Anesthesiology e
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Specialty Profile An est hes io lo gy /An esthesia GENERAL INFORMATION (Sources: Perspectives on Health Occupations, the Canadian Medical Residency Guide and Pathway Evaluation Program, RCPSC) Anesthesiology (anesthesia) is a diversif ied specialty requiring physicians to draw upon their knowledge of pharmacy and ph ysiology and to utilize their technical skills in the provision of perioperative care, critical care, emergency care and pain management. Anesthesiology is a relatively f lexible, mobile specialty and is inv olved in the following settings: • for surgery, anesthesiologists evaluate the patient’s overall health, plan techniques, choose agents, administer anesthesia, and monitor the effects of anesthesia and surgery on the patient’s vital functions • in the ICU, they care for critically ill patients by providing airway management, cardiac and pulmonary resuscitation, advanced life support and pain control • on the maternity ward, attend to the management of pain relief during childbirth • in pain clinics, anesthesiologists provide acute and chronic pain relief to a variet y of patients. Certain strengths may be needed to pursue this specialty such as the ability to perform under pressure, to think quickly in stressful situations, to use your hands and to work in a team environment. The opportunity to establish continuing, long-term physician/patient relationships is limited in this specialty. Upon completion of medical school, to become certified in anesthesiology requires an additional 5 years of RCPSC-approved re sidency training. This training includes: • 1 year of basic clinical training; and • 4 years of RCPSC-approved training that must include: 30 months of RCPSC- approved resident training in anesthesiology; 1 year of RCPSC-approved resident training in internal medicine (to be undertaken preferably after a year of clinical training in anesthesiology); 6 months of training that may include further training in an approved anesthesiology program or research experience in a clinical or basic science department approved by the Royal College; and 6 months training in clinical pharmacology undertaken in an accredited program during the final residency year. For more detailed training requirements go to: http://rcpsc.medical.org/residency/certification/training/anesthesiology_e.html#special There are currently 2,698 anesthesiologists practicing in Canada. Of these, 6% are under the age of 35, 59% are 35-54 and 34% are 55 and older. Nearly three-quarters of practicing anesthesiologists are male (74%) and 26% are female. (Source: 2008 CMA Masterfile).
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Transcript of Anesthesiology e
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DETAILED INFORMATION
The remainder of the data contained in this specialty profile has been extracted from the2007 National Physician Survey (NPS), unless otherwise stated. All percentages are forrespondents only. A total of 946 anesthesiologists responded (for a response rate of
34%). Complete data tables for anesthesiology from the 2007 NPS are available at:http://www.nationalphysiciansurvey.ca/nps/2007_Survey/Results/physician3.1_sp-e.asp
For an index to all specialties, go to:http://www.nationalphysiciansurvey.ca/nps/2007_Survey/2007results-e.asp
Choosing anesthesiology (2004 NPS Data)
In 2004, a total of 35% of anesthesiologists decided on this specialty as a career choiceduring their clerkship year (i.e., the last year of medical school), while 25% decided after
a period of time in practice and 19% decided during their residency.
Most anesthesiologists (83%) chose this specialty for the intellectualstimulation/challenge it provides. Also cited as factors cited were workload flexibility(60%), the influence of a mentor (40%) and the quality of the doctor-patient relationship(40%). From these factors, intellectual stimulation/challenge of the specialty was cited asthe single most important career decision-making factor (46%).
Practice Setting
For half (50%)f anesthesiologists their main work setting is an academic health sciences
centre, while 49% work mainly in a community hospital, 21% work in a privateoffice/clinic and 21% are in a university/faculty of medicine. Anesthesiologists seepatients in a variety of settings, with the academic health sciences centre being the mainpatient care setting for almost half (45%), followed by the community hospital (40%).
Liking the location was the major influence (58%) on an anesthesiologists’ selection oftheir current practice location, 58% liked the location, but the availability of a practiceopportunity (51%), family reasons (39%), the availability of a medical supportsystem/resources (37%) and the opportunity for affiliation with a university (36%) werealso cited as important influences.
Practice Profile
More than half of anesthesiologists (54%) work in a group practice, where on-call duties,equipment, office space and/or staff are shared amongst the physicians, while 23% arein an interprofessional practice setting, where physicians and other health professionalshave their own caseloads and 22% work in a solo practice setting.
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In their main patient care setting, 85% of anesthesiologists share patient care with othertypes of health care providers, including:
• nurses (69%)• pharmacists (46%)• family physicians (39%)
Nearly all anesthesiologists (92%) feel that this collaboration improves the care that theirpatients receive and enhances the care that they can deliver.
During a typical week, anesthesiologists see an average of 36 patients. The majority ofanesthesiologists (65%) serve mainly an urban/suburban population.
Anesthesiologists work an average of 55 hours per week on professional activities(excluding on-call). The majority of this time (42 hours per week) is devoted to directpatient care, with or without a teaching component. An additional 2 hours per week isspent on indirect patient care, such as making appointments with specialists, charting,meeting a patient’s family, etc. The remainder of the time is spent on research,CME/CPD, administration and/or teaching.
Most anesthesiologists (85%) make themselves available to their patients (i.e., on-call)outside of their regularly scheduled hours. Because of the nature and primary location oftheir practice, nearly all (98%) provide on-call for hospital in-patients, but a fair number(38%) also provide obstetrical on-call, while 16% do emergency room on-call and 9%are on-call for non-hospitalized patients (are available by telephone and see patients asrequired). Of those who do on-call, the majority (79%) spend up to 120 hour per monthon-call, 12% put in between 121 and 180 hours per month and 7% spend more than 180hours per month on-call. On average, anesthesiologists spend 94 hours per month on-call. During the time an anesthesiologist is on-call each month, they spend an average of36 hours on direct patient care and see an average of 36 patients.
Income
The majority of anesthesiologists (57%) receive 90+% of their income from fee-for-service and more than a quarter (27%) receive 90+% or more through a blended source(i.e., made up of a combination of 2 or more payment methods like fee-for-service,salary, capitation, sessional, contract, benefits/pensions, on-call remuneration or someother form). When asked their preferred method of remuneration, 58% ofanesthesiologists would prefer some form of blended remuneration, while 25% wouldprefer fee-for-service only.
According to the Canadian Institute for Health Information’s Average Gross Fee-for-
Service Payment Report 2005-2006, the average gross fee-for-service payment peranesthesiologist in 2005-06 was $273,486. Note that this is gross billings and does nottake into account deductions for overhead expenses, taxes, etc.
To protect their income, physicians take out medical liability coverage in the event that apatient is harmed in a medical misadventure. According to The Canadian Medical
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Protective Association’s Fee Schedule for 2009, the annual cost for insurance for ananesthesiologist is:
Quebec Ontario Rest of Canada
$ 3,793 $ 3,840 $ 1,680
Satisfaction
Three-quarters of anesthesiologists (75%) report that they are very or somewhatsatisfied with their current professional life.
Most anesthesiologists (85%) are very or somewhat satisfied with their relationship withtheir patients and with their relationship with other specialist physicians (80%). They aremuch less satisfied with their relationship with family physicians (only 43% are very orsomewhat satisfied).
They also report being less satisfied with finding a balance between personal andprofessional commitments (55%), with their net revenue per hour compared to otheranesthesiologists (50%) and with their net revenue per hour compared with otherspecialties (40%).
ADDITIONAL INFORMATION
Additional information on this specialty can be found from the:
Canadian Anesthesiologists’ Society: http://www.cas.ca/
