Anaesthetics
A Career In Anaesthetics
Introduction
Contrary to what some patients (and, sadly, some doctors) believe, anaesthesia is infinitely more than just "putting people off to sleep". It is a mixture of challenges and hard work, manual skills and in-depth medical knowledge; it is rewarding and can be, without doubt, fun.
Fortunately, the somewhat unjust attitude towards anaesthesia and anaesthetists that has prevailed in the past is changing. In recent years, anaesthesia has begun to receive due respect and recognition and is becoming more and more competitive.
What is it
An anaesthetist working in theatre has only too often been compared to a pilot flying a plane. A pilot is directly responsible for a successful take-off, a wobble-free flight and most importantly a safe landing. Similarly, an anaesthetist not only injects an induction agent and hence puts a patient off to sleep, he is directly responsible for the well-being of the patient throughout the peri-operative period and, most importantly, he is responsible for an uneventful and comfortable recovery.
Training in anaesthesia covers more than "just" general anaesthesia. As part of a structured training programme, trainees are exposed to a busy and demanding life in Intensive Care Medicine where anaesthetists truly represent the "missing link" between physicians, surgeons and A&E doctors or to the equally demanding field of Pain Management.
Junior doctors who have completed the basic SHO and Year 1 and 2 SpR anaesthetic training have quite a few further subspecialty choices apart from the aforementioned Intensive Care Medicine and Pain Management: for example, Obstetric Anaesthesia, Cardio-thoracic anaesthesia and Paediatric anaesthesia. Although the basic exposure to the above subspecialties is covered in SpR years 3, 4 and 5, it is not uncommon that a trainee opts for an in-house fellowship post of his or hers choice.
This exposure and training in various "anaesthetic subspecialties" leads to an important advantage: flexibility. Upon obtaining a consultant post, a Pain anaesthetist or Intensivist can still have some sessions doing general anaesthesia.
How long?
Training programme is divided into:
- a basic training programme for Senior House Officers that lasts 2 years and covers basics in Anaesthesia
- an intermediate training programme for Specialist Registrar (SpR) Years 1 and 2
- higher and advanced programme for SpRs 3, 4 and 5
A junior doctor can apply, upon successfully completing the F1 year, for a post in Anaesthesia in the F2 year. These posts are not recognised as a part of Speciality training. However, they do offer an opportunity to experience this increasingly competitive branch of medicine which essentially serves two purposes: it may help you decide your future career or it may give you an inside knowledge of an important field of medicine that you would not normally obtain once enrolled in speciality training.
Getting a job?
A junior doctor is usually expected to have done some post registration training before applying to a specialist training in anaesthesia at the SHO level. The most desirable posts are in general medicine, intensive care and paediatrics. Needless to say, a further advantage is possession of MRCP or similar qualification.
Obtaining a consultant post is marginally easier than in other medical specialities. Having said that, things do change, so the general advice is, if you consider anaesthesia as your career, to get in quickly.
What makes a good anaesthetist?
At least in theory, not much different from the basic requirements for being a good doctor. Apart from having sound medical knowledge and manual dexterity, it is crucial for a good anaesthetist to be able to work under pressure, to be a receptive and cooperative team member and to have an excellent bed-side manners. It is all about being a good communicator, being able to reassure the patients and allay fears whilst at the same time remain focused on the best management strategy. It is also of paramount importance to have a knowledge and appreciation of one's own limits, so at times it is necessary to swallow your pride and seek advice sooner rather than later.
Hours
Getting better and approaching a 48-hour target. Certainly no worse than other medical specialities. Most hospitals have a full shift system with its advantages and disadvantages. Hours are generally "not fixed" and although there will be times when you will be required to stay longer, it is not uncommon that a surgical list and hence your day finishes early (provided no one else needs a hand and all your patients are safely and soundly back to the ward awake and smiling).
Money
Not bad. Depending on your anaesthetic field of expertise there are relatively good opportunities for private practice. The time an anaesthetist is involved with the particular patient is much less than that of a surgeon. As said above, once your patient is awake and smiling on the ward after surgery (and provided he or she keeps on smiling and most commonly they do), there is very little further involvement.
Further info
As with any career choice, the best insight one can get is talking to as many anaesthetists as possible. For further information and details take a look at the Royal College website at:
> Royal College of Anaesthetists
Dr Serge Nikolic, MD FRCA
Clinical Lecturer to Professor Richard Langford
St Bartholomew's Hospital, London
Last updated 25/12/06
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