Anesthesiology’s allure: High pay, flexibility, intellectual stimulation
This is the first in a series of articles profiling medical specialties.
Anesthesiologists like to joke, “We put people to sleep.” But in fact, the specialty is anything but dull. DOs who specialize in anesthesia describe their field as fast-paced and intellectually demanding, yet amenable to family life, with intense high-pressure workdays offset by ample personal time.
One of the top-paying medical specialties, anesthesiology attracts far more applicants than available graduate medical education positions. To be competitive for residencies, osteopathic medical students need stellar scores on the Comprehensive Osteopathic Medical Licensing Examination—USA (COMLEX-USA) or the United States Medical Licensing Examination (USMLE).
Many DO students who are interested in anesthesiology take the USMLE because it carries more weight with ACGME-accredited residency programs, which outnumber AOA-approved programs in the specialty 10-to-1. However, students need to select their residency route with an eye to the future because certain administrative positions within osteopathic medical education are closed to those who are not AOA board certified.
Normally, osteopathic medical students have limited formal exposure to anesthesiology until the fourth year of med school, when it is offered as an elective rotation. But students contemplating an anesthesiology career need to lay a strong foundation in Year 1 by mastering the basic sciences. Such students should also find opportunities to learn more about and demonstrate interest in the science and technology of anesthesia.
Long career, balanced life
Experienced hospital-based anesthesiologists often make more than $350,000 a year. Compared with other medical specialties, the pay for anesthesiologists is in the top 5%, says Dennis E. Kane, DO, the president of the American Osteopathic College of Anesthesiologists.
Although attending anesthesiologists frequently work 12-hour days and are on in-house call for 24-hour shifts, they typically receive several weeks of paid vacation time per year and they aren’t expected to be accessible on their days off.
“One of the things that was appealing to me about anesthesia was that when I was at the hospital I was at work and when I was on call, I was on call. But when I was not at work or on call, they weren’t calling me,” says Barbara D. Dougherty, DO, a Sewell, N.J., anesthesiologist who raised three children and has been in practice for 32 years. “It was my time when I was at home.”
A former chair of a hospital anesthesia department, Dr. Dougherty is winding down her career by practicing at an outpatient surgical center, which means shorter, more consistent hours.
Today, anesthesiologists have many practice options, with varying hours and flexibility, notes Allan R. Escher, DO, the vice chairman of the American Osteopathic Board of Anesthesiology. “By practicing at a surgery center or with a group administering office-based anesthesia, or by practicing pain management in an office setting, it is possible to have a career in anesthesiology in which you have set hours or work part time,” he says.
Given this flexibility, it is not usual for anesthesiologists to practice well into their 70s, and more and more women are entering the specialty, Dr. Escher points out. Although anesthesiologists sometimes experience career burnout because of daily pressures, it less likely than in emergency medicine and surgical specialties, he says.
Nevertheless, due in part to their easy access to narcotics, anesthesiologists have a higher rate of opiate abuse than do most other medical specialists, warns Dr. Escher, who serves on the Florida Board of Osteopathic Medicine.
What it takes
Despite the adaptability of an anesthesiology career, the requirements to enter the field are strict. Only those with specific interests, aptitudes and personality traits should consider the specialty, anesthesiologists say.
“As anesthesiologists, we essentially are doing applied clinical pharmacology,” observes Mike Green, DO, the director of the anesthesiology residency program at the Drexel University College of Medicine in Philadelphia. “We’re giving patients medications and watching the changes in realtime as they are occurring in the operating room. That’s what makes it exciting.”
The specialty, thus, draws medical students who excel in the basic sciences and pharmacology, Dr. Green says. And it appeals to results-driven individuals, who like to see the fruits of their labors immediately. With patients’ lives hanging in the balance, anesthesiologists must be extremely observant and able to think and act very fast. They must detail-minded and always well-prepared should something go awry.
“Anesthesiology is also a specialty for people who want to work with their hands,” Dr. Green says. “Whether it be vascular access or airway management, we are doing procedures to some degree on every patient we see.”
Hospital-based anesthesiologists constitute a major component of critical care medicine, so individuals considering anesthesiology need to have an aptitude, as well as passion, for caring for patients with life-threatening conditions, Dr. Green notes. “We assess people when they enter the hospital. We assess them preoperatively and develop and anesthetic plan. We take care of them in the operating room. And we take care of them during the postoperative period,” he says.
“The most desirable trait for an anesthesiologist is reliability, followed by honesty, functionality under stress, punctuality and discipline,” says Dr. Escher, who is an attending anesthesiologist at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Fla. “The patients are very dependent on you, and the surgeries don’t happen without your presence. This is the kind of field where if you are having a bad day, you still have to perform at your best.”