How to Become an Anesthesiologist

Anesthesiologists are critical to the evaluation and care of patients in the operating room. We are responsible for making sure patients are relaxed before the procedure/surgery begins. We make sure the patient is asleep without formation of memories (anesthetized with amnesia), that pain is controlled, and that appropriate blood flow and oxygen are delivered to tissues during the surgery. For the majority of cases, this is all easily accomplished with intraoperative monitoring (e.g., blood pressure, heart rate, blood oxygen, and temperature) and reliable medications.

Most patients are healthy and perform well under anesthesia. Usually, the patient is "put to sleep," the surgery is started, nothing happens while they are asleep, the surgery is concluded, and the patient is woken up. This process reflects the adage that anesthesiology is 99% boredom and 1% extreme stress.

When issues do happen in anesthesia (i.e., the 1% stress), seconds can make the difference between health and irreversible injury or death. The expertise of a physician anesthesiologist comes into play here.

Such issues can happen at many points during the surgery, such as "putting a patient to sleep" (i.e., induction of general anesthesia), placing a breathing tube or ventilating for a patient, maintaining appropriate blood pressure and heart function, or traumatic bleeding. The anesthesiologist needs to monitor for proper function of all systems continuously and be able to swiftly and appropriately react when something is wrong.

As a result, an anesthesiologist needs to be present at all times during a surgical procedure and when anesthesia is administered.

Anesthesiologists need to think on their feet and have a robust foundation of medical science to rely upon when analyzing, diagnosing, and treating a patient. They need to be confident.

When most physicians place orders in a hospital, they write an electronic order in the computer, which is checked by the computer before it is routed to a pharmacist (who again checks the order). This order is subsequently routed to a nurse, who either has the order verified by another colleague or has it verified by an electronic medication dispensing system. Finally, it is scanned into the computer and verified again before administered to the patient.

Anesthesiologists often have much less time to diagnose, decide on a treatment plan, and administer a medication. They must rely on themselves for the steps of placing orders and be confident in the decision-making process — able to react on the fly.

Moreover, anesthesiologists ought to be agile and dexterous with their hands. Daily, anesthesiologists place IVs, arterial cannulas, and breathing tubes through endotracheal intubation, and they use ultrasounds for nerve blocks and regional anesthesia. In order to do these tasks correctly and efficiently, anesthesiologists need to have done them many times and be able to rely on their own skill set.

Finally, anesthesiologists need to have charisma and should be able to establish a rapport with patients quickly. For many patients, the unknowns of general anesthesia present one of the most insecure moments of their life. Anesthesiologists often have 10 minutes or less to talk to the patient, gather appropriate information, and establish trust that everything will be done correctly and that the patient will arrive safely in the recovery room.

Anesthesiologists are often called quarterbacks of the operating room. They help direct timing for the room: when the patient arrives, when s/he goes to sleep, how long s/he stays asleep, and when s/he wakes up. Anesthesiologists are assisted by the nurses in the room and help to optimize surgical conditions for the surgeon to carry out the scheduled procedure properly and efficiently.

Successful anesthesiologists ensure the day runs smoothly and on time, and that all patients have the best care possible — including alleviating anxieties, maintaining oxygen and blood flow delivery to tissues, effectively treating pain, and making sure the patient wakes up from anesthesia on time.

There will always be a need for surgeries, and as long as that need exists, we must make sure patients undergo these procedures safely with anesthesia.

Even as intraoperative monitoring improves, nothing can replace the split-second decision-making of anesthesiologists and anesthesia personnel. They are the critical care physicians of the operating room, making decisions every minute that impact patient care. As more surgical procedures are performed each year, there too needs to be a greater supply of anesthesiologists to meet this growing demand.

The process is a long road. Four years of undergraduate studies prepare you academically and extracurricularly (e.g., shadowing physicians, volunteering) to apply successfully for medical school.

Once in medical school, the process accelerates. You must absorb a wealth of information in a short period of time that you formulate into clinical decision-making skills while working in a hospital with patients. During this time, you also worry about making sure your grades, test scores, and performance will be good enough to get accepted to the specialty of your choice at a suitable residency program.

Residency is as gruelling as medical school. You work 60-80 hours a week for a paycheck that frequently amounts to minimum wage or less per hour — when factoring hours worked per month. By the end of this arduous process, you should be adequately trained for something that is exceedingly important: taking care of human beings. There is a reason there is so much training to get to this point.

Two Board exams are required for being able to practice as a Board certified anesthesiologist: the basic and advanced anesthesia exams, in addition to the completion of the three-part USMLE Step exams. At this point, the resident physician is fully certified and credentialed for working as an anesthesiologist.

Anesthesiologists are extremely well-trained, and their services are always in demand. Most graduates will find a job waiting for them upon graduation. Finding "the perfect job" in "the perfect city" may make this job hunt more difficult, but it is usually quickly accomplished.

The same characteristics that make an anesthesiologist an excellent job candidate are many of the same attributes as any general job application. Employers want a physician who is a professional, who arrives early, and who is willing to work hard. Additionally, they want someone with a firm work ethic and who is willing to help others work well; after all, anesthesiologists are constantly surrounded by people every day.

On top of these characteristics, an excellent candidate is versed in the clinical medicine involved in perioperative care, including a firm grasp of human physiology, pharmacology, and anatomy. Finally, s/he should have excellent procedural skills.

Subspecialty positions within the field of anesthesiology — cardiac anesthesiology, obstetric anesthesiology, pain management, regional anesthesiology, pediatric anesthesiology, and critical care medicine — are achieved by additional fellowship training. There will always be specific demands and job opportunities for those who are subspecialized in any field.

Residency prepares a medical student to become a competent physician. It can be a grueling 3-7 years of training depending on the field, but most physicians come out extremely competent on the other side. By graduating from an accredited anesthesiology residency, you signify to employers that you are an exceptional candidate prepared to work in the field. From there, certain attributes like work ethic and charisma can make you shine.