COMMENTARY

Why I Became an Anesthesiologist

Alex Macario, MD, MBA

Disclosures

June 08, 2017

To understand how I ended up an anesthesiologist, you have to first understand how I ended up a physician. My dad is a doctor and has been a role model for me from the beginning. Even now, at age 82, he has outstanding physical exam skills—much better than mine. He was taught and learned those skills before technology became such an important part of medicine.

Alex Macario, MD, MBA

I think I had a first vague awareness I was going to become a physician when I was in middle school. I remember thinking about and weighing the pros and cons of different career choices. I wanted to become a professional athlete, such as a tennis player or a soccer player, but by high school, I knew I was not good enough.

Looking back, the main reason I went into medicine was because every physician I knew or heard about when I was growing up had a job. Although I didn't have specific interactions with any physicians, the general sense I had was that medicine was rewarding work, and physicians seemed satisfied, especially with their place in society.

I recall being focused on the importance of being gainfully employed long-term. I was especially attracted to the idea that doctors didn't get laid off. This consciousness arose early in high school because one summer, I had a difficult time finding work. I didn't like the feeling of being rejected for some of the odd jobs I applied for. Even a pizza parlor didn't offer me a summer job in my hometown of Albany, New York. Although I ended up teaching tennis to young kids at a summer camp in town, I knew job security was priority one.

The fact that I enjoyed math and science was helpful to my objective of practicing medicine. Also helpful was being deeply curious about humans—not only our biology but also the social environment people were from, and how that affected their personality.

I recall being focused on the importance of being gainfully employed long-term. I was especially attracted to the idea that doctors didn't get laid off.

Reflecting back on my early career aspirations, it was also crucial to have gone to a high school with many high-achieving kids. Being around them pushed me academically and also expanded the boundaries of what kind of college or university I could envision attending. Several of those peers ended up at Ivy League schools and other well-known private colleges.

Watching the Rose Bowl football game on TV growing up, I wondered where on earth Pasadena, California, was. How could it be so warm and sunny in January that all the fans were wearing T-shirts? I knew I had to look into that location more, because I loved the idea of being in a nice climate. However, in 1982 when I finished high school, going to California for college would have been a huge leap—almost like going to the moon, culturally and geographically.

I applied to six colleges, was accepted to four, and chose the University of Rochester. I was impressed that they awarded me a merit-based scholarship. I'm sure my parents were thrilled with financial help. For me, it was a strong signal that the school must have really wanted me—more so than other schools that accepted me and had more well-known names and brands, but didn't offer any money.

The University of Rochester also had an innovative program called the Rochester Plan. In this program, college sophomores apply to the medical school at Rochester and receive an admission decision before the start of junior year. My college acceptance letter mentioned the Rochester Plan, and as soon as I arrived to the undergraduate campus, I worked very hard to get the grades to be a qualified applicant. I was ultimately accepted into that plan, which meant a lot of great things, including staying in Rochester for 8 years, getting my MBA, and meeting my wife.

With regard to anesthesiology as a career, the summer after freshman year in college, I worked part-time handing out parking tickets in the parking lots around the medical center. The rest of the time, I shadowed a sports orthopedist on the Rochester faculty. I had voiced an interest in sports medicine because I wanted to be the doctor on the sidelines at professional sporting events. What a great way to get on the field, and be part of a team.

Each day's OR cases offer fascinating stories of the human condition that would fit perfectly well as chapters in a long book.

I was so impressed when patients came into the outpatient orthopedic clinic with some kind of joint pain and the orthopedist was able to give them a diagnosis. Just knowing the medical name for what patients had seemed to provide them great relief. This was before the Internet and Google searching, so it was almost impossible to get a differential diagnosis for an ailment without seeing a physician. Patients are much better informed now when they seek medical attention.

As part of my shadowing experience, I spent time in the operating room (OR) to watch knee arthroscopies. I enjoyed the repetition and technical aspects of the surgical procedure and loved the cleanliness and orderliness of the OR. I also appreciated the pace of the OR day. It felt right. Cases were scheduled, patients were anesthetized, procedures were completed, and patients were discharged.

I ended up speaking with the anesthesiologist because we stood together looking over the blue drapes at the operation. Although I liked sports medicine, I ended up choosing anesthesiology because the variety of patients an anesthesiologist interacts with is much broader, ranging from newborns to very old persons.

The OR also seemed like a place where important things were happening to patients. Every OR has a patient with a family with a story about illness and disease and their efforts to battle ahead with the help of surgery and anesthesia. Each day's OR cases offer fascinating stories of the human condition that would fit perfectly well as chapters in a long book.

I did not feel as intrigued or comfortable in other practice settings. An example was the medicine clinic, where the patient came in with a chronic illness, a prescription was written, and the patient left. I had little idea whether the patient actually went on to fill the prescription, and if they did fill the prescription, whether they took the medications and continued being compliant, given the potential for undesirable side effects. We wouldn't know for weeks until the patient returned, and I was too impatient for that kind of chronic care.

I prefer knowing the outcome of my medical care as soon as I deliver it, as an anesthesiologist does in the OR. I also relish working with my hands. This is helpful, with all the devices, pumps, monitors, and imaging equipment we use.

There is great gratification in being able to reassure and educate patients about their anesthetic. Before wheeling a patient to the OR, I connect with them at a time that may be the scariest moment of their lives.

Once in medical school during the third year, I was finally able to sign up for an anesthesia elective in a community hospital, working solo with the anesthesiologist. I learned that I reveled in discovering how the pharmacology controlled the physiology of the body. There is great pleasure and gratification in being able to reassure and educate patients about their anesthetic. In just a few minutes before wheeling a patient to the OR, I connect with patients at a time that may be the scariest moment of their lives.

There are negative aspects to the job of the anesthesiologist. You never know when the workday will be over, because predicting how long surgery will take is difficult for many types of operations. Also, being on call overnight for emergencies disrupts the sleep cycle. I wish more patients knew that anesthesiologists are doctors. It's also too bad patients that usually don't remember us because of the amnestic drugs we give them.

I did end up at Stanford University for residency and have been here for 25 years, and I've attended a few Rose Bowls in person, wearing a T-shirt on New Year's Day.

I feel very fortunate to have had a satisfying career in academic medicine. Every day is different, and most days I do something I have never done before, such as using the latest medication or device in the OR, taking care of a patient with a recently developed procedure, or working with my research team on some original aspect of the economics of healthcare.

As director of the residency program, I get to work with fantastic, young, smart, hardworking physicians in training. They are all going through the major transformation from medical school graduate to fully trained anesthesiologist able to care for an astonishingly wide range of sick patients—for example, those undergoing a liver transplant or heart surgery, or those diagnosed with complex pain syndromes. In addition, it is a real privilege to be trusted with the care of a small child having a tonsillectomy, providing pain relief during labor to a pregnant woman, or discussing end-of-life care with the family of an intensive care unit patient. Who wouldn't want to be an anesthesiologist?

More biographical information is available on the Stanford University Medical Center website.

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