Today’s inane image of the day:
[I just wanted to point out that this video went live at 4am 🤣]
I start most of my mornings at ~4am. I find that this is the best way for me to start the day to be productive and overall for my well-being. I think for a while I was in denial about being a morning person, but once I became an anesthesiologist, it became clear that my days were just *so much better* when I started them early.
My 4am morning routine looks like this:
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When I started residency, I fully intended on joining a private practice group. But my residency and fellowship @mghanesthesia ended up changing my trajectory. Here are some reasons I stayed in academia:
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It is no secret that ultrasound is a powerful tool for the anesthesiologist and intensivist. During residency, we achieve competence in using ultrasound for vascular access, regional anesthesia, and basic cardiac examination [both transesophageal and transthoracic]. When I was a resident, there were times when it was really challenging to get an ultrasound, which translated into feeling like my own skill was mediocre. Fellowship in critical care anesthesiology certainly helped me build upon my skill and clinical application of ultrasound has continued to advance my knowledge.
During my critical care fellowship, I opted to take the CCEeXAM® Examination of Special Competence in Critical Care Echocardiography. Mostly because someone else was paying for the certification and I thought that it could be a useful certification to possess. At the time, the exam had only been administered a few times; there were limited resources to study from and very sparse information on the internet on how to structure my studying or where to focus my attention.
Luckily, if you’re looking to make this ~$1,000+ [probably more like ~$2000-$3000 after you include the study resources below] investment in your clinical practice, I have some advice from my own experience and a recent test-taker’s experience to help guide your study plan.
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I was recently reflecting on who I was during internship, residency, and fellowship. You might be wondering, “What does that even mean?”
There was a period in my life where I staunchly believed that people do not change. You are fundamentally who you are. There then came an era where I was less sure of this assertion. I started to waver in my belief as I watched my parents evolve. I noticed that my friends showed up in different ways over the years and during life events. I reflected on my own journey and who I was. I wondered if, maybe, people could change.
I’ve now come back full circle in my belief that people have a fundamental foundation… but the way that it is presented and shows up changes with the situation.
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I spent the majority of my life feeling the pressure to “hustle.” That productivity was equated with my worth. If I wasn’t productive, then what purpose do I serve?
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Last week, I reflected on 2023. As sort-of-promised, I decided to set some 2024 intentions. I think that every single day is a new opportunity to set and achieve goals; I don’t think we need a designated time of the year to do these things. I have short-term, intermediate-term, and long-term goals that I set and review on a semi-regular basis. But the idea of intentions feels like the right approach for 2024; they are touchy-feely types of ideas that I’d like to work toward in the new year. There is no checkbox for these items… they are lofty ideals that I hope I can remind myself to embody throughout the year. Maybe my 2024 reflections post will be assessing how these intentions came into play [or didn’t!]. Who knows. Maybe there will be silence on the blog for almost a year again [let’s hope not].
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I keep telling myself I will get back into blogging regularly but the words don’t flow the way they used to. The further along in my career I get [and the older I get], the more it seems “risky” to pour my heart and soul out to the internet. Yet, it feels like there is a part of me I am not honoring by being silent. There is also something to be said about the loss of connection to those of you still reading my updates with anticipation and excitement [I appreciate you – I know you’re out there and support my writing endeavors].
This is by no means a declaration of more consistent writing in 2024, but a reflection that this space is an important one that I want to integrate into my life in a more consistent manner again.
A couple years ago in an effort to reflect upon a relationship ending, I started journaling on a regular basis. I’ve actually kept a journal/blog for most of my life, but consistency was never my strong suit. Or perhaps I should say frequency was never my strong suit since I consistently went back to it. Either way, a couple years ago, I picked up journaling and it stuck. As a result, I have my own written words/emotions/thoughts/feelings to reflect upon on an annual basis. As we near the end of 2023, I figured I’d share some the reflections I had from 2023.
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If you’ve stumbled across this entry, it is likely that either you or someone that you care deeply about has failed some sort of examination. It may be a low-stakes or a high-stakes one. It may be in the setting of a course, or it may be in the setting of a medical board examination. Either way, there is something so disarming about failing an exam. It really cuts deep. I am going to make the generalization that most people who are seeking advice after failing an exam are those who typically haven’t encountered this challenge before.
Either way, you are here and seeking advice on how to move forward.
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I’ve been asked whether my schedule is more “humane” or “manageable” now that I’m an attending. The answer is a resounding “yes!”… but, I still have blocks of long weeks. The work never stops being challenging for one reason or another. There are certainly still weeks when I am scheduled to work 70 hours. Yet even with this assignment, the work still feels so much better than when I was in training. Long weeks as a trainee felt exhausting because there was always something new to learn. Long weeks as a first-year attending also felt exhausting for the same reason. Now that I’m a few years out, I feel more at ease, confident in my clinical skills, and able to appreciate how incredible the work I get to do is.
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It has been almost a decade since I applied to anesthesia residency. It’s crazy how time flies. When I applied to the specialty back in 2014, anesthesiology was a somewhat competitive specialty – for the 2015 match, there was a total of 1,859 applicants for the 1,094 PGY-1 positions offered in through 120 anesthesiology programs [of note, back in my time, there were many more advanced spots available, so of note, there were also 1,581 applicants for the 506 PGY-2 anesthesiology positions; for the sake of consistency to compare between 2014 and currently, I’m going to only focus on the PGY-1 positions]. In the 2023 match, there were a total of 2,959 applicants for the 1,609 PGY-1 positions offered through 172 anesthesiology programs [and there were 2,006 applicants for 301 PGY-2 positions].
If we only look at PGY-1 positions and assume that everyone who applied could occupy a spot, back in 2015, the match rate would be 1,094/1,859 = 58.8% while in 2023 the match rate would be 1,609/2959 = 54%.
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