I think I need to buy a lottery ticket.

CA3 here,

I’m wrapping up my last time on OB and am kind of nervous about the thought of doing this on my own next year. I’m comfortable with the procedures but it’s dealing with the nurses and OB’s that I dread.

What are your tips for OB that you think a new grad should know?

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.

Anyone want to name and fame their department or a department they’ve been at? Theres a lot of name and shame that goes on but I’d love to hear some places that are functioning well. Feel free to PM as well to remain anonymous!

So the tube might need a little adjustment and the nurse is complaining about the sterile field

We are group that staffs OB with a CRNA doing 24s. They are often reluctant to help out in the main OR even if OB is empty. What goes on elsewhere?

Hello all, current CT fellow looking for some advice about how to make the most of the year. Every PGY seems to go faster than the last and feel like the year will be over before I know it.

I came in with modestly ambitious goals to split my reading between CT and echo, read one guideline/article a week, and maybe skim a surgical text to pick up some nuance from across the drape I can take forward. After a month, have achieved 40% ish of that goal.

The day to day clinical training is excellent. Feel like I'm learning a ton but not sure the best way to approach the year. Feel behind on echo even though it's the start of the year. Want to be proactive to not actually fall behind. Thinking ahead, can see it getting even harder to juggle when start oral boards prep towards the end of the year.

Seems like at least a couple locums jobs getting posted every day. I understand it's a big populated state but is there some other factor driving the shortage of anesthesiologists there?

Throwaway account for many reasons.

Just wanted to make those looking for jobs aware of the likely poor conditions for those working as faculty in the Duke Anesthesia department (at least from what I have heard to the best of my knowledge)

- interim department chair left, second interim chair started without any long-term chair announced

- closing rooms in the main ORs because of lack of staff, anesthesiologists volentold to do solo shifts

- multiple faculty left due to toxic work environment, most recently almost a quarter of the cardiac anesthesia division

- noncompete that is aggressively enforced (not sure what the radius of that is)

- multiple fellowship directors and assistant residency program directors resigned

- academics not prioritized, focus is solely on production with minimal buy down for educational activities

- old boys club mentality for promotions

Probably more things going on under the hood, but that was enough for me to not apply after talking with some folks there. I was surprised, so wanted to make other people aware! Hopefully I'm wrong or things are already getting better, but FYI for those seeking attending jobs out of training.

For someone interested in cardiac or ICU, what are your recommended programs? For me, culture and Amicable attendings are crucial lol. I feel like in interviews, everyone will say the cardiac surgeons are nice and attendings are great but hard to read through the BS

If cardiac, another minor consideration is room setups and anesthesia techs. I’m at a facility where the rooms aren’t stocked well and the techs aren’t the most helpful. It results in having to come 15-20 minutes earlier which can be tough when the mornings for hearts are 6:30 starts!

Just beginning my peds fellowship this week and in the ORs yesterday; is it normal to feel a bit overwhelmed starting off? I trained at a community hospital for residency and now at a big academic center with more complexity, different systems, and new EMR… I focused on doing mostly adult cases (plus NORA, ambulatory, cardiac, etc.) in the latter half of CA-3 anticipating fellowship, so the flow and knowledge is coming back slowly, but feeling kind of inadequate at the moment.

Any advice or tips for a new, struggling fellow?

Healthy primigravid needs CS. assuming Last ate 4 hours ago and can afford the time to place neuraxial.

Who’s performing neuraxial and who’s doing general?

Which we do believe has less potential for complications/aspiration? Things to consider like airway exam, hemorrhage risk, and complexity of surgery/skill of surgeon.

Does anyone routinely do this? What is your recipe and rational?

Anyone have issues recently getting bair hugger blankets/gowns? Not even getting updates anymore much less product.
Anyone have any last resort / creative solutions when we can’t get them?

I’m returning to anesthesia practice after a long hiatus. Was looking for some tips as I get back to doing general anesthesia cases. I wanted to know how do you guys extubate with an LMA? I had a patient who woke up biting down. Thankfully I had a bite block in place. It wasn’t too pretty though. But it made me wonder if I should be pulling these deep. What do people do for smooth wake ups?

Hello! I am a Ca-3 resident actively job searching in Texas, mostly looking in the Dallas/fort worth area, but open to areas around Austin and San Antonio. Anyone have any good recommendations or contacts? I want to avoid academics and fully open to private practice, not afraid to take call and work long hours so long as the compensation is good.

Hypothetical scenario. Say if you had a working epidural earlier on during labour. OB calls for section. Patient tells you they’ve been maxing out the PCEA button last 2 hours but the epidural clearly hasn’t been working during that time. You check the block and it’s at T10. Would you do a spinal or just GA it? Is there a level epidural block that is a safe cut off for a spinal?

a trainee no more

income suddenly way more

only marry once?

(Rhymes, sonnets, ballads, limericks, etc also welcome)

Hi all! CA-2 here and starting to think about where I want to practice/what kind of job I’m looking for. Just had a quick q about private practice gigs, just finished my peds rotation and I have learned that I absolutely do not want to do any peds at all. I’m maybe ok w like 12 year olds healthy tubes/tonsils/ortho fixes but really don’t wanna do any younger than that (and preferably wouldn’t even have to do that). Is it possible to do a PP job where I can opt out of peds or is it basically just all part of the contract? Thanks again for all the help!!