Specialty Spotlight Podcast, Episode 12: Anesthesiology

Introduction to the Podcast and Guest

[00:00] Welcome to the W med specialty spotlight podcast your virtual guide for exploring medical specialties in planning a career in medicine in each episode We interview practicing physicians to learn about their specialty the decision-making process

[00:20] that led them to determine that the specialty was right for them and then for advice about long-term career planning, regardless of the field they went into. I'm your host, Dr. Brian Shaw, Assistant Dean for Career Development at WMed, here to guide you through the broad array of medical specialties. Before introducing Dr.

[00:40] Today's guest, a quick reminder, you can find the show notes for this episode and all previous ones on our website at wmed.edu forward slash specialty spotlight. If you're interested in supporting the podcast through sponsorship, or if you're a physician willing to discuss your specialty in an interview, please email

[01:00] at brend-shaw at wmed.edu. The specialty of today's show is anesthesiology and the physician here to tell us all about it is Dr. Tristan Wilson. Dr. Tristan Wilson is a board certified anesthesiologist with Kalamazoo Anesthesiology in Kalamazoo, Michigan.

[01:20] He is also the chair of the Department of Anesthesiology at Western Michigan University Homer Stryker MD School of Medicine since 2017. He's a graduate of Alma College in Alma, Michigan. He earned his medical degree from Wayne State University School of Medicine and he completed

[01:40] a residency in anesthesiology and critical care with St. Louis University. So without further ado, Dr. Tristan Wilson. Dr. Wilson, welcome to the show. Hi, thank you for having me. Well, it's great to have you here. You know, I never did anesthesiology

Dr. Wilson’s Journey : From High School to Medical School

[02:00] elective rotation during medical school and so I'm interested to learn about your specialty. So you heard me read your bio. Is there anything that you would like to add and maybe you can take us back into time before medical school and walk us through your decision?

[02:20] to go to medical school in the first place? Well, when I was in, I guess back to the beginning, in high school, I did very well in school and people always said, you should be at

[02:40] doctor or a lawyer and I kind of rode the wave of the good grades wave that takes you to those things. So I kind of had to discover the love for something that I basically already got pushed into. And it's

[03:00] And one of the symptoms of that was the only exposure I had to medicine was through shadowing through the school and through college. And most of the time when you shadow, you shadow at a family clinic or something in a mortuary.

[03:20] traditional shingle, put up a shingle and accept undergraduate students kind of to shadow you or rotate with you. And so when I've gotten to med school, that's the only version of being a doctor that I thought I was looking for.

[03:40] And as most Med students know, some of the subspecialties you don't really get exposure to until basically about the time that the decisions should have been made already to what specialty you want to do. So I felt a lot of pressure in my career.

[04:00] development time between my second and fourth year basically for what I should pick and what's out there and like basically I did an anesthesia rotation during my fourth year that was the month that I had to make the decision. So you know do your grades match?

[04:20] to your personality match. Is this a good fit for me? I kind of had to make all those decisions pretty quickly. I'd always kind of looked like the idea of being a doctor and some of the elements of things, but I didn't put my finger on exactly what I was going to do until the first two months of

[04:40] fourth year at Wayne State University. So that's kind of a tough, I distinctly remember that being a tough time for me and my life. So I kind of want to transition to the first part and that is where I basically ask you every

[05:00] thing about anesthesiology. And the way I like to like to start it off is read you a description of your field from the careers in medicine website, which is hosted by the American Association of American Medical Colleges. And then I'll ask you

[05:20] what you think. Okay, here goes. Anesthesiology. An anesthesiologist is a physician who provides anesthesia for patients undergoing surgical, obstetrics, diagnostic, or therapeutic procedures while monitoring the patient's condition and supporting

[05:40] vital organ functions. The anesthesiologist also diagnoses and treats acute chronic and or cancer pain as well as provides resuscitation and medical management for patients with critical illnesses and severe injuries.

Understanding Anesthesiology: Role, Responsibilities, and Misconceptions

[06:00] How much of that do you agree with? What would you add or subtract to ensure that anyone listening was well informed of the practice of anesthesia? I would agree with most of that. It's kind of a good definition of what we do and I kind of feel like

[06:20] Sometimes people think that anesthesia is the same for every case and every procedure. And my family sometimes teases me that I go to work to turn a big switch on. Anesthesia on.

[06:40] switch. And that when you read that definition, you kind of, you know, it did describe lots of different parts of it, but the actual going to the work every day to do sedation and anesthesia for the cases that we do, it's definitely more

[07:00] varied than you think about it on the outset. The different types of sedation, different levels of sedation, and then obviously cases can make what we do for every single case very different. In my work, where I work in Kalamazoo

[07:20] too. My family knows what types of days I have. There's lots of, because some days are more walking and supervising roles and then other days are intense, but mentally intense in the room. There's providing anesthesia and then

[07:40] Some types of cases take a lot more hands-on, more manipulating. The healthier and the sicker of the patients are definitely changes. The work on a case-by-case and day-by-day basis, and that is with

[08:00] me, I do general anesthesia. I didn't do a fellowship and even within general anesthesia, there's quite an array of the different types of days that can be done within anesthesia.

[08:20] What is the typical daily or weekly routine? And maybe, I don't know if there's a typical patient or typical outcome for these patients. But can you just kind of touch on that for you? When I like to start with that kind of

[08:40] question. I like to tell people that every day across the country in surgical centers and hospitals, the first case of the day starts at 730. So most operating rooms that get used get used at 730 to 9 o'clock. And so

[09:00] That's when the day starts and you get there before then to set up and earlier for more complicated cases. And then if you're in a private practice center that's doing finger surgery, you're going to see a lot more people and you're going to be involved

[09:20] in a lot more cases and if you're doing cardiac surgery or academic medicine, you might only do one or two or only one case in a day. But then basically through the afternoon of the average day across anywhere, the cases tend to finish up and

[09:40] Then it comes down to the end where there's only a few cases going on or one case on into the evening. An anesthesia is one of the few specialties that most of the time the anesthesiologist on the call means at the hospital and it dwindles down to one person's

Daily Routine of an Anesthesiologist: Supervisory vs. Hands-On Work

[10:00] staying the night and waiting for emergencies. In OB, that's C-sections. In the main hospital, that's trauma. And we'll see sections in epidurals. But in the main hospital, that's trauma and emergent surgery. And I like to mention that early on because

[10:20] There is a lot of off-hour work, but the off-hour work is for the one person that's still in the hospital, not every OR is open at 7.30, because that's the whole partnership basically, is working at 7.30. But that's the typical day.

[10:40] supervising anesthesia and that is where I evaluate and consent patients in the pre-op area and set the plan up with providing CRNA or resident if we had residents and then do

[11:00] do the nerve, peripheral nerve blocks or set up any invasive lines that need to happen and then make sure the induction of anesthesia goes well. And then once that's accomplished in each of the locations that I'm covering, then basically the cycle starts over again

[11:20] then you got to evaluate the next patient and then maintain. Less dramatic things happen during the maintenance of anesthesia, but emergence is the end of anesthesia and I'm involved in that and also involved in the patients in the PACU and answering

[11:40] questions from the patient and from the nurses and in the post-op area for those patients. That's supervising anesthesia, which is what you get more in private practice. And in certain parts of the country, supervising anesthesia is the more the norm. And then providing

[12:00] anesthesia is where I do the same evaluating in the preop area, but then I'm the one in the room turning the inhaled agent's knob to keep the patient, to induce the patient through medicine through the IV and then do the

[12:20] I'm in the room the whole time. And then you're in the room the whole time waking the patient up and then between the cases you're seeing the next one and stuff like that. And that is more, some states are more providing, anesthesiologists are providing anesthesia. Some groups like traditionally Grand Rapids was more of

[12:40] of providing anesthesiologist role and Kalamazoo is more of a supervisory role. But those things change over time, but they are defined differently. I like my job because like today I provided anesthesia and tomorrow I'm probably going to supervise as I'm on call tomorrow.

[13:00] So I like that mix, but that makes it different in different groups in different parts of the country. And you alluded, I just wanted to ask you how, and you're touching upon this, this has been great, touching on some of my questions, how does the practice of your specialty of anesthesia

[13:20] physiology change based on inpatient versus outpatient, academic versus private versus public, urban, suburban rule. Can you touch on that? The easy answer to peel off there is the private practice job.

[13:40] jobs, you are allowed to supervise four mid-level providers, the CRNAs or anesthesia assistants, which are AAs. You can supervise up to four at a time, which is the functional max of a human

[14:00] By the way, if the cases are going normal speed, then that's about all you can do before you're not really knowing what's going on in any other room. But 4 is a comfortable number for that. But you don't have much time for much else. You're seeing the patients and you're going from room to room.

[14:20] And then, so CMS has made that limit to anesthesia sites if a resident is involved. And that is to allow for time for teaching, basically. So the CMS covers the difference there. They

[14:40] fund the difference for that inefficiency and allows for academicians to be able to teach. Now with academics though it is definitely slower, obviously you're only covering two rooms and it's slower paced because everyone else in an academic hospital is learning as well, so cases generally go slower.

Anesthesiology Across Different Settings: Academic, Private, Inpatient, and Outpatient

[15:00] Those jobs are of a slower pace. But when you're in academics, you're responsible for other things, the things normal academic people are responsible for. Didactic teaching and research and all those other things that they have to make time for.

[15:20] in a day. So that's the big division. Most people know pretty early in their med school training really, but residency training for sure if they're interested in academic anesthesia. And that's the big one.

[15:40] patient versus outpatient, you're in outpatient surgery centers, which we do a lot of these days. You're going to deal with a lot of healthier patients with faster cases. And it's more about they're all about customer service. But those are often more about customer

[16:00] makes sure everyone's questions are answered and stuff like that. You still have to be in tune for when things go, because even in those surgical centers, things can go awry and turn into a medical code and things like that. And then I've always said I enjoy

[16:20] Most of the things that happen after hours are inpatient work, people that have come from the ER or from an ICU. And I always tell people that I really enjoy that work because one of the big questions that you ask when in the pre-op area in your head, not to the patient, is do we need to do this

[16:40] today? Is this patient ready for surgery today? And does their health status match doing this today? And when you're dealing with someone who is worried about life and limb, then that question is answered. You have to do this today. It's important that this gets done and gets done

[17:00] as quickly and efficiently as possible. So that's another division. I would say one of the big things that occurs between urban and rural and suburban, most anesthesiologists are probably going to operate in the suburban to urban area. Most of the rural

[17:20] anesthesia is in this country and definitely in the state, the smaller places that only have a couple of ORs. Those are often covered by mid-levels by themselves, either practicing independently or in cooperation with a larger group of

[17:40] anesthesia out to someone else or with a surgeon. In our group, we have a couple locations where CRNAs practice independently on the day, but they're supported by our group if they had questions or

[18:00] if they in an administrative context they are supported by backbone of anesthesiologists. I like to bring up that overnight work because it's either going to be part of your life as an anesthesiologist or something you're going to have to give up something else to not have to do that. People can opt out of doing

[18:20] doing that, but it'll cost you something either monetarily or your partnership or things like that. What do you find most exciting about your specialty and conversely, what do you find or what do you consider most mundane about anesthesiology?

[18:40] It's one of those, the old adage about anesthesia is 99.9% of the time things go well. Every case doesn't go awry. Patients generally have good outcomes. They go to

[19:00] sleep and they wake up and they got their surgery done or their problem fixed and then they go home. But there's that 0.1% of the time that they have an issue that you've got to be paying attention for. So that doesn't answer that question exactly.

[19:20] kind of shows how the days go because most of the time they are kind of wrote as far as the, you know, the, have done cases that are very, very similar. And, you know, have done cases very, very similar back to back. But those, there's always some, you know, patients don't always

[19:40] on exactly like you think they will and patients will in cases don't go as with different surgeons have their surgical mishaps that are unforeseen and can change your day pretty quickly. And then even questions come up that are different. There's just certain patients will have different

[20:00] problems I've never seen before in Pac-Q. Like today, there was a woman that was so bradycardic, she went into junctional rhythm and I had to answer the question, should she go home? And then you have to, and I never actually answered that particular question until today.

[20:20] I do still enjoy, I don't enjoy being in the hospital overnight, but I still kind of get excited for when the phone rings at two in the morning because you know it's going to be interesting and some cat is going to be interesting. I might be one of the only

[20:40] partners of mine that I like to go to the emergency room if there's something happening at the witching hour of seven to 10 at night because things can develop pretty quickly downstairs. And instead of being the recipient of that information, I like to go down there and kind of create a plan, sometimes

[21:00] just a couple of minutes before the patient comes up, you can kind of have more equipment in the room or better plan or I can kind of guide the trauma surgeons to what they need to do downstairs versus what I can do upstairs. And I still lack that part a lot.

[21:20] What is one thing that you would have wished you would have known before entering anesthesiology? What would you encourage a medical student to think about in earnest before committing to going into your specialty? I know you kind of touched upon the

[21:40] ability to, you know, the hours and, you know, the call and all that, but anything else? Yeah, the hours of work for this next generation is going to be pretty pivotal, even more than for me, but the next generation seems to

[22:00] be that seems to matter to them even more, in addition to that little subject. But one thing I tell students is that this patient is not your patient. Much like in radiology, this patient, you are a consultant on this being

[22:20] the surgeon's patient. And that comes with a couple things that kind of change how your career goes because you don't have to do the development of your craft to become a busy person. You don't want to craft development of a clinical

[22:40] clinic or anything like that to become a busy practitioner. You don't have to do some of that marketing and some of the interpersonal marketing in that way. But then at the end of the day, that patient, they see the surgeon afterwards.

[23:00] The surgeon is the one that has that long-term connection and long-term follow-up with patients. And you do not. In anesthesia, around the office, we tease about having continuity of care in anesthesia and that is almost

[23:20] Those are people that have had multiple surgeries over a short period of time and the same people are around. And so it's not not a joke, not a real thing. And you don't have that. And I think a lot of people that a lot of kids that go into med school, they go to med school

[23:40] to become the doctor in the room. I have an example. I am socially friends with a surgeon and around the docks in South Haven, he's Dr. Dan and I am just Tyler's brother.

[24:00] Like, and it's, you know, it's a little bit of my personality, but it's also part of this, part of where, what the specialty is. You just, you're more of a background of the patient's care and not the forefront. So if you needed that, that's not, then this might not be the specialty for you.

[24:20] too. And I always tell kind of students that even if you asked around the office of the anesthesiologists, they generally, the work of anesthesia, how most of them love it, most of them enjoy it.

[24:40] But a lot of times they have something else. If you ask around, you'll find that they have some other thing in their life that gives them a little bit of vocation, like their hobbies or their volunteers or their other things. If you ask them, that might be more of a lead. Where some specialties like cardiovascular

[25:00] cardiovascular anesthesia, cardiovascular surgery, there's no room in a life for something else. Those kind of people, they're kind of the last of the Mohicans. They are that thing and there's not a lot of room in their mind and in their time for a whole lot else.

[25:20] That's good and bad. That's good for how I like my life, but for some people that are going into medicine for that gratification, you may not exactly get it. No, I'm glad you bring that up and, yep, radiology is one. You're kind of behind the scenes.

[25:40] So it was pathology. So, you know, having to be comfortable with that. What do you think is the biggest challenge facing anesthesiology and where do you predict the specialty to be in maybe 10 or 20 years from now? One of the challenges

Future of Anesthesiology: Evolving Practices and Advancements

[26:00] that we've always faced and that gets brought up a lot when I talk to students and other people. It's the challenge of other mid-levels doing anesthesia and then the venues changing, the two kind of big ones, the serenade

[26:20] days have always been fighting in the hallways of the Capitol buildings to get to independent practice and try to have independent practice without us. And that battle's been going on a long time, and that's not going to change. Those things are going to still be going on.

[26:40] there's always going to be that threat of something in that realm changing and changing our practice. But the short answer to that is we're in such a shortage of anesthesia currently and the projected many years to come. We're

[27:00] will show short that even if every single person that knows how to do anesthesia went into a room, we're still going to be short. So it will change what we do because the days of anesthesiologists being assigned to a simple room where they do their

[27:20] own cases with healthy patients, that might not be the way. We might only be supervising the more complex things. We're going to have to learn how to work more collaboratively with the CRNAs and work as they do more in their practices.

[27:40] and learn when it should be an anesthesiologist involved. Basically, that probably boils down to most anesthesiologists in the future will be in the hospital, those smaller places. That's kind of the battleground where more and more of those will be independent practice for mid-level kind of play.

Advice for Medical Students Considering Anesthesia

[28:00] places. So that's a little bit of where it's going and what's the movement of things 30 years ago to now, the movement would be the introduction of new medications and the acceptance of better and cleaner

[28:20] medications. And we're really at a point now where there's hardly anything that's terribly dangerous. In the beginning, like, halofen would spontaneously cause liver problems. Like, we don't have to look for that kind of stuff at all. Most of the things we have are very clean, very benign and a healthy person on the day.

[28:40] And where that stuff's not changing as much, we've introduced several tools that are widely used. TEE and peripheral nerve blocks have kind of come in with in the last 20 years and are getting to the point where they're used in almost

[29:00] every case that they should be used in. So the actual practice may not change a whole lot, but the where we practice might change a little bit in the next coming years. Yeah, okay. Well, no, thank you for that.

[29:20] What resources would you recommend to students to learn more about the specialty? You know, there's the docket of resources that the school

[29:40] provides them, whether it's the information, the definition you provided, or places that you get stuff like that to kind of describe out what it is. And then I always found it kind of interesting to as a student to look up what the fellow

[30:00] relationships are within anesthesia and where they are and how many there are and if they filled or not and that kind of thing. But the one thing I always tell students that I tell them to not tell the dean is your badge and your email

[30:20] Those those that's what you pay for as a med student and as long as you're polite and then you if you want to see something that you are not going to see until as an official rotator just just you know be polite and ask they can only

[30:40] tell you no. So anytime the students approach me, I always let them shadow me. It doesn't really matter where their status is on their time, where they are in their training. Just a couple of hours with someone.

[31:00] In anesthesia, you can get a pretty good clue whether you're kind of like it or not. And really, the students, anytime they're in an operative rotation or around the operating room, there's a lot of anesthesia people that are around. Because hurry up and wait is a real phrase in anesthesia.

[31:20] So there's always some waiting around and then there most wouldn't take very many people before you find somebody that you get along with and would explain what they're doing and why they like it and so they're not just hearing it from me. So I always say use as an early med student, use your email.

[31:40] and to ask politely around and get forwarded to the right place to get the information you want and the shadow day because you probably spend a week's worth of evenings reading about anesthesia, but if you spent 90 minutes following a supervising

[32:00] anesthesiologists around, you'd probably know pretty quick if this is a good fit for you or not. Yeah, no, I think that's great advice. That's wonderful. I want to kind of move to our second part, and that is in which you were getting into

[32:20] a little bit early on and that is kind of tell us about how you decided your specialty was right for you. So if you could kind of talk about your story, how you came to realize that anesthesiology was right and that eventual aha moment.

[32:40] that it made all sense. And if you had any struggles of maybe other specialties that you were considering? My tale, like I was saying, I had only really thought about doing family medicine and that primary care medicine. And then

The Importance of Electives, Research, and Career Planning

[33:00] During the time, I actually really didn't think I would like that and I kind of fell out of the whole medicine because I didn't really grab ahold of anything that really interested me. And during my third year, I did a couple of days

[33:20] in an ICU and it was the neuro ICU which is like the long version of ICU to protect at that and somebody said oh you like critical care you probably should think about anesthesia and I was like okay and I you know put it in my brain and thought about it.

[33:40] But I still kept my doors open for the backup options and the other things. And really, it wasn't until I hit fourth year and did a week and I was like, during my first couple of weeks, I had made the decision. I remember I told myself, I'm going to do this.

[34:00] no matter what the score of my step two came back. It was like to me that hung. So even if I'd have to do extra time and other things and find the right place to ask the right questions to do it. And then so

[34:20] Really, it was the rotation itself. One of the things that guided me is early in my training, I would see these back in the good old days when there were paper charts. The clinic medicine people would have the paper charts kind of pile up.

[34:40] they prioritized and they would respond appropriately to the things, but the standard sign the form and write the normal note didn't get done and they would just stack up everywhere. Basically, they would never be done with their

[35:00] work and I just thought that that would I would be that guy. I love talking to people and I love like spending more time with you know like if it needs more time and I can see myself not getting my the

[35:20] notes done before getting in trouble for not having my notes done. And you're either giving up your free time and working longer hours to get that done or your modern day version of that is your health care group would probably only let you see two patients

[35:40] hours or if they forced you to do more, you'd be unhappy. And I was like, I just feel like that would be a course for me being unhappy. And really, anesthesia with a few other fields, you really leave your work at work. Very few things from one day come up on a different day.

[36:00] There's limited signing of anything from a previous day. I can leave the hospital or surgical center and know I'm done with that day and nothing's going to come up from that. And even in even bad outcomes, like most of the time, I can leave a day and I know pretty good that nothing from that day is going to develop into anything.

[36:20] that I'm going to have to answer a question about in the future because everything went well. And obviously there's caveats to that. And so you do really leave your work at work a lot more. And my only change to that is in my position now as someone that's been

[36:40] out for 10 years than on the other side is my work at work is getting that whole phenomenon for me is changing because I'm now the chair of the W Medzian anesthesia department and I'm like the site lead at Bronson

[37:00] Lakeview and those kind of questions come up and those those times when I'm doing interviews like this and seeing students and writing letters of recommendation and stuff like that those come up those come up after hours and and odd times and really that's not just

[37:20] me. Anesthesia is poised right in the middle of all of the specialties and in the middle of the network of how the hospital works that anesthesia is a really good place for a hospital to look for people that want to coordinate how the hospital works and lead the hospital. So our

[37:40] group is big on that, all anesthesia groups have some element of that. And when you get nice and mid-career like myself, you get asked to do these things. And so I'd say that the anesthesia itself gets left at work, but I've been able to add back

Residency, Research, and Specialty Training Considerations

[38:00] Those things have I've been able to add as I can kind of as it fit my life and and the my availability and my time that I have so But yeah, that's Great I want to have a few this is this comes up often

[38:20] often with students, are we electives necessary? So what I tell students that are in their planning phase for fourth year has not changed since I took over is we don't have, in WMed, we don't have an anesthesia or a residency.

[38:40] And I think it's really important for a student that wants to go into anesthesia and a student that's going to interview at anesthesia programs, they need to see what an anesthesia resident does and feels like and the questions that come up with them and basically a framework for asking questions.

[39:00] about presidency. So they have to, from WMed, I say it's very, very important for them to do an away rotation. So I always tell them they should do a couple weeks with us, take advantage of the opportunity to only do two weeks to not waste more time

[39:20] doing a rotation with us and then do an away rotation somewhere that has a residency. But other than that, other than that caveat to the away rotation question, you don't need to do more than one. You don't need to do multiple, multiple, maybe

[39:40] some kind of specialty of some kind at a different institution, but doing general anesthesia in five different places just to show them that you're interested isn't really the way. The prototype specialty that does that to students is orthopedic surgery, and I always

Final Thoughts, Work-Life Balance, and Long-Term Career Insights

[40:00] explain that orthopedic surgery is different. The first rotation for an orthopedic surgery student, they know that it's their first one and it's almost like being an early third year as opposed to a late third year. The orthopedic students that are in their fifth one of those, they contribute to the team

[40:20] in a different way because they've done it, they know more than able to help more answer questions more and stuff like that. Where anesthesia, the way rotations work, you work with a different person every day. There is no longitudinal team per se with a student and the way rotations

[40:40] usually work at most places and it's not like you get put in charge of doing the anesthetic by yourself in a room or anything in most in almost every single place. So you don't get that building of your knowledge base and of the responsibility level that you get with other specialties. So doing

[41:00] a bunch in a row is not really, it doesn't do justice to their own training because there's other things they need to see while they are still paying that valuable dollar to go to school and get to see it without any responsibilities in med school. And so I feel like doing one

[41:20] away for a WMed student is very important. But doing multiple multiple of the same type of rotation is not as important. So best advice that I've been giving for until somebody tells me I'm dead wrong. No, no, that's that's great. How

[41:40] important is research or scholarly productivity for matching into anesthesiology? I would say generally the research in the field that is required for certain types of specialties, I don't want to dwell on

[42:00] ortho or ophthalmology is another good example of there needs to be some addition to the field to be taken seriously. That kind of thing is not as important. And I get asked, I've been asked quite a bit from students that

[42:20] want an anesthesia experience. I wish that we had an ongoing project that we could add these students to and have the staff or support from school to kind of get those things so I could say yes to that, but I don't because I don't have that.

[42:40] But it's not as important. Really, it's doing something scholarly, checking that box of something scholarly, and it doesn't always have to be in your first year of med school. It can be kind of the things you've done beforehand, count towards that. So it's not as important, especially when it happens.

[43:00] And when it is important to other specialties, it's research in the field or adding value to the field. And that's a really high bar for most students. And certainly most students would have to take time off to

[43:20] doing an extra research year or stuff like that to add to the field. So and that's just not obtainable by most students. So yeah, I would say checking the thing I think about students in there and an application for anesthesia is really well rounded, making sure you

[43:40] check boxes, but check all the boxes. Doing the leadership thing and doing the academic thing or the research thing and doing them early enough that it doesn't look like you're just trying to check the box. And really the thing is getting involved early.

[44:00] So it looks like you've committed to something. Those are important things. I tell kids that are interested in anesthesia, the very cheap one, not the free one, but is joining the anesthesia association for a medical

[44:20] student it's like ten dollars and you can say that you've been a member of the ASA for the last four years. Well the secret for me was I was a member of the ASA but I also was a member of ACOG for OB and family practice. Those are easy to do and they show that

[44:40] you've been interested for a while, my interest in the other ones waned and I'm doing this. But so I would say that that's important. But that's important for every med student to do those things and do them early and get involved in them early. So great. And we'll make sure in our show notes we

[45:00] We add the ASA, as you mentioned. Yeah, that's a good one for them to know. Like I said, that's the easy one. It's not free, but it's close. Yeah, yeah. Okay. I want to get to our last section, which is kind of giving advice.

[45:20] for long-term career planning irrespective of your choice of specialty. And so my question is, if you could go back and do it all again, what would you do differently and what would you do the same and why? Probably would take my own advice.

[45:40] that I give students about the visiting things that they don't normally see. I kind of, during my third year, you know, I had very limited experience in a hospital, so everything was new to me. So I kind of wasn't very confident in my

Final Thoughts: Work-Life Balance, Career Growth, and Personal Reflections

[46:00] And I didn't, I feel like I left a lot of things I could have seen, some specialties that are more, that are deeper inside the hospital. And I don't really know what that would have ended up for me. Like it's all, each individual med student has their own kind of

[46:20] path through med school that they meet a different set of people and they get exposed to kind of a different set of specialties. You know, the school tries to give them equal exposure and the most exposure, but there's no way around them meeting different people in the hospital. So I probably would have taken my own advice and seen a

[46:40] a few different things. At the end of my fourth year, so right before I started residency, I did like a surgical skills class and I had this like weird feeling of regret of like, man, I kind of like this. But the ship had sailed. I

[47:00] matched and my first rotation in my third year was surgery and I was so scared of all those grown adults that were seeing your residents that I now think are kids. So I didn't get the same kind of exposure that I feel like I could have

[47:20] and maybe would have changed what I would have chosen. That's one kind of regret. Every once in a while, I think about the subspecialties within anesthesia. That's kind of a bigger discussion for those going into it, closer to getting into it.

[47:40] But and I think about, man, I wish I would have done this, but I really would have liked being a little more of an expert in this type of, you know, this type of anesthesia. But then anytime that my teaching with that students is like, if you're going to pick a specialty,

[48:00] a subspecialty and do a fellowship, you got to be prepared to do pretty much that every single day. Like you can't get into a group because you're a cardiovascular anesthesiologist and then just tell them, I don't do that anymore. So you're kind of committed to doing that kind of case, so you better like it.

[48:20] never do it just because somebody else told you to. And I'm happy with what I did there. But every once in a while, it's like, yeah, I wish I could do that. But it's with the way medicine works, going back to do fellowships is definitely tedious.

[48:40] kid could happen. So yeah. What would you say is a career mistake that you've seen other physicians make? Oh, I'm trying to think. Other physicians of any kind? Yeah, any special

[49:00] What do you think a career mistake you've seen other positions make? And maybe, you know, and vice versa, what is something that you've seen a physician do well that makes you want to emulate it? Yeah. You know, it's

[49:20] it's interesting. Anastasia seems like medicine going through an IV and picking the right dose and monitoring being more vigilant and doing all those things would be the absolute

[49:40] measure of quality and the thing that's going to make you be satisfied that you're and your colleague satisfied that you're a great anesthesiologist. But really, it's more interpersonal than you would ever think.

[50:00] So my story about this, my personal statement was this flowery thing about meeting someone right before they go to surgery and being the person that gave the patient confidence and

[50:20] and the comfort that are well taken care of. So I gave this to a cardiovascular surgeon who was going to write me a letter and he goes, this is garbage. Like no one cares about any of that stuff. All we care is that the medicine going through the IV makes the patient go to sleep and you do a better job with the probes in the other.

[50:40] things. And it's funny because I'm more right. I ended up being more right because the other things, the interpersonal communication between the surgeons, the my rapport with the nurses, and really interpersonally, those things matter a lot. So

[51:00] You know, the thing that in a young career in any field in medicine, anesthesia is kind of the perfect example because it shouldn't have anything to do with that really. But in the end of the day, my job is easier and my success is greater when people have confidence in me and my interpersonal

[51:20] relationship with the others, the surgeons, the staff, the nurses, the room staff, all that stuff is better. And everyone has their own style at how to gain that rapport with people. But I've seen a lot of people, a lot of others, our specialty and others, they come in with

[51:40] this idea that they're really important and that they don't realize they're going to have to live there. Whether it's residency for four years or career as long as they'll have you, you got to basically build those relationships from the day

[52:00] day one. And some of those ways of getting along with others in the sandbox that have nothing to do with medicine at all, they matter and it's kind of the unfortunate truth. Most of the time when my colleagues get in

[52:20] trouble or I get in trouble with other specialties. What they write on the email to the chair people doesn't actually sound that bad. It's just how you said it. No, no, that's a great, great pearl of wisdom to share. What's

[52:40] one thing that you're struggling with or lamenting about your career today and what are you doing to remedy it and what would you encourage a medical student to do right now to help avoid this problem entirely later?

[53:00] You know, I kind of touched on that a little bit with the things I'm adding to my career, which is the WMed outreach and the site leads and the leadership roles and those kinds of things. I think those kind of make

[53:20] My profession, a little bit more also, my profession of anesthesia, also my vocation. And I see in others that don't do something like that or they don't have an outreach of a different kind in their home life, they do

[53:40] They do burn out, whether it's they really hate being at work or you'll hear people subtly talk about wanting to be home more. And that's always a symptom of really despising being at work.

[54:00] But like, I think I have worked to remedy those things in my life. I think, you know, students to plan for these things, it's hard to plan for what leadership role you're going to grab or what extra

[54:20] thing you're going to do with your life. Sometimes that extra thing is just being a good parent. I don't know. It can be something that's more obvious like that. But yeah, I think definitely having conversations with the people in the specialty and seeing what fulfills them

[54:40] and seeing if that is the same thing that would fulfill you and if you're going to need something else to add to what you do, that's more obvious in anesthesia than other specialties, but other specialties still have that problem.

[55:00] I like to end the interview by asking what is one book, medical or non-medical, that you think every person pursuing a career in medicine should read? Talk, man. Wow. Oh, no.

[55:20] I want to be weird and say kitchen confidential because that book is so good. Just kind of describes all the weird things that happens and interpersonal things that happen in kitchens and around are just like for me like kind of I don't know.

[55:40] I don't really have a great one for that. Most of what I read these days is Harry Potter before my nine-year-old goes to bed, so I'm a bad reader. Is there anything else you think that we haven't touched upon that you want to make sure our listeners know about the career

[56:00] year in the specialty of anesthesiology? I mean, really, I like it and I'm happy with what I do. I like my job most days. There's good days and bad days, but I like my job most days. I think that's kind of my message

[56:20] with some of the other stuff about the field and about other things that I talk about as far as profession and vocation and things like that about anesthesia can make it seem like I don't and I'd like to say rather obviously that I do. I like what I do and I don't think I it fits me. I think that this is

[56:40] For me and the way my life works and my personality, I think I wouldn't be nearly as good at other things. Well, that's great. Well, Dr. Wilson, it's been a pleasure having you as a guest on the WMed Specialty Spotlight. For everyone listening, we'll wrap up the show with that. Well, I hope you enjoyed the conversation.

[57:00] conversation with Dr. Wilson for the resources and other tidbits that were mentioned in this episode. You can find them in the show notes on the Wmed website, wmed.edu forward slash specialty spotlight. If you like what you heard, please share this episode with your fellow medical students, especially if they're having some careering

[57:20] It is truly my hope that these conversations with physicians who've been there and done that will help you move forward with your own career choices. For any questions or if you'd like to reach out to me for any reason, which I encourage you to do, you can do so by emailing me at brendatshaw at wmed.edu.

[57:40] you, but until next time, take care.