Session 4 In this episode, Ryan talks with Dr. Patrick Pickett, an anesthesiologist who practices in the community hospital in Oklahoma as he shares about his path to anesthesiology, his typical day at work, work-life balance, as well as the things that he like most and least about being an anesthesiologist. Finally, he gives his opinion on the future of anesthesiology specifically merging with CRNAs. Here are the highlights of the conversation with Patrick: Choosing the kind of setting to practice in: Always thinking he wanted to do academics Realizing he didn't want to do academic setting after doing a fellowship in critical care medicine Started looking for jobs and happened to find a community job and realized it was a better fit for him When he knew he wanted to be an anesthesiologist: Patrick majored in engineering and volunteered at a biomedical engineering department at a hospital and realized it wasn't something he wanted to do. Getting to watch surgeries and working with the anesthesia side of it Went through shadowing and didn't like it but after going through rotation and training, he had a turnaround What caused him to like anesthesiology after rotation: Coming from a family with medical background, he knew what specialties he didn't like Thinking he wanted radiology coming into medical school Not liking clinic and liking hospital setting Liked being in the operating room but not liking to be a surgeon Choosing the specialty through the process of elimination Traits that lead to being a good anesthesiologist: Flexibility in time and treatment options Thinking on your feet Being well-versed and liking different things Having broad knowledge Being able to change gears quickly Being able to get along with people and the team Being able to assume leadership role at times A typical day in the say of an anesthesiologist: Starting before 7 am and ending the day 4-5 pm on average There is no one typical day since you will be working at different locations for different cases If in the operating room: 3-5 cases on average for 1-2 hours each If in the GI lab: 10-15 cases for 30 minutes each If in neurosurgery/spine surgery/cardiac: 1-2 cases for 4-8 hours each If in general surgery: Meets with patients; talks about the plan, risks, and alternatives and then to the operating room Walks patients through the procedure to reduce anxiety; manages vital signs, making sure all things are in place At the end of the surgery, takes them to the recovery room Taking calls: Less frequent calls but more likely to go to the hospital to be there Work-life balance: Yes.This is one of Patrick's pre-requisites in choosing a specialty because he wanted something that would give him some flexibility. 55-60 hours a week Some days are predictable so he gets to see his kids more. Being on call is part of the deal but it's manageable. What makes a competitive applicant for anesthesia: It's almost like Emergency Medicine in terms of the board scores and the grades Intangible aspect: Being appropriately aggressive, knowing when to step back and when to step forward to help out Doing well in your rotations It's not a small field as there are many programs in anesthesiology (around 1500 spots) What residency looks like: 4 years - Intern year (medicine, surgery, EM, ICU, etc.) + 3 years (general rotations) Most programs won't put you in the OR by yourself on day 1 of that 2nd year More independence and advanced rotations as you go along Pain management as a multidisciplinary field in anesthesiology similar to critical care Less calls than surgeons but more than some others and almost always in-house and they couple a senior and a junior on-call Orals boards: 2 hours 2 rooms (an hour each room and with 2 examiners in each room) Each candidate has the same stem of the case but which direction each goes is up to the examiners. It probes the limits of your knowledge and the format can be intimidating. Written board exam first before takin