Anesthesia - Why I chose this specialty (and is it right for you too)

If you thought being an anesthesiologist meant giving a shot and then sitting around playing Sudoku - this video is for you.

Medical students and interns - if you're deliberating about choosing a specialty, it's important to get real information about every profession in medicine. In this video we'll talk about my profession - anesthesia. What residency looks like, which subspecialties you can focus on, what life looks like as an anesthesia specialist, and why I chose this profession - so you can choose well. And by the end of the video you'll be able to tell whether this profession is right for you or not.

I'm Dr. Elisheva, and on "Medicine Without Filters" I talk to you honestly about the path through medicine, from school through residency, and tell you about the real life of being a doctor.

Let's go.

## What does an anesthesiologist do?

First - let's start by defining the profession - what exactly is the role of the anesthesiologist.

An anesthesiologist is responsible for providing anesthesia for surgeries of all kinds in the operating room - but not only that. Anesthesiologists do a lot more than that, things not everyone is familiar with: we provide anesthesia outside the OR for all kinds of procedures (anesthesia for MRIs, for GI procedures, for procedures on the ward), we obviously also work in the delivery room - epidurals, anesthesia for cesarean sections - we also work a lot in the ICU, and in most hospitals we do call shifts there alongside the residents.

An anesthesiologist's training is one of the medical trainings that most emphasizes emergency skills - resuscitation, airway management, trauma. That's why in most hospitals we're also part of the resuscitation team - meaning if there's a code on the internal medicine ward, they call us to run it, and if there's trauma in the ER - we're called there too, either to manage the whole trauma or just the airway. We're also called for all kinds of procedures we're skilled in, like inserting a central line, or just helping with IV access in complex patients.

## What is anesthesia residency like?

Anesthesia residency lasts 5 years. In terms of hours and workload, it of course depends on the hospital, but the average number of call shifts per month is around 4, and in most hospitals there are also "sessions" on top of that - which is an operating program done after normal work hours for additional pay - some places make sessions mandatory, others don't.

In most hospitals you start at 7 AM and finish around 3-3:30 PM if there's no call or session that day, because that's when the morning surgical schedule is supposed to end.

During the residency years you spend most of your time in operating rooms, and there are also rotations through subspecialties - delivery room, pediatric anesthesia, cardiac anesthesia, regional anesthesia, pain medicine, neuro anesthesia, and six months in ICU. That's in addition to elective rotations you can do in various departments like pediatric ICU, cardiology, pulmonology and so on, and six months of basic sciences like every residency.

Like every residency, there's a Part 1 exam and a Part 2 exam - Part 1 is a written exam taken after at least half of the residency, and Part 2 is an oral exam taken sometime during the final year. Part 1 in anesthesia is actually considered one of the harder ones compared to other Israeli specialties.

In terms of call shifts - in many hospitals they're split between OR, delivery room and ICU call, and the workload varies between hospitals. I did my residency at Ichilov, and the calls there were very busy, both in the delivery room and the OR - and on most calls you work almost the entire night, and in the best case maybe sleep 3-4 hours.

On the more social side - it's generally a residency with a fairly positive social atmosphere, and a lot of that has to do with the fact that, first of all, we're not working together all day on top of each other, so when we meet we're happy to see each other - and also because we're less dependent on each other workwise, so there's less room for fights between residents. By contrast, in an internal medicine department, if a resident doesn't show up or works more slowly it loads onto the other residents and creates more complex relationships - and that's not how it is in anesthesia.

In terms of admission to the residency - less competitive than surgical specialties like plastics, OB-GYN, ENT etc., but there are hospitals with a waiting list of several months. As a rule though, it's not a specialty where you have to do two years of external call shifts just to earn the right to maybe go to an admissions committee.

## Fellowship options after residency

After finishing anesthesia residency, many anesthesiologists continue to work as generalists who do a bit of everything and don't necessarily subspecialize, but some do choose to do a fellowship or subspecialty. After anesthesia, there are two fields that require a full subspecialty - meaning two years where you're back in resident status, and you do Part 1 and Part 2 again. Those two fields are pain medicine and ICU.

All the other fields you can specialize in - pediatric anesthesia, cardiac anesthesia, regional anesthesia, cardiac surgery anesthesia, neuro anesthesia - these are fields where you do a peer fellowship or what's called a "fellow." You can do the fellowship in Israel or abroad, and it's usually a year or two of experience in the field you chose, with no exams.

And something important to know - in anesthesia there's really no requirement to do a fellowship abroad, unlike in surgical specialties.

Like in any specialty, it's a field where you can do research and advance that way if you want to - it's true that until not long ago many anesthesia departments were a bit less research-oriented than other fields, but that's changing a lot and many young doctors are doing research in anesthesia.

## A day in the life of an anesthesia specialist

First of all, it's very important to understand that unless you go into pain medicine - anesthesia is almost exclusively a hospital profession. Even if you want to do anesthesia in a private hospital - that's still a hospital, and the main work environment is the operating room. It's not a profession where you can go out to a community clinic, and it's less likely you'll have the option to manage your own time and work hours independently like a doctor who sits in a clinic.

In the case of anesthesia, the day-to-day of a specialist working in a public hospital is fairly similar to that of the resident.

Usually we're assigned to anesthetize in a particular OR for that day - say we're scheduled to anesthetize in the orthopedics room - there might be 5 very short surgeries or one big surgery - it varies. We meet our patients in the admissions area, examine them, bring them into the OR, and start the anesthesia induction.

On some days, if the surgery is a bit long, after induction you have some time to sit... and read articles and write research, of course, what else? But seriously, as a resident it can be a good time to study for Part 1 and Part 2.

On the other hand there are days with complex unstable patients, super complex inductions and big surgeries where we don't sit for a second and constantly treat the patient. There are also days with lots of short surgeries in the room, and then too there isn't much downtime.

So the stereotype of the anesthesiologist who pushes propofol and sits there playing Sudoku isn't exactly true (usually) (sometimes it is).

We usually finish around 3-3:30 PM, and if the surgeries in that room aren't done by then, usually the on-call doctor comes and takes over from us.

Another important point - anesthesia is a profession where in principle you keep doing call shifts for your whole life, even as a specialist. (Yes it's terrible.)

The number of call shifts you do as a specialist varies - where I work it's 1-2 but there are places where it can be 3-4. We also do home call like specialists in every field of medicine, meaning you're at home and can be called in if needed. It's important to emphasize that call shifts as a specialist also make up a significant portion of our salary in public hospitals because the call shift pay for an attending is significantly higher than for a resident.

And of course you can't talk about being an anesthesiologist without mentioning our breaks - in our field there's always a morning break and a lunch break, meaning another anesthesiologist comes to replace you so you can go on break, and then all the surgeons are really jealous of us, it's really nice.

## Work-life balance for anesthesiologists

Anesthesia is a profession that relatively allows for work-life balance both during residency and certainly as a specialist. You usually finish on time, it's less of a profession where you get stuck unexpectedly in the OR until late hours like surgical specialties, and in most places you don't do a crazy number of call shifts. And the general vibe is usually fairly reasonable consideration for your life even as a resident.

Financially too - an anesthesiologist earns well from a career in a public hospital - meaning you don't need to run between a million different places to make a good salary. But of course you can also work in private hospitals, where the work format is a bit different, you work 8-hour shifts of morning or evening shift.

## Who is this career right for?

So who is this profession actually right for?

We like to say that those suited to anesthesia are people who are a little OCD with an addiction to adrenaline.

You have to be able to accept that a mistake you make could kill a patient - not sometime in the future, but immediately - and that leads to a certain mental pressure.

People who go into anesthesia are people who really love working with their hands, and also a bit impatient in the sense that we want to give a medication and see immediately how it affects, not wait two months.

Another important trait is being task-focused, being able to distinguish the essential from the unessential - to know what's important and what isn't.

And you need to be a person who can stay calm and function in emergency situations.

I'd also add - those who go into anesthesia are people who don't mind being a bit more behind the scenes ego-wise - the patient usually belongs to the surgeon, who is their primary caregiver, and our role is critical but somewhat less in the spotlight.

The profession is also less suited to someone who wants great independence as a specialist and the option to open a clinic and fully control their work hours and not depend on anyone else, and less suited, obviously, to someone who doesn't connect with the operating room and the hospital environment.

## Why I chose anesthesia

And I'll finish by saying personally why I chose this profession.

What I love most about anesthesia - is that you have to earn your patient's trust in a very short time. People always joke that anesthesiologists are people who don't like talking to people, not exactly people persons, but as you can see that's not so true - I've been monologuing for 6 minutes already?

But we have an important role in calming and accompanying the patient through stressful moments, especially when it comes to the delivery room and cesarean section, for example.

I really love working with my hands and feeling in control during high-pressure situations.

I love that there are stressful moments sometimes but I'm not all day every day in a state of overload like in the ER, for example - there are moments of adrenaline but also time to order things from Amazon.

One of the big advantages of the profession is that you're never treating an entire ward - you're treating one patient, and focused only on them for the duration of the surgery - instead of spreading yourself across a ward of 50 patients.

It's also a profession with relatively little bureaucracy compared to other professions - no discharge letters, consult requests and phone calls all day like in the wards. You really feel that you're spending most of the day actually doing the profession you studied.

Another thing I really love is that even though we work alone as the anesthesiologist in the room, we always work with the OR team - surgeon, nursing staff - so on one hand you have the independence to make anesthesia decisions on your own, on the other hand - there's none of that loneliness you can feel when you're sitting completely alone in a clinic.

I hope this video helped you. If you're deliberating about choosing a specialty, I also recommend watching my video on the 5 common mistakes in choosing a medical residency.

Don't forget to subscribe to the channel. You're welcome to write me questions below and I'll answer.

See you in the next video.