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Specialisation in Anaesthesia

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anasthesiaA stereotypical imagination of an anaesthesiologist is someone in the operation theatre who puts the patient to sleep and wakes him up at the end of the operation. But the matter of fact is that an anaesthetist does much more than that.

An anaesthesiologist is actually a peri operative physician. He doesn't only have a role to play in the operation theatre, but he also plays a critical role pre and post the surgery.


Pre Surgery
Any surgery, be it small or big, right from appendix, to an open heart surgery,, the anaesthetist has to first bring the patient to his optimal health. For example in cases of problematic blood pressure, or congested chest, the anaesthesiologist takes care and makes efforts to bring the patient to the fittest health possible in his condition.

During the surgery
The job of the anaesthesiologist is to create something like an amnesia. , so that the patient doesn't have a bad recollection of pain. So the anaesthesiologist either gives a general or a regional anaesthesia to the patient in the operation theatre, before the surgery begins. General anaesthesia means making the patient completely unconscious. Regional anaesthesia is where only a part of the patient is made num. once the appropriate anaesthesia is rendered to the patient, the anaesthetist has to monitor and regulate the patient. For example if the patient's blood pressure is dropping, or the heart beat is slowing down, it is the anaesthesiologist's job to manage the situation.

This is done because it is the anaesthetist's job to create optimal condition for the surgeon too operate. If the patient feels the surgical discomfort and pain, then he may shout, move, or otherwise disturb the surgery. Also, since the anaesthesiologist takes care of the patient's over all well being, the surgeon can concentrate only on the surgery.

Post Operative care
At the end of the surgery, it is the anaesthesiologist's responsibility to wake up the patient, i.e. bring him back to consciousness. Once the patient is out of the operation theatre, it is the anaesthetist who takes care of the pain and sedation. Without a go ahead from an anaesthetist no patient can be discharged from the intensive care unit to the ward/room.

Acquiring a seat in anaesthesia
After the Bachelor in medicine and Bachelor in Surgery, doctors with an inclination to study further and specialise, have to sit through an entrance exam. At the national level, there is All India Post Graduate Entrance test, at the state level there are individual state entrance exams for domicile holders, and there are exams of private colleges and deemed universities.

The rank acquired in these exams determine your admissions in different colleges. Earlier the ranks could be as relaxed as early one thousand, but in the last three to four years, the ranks opting for anaesthesia have moved up by a few hundreds.

The MD degree is of three years, and so is the DNB. Whereas the diploma in Anaesthesia is of two years, after which you could apply for MD or DNB which will be reduced to two years. There is a separate entrance exam for DNB.

Super Specialisation
This branch is such which doesn't really require a super specialisation. All across India, DM in neuro anaesthesia and DM in cardiac anaesthesia are the only super specialisation courses available and that too only in AIIMS.
The other fellowships of varying durations available are fellowship in pain management, fellowship in paediatric anaesthesia, fellowship in obstetric anaesthesia, fellowship in regional anaesthesia, fellowship in transplant anaesthesia, fellowship in neuro anaesthesia, fellowship in cardiac anaesthesia, and so on.

Post study options
Generally the MD and diploma specialists have equal career and job opportunities. The only hitch is that the MDs are slightly preferred over diploma holders
As an anaesthesiologist you can join a government hospital as an assistant professor. The other options are to either join a private/ corporate hospital. Or take up free lancing. Joining a corporate hospital would mean you would have a typical 9 to 5 job and emergencies on and off. Free lancing would mean that you build your own network and get attached to a couple of hospitals / nursing homes who will keep calling you as and when a surgery requires.
Another upcoming option is the concept of a pain management clinic. This means setting up your private practice and helping patients suffering from chronic pains [like cancer pains, severe headaches] to get relief.

Skill set required:
Calm, confident, and sharp- it is an absolute must for an anaesthesiologist to be calm in every situation. There could be a sudden change in the patient's condition during the surgery, in which case the first rule is don't panic. So someone with a cool head and a calm approach is needed. When the situation worsens, an anaesthetist has to be sharp and confident enough to quickly take the needed steps. He cannot not think of a solution. If he panics or gives up, the surgeon will feel the tension, and his attention may deviate from the surgery.
Constant vigilance- an anaesthesiologist should constantly observe and monitor his patient during the surgery. With absolute alertness, he has to stand by or sit by his patient no matter what. Even for a couple of minutes, he cannot excuse himself physically or mentally.

Patient
- sometimes, like in the case of cardiac surgeries, the operations are quite long. During those hours, there is a possibility that the anaesthesiologist may have nothing to do. Yet he cannot get bored, or leave his patient even for a short while.

Team player
- an operation is a team work. An anaesthesiologist is a vital member of this team. And hence requires the skills of a team player.
Efficiency in communication- an anaesthesiologist needs to communicate with the medical staff and the surgeon, so that there is no misunderstanding during the operation and recovery of the patient. Hence good communication is a must.

Knowledge of the entire body- an anaesthesiologist is called forward for surgeries related to any part of the body; hence he/she must possess the knowledge of each and every body part, and should be aware of all relevant latest developments. The medical and surgical knowledge combined helps you remain in the OT as well as be the physician.

Disadvantage
Albeit the anaesthesiologist plays as vital a role in the operation and recovery of the patient as a surgeon, his hard work and contribution is seldom acknowledged. This lack of acknowledgement and gratitude can lead to dissatisfaction in some cases.
Another disadvantage is the mental stress. An anaesthesiologist has immense responsibility to be alert and make quick and correct decisions; hence the mental stress is enormous.
Medico legal cases also form a part of the anaesthetist's life. If anything goes amiss or wrong in the OT, the anaesthetist has to bear the major portion of the blame and subsequent legal entanglements.

Investment and earning
This is a branch where you don't have any investment, neither for an operation theatre, nor for any equipments. Even as a fresher the earning at hospitals is good, which becomes even better with time. As far as free lancing is concerned, there is no limit to how much or how little you can earn.
The only expenditure you will incur is of rent if you set up your own pain management clinic.

Emergencies
Since this field is so closely intertwined with surgeries, your life will be well peppered with emergencies.