Careers in Anesthesiology

Transcription

1 Careers in Anesthesiology Cerebral, fast-paced, technologically oriented specialty Substantial procedure base Off-time is your own Average work time hours/ week Flexibility in time worked is a lifestyle draw High stress environment (right now!)

2 Outline National trends in Anesthesiology Compensation Factors driving changes in compensation Duke Anesthesiology Clinical Faculty # s Types of practice Research Controversies

3

4 Issues for Ongoing Shortage Marked reduction in trainees Lag time from training to market Disproportionate reduction in revenue

5 Continued Supply/Demand Imbalance Continued manpower issues Continued financial pressure

6 Improved Prevention Improved Early Patient Awareness Intervention Patient Education Evidence-Based Best Practice Education Improved Education Public Education Public Relations Development Enhanced Patient Care Research Knowledge Development Operations Enhanced Patient Care Information Scientific Output Database Management

7 TIME February 19, 2001 Public Relations

8 Scientific Output

9 Stroke by SRI and DOS Stroke Rate Stroke Risk Enhanced patient care!!!

10 Public Relations Duke Relations

11 Types of Practice Private mostly OR Hybrid Academic OR based/ Teaching/Research ICU Pain Research/ Physician Scientist

12 OR Practice Supervision of CRNA s Personal provision of care Service specialty

13 Types of Research Anesthetic mechanisms (molecular) Outcomes and Quality of Life Organ protection Cardiac Neuro Renal Coagulation Human factors engineering Tissue engineering

14 Types of Research Intensive care ( infection, MODS, ventilatory management) Pain management (chronic, acute, regional anesthesia) Risk assessment and management of high risk patients Aging and cognition (long-term effects of anesthetics and surgery on cognition and quality of life) Genetics of organ injury (OR as laboratory)

15 days % Degrees of renal dysfunction and adverse outcomes 60 # Peak Cr 2.0 mg/dl AND increase in Cr 0.7 mg/dl % 30 no RD ( n=2051) #RD ( n=141) dialysis ( n=30) 0 mortality 2222 CABG +/- valve ICU stay* 0 hospital stay* 0 extended care* * excluding in-hospital deaths Mora-Mangano et al. Ann Int Med 1998;128:

16 Acute Perioperative Nephropathy and Projected Progression of Chronic Renal Failure after Heart Transplant Surgery Projected Progression of Chronic Renal Failure 400 High acute renal injury (n=35) (% Cr > 60%) % Cr Low acute renal injury (n=64) (% Cr < 60%) years after surgery Swaminathan et al. Anesth Analg 2002;94:SCA23

17 Cognitive Change Over Five Years 2 Change from Baseline Not Impaired at Discharge Impaired at Discharge Discharge 6 Week 6 Month 5 Year Time of Evaluation Newman. NEJM, 2001.

18 Postoperative Cognition and Perception of Health General Health Self-Rating Excellent 1.11 Very Good 0.46 Good Fair / Poor Year Cognitive Function Score Newman. Stroke, 2001; 32:2874.

19 Postoperative Cognition and Work Status Work Status Full Time 1.54 Part Time 1.07 Homemaker Retired Unemployed / Disabled Year Cognitive Function Score Newman. Stroke, 2001; 32:2874.

20

21

22 Controversies CRNA s (two edged sword) Disproportionately low Medicare and Medicaid reimbursement RESPECT based on professionalism

23 How can we begin to prepare for a residency in Anesthesiology? Strong academic base with good Board Scores! (increasing competition) Critical care experience Early rotations Letters from individuals that know you Letters from the chair