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Anesthesiologist

[an-uhs-thee-zee-ol-uh-jist]

An anaesthetist (English), or anesthesiologist (US English), also "anaesthesiologist," is a medical doctor trained to administer anesthesia and manage the medical care of patients before, during, and after surgery.

Role in Healthcare Delivery

According to the American Society of Anesthesiologists, anesthesiologists provide or participate in more than 90 percent of the 60 million anesthetics delivered in the USA annually.

Anesthesiologists are perioperative physicians ("peri-" meaning "all-around") who provide medical care to patients before, during, and after their surgical experience. This includes a preoperative medical evaluation of each patient before surgery, consultation and planning of the surgery with the surgical team, creating a plan for the anesthesia tailored to each individual patient, airway management, intraoperative life support and provision of pain control, intraoperative diagnostic evaluations as needed, and critical postoperative life support. This also includes medical management of preexisting medical conditions, care and management of medical or surgical complications, provision of pain management, and intensive care management as the situation warrants. Management, direction of, and performance of cardiac and pulmonary resuscitation, advanced life support, pain control, and stabilizing and preparing patients for emergency surgery are mandatory, essential, and critical skills which anesthesiologists have been trained to employ.

Historically in the United States there has been a shortage of anesthesiologists. In order to better serve the population, residency positions in anesthesiology for physicians have been steadily increasing the past several years. In addition, physicians supervise ACTs, or Anesthesia Care Teams, which are composed of a supervising physician with several certified registered nurse anesthetists (CRNA's) or anesthesiology assistants (AA's), working together to provide healthcare to the population. In other areas of the country, anesthesiologists work in what is deemed a "solo" or "MD/DO only" practice, during which they provide anesthesia in a "one on one" relationship with the patient.

As perioperative physicians, anesthesiologists also work in ICU's, PACU's, Pain Clinics, infusion centers, and ambulatory surgical centers.

Anesthesiologists and Patient Informed Consent

Patient informed consent is a fundamental ethical and legal principle and is considered essential to patient autonomy. The American Society of Anesthesiologists and the American Osteopathic College of Anesthesiologists support the principle that patients should be fully informed regarding the manner in which their anesthetic will be administered.

Due to medications given before, during and after surgery, a patient may sometimes not remember interacting with his or her anesthesiologist and other members of the anesthesia care team. Therefore, patients should request to know, before surgery, the identity of their anesthesiologist as well as the identity of mid-level providers, such as nurse anesthetists or physician assistants, who will be involved in their anesthesia care. The anesthetic plan, as well as alternatives, risks, and benefits of the chosen anesthetic techniques, should be discussed with the patient prior to surgery.

Patients should discuss medical conditions with their anesthesiologist prior to surgery. Medications, allergies, and any history of medical problems, particularly diseases of the heart and lungs, should be discussed with the anesthesiologist. It is critically important for a patient to disclose any family history of problems with anesthesia as well as whether the patient has had anything to eat or drink before surgery.

Training by country

Physician training in anesthesiology in developed countries is similar.

Australia and New Zealand

In Australia and New Zealand, anaesthetists are physicians (with the degree MBChB) who have specialized in the medical field of anaesthesia or anesthesiology.

In Australia and New Zealand, training is overseen by the Australian and New Zealand College of Anaesthetists. The ANZCA approved training sequence encompasses an initial two-year Prevocational Medical Education and Training (PMET) period and the five-year period of ANZCA Approved Training (two years Basic Training and three years Advanced Training).

In the course of Approved Training, you are required to successfully complete:

- Five years of supervised clinical training at Approved Training Sites
- Both the Primary and Final Examinations
- A program of 12 modules
- An EMAC (Effective Management of Anaesthetic Crises) or EMST (Early Management of Severe Trauma) course or equivalent

On completion of all Training Program requirements the Trainee will be awarded the Diploma of Fellowship and be entitled to use the qualification of FANZCA – Fellow of the Australian and New Zealand College of Anaesthetists.

Germany

After earning the right to practice medicine, German physicians who want to be an anesthetist have to go through a 5-year residency, ending with a board examination. During this time, physicians are educated in all aspects of their chosen field of medicine. Usually this includes rotations serving in the operating room to perform anesthesia on a variety of patients being treated by every kind of surgical sub-profession (i.e. general surgery, neurosurgery or invasive urological and gynaecological procedures), followed by a rotation on various intensive-care and intermediate-care units. During this time of residency, many physicians choose to complete a course in emergency medicine, which once completed, enables them to be referred to as Notarzt, a physician of the Emergency Medical Service, treating patients at home or on the scene of accidents, either on their own or assisted by paramedics.

United Kingdom

In England, Northern Ireland, Scotland and Wales training is overseen by the Royal College of Anaesthetists. Anaesthetists in the United Kingdom are doctors who have completed a five-year or six-year undergraduate training program.

Following the completion of medical school, doctors enter the two-year Foundation Programme which consists of at least 6 four-month rotations in various medical specialities. It is mandatory for all doctors to complete a minimum of 3 months of general medical and general surgical training in this time.

Following the Foundation Programme, doctors compete for specialist training in anaesthetics. The training programme in the United Kingdom currently consists of 2 years of Core Training and 5 years of Higher Training. Trainees wishing to hold dual accreditation in Anaesthetics and Intensive Care Medicine may enter anaesthesia training via the Acute Care Common Stem (ACCS) programme which lasts three years and consists of experience in anaesthesia, emergency medicine, acute medicine and intensive care. Trainees in anaesthesia are called Specialty Registrars (StR) or Specialist Registrars (SpR).

Before the end of Core Training, all anaesthetic trainees are expected to have passed the primary examination of the diploma of Fellowship of the Royal College of Anaesthetists (FRCA). The final part of the examination is taken as a higher trainee (usually in the 5 year of training). The FRCA examination is notorious for its difficulty and is said to be the most difficult of all post-graduate medical examinations. The examination covers physics, pharmacology, physiology, anatomy, clinical sciences, pathology, respiratory medicine, emergency medicine, critical care, pain medicine.

The CCT programme in anaesthetics is divided into three levels - basic, intermediate and advanced. During this time, doctors experience anaesthesia as applicable to all surgical specialities. The curriculum focusses on a modular format, with trainees primarily working in one specialist area during the module, for example: cardiac anaesthesia, neuroanaesthesia, ENT, maxillofacial, pain medicine, intensive care, trauma.

Traditionally (before the advent of the Foundation Programme)trainees have entered anaesthetics from other specialities, such as medicine or accident and emergency. Specialist training then takes at least seven years.

On completion of specialist training, doctors are awarded the Certificate of Completion of Training (CCT) and are eligible for entry on the GMC Specialist Register and are able to work as Consultant Anaesthetists. A new consultant in anaesthetics will have completed a minimum of 14 years of training (including medical school).

Those wishing to dual accredit in intensive care are required to undertake an additional year of training and normally complete the Diploma in Intensive Care Medicine (DICM). Pain specialists sit the Fellowship of the Faculty of Pain Medicine of the Royal College of Anaesthetists (FFPMRCA) examination.

United States

In the United States, anesthesiologists are physicians (MD or DO) who have chosen to specialize in anesthesiology. The majority of anesthesiologists in the United States have completed a four-year undergraduate college degree, including pre-medical requirements. Like other physicians, anesthesiologists complete four years of medical school (several medical schools offer a six year program following high school. The first two years fulfill the pre-medical requirements, and the following four years are the traditional medical education). Physician training programs in the United States, without exception, require four years of residency training for board certification eligibility in the specialty of anesthesiology (usually one year of general medical or surgical training followed by three years of clinical anesthesiology training under the tutelage of experienced anesthesiologists, usually faculty at medical school hospitals). In all, after graduating high school, physicians specializing in anesthesiology complete at least ten to twelve years of education and training prior to becoming eligible for board-certification.

Anesthesiology residency training in the U.S. encompasses the full scope of perioperative medicine, including pre-operative medical evaluation, management of pre-existing disease in the surgical patient, intraoperative life support, intraoperative pain control, post-operative recovery, intensive care medicine, and chronic and acute pain management. After residency, many anesthesiologists complete an additional fellowship year of subspecialty training in areas such as pain management, cardiac anesthesiology, pediatric anesthesiology, neuro anesthesiology, obstetric anesthesiology or critical care medicine.

The majority of anesthesiologists in the United States are board-certified by a specialty medical board; either the American Board of Anesthesiology (ABA) or the American Osteopathic Board of Anesthesiology (AOBA). The ABA is a member of the American Board of Medical Specialties, while the AOBA falls under the auspices of the American Osteopathic Association. Both Boards are recognized by the major insurance underwriters in the U.S. as well as by all branches of the U.S. Uniformed Services. Board certification by the ABA involves both a written and an oral examination. AOBA certification requires the same, in addition to a practical examination with examining physicians observing the applicant actually administering anesthetics in the O.R.