What does an anesthesiologist do? Michael Sopher, MD, began to find out when he pursued an acute care specialty. He made that choice during clinical rotations in his third year of medical school.
Now a clinical professor of cardiothoracic anesthesiology and vice chair of anesthesia clinical services at the David Geffen School of Medicine at UCLA, Dr. Sopher initially narrowed his choices to emergency medicine, intensive care medicine and anesthesiology. "I liked the idea of seeing patients on an acute basis for a short period," he says. "It felt more on the edge, which suited my personality."
Dr. Sopher notes that being an anesthesiologist is often compared to being an airplane pilot: "Even though our work typically goes smoothly, we must prepare for a huge variety of adverse events," he says. "Each one can be extremely rare but of critical importance."
When it comes to guiding medical students, he finds that the initial question still applies: acute care or chronic care? "Once you make that choice, you'll find many attractive specialties of each type. Ask yourself if you want to work in a clinic setting and develop long-term patient relationships," he says. "Or maybe you would prefer high-pressure, short-term patient interactions. They're both very legitimate paths."
What does an anesthesiologist do?
A typical day in the operating room actually starts the day before a surgery, when Dr. Sopher reviews the next day's cases with a resident. "Then I'll often call patients the night before to reinforce instructions and answer questions," he says.
He arrives at the hospital by 7 am on surgery days to assess the day's patients and obtain consent for anesthesia. Since he is a pediatric cardiac anesthesiologist, he and his team often take extra time to get a parent gowned up to help ease their child's nervousness by accompanying them to the operating room (OR).
Once the patient is unconscious, Dr. Sopher says, the anesthesiologist's primary duty is to manage blood pressure, heart rate and response to surgery. "We also protect them from trauma by lubricating and taping their eyes and positioning their arms and legs appropriately," he says. "A lot goes into keeping the patient stable."
Operating days run until about 5:30 pm. "As soon as each patient is in recovery, we come back to the OR and set up for the next case," Dr. Sopher says. "It's very fast-paced."
Ironically, that intensity offers the specialty's best and worst moments. "We often deal with very sick patients who are literally on the edge of life and death, and that is both rewarding and difficult," he says. "On the other hand, I think many anesthesiologists would be bored in a job that was not so high-intensity. Many of us say we hate the stress, but secretly love it."
A changing focus
Anesthesia as a specialty is focusing more on the perioperative environment than ever before, says Dr. Sopher. "At UCLA, we do 30 percent of our total cases outside the OR, including cardiac catheterization, interventional radiology and GI procedures like ERCP, endoscopy and colonoscopy," he says. "When I first started we worked nearly exclusively in the OR. Today's perioperative focus increases patient safety and keeps things interesting for us."
Dr. Sopher notes that the specialty's broad spectrum means that operative care is only one career path of many within anesthesia.
"From the clinical work of chronic pain management to being in the labor and delivery room to care for mothers and neonates, we can do it all," he says. "What all these roles have is that patients are in difficult circumstances and we are able to bring them through."