Robert C. Hinckley's The First Operation Under Ether (1883) recreating the milestone that occurred in 1846 at Massachusetts General Hospital.

INTERVIEW: Dr. Timothy Long
Residency Director, Mayo Clinic (Rochester)

What attracted you to the field of anesthesiology? 
There are many things that have attracted me to the field.  I have always enjoyed the operating room.  Although I am very procedurally oriented, I also enjoy the intellectual aspects of medicine.  Anesthesiology provides a nice mix between the two. 

Are you satisfied with your specialty choice? What would have been your second and third choices? 
Yes.  I considered various surgical specialties.

What is a typical day like for you?
This depends on the type of practice you are in.  It is not uncommon for anesthesiologists to be the first physicians to the hospital in the morning.  Our hours are very dependent on surgical volumes, so the hours can be quite variable.  If you are in a practice that does medical directions (i.e. directing CRNA cases), your day can be quite busy, as you generally will be supervising up to four rooms.  This involves preoperative interviews with patients, induction, emergence from anesthesia, and being available for critical events. 

What is your favorite part of the career you have chosen? Least favorite?
I enjoy working in the team environment.  Working with people from many different specialties and backgrounds can be very challenging, yet very rewarding.  The opportunity to work in an academic environment has allowed me to be involved with medical student and resident education.  This is without a doubt the best part of my job. Having spent some time in private practice, the part I liked least was “running a business”. 

Does a career in anesthesiology allow you to strike a satisfactory work-life balance? How does this compare to your colleagues in other sub-specialties?
Anesthesiology is unique in the ability to have a satisfactory work-life balance.  When you leave the hospital, you leave with a sense of having accomplished/finished something.  We work hard while we are in the hospital, but once we leave we don’t have the worries of chronic follow up with patients.  

Are there part-time positions available? How prevalent and practical are these?
There are many part time positions.  Often those who are interested in working part time in private practice are not on partnership tracks. 

 Did you sub-specialize? How do these affect lifestyle? 
No. Many people seek fellowship training in anesthesiology.  Currently, certificates are only granted for pain and critical care.  Most people that seek fellowship training stay in academics.  That being said, there are many private practice groups seeking anesthesiologists with specialty expertise in various areas.  

What does the future hold for your field? How do you see it evolving? 
The future is bright.  There is still a relative shortage of anesthesiologists in the U.S.  In the future I anticipate more involvement by anesthesiologists with perioperative medicine – i.e. preoperative evaluations, postoperative care, and pain medicine.  

Would you change anything about your specialty choice if you had a chance? 
No

In your opinion, what qualities would make a student particularly suited to this specialty?
Those who succeed in anesthesiology are not only bright people, but they are hard workers, team players, and people that can work with many different personalities.  You have to be willing to be the “unsung hero”.  In Anesthesiology, if you are not noticed, you are doing a great job.  

What advice would you give medical students who are considering a career in anesthesiology? 
Anesthesiology has become very competitive.  Although USMLE scores are important, your performance during medical school probably provides a better evaluation of your capability.  It’s also important to get some exposure to anesthesiology with a formal rotation.  Many schools do not offer a rotation until relatively late in medical school.  In these situations, you can get some exposure while you are on other services – i.e surgery, obstetrics, etc.  

INTERVIEW: Drs. Flores and Shakespeare:
Residents, Mayo Clinic (Rochester)

When did you first become interested in pursuing the field of anesthesiology? 
Flores: I completed a two-week elective in Anesthesiology during 2nd year of medical school. While observing residents and attendings, I discovered an attraction to this field due to the combination of procedural and cognitive aspects within the daily practice. Anesthesiologists perform nerve blocks, obtain central access, and manage the airway; all in addition to, ensuring the co-morbidities of the patient are well-compensated and keeping the patient safe and comfortable.
Shakespeare: I didn’t encounter the field [of Anesthesiology] until the first year of my Emergency Medicine residency. By the end of the third week I realized that the specialty shared many of the virtues of Emergency Medicine—including care of the acute patient and a strong procedural component—but also offered a control and a physiologic rigor that was exciting to me.

What where the top 3 medical specialties you considered?
Flores: Many people who are drawn to Anesthesiology often are also interested in Emergency Medicine or Surgery. However, I was interested in Anesthesiology, Medicine, and Radiology in medical school. I enjoyed the cognitive aspect of Medicine and the anatomical knowledge necessary for Radiology, but ultimately chose Anesthesiology...
Shakespeare: Emergency Medicine, Internal Medicine, and Anesthesia 

Is an internship required? If so what type of internship was it (surgery, internal medicine, transitional year)?
Shakespeare: The classic path into anesthesia involves a preliminary year (either surgical, medical, or even pediatric), followed by three years of dedicated training in anesthesia. My Intern year consisted of an exposure to various medical disciplines; I spent time in the ICU, the Emergency Department, on the General Medical service, on Obstetrics, and on Orthopaedics.

 How many hours do you work on average in your residency now? How often are you on call?
Flores: The average anesthesiology resident works around 55-65 hrs/wk and usually enjoys 2-3 weekends off each month. The call frequency varies but is usually every 5-6th night. Of course, the hours and call can be more frequent on certain rotations (i.e. ICU, obstetric anesthesia).

Pressure = intensity + time. On a one-to ten scale, how would you rank anesthesiology residency in comparison to other residencies?
Flores: Anesthesiology is interesting in the fact that it generally is 90% routine and 10% chaos. Most the day-to-day motions, once learned, are not usually stressful; however, when something goes awry it can become stressful in an instant. That being said, the residency compared to others is less stressful and generally allows one more time for activities out of the OR (i.e. reading, time with family)
Shakespeare: If neurosurgery is a ten then anesthesia is a two or a three. The intense situations in anesthesia are among the most critical and acute medical events there are, but the care is confined to the perioperative period so there is a well circumscribed end point to the responsibility.  Also, anesthesiologists have led the medical field in recognizing the dangers of physician exhaustion and have streamlined the process of workflow and hand-off.  

What is a typical day like for you? Do you find it repetitive or continuously engaging?
Flores: A typical day starts for an anesthesia resident start around 6 am where you come in and setup your OR for the day. We then have a short lecture at 7am. The surgery generally starts around 8am. We are generally in the ORs until 3-5pm (depending on the rotation). Once you get into a routine of the rotation it can be repetitive at times, but you must keep constant vigilance of the patient at all times due to the possibility of an untoward event at any time. This keeps you mentally engaged. 
Shakespeare: …Anesthesia is extremely engaging.  It is like critical care in the ICU but managed with a patient undergoing a tremendous surgical stress that affects hemodynamics, neurophysiology, and respiratory function.  This requires moment to moment diagnosis and treatment.  I often look up from intense management of a busy case and find that hours have passed without my realizing it. 

Are you able to balance a your training with an appreciable home life?
Flores: In anesthesiology I have been able to find a great balance between my training and home life. My wife works full-time and yet we are still able to take short trips, watch movies, and eat dinner together often. I also have maintained a regular workout schedule. This is an important outlet that helps relieve the stress of residency training.
Shakespeare:  I find the schedule of Anesthesia to be very functional.  I am a husband and father and I find that having a career that is very morning-loaded means I am usually done in plenty of time to study in the early afternoon and then spend the evening and weekend with my family.  Anesthesiologists love their jobs and their families love their jobs too.  

In your opinion, what qualities would make a student particularly suited to this specialty?
Flores: There is no one particular qualities one needs to be an anesthesiologist. However, generally, anesthesiologists enjoy pharmacology and physiology, and like working with their hands but are also adept at problem-solving and crisis management.
Shakespeare:  Interest in critical care, pharmacology, procedural medicine, and physiology plus compatibility with a team make a student a prime candidate.  

Are you happy with your choice?
Flores: At this point, I am very happy! A career in anesthesiology challenges me mentally almost daily and yet allows me time to read and pursue a good home life.
Shakespeare:  I love my job even as a resident—I can’t imagine a better fit.  My look further down the career road, based on the examples I see around me, leads me to believe that Anesthesiologists work long careers and never regret their specialty choice.

COMMENTS