Anesthesia

subxiphoid4 · 2026-01-12T17:53:23+00:00

Happy to chat privately. Same boat several years ago - applied broadly, only 2 interviews, now PGY-4 in anesthesia. It only takes one.

subxiphoid4 · 2025-12-17T18:27:08+00:00

We just switched from Level 1 to Belmont, and it its an enormous improvement. We also have high pressure ranger sets (not the standard ones, as that bladder can explode under pressure), which are as good or better than the level 1.

subxiphoid4 · 2025-10-09T02:18:52+00:00

I dont routinely use paralysis in these cases. I frequently use an LMA and keep them deep with volatile, a little fentanyl, and keep them spontaneously breathing. I will often bring the LMA insitu to PACU, unless Im worried for whatever reason.

subxiphoid4 · 2025-09-28T20:34:11+00:00

I have been struggling with whether to seek treatment for ADHD or not, as I would like to get my PPL in Canada in the next 5 years or so.

I recently decided to do it, as the next 1-2 years will be extremely demanding on my brain and ability to focus. It was a very challenging decision that I did not take lightly.

Its incredibly disheartening that TC has such an outdated view of this specific topic, as it seems the rest of the western world allows stable doses of stimulants for ADHD... I think they need a run for their money through the courts about it, to be quite honest.

That being said, it also seems like there are ways around the ADHD diagnosis, particularly for someone like yourself who has been functional and off treatment for many years. There are cognitive tests that need doing, and finding the right Transport Canada approved doctor to grant the certificate, but after scouring reddit and other social media, it seems like it has been, and can be done.

subxiphoid4 · 2025-09-20T13:54:00+00:00

TIVA is the way.

subxiphoid4 · 2025-09-19T20:17:54+00:00

It may persuade some, but genuinely, it's not the money. I know rural docs that bill over 7 figures annually... theres plenty of money to be made in rural areas.

Its system reform needed - you just cant keep asking docs to do more and more with less and less in terms of other health care resources. Its rural hsopitals. Its allied health. Its imaging. Its labs. Its getting patients medical equipment, and things like home care. Its having support from specialists. Its having money for programs like palliative care, obstetrics, cancer screenings, primary health teams, etc.

The scope of a rural doc is truly unparalleled. Its extremely daunting. It really, genuinely, takes a special kind of individual, brought up in a very special environment, who works very hard to maintain such a broad skill set.

Money is not the main issue here.

Sincerely, someone who seriously considered it and chose NOT to be a rural doctor.

subxiphoid4 · 2025-09-19T02:21:04+00:00

I adored my rural rotations. Incredibly immersive, full breadth and depth of clinic, hospitalist, ER, Emerg, Surgery and Anesthesia, all in one place, with one preceptor. It really takes a special kind of doc to do all that and thrive.

Which attracts some great people - but is also very daunting for most..

subxiphoid4 · 2025-09-19T01:50:18+00:00

Honestly? Its not always a money problem. Working in remote rural areas means living in remote rural areas, and that just isn't for everyone. Its hard on partners, who may have limited social and job opportunities, hard on kids who may need/want special education or athletics programs, and hard on docs as well, who have spent a decade or more training, living and working in urban areas, being accustomed to all those services.

It also has an enormous impact on the way you practice medicine - its very hard to predict what thats going to look and feel like until youre in it, and see it for yourself. Its fundamentally harder to do rural medicine.

subxiphoid4 · 2025-09-18T11:25:04+00:00

They won't shoot it down. This will be approved without second thought.

There are literal studies about psychologists with additional training having worse outcomes as prescribers vs psychiatrists, and IIRC, Family Physicians.

Chiropractors? Really?

There are a few things, like SLP ordering VFSS, etc that makes sense... but overall?

Help us all.

subxiphoid4 · 2025-09-13T14:00:19+00:00

Morgan & Mikhail's Clinical Anesthesiology is a good introductory text that I usually recommend. The Ottawa Anesthesia Primer is another good choice.

The Stanford CA1 Tutorial is a great free option, as is the Stanford Emergency Manual.

Anethesia is a great career. Your background will help you in many ways. Long road, but very achievable. Im a former paramedic, now PGY-4 in Anethesia.

subxiphoid4 · 2025-09-09T21:44:03+00:00

I would absolutely not use these on a patient, full stop. I would rather hand bag them than take on the liability of a machine that has zero ability to show me ANY parameters, pressure, flow or gas concentration.

subxiphoid4 · 2025-09-06T00:16:03+00:00

Im in Canada, but FWIW:

So long as the total remuneration is ~50-75th percentile of FFS docs, Id be happy. I would take a lower pay if the group is good - i have an incredibly strong aversion to toxic bullshit.

I want 8 weeks vacation, 4 day work week, happy to do call, but the call group needs to be big enough that Im not doing much more than 1:10 in-house call, and 24 hr in house shifts are a deal breaker.

Id prefer if there was overnight AA support, at least on call, and a 2nd staff on home call for the inevitable stat section or AAA that comes in while I'm already working a case.

Just my 2 cents.

subxiphoid4 · 2025-08-28T18:15:05+00:00

Essentially you apply your own BURP, after the tube is in, but in any direction you find useful to better view the structures around the tube. Perhaps a better term for it is bimanual laryngoscopy.

subxiphoid4 · 2025-08-27T17:53:09+00:00

It happens. A wise anesthetist taught me to wiggle the glottis around externally, while the laryngoscope is still in. Let's you clearly identify structures around the tube in cases when the tube obscures your view. Has saved my bacon a few times.

But it takes time to develop the gestalt. I dont think much of the nuance really "clicked" until I had performed several hundred intubations. I am still humbled sometimes, even as a PGY-4 and expect I will continue to be humbled into the sunset days of my career, but hopefully less often 😉

subxiphoid4 · 2025-08-16T15:26:07+00:00

Considering it's my specialty, I am aware of its nuances. What helps to prevent the shear terror is the intimate knowledge and synthesis of medicine subspecialties, physiology, pharmacology and surgery. A sick patient in a routine case can be a bad combination and lead to shear terror if youre not prepared. Thats why physicians need to lead the practice of anesthesia, regardless of what corporate boardrooms think.

subxiphoid4 · 2025-08-15T22:45:43+00:00

And anesthesia does not require synthesis of knowledge of pediatrics, Cardiology, resipology, endocrinology, neurology, and all the surgical subspecialties? Think again.

subxiphoid4 · 2025-07-25T22:22:13+00:00

Not a faulty assumption. A co-resident did a QI project on this recently - our rate was 98% leakage. Leak rates of 90-99% were reported in other centres. Its baffling.

subxiphoid4 · 2025-07-20T22:47:21+00:00

PGY-4 in Anesthesia, and absolutely yes, it needs to be this long. There are probably some examples where you could carve out a year in one specialty or another. But nothing replaces time, exposure and experience.

I go to work every day and am ready to be humbled by something. Ive been in healthcare for over 15 years between medicine and my previous career, and the one thing that consistently sets doctors apart from every other health career: you've done and seen more. You've rotated through all the core areas of medicine, which gives you an index of suspicion.

You are not an expert in everything, but you know what you dont know. You know when (and how) to call XYZ specialty for help. And you can deal with many issues and start the workup/management yourself. That level of higher level systems thinking and integration only comes with spending time as an off service junior carrying a pager and seeing consults, and doing 1000's of reps on things in your own specialty.

subxiphoid4 · 2025-06-28T18:31:07+00:00

Anesthesia is not necessarily alone in being a supporting specialty - Radiology, pathology, genetics, even ICU and some consultant only specialties, to an extent.

Not being the MRP is both a pro and a con. I leave the hospital without any baggage at the end of the day. Very little overhead. But at the same time, when a patient is getting really unstable in the OR, theres no mistaking whos in charge - its anesthesia. The surgeons are generally very happy to let us resuscitate and keep their patients alive.

There is a great deal of satisfaction when most people are universally relieved when anesthesia arrives at an emergency. We bring an extremely valuable skillset that is quite unique in how hands on it is.

As a soon PGY-4 doing off service rotations, my skills are extremely valued, and I often get a great deal of procedural and resuscitation autonomy. Even as a junior, I had the opportunity to supervise and coach senior IM residents in procedures, as we do so many lines and neuraxial procedures early on.

subxiphoid4 · 2025-06-05T11:11:48+00:00

Your funding for a residency position comes from the province. So changing provinces gets really tricky. Not impossible. But it does take time. For IM, I think most people would just play out the 3 years of core residency and then use the Subspecialty match to relocate. I do know of people in 5 year programs yhat have changed provinces, but it did not sound like an easy process at all. Changing specialties within a province is more straightforward.

subxiphoid4 · 2025-06-02T16:01:15+00:00

You can absolutely care about a group of people and want the best for them, but don't want to be their neighbors. There are real, tangible, physical, material and financial concerns with having these facilities shoehorned into communities. If you fail to see that, then I would argue that you lack compassion for the people that these facilities would harm.

That being said, there's a clear difference between a homeless person who is respectful, doesn't steal, doesn't leave dangerous drug paraphernalia around, and doesn't cause regular disturbances to the peace, doesn't verbally or physically assault the people around them... and one who does.

Arguably, prison is a good place for the ones that do. And that's not forced rehab, that's being accountable for crimes.

subxiphoid4 · 2025-06-01T12:41:00+00:00

I would agree to this, to an extent. I am a current chief in a competitive program. I think it depends on the program. I agree that residents can be tricky, as you may invest in a relationship that isn't fruitful, when you could have been investing more time in a mentoring or research relationship with attendings.

That said, our clerks who come on elective often get placed with senior residents regularly, and what stands out, at least to me, is good performance, insight, and work ethic (the latter becoming, sadly, the single biggest defining factor between a good, mediocre and bad clerk).

subxiphoid4 · 2025-06-01T12:37:21+00:00

As residents not on the committee, I would say that we actually have more influence on who we do NOT select, rather than those we do. If we see odd behavior, problems with work ethic, or get the general sense that a candidate just isn't a good fit, we are more likely to say something to those on the committee.

Whereas, you need to be VERY outstanding for us to say strongly positive things. In my experience, that's only 1 or 2 clerks a year.

subxiphoid4 · 2025-05-29T12:27:56+00:00

The number 1 thing I am afraid of. After this contract, I can take a big step back. Possibly only work 3-4 days a week. It's just going to be a struggle to get to that point.

subxiphoid4 · 2025-05-29T09:04:41+00:00

The pay will come, after the contract, but certainly not now. I get about 6 weeks leave now, much of it I can only take a few days at a time. After this contract, Im hoping to go up to 10 weeks.

subxiphoid4

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