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Duke University Health System
Careers in AnesthesiologyCareers in AnesthesiologyCerebral, fast-paced, technologically oriented specialtySubstantial procedure baseOff-time is your ownAverage work time 50 – 60 hours/ weekFlexibility in time worked is a lifestyle drawHigh stress environment (right now!)
Duke University Health System
OutlineOutlineNational trends in Anesthesiology CompensationFactors driving changes in compensationDuke Anesthesiology Clinical Faculty #’sTypes of practiceResearchControversies
Duke University Health System
Duke University Health System
Issues for Ongoing ShortageIssues for Ongoing Shortage
Marked reduction in traineesLag time from training to marketDisproportionate reduction in revenue
Duke University Health System
Continued Supply/Demand ImbalanceContinued Supply/Demand Imbalance
Continued manpower issuesContinued financial pressure
Duke University Health System
EnhancedPatient CareEnhanced
Patient Care
Public RelationsPublic
Relations
DevelopmentDevelopment
OperationsOperations
Database Management
Database Management
Scientific Output
Scientific Output
ResearchKnowledge
Development
ResearchKnowledge
Development
Public EducationPublic Education
Improved PreventionPatient Awareness
Improved PreventionPatient Awareness
Improved EarlyIntervention
Improved EarlyIntervention
PatientEducation
PatientEducation
Enhanced Patient Care InformationEnhanced Patient Care Information
Evidence-BasedBest Practice
Evidence-BasedBest Practice
ImprovedEducationImprovedEducation
EducationEducation
Duke University Health System
TIMEFebruary 19, 2001
Public Relations
Duke University Health System
Scientific OutputScientific Output
Duke University Health System
0
1
2
3
4
1993
1994
1995
1996
1997
1998
1999
Stroke RateStroke Risk
Stroke by SRI and DOS
Enhanced patient care!!!
Duke University Health System
Public Public RelationsRelations
Duke Duke RelationsRelations
Duke University Health System
Types of Practice Types of Practice Private – mostly OR HybridAcademic– OR based/ Teaching/Research– ICU – Pain– Research/ Physician Scientist
Duke University Health System
OR PracticeOR Practice
Supervision of CRNA’sPersonal provision of careService specialty
Duke University Health System
Types of ResearchTypes of ResearchAnesthetic mechanisms (molecular)Outcomes and Quality of LifeOrgan protection– Cardiac– Neuro– Renal
CoagulationHuman factors engineeringTissue engineering
Duke University Health System
Types of ResearchTypes of ResearchIntensive care ( infection, MODS, ventilatory management)Pain management (chronic, acute, regional anesthesia)Risk assessment and management of high risk patientsAging and cognition (long-term effects of anesthetics and surgery on cognition and quality of life)Genetics of organ injury (OR as laboratory)
Duke University Health System
days 10
5
ICU stay*0
15
hospital stay*
20
10
0
30
% 25
extended care*0
50
no RD ( n=2051)
#RD ( n=141)
dialysis ( n=30)
* excluding in-hospital deaths
2222 CABG +/- valve
mortality
60
30
0
%
Mora-Mangano et al. Ann Int Med 1998;128:194-203
# Peak Cr ≥ 2.0 mg/dL AND increase in Cr ≥0.7 mg/dL
Degrees of renal dysfunction and adverse outcomes
Duke University Health System
Acute Perioperative Nephropathyand Projected Progression of Chronic Renal Failure
after Heart Transplant Surgery
0
100
200
300
400
500
600
1 2 3 4 5 6 7 8 9 10 11 12 13
Projected Progression of Chronic Renal Failure
%∆
Cr
years after surgery
Swaminathan et al. Anesth Analg 2002;94:SCA23
(%∆Cr > 60%)High acute renal injury (n=35)
Low acute renal injury (n=64)(%∆Cr < 60%)
Duke University Health System
Cognitive Change Over Five Years
-2
-1.5
-1
-0.5
0
0.5
1
1.5
2
Discharge 6 Week 6 Month 5 Year
Time of Evaluation
Cha
nge
from
Bas
elin
e
Not Impaired at DischargeImpaired at Discharge
Newman. NEJM, 2001.
Duke University Health System
General Health SelfGeneral Health Self--RatingRating
1.11
0.46
-0.10
-0.59
-0.80 -0.60 -0.40 -0.20 0.00 0.20 0.40 0.60 0.80 1.00 1.20
5 Year Cognitive Function Score5 Year Cognitive Function Score
Fair / Poor
Good
Very Good
Excellent
Postoperative Cognition and Perception of HealthPostoperative Cognition and Perception of Health
Newman. Stroke, 2001; 32:2874.
Duke University Health System
1.54
1.07
-0.37
-0.49
-1.02
-1.50 -1.00 -0.50 0.00 0.50 1.00 1.50 2.00
Work Status
5 Year Cognitive Function Score
Homemaker
Retired
Unemployed / Disabled
Part Time
Full Time
Postoperative Cognition and Work StatusPostoperative Cognition and Work Status
Newman. Stroke, 2001; 32:2874.
Duke University Health System
Duke University Health System
Duke University Health System
ControversiesControversies
CRNA’s (two edged sword)Disproportionately low Medicare and Medicaid reimbursement RESPECT based on professionalism
Duke University Health System
How can we begin to prepare for How can we begin to prepare for a residency in Anesthesiology?a residency in Anesthesiology?
Strong academic base with good Board Scores! (increasing competition)Critical care experienceEarly rotationsLetters from individuals that know youLetters from the chair
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