When I first started this blog, I was speaking mostly about my experiences in the field of anesthesia. Today I am going to go back to the type of information. Recently I have posted some clinically relevant information about the practice of anesthesia. These posts haven't been as popular as the older posts I have put up that talked about my personal experiences.
Today I will touch on my experiences since I have finished residency.
I finished my residency from Baystate Medical Center which is part of Tufts University and it is located in Springfield MA. It is a great program for learning. The first year of residency is called intern year or CA0 (clinical anesthesia year zero). I did required rotations in surgery, medicine, ICU, SICU, pediatrics and pain management. I would say that of all the rotations the SICU and the ICU rotations were the most enjoyable and the most brutal as far as time commitment. I would arrive by 5am and leave around 6pm if not on call. If on call I would arrive at 5am and not leave until 12pm or 3pm the next day. I know there are new time requirements for residents and interns, however, I personally believe that we as physicians are supposed to be the individuals who work their best under intense psychological and physical pressure. I for one enjoy the testing of my self. It is like a training ground for a navy seal. We are pushed to our limits and we either crack or excel. Luckily I excelled.
After intern year it is the first year of being an anesthesia resident (CA1 year). This is the year that I learned the fundamentals of anesthesia. Next is year two of residency (CA2 year) where I learned the skills of the more complex surgical cases. This is where the nuances and the fine tuning of the skills of the anesthesiologist come into shape. Year three (CA3) is the best. It is getting ready to be on my own. To perfect my skills in the areas of my interest. My interest lay in regional anesthesia, obstetrical anesthesia, and outpatient anesthesia. Regional anesthesia is multifaceted, and my interest was in regional blocks. I have become highly skilled in performing a number of nerve blocks using ultrasound guided techniques.
This skill has carried over into my career as an attending anesthesiologist. An attending is a fancy name for the boss or a doctor no longer in training. Some also refer to a practicing physician as a staff physician or a consultant. In other countries such as in Europe the terminology is slightly different. When I was about six months from completing residency, I began to interview for positions across the eastern United States. The position I settled on was at Cooley Dickinson in Northampton MA. The reason I prefered this position is because it was an independent contractor position plus I also would do my own cases without CRNA supervision. CRNAs are nurses that go for extra schooling after nursing school to learn how to administer anesthesia. I won't elaborate to much on this, unless I am requested to, as there are many facets to CRNAs and MDs and the politics and hierarchy involved, but lets just say that coming out of residency I wanted to practice on my own. In residency there is always an attending anesthesiologist that I had to answer to, that would critique my anesthesia plan and always be shadowing me to ensure that I followed the plan of the attending anesthesiologist. I wanted to do my own cases with supervising a nurse to learn the ins and outs of giving anesthesia that was entirely performed my me, solo. That decision, was a great decision. I have learned more about anesthesia and how I should practice and how I want others to practice that I will supervise than if I hadn't practiced on my own for a period of time.
Also when I first started to practice at Cooley Dickinson Hospital (CDH) I also was an independent contractor. This means I didn't belong to a bigger group and I had my own business to run. This was another excellent decision. Having the experience of being my own small business meant I had to learn how to start a business how to handle the finances of that business etc. If I could I would continue to be a 1099 S corporation. But that isn't how it has happened. The hospital thought that the anesthesiologists weren't a cohesive enough entity for the hospital to work with, so the hospital forced us to form a group. This is another great opportunity that I have been a part of. I had to dissolve my corporation set up a new corporation with a group of partners. I immediately became a partner in the new group and have advanced to Vice Chief and Administrative Director of this corporation. Not many anesthesiologists can say over a four year career that they have been a S Corp, dissolved that and started a group corporation, become a partner, practiced solo, and then practiced with a group of CRNAs. So far my career as anesthesiologist has been loaded with a lot of business and clinical practice experiences that I would never trade.
Once our I became a group with the other anesthesiologists in the hospital we had to make a lot of changes. We had to hire employees and a practice management group to help us oversee the running of the practice. This is quite a detailed story that I want to share to try to help other people understand the starting of a small business, or a corporation, and I will continue this at another time.
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