Thursday, January 06, 2011

How To Become An Anesthesiologist

As fourth years wrap up interviews and third years begin to ponder the process, we will try to present posts regarding the career path for each specialty. Today, Scrub Notes contributor JCL, a fourth year medical student currently applying for residency programs, writes about how to become an anesthesiologist

Anesthesiology is a very demanding specialty which requires the mastery of a wide array of knowledge--from physiology, pharmacology, anatomy, to internal medicine and surgery. Anesthesiology not only challenges the cerebral arena but also requires manual dexterity and finesse. The best anesthesiologists are those who are very observant, fully utilizing one’s sensory and perceptive skills to make vital decisions that directly impact the outcome of a patient. They are also most often the calmest person in a room when something chaotic is occurring; they keep their heads when others are losing theirs. The anesthesiology profession calls on an intense but relatively short doctor-patient relationship. Do you trust a person to be your personal advocate to keep you alive during an operation which can potentially cause you death? An anesthesiologist must be calm under pressure, intelligent and decisive, as well as a team player to fully assure the best outcome for a patient, whether the patient is in the operating room or in the intensive care unit. The field of anesthesiology is a rewarding one in that one can choose from subspecialties within the area such as cardiothoracic, obstetrics, pediatrics, critical care, etc. The anesthesiologist is THE peri-operative physician. These “caped avengers” are also called upon to secure the airway in a code blue scenario or consulted on treating various acute cardiopulmonary diseases in the ICU.

One can become an anesthesiologist after going to medical school. Before doing so, one must decide if they want to become a licensed physician. Remember, nursing tracks to become a CRNA (a nurse anesthetist) are also available. CRNAs usually have some experience in ICU nursing care. CRNAs are usually supervised by MD-anesthesiologists in everyday practice and function as a part of the anesthesiology team.

To become a MD in the US, one must complete primary school, secondary school as well as college. One must take the MCAT to apply to medical school. The most important aspects of a medical school application are the applicant’s GPA and MCAT exam scores. Other things that would be extremely beneficial for a medschool application would be volunteering in the healthcare areas, research, as well as other interesting endeavors.

During medical school, it is important to decide whether a career in anesthesiology is for you. Those who seek the limelight or center of attention might not do well as anesthesiologists. Anesthesiology is considered successful when something DOESN'T happen. In the public eye, the anesthesiologist disappears from recognition. The happy anesthesiologist often recognize that the reward is the well-being of the patient at the end of the day, and that the patient made it safely through surgery.

If anesthesiology is for you, the anesthesia residency program is a total of four years of training after obtaining the Doctor of Medicine degree. To successfully match into an anesthesiology residency, the academic achievements are the most important aspects of the application (i.e. GPA, USMLE Step 1 and Step 2 scores). The anesthesiology residency has been getting more competitive in recent years.

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The anesthesiology residency is made up of an intern year and three clinical anesthesia years. The first year is an intern year, which can be one of several options, such as a preliminary internal medicine year, a preliminary general surgery year, a transitional year which is made up of various areas, or some other internship year (peds, etc). The transitional year is usually a combination of medicine, surgery, ER, peds, and sometimes Ob-Gyn and elective time. Most anesthesia residents complete a prelim medicine year or a transitional year. Anesthesia residencies are either “categorical” or “advanced.” Categorical residencies are those which includes internship year in the program so the applicant does not have to apply to different programs. The advanced programs require the intern year to be completed before matriculating into a program. The average anesthesiology applicant applies to both categorical as well as advanced to maximize matching outcomes.

After anesthesiology residency, one can either go into private practice, academics, or pursue a fellowship (i.e. subspecializing). The current ACGME accredited fellowships are pain, cardiothoracic, pediatrics, and intensive care. To be “boarded” by the American Board of Anesthesiology, one must take written boards as well as oral boards. Nationally speaking, written board pass rates are about 85-88% and the oral pass rate 75%. After obtaining board certification, you have become an anesthesiologist!


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