individualized experience for each child, based on his or her needs. After surgery, pediatric anesthesiologists are involved in prescribing pain medication or recommending pain-relieving techniques for each child that is best for providing comfort and rest for optimal recuperation.
Pediatric anesthesiologists are also involved in caring for children during radiological imaging or scanning procedures, gastrointestinal procedures, and other non-surgical treatments that require a cooperative and motionless patient.
Other careers within anesthesiology (not physicians):
A nurse anesthetist (or a certified registered nurse anesthetist (CRNA)), is someone who has completed graduate-level education and has been board certified in anesthesia.
They are capable of administering anesthesia under the oversight of an anesthesiologist, surgeon, dentist, podiatrist or other qualified healthcare professional. Some nurse anesthetists hold credentials in fields such as respiratory care or critical care nursing, and some choose to specialize in obstetric, neurosurgical, pediatric, dental or cardiovascular anesthesia services.
They are independently licensed health professionals, and are often the sole providers of anesthesia services that offer surgical, obstetrical, and trauma stabilization services in rural hospitals and areas where it would otherwise not be possible.
An anesthesiologist assistant (not to be confused with a nurse anesthetist) is a non-physician anesthesia provider who practices anesthesia under the medical direction of an anesthesiologist.
The assistant will operate anesthesia equipment, monitor patients, and provide quality anesthesia care. Anesthesiologist assistants accompany the patient before, during and after anesthesia to ensure quality and continued care. They are trained to assist in life-saving measures, such as CPR, and life support.
What is the workplace of an Anesthesiologist like?
Anesthesiologists often work in high stress situations, where a great deal of concentration and alertness is necessary, such as in the operating room. They also work in many outpatient facilities, and they will often have to work with people who are recovering from an operation, or those who need pain management treatment.
Frequently Asked Questions
What does it take to become an Anesthesiologist?
The requirements to enter the field of anesthesiology are very specific; only those with certain interests, aptitudes, and personality traits should consider this specialty. Anesthesiology draws medical students who excel in the sciences and pharmacology and who are results-driven individuals. Anesthesiologists must be extremely observant and able to think and act very fast as their patients' lives are hanging in the balance; they must be detail-orientated and be well-prepared should something go wrong.
Anesthesiologists assess patients when they enter the hospital and develop an anesthetic plan. They take care of patients in the operating room as well as during the postoperative period. Individuals considering anesthesiology need to have an aptitude and a passion to care for patients with life-threatening conditions.
What is the difference between an Anesthesiologist and a Nurse Anesthetist?
An nurse anesthetist is a nurse with extra training (typically two years) in the field of anesthesiology, and has the ability to administer anesthesia. In most surgery centres and hospital settings, they work under the supervision of a board certified anesthesiologist. An anesthesiologist is a physician who has gone through medical school, internship, and then an accredited residency training program in a US hospital.
What are the pros and cons of being an Anesthesiologist?
See if anesthesiology can be the right career fit for you. The following are some of the pros and cons in the field of anesthesiology:
- high salary
- job security
- wide variety of patient types
- professional respect
- working with your hands
- instant gratification and feedback in the operating room
- good working schedule
- over ten years of schooling
- getting residency positions can be very competitive
- lack of follow-up and continuity in patient care
- requires high level of responsibility and potential stress
What is some good advice for aspiring Anesthesiologists?
It is good to concentrate on science classes such as biology, chemistry or other advanced sciences in high school. After high school, the student who wants to practice anesthesiology should continue to concentrate on advanced science courses in university such as: anatomy, physiology, organic chemistry, physics and advanced math classes such as calculus.
All medical students applying in anesthesiology must do well on the USMLE (United States Medical Licensing Examination). If your scores are not competitive, you will have an uphill battle to get a residency slot at a top program.
At the very least, individuals should do an anesthesiology rotation at their local institution. Medical students who stand out pay attention to what is going on, anticipate events, know how to be helpful, and get involved with the entire patient care experience. It is not recommended to stand around and give off a bored presence.
Anesthesiology departments receive hundreds of applications each year. Some things that may set you apart from the pack: excellent grades and USMLE scores, a strong dean’s letter and other recommendations, personal experiences, prior careers, other degrees, thought-provoking research, a list of activities, and a unique personal statement.
How long does it take to become an Anesthesiologist?
It takes approximately 12 to 13 years to become an anesthesiologist. A bachelor's degree takes four years, medical school takes four years, and then another four years are spent as a resident. Some doctors follow their residency with a fellowship (another year) to further train in anesthesiology specialties like pain management, pediatric anesthesiology, or obstetric anesthesiology.
What types of anesthesia do anesthesiologists use?
The type of anesthesia an anesthetist uses during surgery will depend on the length and type of surgery, the patient's state of health, and the preference of the anesthetist.
There are four types of anesthesia:
General anesthesia is the strongest anesthesia - it is essentially a medically induced coma which makes the patient unresponsive during surgery. This allows the surgeon to perform surgeries that would normally be very painful if the patient were to be awake. Because this type of anesthesia paralyzes the muscles of the body, patients require a ventilator to do the job of the diaphragm.
Unlike general anesthesia where the patient is unconscious and the whole body is paralyzed, local anesthesia allows the patient to stay awake during the procedure. This type of anesthesia is used for minor procedures that can be completed in a short time, such as dental procedures or for numbing an area that needs to be stitched. The patient typically returns home the same day.
Regional anesthesia only numbs the area of the body that would feel pain, which enables the patient to have the procedure while they are still awake or sedated. Examples of this type of anesthesia are spinal or epidural blocks, where sensations in the lower body are blocked by injecting anesthesia near the spinal canal. This is different from local anesthesia in that a larger region of the body is numbed.
Monitored Anesthesia Care (MAC)
Monitored Anesthesia Care (also known as conscious sedation or twilight sleep), will make a patient sleepy and calm during a procedure. This type of anesthesia is given through an IV, and the level of sedation can range from light (patient is very relaxed), to heavier (patient only responds to significant stimulation). This type of anesthesia is different from general anesthesia in that the patient is not chemically paralyzed and does not require assistance with breathing - however their vital signs are closely monitored.
This type of sedation is used for procedures such as colonoscopies, endoscopies, dental procedures, bronchoscopies, eye surgeries, and pain management procedures. The patient is typically expected to go home after the anesthesia has worn off.
Should I become an Anesthesiologist?
A career as an anesthesiologist is rewarding but is not meant for everyone. Someone interested in this field might want to consider the following:
The educational debt for anesthesiologists can be broken down into three major parts:
Undergraduate Tuition - Some colleges are as low as $6,000/yr; others as much as $20,000/yr (don't forget to add another $10,000/yr for living expenses).
Medical School - An average of $160,000 for four years of study
Residency Training - There will be a salary during these four years, however you can expect to carry an additional $100,000 in debt.
Certification Costs - Certification gives anesthesiologists a competitive edge and recognition from peers. Certification is not required, however it does demonstrate professional competency. Anesthesiology certification fees are approximately $750 for the application, $1,400.00 for the CBT exam, and $1,600 for the oral exam.
Anesthesiologists are on-call and work around the clock in hospitals to administer anesthesia or pain medication to patients. This may not be the best work schedule for those with families.
Stressful Work - Not Much Recognition Working in a hospital environment is stressful, especially in emergency situations. Patients seldom recall who you are, as you are the first in and last out. You are sometimes seen as a technician instead of physician, and you are often mistaken for a nurse.
Patients may not remember a job well done, but they will remember a problem. They do not see that the anesthesiologist is watching every second, monitoring trends, response to medication, and reactions to surgical stimuli. Anesthesiologists must carry liability insurance in case they are sued for malpractice.
One of the biggest benefits to becoming an anesthesiologist is the high salary.
Anesthesiologists are also known as: