We often think of sports stars as the masters of maintaining grace under pressure. The term “clutch athlete” obviously exists for a reason. But these individuals are far from the only professionals who need this competency. In fact, some physicians probably have athletes beat in that department.
If you want to pursue a career in medicine and know you’re great at maintaining composure during extreme circumstances, you might want to get more acquainted with anesthesiology. Anesthesiologists work in high-pressure situations all the time. But aside from being the doctor who helps people fall asleep before surgery, what is an anesthesiologist, exactly?
It’s hard to imagine what it would be like if common procedures like appendectomies and cesarean sections weren’t feasible. Believe it or not, that was the case in the not-too-distant past.
How did modern anesthesiology come to be?
Medicine has come a very long way in a relatively short amount of time. The first medical professional organization in the colonies, which eventually became the US, was established in the latter half of the 18th century. Surgery has undergone some of the most impressive advances thanks to doctors’ ability to effectively apply anesthesia. Before then, most surgical procedures were too painful to perform.
While nitrous oxide had been introduced to the medical profession by around 1800, surgical use of anesthesia wasn’t demonstrably feasible until 1846. Soon after, medical professionals began developing regional anesthesia to numb an area of the body when they realized the potential clinical applications. Anesthesiology began to emerge as a physician specialty at the beginning of the 20th century. As practitioners continued to improve patient safety, anesthesia use became more precise and mortality rates dropped drastically.
Anesthesiology has clearly advanced rapidly over the last several decades, but that doesn’t mean it’s an easy field. Physicians who practice this specialty need to be incredibly well-versed in the medications they use and how they affect the body. Dr. Justin Roberts, Anesthesiology Resident Physician at Rutgers University’s Robert Wood Johnson Medical School, can’t drive this point home enough.
"You also need to read as much as you can about the drugs you’re using—the side effects and complications."
“When you’re learning the process with anesthesia and the flow of surgery, you also need to read as much as you can about the drugs you’re using—the side effects and complications,” he emphasizes.
What is an anesthesiologist, exactly?
As the brief history overview above suggests, anesthesiologists are the physicians who specialize in the medical use of anesthesia for operations and other procedures. They’re involved in patient care before, during, and after surgery, and they work closely with surgeons and other members of the medical team.
For Dr. Roberts, the role really came into focus when he was completing clinical rotations during medical school at St. George’s University (SGU). He witnessed a coronary artery bypass surgery that had some complications.
“Seeing the way that the anesthesiologist conducted himself,” he reflects, “the way he orchestrated his next plan of attack in terms of helping the patient, moving things along, and really taking control of the situation was exciting and intriguing for me.”
What does an anesthesiologist do?
In truth, there is no average day for anesthesiologists. A certain degree of unpredictability is inherent given the wide range of tasks they perform all over the hospital.
“Your day can shift at the drop of a hat.”
“The anesthesiologist has to be very pliable and ready for anything,” Dr. Roberts says. “Your day can shift at the drop of a hat.”
That said, anesthesiologists have clear responsibilities. They review a patient’s medical history prior to an operation to create a safe, effective plan in tandem with the surgical team. If a regional anesthetic is necessary before the procedure—to control postoperative pain, for example—the anesthesiologist will administer it before proceeding with other surgery preparations.
During the procedure itself, the anesthesiologist is constantly monitoring vital signs and making adjustments as necessary. The idea that anesthesia is something you can set and walk away from is radically inaccurate. Dr. Roberts recalls a procedure when he was getting some unusual blood pressure readings. He made the appropriate changes, but had a gut feeling something wasn’t right. The team soon discovered there was some bleeding that wasn’t visible to the naked eye.
“We were able to step in and correct it so there was no adverse outcome for the patient,” he emphasizes. Still, it was a reminder that practicing anesthesiology comes with a huge amount of pressure and responsibility.
Anesthesiologists also perform quite a number of procedures. In any given day, these physicians may need to administer epidurals, intubate a trauma patient, place arterial or central lines, perform transesophageal echocardiograms, and more.
"A lot of people don’t realize how procedurally oriented anesthesiology is."
“A lot of people don’t realize how procedurally oriented anesthesiology is,” Dr. Roberts says. “We’re constantly moving from procedure to procedure between administering surgical anesthesia in the operating room.”
How do you become an anesthesiologist?
As with any other aspiring physician, future anesthesiologists need to begin by obtaining a bachelor’s degree. You then need to apply to medical schools and attend a program that includes two years of classroom and lab learning as well as two years of clinical rotations. At the end of the four-year program, you’ll obtain your medical degree.
You’ll also begin taking the United States Medical Licensing Examination (USMLE) series and apply for postgraduate residency positions during medical school. Anesthesiology residencies are incredibly competitive. You’ll want to make sure you perform as well as possible on the USMLE Step 1, Step 2 CK, and Step 2 CS. It’s also essential that you secure strong letters of recommendation from respected anesthesiologists.
“It’s a small group of people who know each other very well,” Dr. Roberts says, noting it’s very common for anesthesiologists to share overlapping networks.
"It’s a small group of people who know each other very well."
After attending residency interviews and matching for a postgraduate position, you’ll complete an intern year and then three years of dedicated anesthesiology training. At some point, you’ll also take the final USMLE test. You can also pursue an additional fellowship if you wish to further specialize. Then, you’ll need to obtain your medical license in the state(s) of your choosing and obtain board certification to practice.
Dr. Roberts has a few more words of advice for medical students interested in anesthesiology. He suggests getting exposure in more than one setting during medical school by completing an away rotation in anesthesiology. He also says it’s good to be adaptable, open-minded, teamwork-oriented, calm under pressure, and introspective. That last one is particularly true when you’re working with severe trauma cases or when a patient isn’t doing well during a procedure.
“It’s at those times when we need to be at our best as anesthesiologists,” Dr. Roberts offers. “I think at that moment, we need to take a step back and ask ourselves, ‘What is truly going on here and how do we fix it to have the best outcome for the patient?’”
How much do anesthesiologists make?
This is unquestionably a demanding specialty—and the typical anesthesiologist salary reflects that. According to a recent physician compensation report, anesthesiologists earned an average annual salary of $386,000 in 2018. Bear in mind this is an average, so newer physicians typically start on the lower end of the spectrum.
Perhaps even more encouraging is the growing demand for anesthesiologists. Employment of these specialists is projected to grow at a rate of 15 percent or higher through 2026. That rate is much faster than the national average for all occupations.
Pursue an MD career path
So, what is an anesthesiologist’s typical day like? It really depends. Procedures can vary substantially and there may be complications at times. If you’re unfazed by needing to adjust for shifting priorities, anesthesiology could be a great career path for you.
But getting into medical school is the first step. And while admissions committees obviously want smart students, gaining acceptance is about so much more than your classroom performance. Learn more about how programs identify the best candidates by heading to our article “Medical School GPA: Why Good Grades Are Only Part of the Equation.”
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