You are soon to be a trained and certified anesthesiologist. As your hypothetical attending, I can’t (and don’t really want to) tell you what to do anymore - it might reveal my own ignorance. Despite the curse of interesting times, the anesthesia job market is still hopping, and hospital systems are looking for you and your superpowers for their departments. You are very “essential,” even in a field of essential workers.
Job market conditions ebb and flow. But surgical volume has continued to rise overall, despite the pandemic effects this spring, so the long-term trend is good - people increasingly need procedures and surgery and the concomitant anesthesia. But good marketability is not your superpower. Your superpowers, enumerated here, are granted to you upon graduation. Your attendings may have had a chance to communicate these to you in one of the hopefully many teaching lessons between a trauma code and a liver transplant case. But in case you weren’t paying attention, well here they are.
Superpower 1 - Trust
The role of anesthesia has been debated, fought over, and even minimized by others outside the field for decades. Guess what? Anesthesiology is still standing and even flourishing. By now, decades of naysayers would have anesthesiologists replaced by nurses, physicians assistants, surgeons, Joe The Plumber off the street, spreadsheet algorithms, or some kind of advanced AI. Anesthesiologists didn’t get replaced though. Why is that?
Anesthesiology is still the practice of medicine. You have a medical license issued by a state medical board. Anesthesiologists with training certification (soon to be in your gloved hands), can get medical staff privileges at licensed facilities that have Departments of Anesthesia, can be credentialed by payers such as Medicare and all private insurer payers with an individual NPI number, and represent the standard of education and care with malpractice insurance of carriers.
Physician anesthesiologists remain the standard bearer of anesthetic care and, for now, remain independent. Corporations, hospitals, and government entities would encroach on these rights, albeit in the name of some kind of cost-saving pablum. But patients know better - they trust corporations, hospitals and governments the least in every poll relative to a physician. State and federal laws still remain in place, born of a history of patient abuse and witnessed distrust, that ban the practice of medicine by anybody but a physician.
Ostensibly cheap knockoffs from distrusted entities are not acceptable to the current medical system or to patients. Nobody trusts an airplane pilot that flies safely 99% of the time. 99% of you is still not good enough. Patients, surgeons, hospitals and surgical facilities just trust you. They want the 100% you. Just ask your patients. Just ask Siri. You’ll see.
Superpower 2 - Time
As a young, thirty-something anesthesiologist with all the proper education and paperwork, you will soon be getting credentialed at some facility (probably for the first time). You will put on new scrubs. You will be the new kid on the block, and you will have a chance to prove yourself. Clinical practice tends to be easier in some ways than academic training - the cases may not be as complicated, and you are finally getting paid what you are worth.
But no matter what your situation, you will still have prove yourself. You will have time to adapt and change, to learn new skills, and to learn the facility and group politics of surviving and thriving. Don’t like how something is being run? Can’t stand that medical director, surgeon, or administrator? You can play the long game of patience. You can literally wait them out. Keep your head low, be persistent, and wait. Their clock will run out before yours. Still don’t like what you see? You can find a different situation. You still have time.
About the time the powers above you start posting pictures of their retirement plans on Facebook, you can start making the wholesale changes you have been scheming about all these years. You can walk into their job if you so desire.
Jealous of your senior partners with the big houses, vacation homes, and padded retirement accounts. Don’t be! It’s all the time value of money, and the compounded interest of investments. Get a house, save in your retirement accounts, make good investments, and let time take care of the rest.
Many of your senior partners would trade it all, all the accrued wealth and experience, to be thirty-something again.
Cherish this superpower. When it’s gone, you’ll wish you could run back the clock.
Superpower 3 - ABC
For some reason as an anesthesiologist, you are trained in the arts of ABC: Airway, Breathing, Circulation. You can literally prevent clinical and textbook death. You are the ABC guru, capable of stabilizing or rescuing almost any coding or near-coding patient.
With this superpower as you wander around the hospital or surgical center, you are the expert on securing an airway, mechanically breathing, or getting circulatory access for patients. Everybody is literally happy to see you. You are an anesthesiologist! Your superpower is the magical ability to suddenly stabilize a patient, even ones that aren’t yours. This brings relief to everybody. “It’s okay, take a deep breath, there is an anesthesiologist here”, they are thinking as you walk by.
This is even true amongst fellow medical providers and physicians. You are better at intubating, managing a ventilator, and getting venous/arterial access than almost any medical professional, and certainly at doing all three in combination. The essential tools of medical life. You can prevent immediate death better than anybody. They know it and you know it.
Still not convinced? Imagine one day soon you are at wedding, political fundraiser, or on an airplane to Hawaii. All crowded. There are lawyers, politicians, accountants, teachers and business people. There are other medical professionals. A person you don’t know collapses. The call for “a doctor in the house” goes through. Amongst those who respond are pediatricians, internists, neurologists, dermatologists, psychiatrists, and radiologists. And then there is an anesthesiologist – you, AKA the ABC guru.
Other than perhaps an ER physician, there is nobody better equipped to stabilize the patient in a crowd, in an emergency. This has happened to all of us. You will be one of the last doctors remaining, the one sitting with the patient waiting for EMT's on arrival to Hawaii on a transpacific flight. You are that essential. You can stop death in front of everybody. You have special powers. The looks from others on the plane or at the wedding will confirm that. In that moment you have revealed your superpower.
From Star Trek, “I can do that”:
Superpower 4 - Anesthesia
All across the country and across world people are anesthetizing themselves both legally and illegally. Some are drinking alcohol, others are using narcotics, smoking hallucinogens, taking benzodiazepines, or smoking cocaine or methamphetamines. All are using bioactive substances, anesthetizing themselves for some personal purpose. And all of these substances and the receptors on which they work are what we work with every day in our clinical lives.
We administer our medications for anesthesia to prevent or relieve the pain and suffering from surgical trauma. We are the acknowledged expert of anesthesia in a world seeking anesthesia. We know the pharmacodynamics, the pharmacokinetics, and we know how to administer it safely or when it is unsafe to administer.
We are the smartest EQ in the room when it comes to safety and anesthetics. When patients are in pain, we know how to use anesthetics as analgesics. Combined with neuraxial and peripheral nerve techniques, we can in myriad ways provide analgesia to prevent patient suffering. We literally give drugs and perform techniques that almost any other medical provider is afraid to.
We know pain. We can prevent pain. We can stop pain. When patients are screaming in pain, whether from surgery, injury or labor pain, how do patients look at you when you stop the pain? They look at you like a superhero.
Conclusion - Some superheroes wear scrubs
Next time you see a patient, communicate these superpowers. Make eye contact and acknowledge your power in service of the patient, primate-to-primate. It just takes seconds. “I will take care of you. I put a long time into my education. You will not die. You will not suffer. This I promise you.” Through your eyes and your demeanor, you should tell this subconscious story.
These are your superpowers. They belong to you and only you. You have a unique Medicare NPI number to prove it. These powers will not last forever, and sometime later when your superpowers fade away, you will miss them and wonder where did they go? Be cautious of those who will attempt to demean them, subvert them, or profit off of them. Only you can give these powers away.
Congratulations again, it’s been a long road through a lot of hardship. You’ve trained longer to get where you are than almost any other educational path known to mankind. If nothing in this blog post has gotten through, then just watch this short video summarizing your medical training and graduation and…the long awaited payoff. It is from one of my all-time favorite movies, The Shawshank Redemption. Enjoy your freedom...you earned it. https://www.youtube.com/watch?v=YvPerZLPnm4
Harrison Chow, M.D., M.S. is a frequent contributor to the CSAOF. He is an Associate Professor of Clinical Anesthesia, Stanford Medical School. He is also a former Department of Anesthesia Chair of Good Samaritan Hospital and is a current Delegate for the Hospital-Based Practice Forum at the California Medical Association and District 3 for the CSA.