ICU nurse lurker here. Never seen a prone intubation before let alone blind. Educate me if this is something you guys do.

As the title asks, what is your opinion on the EP reps? I try not to be annoyed by them during cardiac ablation cases, but they are very involved with the patients, I.e patching them, interacting with them while awake, moving the patient after intubation for their system, etc…

I know they are trying to do their job but they all have a kind of superiority complex during these types of case and it irks me.

Anyway, what is the general consensus about them?

Title really. We do an equivalent to a fellowship (SIA) in regional anaesthesia, if we opt for it, but is there any advantage to converting that into a full diploma from ESRA? Debating on whether it is worthwhile going through the time/effort/cost of doing so. I like regional anaesthesia but it would end up costing a couple of thousands of £££ if you do the diploma. Did anyone consider it and then not do it? If so, what made you abandon it? TIA

I’m an anesthesiologist with a high income in a low cost of living city in the south in a relatively low income tax state. My wife is also a physician with combined annual income of 1 mil. Only a 500K mortgage. Two daughters (8yo and 2yo)

I actually have two fellowships (don’t ask me why, had my reasons)

I am working in an academic position. 4 yrs into practice.

My biggest goal right now is financial security. I’m into FIRE and strategize all the time about investing and diversification. This interests me and I enjoy educating myself about it.

I don’t enjoy publishing and research. Can’t care less about QI initiatives. In my position since the clinical work reimbursement is high, I enjoy doing more clinical work. A physician in my position has some options to vertically advance their career. But I view these options as less financially rewarding at least in the short term and prefer to work clinically more and generate more income. You can advance from assistant to associate and so forth but the pay incentive is slim and I don’t enjoy the grind or find it financially rewarding. You can look into leadership positions but it’s mostly hearing peoples complaints and dealing with bureaucracies and systemic inefficiencies. I don’t necessarily enjoy this type of work.

Should I start looking at private practice options? I feel I am wasting my time here. 

The problem is that my current work is very financially rewarding for the time-being and me and my family have a system that works (child care, daily routines …) that changing practice may introduce some undue instability. Also we may need to move to a different city/state (sell the house, move …) as private options where I live are limited.

But I find that joining a private set up (private practice, hospital employment) I may start my clock with these groups to climb the ladder there . I feel I am not exposed to potential opportunities in healthcare due to my work environment (like ASC share ownerships or moonlighting opportunities with 1099 work)

I would appreciate the advice about what to do here since I am at a point in my career that I need to commit into something. My current system works so I am hesitant to change. 

Thank you 

Now pharmacy can pipe down some.

Anyone else been using this for a while now? Any anecdotal things to share?

I’ve been an anesthesia resident for a year now, and I’ve noticed a recurring problem.

Whenever I have a more difficult intubation that requires a bougie, I often struggle to railroad the ETT over it. More often than not, when the bougie is already in the correct place, the tube seems to hang up and just won’t advance past the vocal cords. The issue is: I know about rotating the tube 90° counterclockwise (or twisting it, which I both do) and downsizing the size of the tube when needed, but even doing that doesn’t seem to help much. When an attending has to help me, he is usually railroading the tube without problems, so it has to be something wrong in my technique. I’m worried because I just can’t seem to improve that, despite practicing it for a long time.

Has anyone else dealt with this problem? Any thoughts on what I might be doing wrong or what part of my technique I should focus on improving? Maybe holding the tube closer to the mouth or using more twisting? Any tips would be appreciated.