Can A Machine Replace An Anesthesiologist?

It could happen. A recent article discusses the Sedasys anesthesiology machine:

TOLEDO — The new machine that could one day replace anesthesiologists sat quietly next to a hospital gurney occupied by Nancy Youssef-Ringle. She was nervous. In a few minutes, a machine — not a doctor — would sedate the 59-year-old for a colon cancer screening called a colonoscopy.

The Johnson & Johnson device won approval from the US Food and Drug Administration in 2013, but so far only four hospitals are actively using the machine. Of course, anesthesiologists are opposed to the machine, as it threatens their livelihood. So far, they have succeeded in having the machine limited to very restricted indications, mostly simple screening procedures. The benefit of using the machine over referring physicians self-administering sedatives is that the machine can administer more powerful drugs like propofol, and more closely monitors vital signs.

Your next anesthesiologist?
Source: fda.gov

What this means for anesthesiologists of the future is unclear. Will the machine stay limited to such narrow indications? Or will it gradually increase its scope, eventually displacing anesthesiologists in all but the most complex of cases? In some ways, the situation is even more dire for nurse anesthetists, as one can more easily imagine replacing them with such a machine. The question of liability is left open in the article, but I imagine most referring physicians and hospital administrators would take on the increased risk if the machine proves to improve patient volume sufficiently without sacrificing safety.

What about medical students deciding on a specialty? It is always hard to forecast the future and one certainly shouldn't make career decisions simply off of potential risks. Each specialty faces the threat of technological disruption (just ask cardiothoracic surgeons who trained before the advent of coronary cath). The world described by physicians past in books such as The House of God no longer exists, much like the world we now inhabit described in Intern will be considered antiquated in decades hence. What is a medical student considering anesthesia to do?

Each person has to answer this question for themselves. However, if you are passionate about a specialty such as anesthesia, the answer is simple: pursue it. Do not let fears of future change dissuade you from the field where you believe you can be your best. Instead of avoiding the risk, embrace it by keeping abreast of the changes in the field, staying ahead of them, and perhaps even being the game-changer within the specialty. Over time, all medical fields evolve. Make sure you choose a field where you will be excited to change to meet the future.

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.

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!

Share your passion by publishing your writing on Scrub Notes today!

Updated 2015-12-20

77 New Cases of Hepatitis Are Identified in Las Vegas

Can you believe that 77 New Cases of Hepatitis C were identified in Las Vegas recently? This marks one of the largest outbreaks in the U.S. in recent times. The cause?

The officials had previously identified seven cases of the disease linked to the gastroenterology practice, one of the largest in southern Nevada, and a single case in one of the practice’s sister clinics. The infections were caused, they said, by the reuse of anesthesia syringes among multiple patients.

How avoidable, ridiculous, and tragic. These poor people are now victims of a chronic potentially fatal disease all due to someone's negligence and likely cost-cutting measure. No wonder many people out there are skeptical of physicians and how they practice.

Awake: The Movie - Hollywood Meets Anesthesiology

I recently read an article on the recently released Awake: The Movie. As the movie's IMDB profile notes, "The story focuses on a man who suffers "anesthetic awareness" and finds himself awake and aware, but paralyzed, during heart surgery. His young wife must wrestle with her own demons as a drama unfolds around them." Yawn. The only thing this movie has going for it is Jessica Alba. Heh, I just used that as an excuse to find that gallery. At any rate, the movie has some anesthesiologists concerned due to its portrayal of unscrupulous anesthesiologists torturing a patient and planning his murder during a procedure in which he has already been sedated but is still aware.

I have not seen this movie, nor do I plan to. The trailer I saw just sounded ridiculous. I sure hope no one out there is dumb enough to believe that this is commonplace. If so, that person probably also believes in The Force, hobbits, and the Matrix. How do movies like this even get made? Do they just draw ideas out of a hat? I remember when I was younger, people would always tell me to be "creative" by coming up with an idea, putting it in a bubble and then drawing lines to other bubbles and seeing what I came up with. At least, I think that was the idea. I imagine the bubble system here went something like:

"Jessica Alba" --> "Some dude" ---> "Grey's Anatomy's popular right?" --> "Okay, hospital" ---> "Jessica scared means she has to run around, right?" ---> "Okay, some kinda thriller" --> "Uhh... " ---> "What if the dude was really awake during surgery and people were trying to kill him?" ---> "JACKPOT"

If that's all it takes, then... damn, I am in the wrong field. Hollywood, here I come!

Updated 2015-12-07