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The 10 Biggest Stressors in Anesthesiology

By Debra Wood, RN, contributor

Medicine is a high-stress profession, affecting physicians in every specialty. Caring for patients, making urgent decisions and balancing administrative duties can take its toll—even in the best work situations.

Anesthesiologists tend to have their own set of pressures. While the specialty offers many benefits, there are also several factors that can ratchet up stress levels in anesthesia practice. Here’s a look at the top issues, and how practitioners can mitigate their effects.

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10 factors that cause stress in anesthesia practice

1. Responsibility for the patient’s life - the prime stressor 

“The main stress is the life of the patient is in your hands,” said Mary Dale Peterson, MD, president of the American Society of Anesthesiologists. “And we give extremely powerful drugs. You can give a drug that can kill someone in two to three minutes if it is not managed correctly. That responsibility is always weighing on your shoulders.”

While anesthesia has become safer, Peterson said, risks continue to exist. 

Christine Doyle, MD, FASA, president of the California Society of Anesthesiologists, agreed that patient safety is paramount: “I’m literally holding someone’s life in my hands.”

2. Long hours and on call

Anesthesiologists put in long hours, Peterson said. They can be called in the middle of the night to come in for a surgical procedure. 

“A lot of people in private practice are in the hospital for 24 hours at a time,” Peterson said. 

“Although we work long hours, when we are off we have the opportunity to be completely off,” Doyle said. “We do relaxing things with family and friends.”

3. Older patients with more comorbidities

A primary stressor, according to Doyle, is the patient population, which is older and sicker with more comorbidities than in years past. About a third of today’s patients would not have been considered surgical candidates 40 year ago. 

“We may have better drugs, but they are still potent,” Peterson said. 

4. Multimodal pain treatments

As the “opioid crisis” has affected how clinicians practice medicine, anesthesiologists have started using more blocks and other procedures to minimize pain to reduce the need for opioids.

“We like to think of ourselves as part of the solution,” Peterson said. 

5. Issues with drug shortages

Supply chain issues and drug shortages complicate anesthesia practice, Doyle said. Older generic drugs are especially at risk of short supply.

Peterson agreed that drug shortages are a problem. Anesthesiologists often have go-to drugs they like to use, but when those are not available, they must make substitutes.

6. Working without enough colleagues

“We are short staffed for anesthesia coverage pretty much everywhere in the country,” Doyle said. “It’s a never-ending battle.”

7. Team care

Managing CRNAsand other staff can be stressful for the anesthesiologist, Peterson said. 

“That’s especially true if you are over-stretched, especially if trying to do medical direction,” she said, adding that trying to supervise more than two rooms is a challenge and stressful. 

“It’s a responsibility of having that patient’s life in your hands,” Peterson said. “You cannot be two places at the same time.”

“Interpersonal relationships can make or break the site,” Doyle said. “That includes every member of the team, but I would not focus on that as a major stressor.”

8. Production pressure

Operating rooms are expensive places, and hospital management often exerts pressure on clinicians to speed up surgeries and expedite cases, Peterson said.

Often the business side of medicine presents stressors, Doyle agreed. Leadership with training in medicine and nursing are less likely to pressure fellow providers to do more than is possible.

9. Electronic medical records

Many anesthesiologists find electronic medical records stressful and frustrating, Doyle said. Multiple studies have found electronic recordkeeping increases physician stress.

10. Ethical issues

Many ethical issues facing physicians also apply to anesthesiologists, such as organ procurement, determining cardiac or brain death and reasons for procedures in patients who likely will not benefit. An ethics consult can help flesh out the issues. 

+ Coming Soon: Rationing care with COVID-19

While the idea of rationing care seems to go against the values of all health care providers, it’s happening in some places as a result of the COVID-19 pandemic. Facilities in the United States could be next.

Elective surgeries may be cancelled, so space is available for COVID-19 patients, Doyle said. Hospital ORs and PACUs can be used as ICUs for COVID-19 patients.

“That is one of the things we are dealing with now,” said Doyle, adding that we are now seeing the effects of past cuts to service lines.

The prescription for anesthesiology job stress

So how should anesthesiologists combat stress?

Both Doyle and Peterson recommend healthy coping mechanisms, such as spending quality time with family and friends, traveling, pursuing a hobby not related to medicine, sleeping late, getting a massage, crafting or other personal pursuits. These types of things can temper the effects of anesthesia job-related stress.

“Little things make a huge difference,” Doyle said.

Peterson recommends self-care, such as getting sufficient rest, eating right and resisting turning to alcohol. She also recommends debriefing after catastrophic events in the operating room.

“We all chose a stressful profession, and I think we knew it,” Peterson said. “We’re people used to staying calm under a lot of pressure.”

Related:
The Employment Outlook in Anesthesiology for 2019

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