how much is this job worth?

[CD125]

I’m only 3 years out of training but haven’t done OB since residency. Might be pigeonholing myself for future jobs but loving the no OB.

---

Members don't see this ad.

 

[dabears505]

I’m only 3 years out of training but haven’t done OB since residency. Might be pigeonholing myself for future jobs but loving the no OB.

It's a nice pigeonhole to be in.

 

[medicine2wallstreet]

You've never crashed on ECMO due to AFE with complete thrombo-embolization of the pulmonary arteries/RV or had to do a crash section/hysterectomy with MTP on a morbidly obese patient with no pre-natal care who was bleeding out who you find out later had multiple elective abortions and C/S.s with placenta percreta.

Experience is a sometimes harsh instructor.

No I haven't done afe. But Afe is once in a lifetime. Just have to be an agile when the time comes. No way to prepare for that otherwise. Use exotic potions to keep them alive as best you can to bridge to higher care.

And I have done crash sections with subsequent take the whole uterus because she's exsanguinating-put big lines in her-nuke her with product, sequence.

I'm not getting into a pissing contest about cases. Just said what I said that I feel comfortable with OB.

 

[Simba1711]

I haven’t done ob since residency. I think it has increased my lifespan. Too stressful. Constant pages , challenging patients, and annoying nurses.

 

[Volatile]

I haven’t done ob since residency. I think it has increased my lifespan. Too stressful. Constant pages , challenging patients, and annoying nurses.

The first thing I’ll give up is OB, not quite ready yet, but in 10yrs absolutely

 

[DirtDocMD]

Other than OB patients (“I still feel pressure!), OB nurses (“She still feels pressure!”), and OB Docs (“This patient has failed to progress/My clinic starts in 45 minutes!”), I thought OB was great…🙄

(Currently NOT missing it for 12 plus years….)

 

[Anesthesia_Guy]

OB - the bane of every anesthesiologist's existence.

 

[GassYous]

OB - the bane of every anesthesiologist's existence.

But $$$

 

[dabears505]

Those that are earlier in their career and don't do ob, do you feel like you've lost the skill and can't do it anymore? Or do you feel like just a few shifts and you'd be back to good?

 

[anesthesiadoc]

Having a fellowship in something else offsets my skill atrophy guilt for dropping OB like a hot rock.

 

[Dr. Rude]

Those that are earlier in their career and don't do ob, do you feel like you've lost the skill and can't do it anymore? Or do you feel like just a few shifts and you'd be back to good?

I didn’t do OB for the first five years post residency. Picked it up fairly quickly on my next job.

One Caveat, my second job was NOT a tertiary center. Nothing fancier than preeclampsia, HTN, and the usual endemic morbid obesity and other mild comorbidities. Didn’t to hardcore known comorbidities. We did have our share of obstetric hemorrhages.

 

[rick roller pump]

Surprised to see so many of you don't cover OB. That must be nice. In my region it seems that every group covers at least one hospital with OB. So basically every job besides academics and the rare ASC only job, you will do at least some OB.

 

[PpfSuxTube]

It's basically unheard of in our area for anyone not nearing retirement to drop OB. It's lucrative also so no one really minds. We all grumble about their nonsense but equally take the money

 

[Anesthesia_Guy]

But $$$

Not worth it.

 

[NumTacos]

Alright disclaimer I'm just a resident but this job sounds un friggin believable. Can't imagine a better job honestly. This is well past any of the groups I'm currently interviewing with. Almost a damn joke it's so good. 14-16 weeks vacation? Come on man. I don't care how bad ob is at night. Ob is easy as hell. The only thing that would make this a moderately difficult job on night call is if you're getting blasted by peri arrest traumas.

Is this a troll post by OP?

There is no such thing as complex ob no matter what high risk labels OB says. Drive the needle push the drug. Get the video scope for hostile airway. If things get bad cause of bad tone bomb the patient with volume. Ob patients can tolerate so much anyways. Again, ob is easy.

14 weeks vacation and 550k salary. Out by 3 or 4 most days. I mean let's be real here.

If you aren't a level I trauma center, which I surmise you aren't because no mention of trauma, this is a cush job.

Please do yourself and your patients a huge favor, and learn some humility. Docs like you can get themselves in a LOT of trouble when you are first starting out. Seriously, I am not trying to be a jerk, you need to realize that you still have a lot to learn, and you should be open to that. I’ve been doing this job for over 20 years, and I am still learning.

 

[NumTacos]

Yeah, can’t tell if this kid is for real or not, so bombastic.

 

[Anesthesia_Guy]

Please do yourself and your patients a huge favor, and learn some humility. Docs like you can get themselves in a LOT of trouble when you are first starting out. Seriously, I am not trying to be a jerk, you need to realize that you still have a lot to learn, and you should be open to that. I’ve been doing this job for over 20 years, and I am still learning.

Sit down..........Waldo!

 

[TeddyBoomBoom]

Alright disclaimer I'm just a residentl

[…]

Ob is easy as hell.


There is no such thing as complex ob no matter what high risk labels OB says. […]

Again, ob is easy.

Good lord. Full disclosure - I’m an EM attending not an Anesthesiologist, but I bounce into these forums because our jobs, while very different, have some small overlap. It’s not *much* overlap, but when it occurs, it’s bc things have gone terribly wrong either in the OR or the ED. I always appreciate professional reciprocity in either direction.

I have mad respect for my anesthesiologist colleagues, and I would never presume to speak for them. But I would bet good money that both they and I have no trouble managing the traumas that OP seems to have respect for. However, the 40 yr old 30-weeker fairly sick/kinda-sorta hypo/hypertensive/maybe PE/maybe early DIC/maybe the baby is struggling is where the money is. These are not easy cases. You are essentially managing two patients.

I would 100% say something similar to an ER resident whose never heard of Dunning-Kruger - Show some goddamn respect to the job.

 

[aneftp]

[…]




Good lord. Full disclosure - I’m an EM attending not an Anesthesiologist, but I bounce into these forums because our jobs, while very different, have some small overlap. It’s not *much* overlap, but when it occurs, it’s bc things have gone terribly wrong either in the OR or the ED. I always appreciate professional reciprocity in either direction.

I have mad respect for my anesthesiologist colleagues, and I would never presume to speak for them. But I would bet good money that both they and I have no trouble managing the traumas that OP seems to have respect for. However, the 40 yr old 30-weeker fairly sick/kinda-sorta hypo/hypertensive/maybe PE/maybe early DIC/maybe the baby is struggling is where the money is. These are not easy cases. You are essentially managing two patients.

I would 100% say something similar to an ER resident whose never heard of Dunning-Kruger - Show some goddamn respect to the job.

Never say ob is easy.

The most dangerous medical malpractice patient is “in the eyes of the jury”. A previously healthy Asa 1 young mother of young children. The jury doesn’t look at all those complications that can happen with ob. They look at pictures of a young mother age 30 and 2-3 kids under age 5.

Than they start determine how much needs to pay paid how to raise these kids without a mom.

So it’s not the Asa 4 100 year old
Hip fracture with severe as and pul htn who dies. It’s the previously Heathy ob patient who’s the most dangerous malpractice patient.

 

[makemoney2024]

I’m only 3 years out of training but haven’t done OB since residency. Might be pigeonholing myself for future jobs but loving the no OB.

Nah. I went two years without it and then went back to it. I gave crappy epidurals at first because I was doing my LOR with water. I had to relearn how to do it properly with air again. Then went a few more years again and when I came back I gave a wet tap but the rest were good cuz I went back to air again. My hands were a little shaky though not gonna lie cuz it was a town full of larger patients. Haha
Over the summer the need was so bad at one of the towns I worked in w NAPA that they brought in people who hadn’t done OB in decades. Decades!!!

 

[makemoney2024]

Surprised to see so many of you don't cover OB. That must be nice. In my region it seems that every group covers at least one hospital with OB. So basically every job besides academics and the rare ASC only job, you will do at least some OB.

I honestly think most of us despise it and it’s just something we suck up and do. I prefer my patients out.

 

[Hoya11]

I honestly think most of us despise it and it’s just something we suck up and do. I prefer my patients out.

The worst thing about OB is interfacing with the OB medical team. The anesthesia is the easy part

 

[abolt18]

Nah. I went two years without it and then went back to it. I gave crappy epidurals at first because I was doing my LOR with water. I had to relearn how to do it properly with air again. Then went a few more years again and when I came back I gave a wet tap but the rest were good cuz I went back to air again.

That's the complete opposite of my experience with LOR with saline vs air. Continuous LOR with saline for life here. Definitely like it more than air and have personally had far greater success/less ambiguity with saline.

 

[Arch Guillotti]

LOR to air with a plastic syringe is unquestionably the best approach.

 

[abolt18]

LOR to air with a plastic syringe is unquestionably the best approach.

Plastic?!!?! Now you've gone too far!

 

[MirrorTodd]

LOR to air with a plastic syringe is unquestionably the best approach.

 

[medicine2wallstreet]

LOR to air with a plastic syringe is unquestionably the best approach.

Arch is right. Slip tip is the only thing I will add to that.

 

[makemoney2024]

Arch is right. Slip tip is the only thing I will add to that.

Ok, why did I think dirty????

 

[makemoney2024]

LOR to air with a plastic syringe is unquestionably the best approach.

I just use the glass that comes in the kits. In residency we had the plastic and after that I haven’t seen them in the kits.
But to relearn them? For sure Air is better for me!! Much more of a noted difference in LOR.

 

[cchoukal]

I was out of OB 12 years and joined a practice where I need to do it. I was mentored and proctored mostly in the "continuous pressure, saline" camp, and I have to say I've found it to be incredibly (and surprisingly) reliable.

 

[caligas]

Two words:

hanging drop

 

[PainDrain]

Two words:

hanging drop

Of CSF. FTFY.

 

[caligas]

Of CSF. FTFY.

Next you’re gonna tell me there’s something better than the light wand for difficult airways

 

[makemoney2024]

Two words:

hanging drop

You people crack me up!!

 

[mmag]

Mostly saline with a bubble of of air and intermittent pressure. I like combo appetizer plates too.

 

[amyl]

Saline with an air bubble. I use the glass syringes in the kit. Cse… used to not like it but now I do. Huge liability in OB. OB is great if it goes well, horrible if there are issues. Lots of OB mishaps are catastrophic- vback uterine rupture, accreata, amniotic fluid embolism… bad outcomes when things are done right… and most l and d nurses and obs are usually pretty useless in real emergencies…. I’ve never once seen on handle stuff going down like my trauma teams do. I think the trauma team drunk af could do a better job…
Belittling OB shows inexperience and overconfidence- the deadliest of duos in anesthesia imho. But then, you can listen to me…. Or life can teach you.

 

[thinkorswim]

Two words:

hanging drop

Great for thoracic epidurals. No point in doing it for lumbar.

 

[makemoney2024]

Mostly saline with a bubble of of air and intermittent pressure. I like combo appetizer plates too.

It’s what I do now!!!

 

[caligas]

In all seriousness, a crisp LOR to continous pressure with saline is one of my last remaining pleasures in doing anesthesia.

 

[abolt18]

In all seriousness, a crisp LOR to continous pressure with saline is one of my last remaining pleasures in doing anesthesia.

Feels like a magic trick, every time!

 

[Bertelman]

In all seriousness, a crisp LOR to continous pressure with saline is one of my last remaining pleasures in doing anesthesia.

I wouldn’t quite go that far, but yes, continuous pressure with saline is the best technique.

 

[T-burglar]

That’s the second best technique , the best technique is never setting foot in OB unless it’s to rescue an AFE or PTE with your ECMO team

 

[sevoflurane]

I still enjoy it from 7am-7pm. Certainly enjoy effective and quick needle jockeying. The “urgent” c/s at 4-5am before change of shift is def. a downer as is the quality of OB nurses in comparison to say a cardiac or ortho nurse.

Wife and some of my best friends in my practice quit years ago and couldn’t be happier.

The biggest drawback as I get older is recovery after a busy 24 hour shift.

It’s still the most profitable shift in our practice yet probably only 1/2 the group actively participates in OB.
It is unanimously hated.

 

[sevoflurane]

+1 for saline bubble/glass syringe and continuous pressure until loss with a springwound catheter.
Anything else is inferior IMO.

 

[sevoflurane]

Next you’re gonna tell me there’s something better than the light wand for difficult airways

Definitely the coolest intubation… just add some deamau5 and a strobe light after the lights go off.

 

[nimbus]

Next you’re gonna tell me there’s something better than the light wand for difficult airways

There ain’t no Hocus in POCUS: Ultrasound is not just for central lines anymore!

Myron Yaster MD, Justin L. Lockman MD MSEd, and Alan Jay Schwartz MD MSEd

ronlitman.substack.com