Ask Me Anything With An Anesthesiologist: Dr. Alex Tripp

This is a transcript of the Ask Me Anything with Dr. Alex Tripp, MD, anesthesiologist. We encourage you to watch the entire conversation here.

We welcome Dr. Alex Tripp to do an Ask Me Anything (AMA), who is an anesthesiologist with a private practice in the Kansas City Area after struggling to decide on a career path. It showed during his tough application process, and after receiving one interview after 28 applications, he was accepted off the waitlist at the University of Arkansas for Medical Sciences. He then went on to do his residency in anesthesiology at the University of Kansas Medical Center. This is what he and our very own Samantha Mellinger of SDN discussed:

Samantha Mellinger: Before we get into questions Dr.Tripp, why don’t you share a little bit more about yourself and any initial thoughts that you would like to share with us tonight?

Dr. Alex Tripp: Awesome well thank you first off. Thank you for having me. This is really cool. I appreciate the opportunity. Like Samantha said, I am an anesthesiologist, and I’m in private practice in the Kansas City area in a small independent group. I’m married and have a four-and-a-half-year-old, just kind of cruising right at the moment. I’m a huge nerd which is why I’m here streaming this basically, but yeah, I used to do a whole lot of pre-med and med student advising. That really just sort of shot craps when I went to residency, and I’m really looking forward to getting back into it. I’ve done a couple of these live streams for like a few like discord servers and smaller groups but looking to kind of step that up a little bit. It’s nice to be here.

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Samantha Mellinger: Let’s start with our first question again. If you have questions for Dr. Tripp, please submit them in the comments section of Facebook or Youtube or whatever platform you’re watching from, and we will pull it on the screen for him to answer. But first, when did you decide to become a physician, and why?

Dr. Alex Tripp: As I mentioned, I sort of had a bit of a difficult path to medicine; so, I didn’t really decide that I wanted to be a physician like until maybe a couple months before I applied. I was sort of torn between being a physicist or being  like a pharmacist doing some sort of research, whether it’s  biologic or pharmaceutical or who knows. All of the science nerd things were on the table, and I was like  what medicine really fits me. I shadowed a few of my parents’ friends who just like coincidentally happened to be anesthesiologists. I was like I can do that. It seems like a pretty cool job, and so I just sort of set about figuring out what I needed to do to get into med school. I was like I need to take the MCAT. I’ll guess I’ll do that; so, took the MCAT and did really well on it. That’s really kind of what carried me. I would say even like up until I attended med school, I wasn’t like a hundred percent sure that’s what I wanted to do, but as for why I decided that I wanted to be a physician.

This is an interesting question to start off with because I’m going be super blunt with you about this, so income right. You’re guaranteed a six-figure income. That’s an obviously pretty nice perk. I like  the subject matter obviously, and I like just learning how things work whether it’s in physics, what I have a degree in physics by the way. So that might make a little bit more sense. I just like knowing how stuff works, and what better to figure out than the han body. So, I like that, anesthesia in particular. I chose because I really like pharmacology. I like all of the medicines and sort of like the acuity of it.

Not to wax poetic on that too much, but like it’s really interesting to me. All of the like interactions between drugs and medical conditions, and all that I think is fascinating and the fact that you have to like kind of know everything to be good at the job. This is not to say that I necessarily am all the time, but that’s the goal at least but the other thing is authority and like independence. I wanted a job where I could essentially function  without people messing with me basically, like I don’t mean to say that like I wanted  total autonomy and just like to  do whatever the hell I want. But like it’s nice to just be trusted to like do your job and not have somebody like totally breathing down your neck all the time and have like deadlines, and  like I have to keep track of what I need to do or else everything sort of falls apart right, especially in my situation because we were like I said a small private group and if somebody like sandbags like the whole operation just comes to a grinding halt because we don’t have enough people to make up for that. Yeah there you go.

Samantha Mellinger: Thanks, that was great; so Ashley’s got a great question, What’s the best way to find and ask physicians to shadow in your opinion? Obviously, the pandemic has shifted a lot of that for students, and we know many students are struggling in that area. You have to have shadowing hours to apply so what advice do you have?

Dr. Alex Tripp: Yeah so that is an awesome question. That’s actually one that’s a very common problem that a lot of students seem to be having; so  the best way is if  have a family friend or something who’s a physician or like a friend of a friend or whatever like some somebody that you’re connected to that you could call in a favor from. Potentially otherwise cold call man. I’ve had a couple people call me, and like my personal opinion and I know the opinion of most people I know is if somebody’s motivated enough to go out of their way to contact you, like that’s a green light as far as I’m concerned.  if you care enough to just  give me a like call a stranger call a physician you don’t know, and say, “hey can I shadow you?” and be like, “yeah come on man I’ll show you around.” Unfortunately with the pandemic that’s kind of what you’re reduced to really because so many places have still have like restriction restrictions on like who can be in the clinics or in the hospitals like I know my hospital in particular just started letting volunteers back in like maybe two months ago. So it’s tough, and you’re going to have to use the batting average strategy basically and just like just kind of shotgun apply like call people, but yeah I think like if you cold call private practices in particular, then you would be much more likely to be successful with that.

Samantha Mellinger: All right, another question about shadowing so when you, oops let’s see, sorry about that. Is it possible to shadow when you’re in high school?

Dr. Alex Tripp: It certainly is. In fact, the last person that shadowed me was in high school. It’s unusual I’d say. There aren’t a whole lot of people who like meet the criteria that I mentioned earlier like who are dedicated and motivated enough to  get involved in medicine at that stage, but I mean I don’t see why not.  there may be like if you’re not 18, there may be some  like hospital specific policies that will affect you, but usually all you have to do is get patient consent.  just say, “hey I have the student with me. Is it okay if they observe?” I’ve never had anybody say no I mean I’m sure it happens, but I personally have never experienced that; so yeah I mean if you’re interested why not man give it a shot. Go check it out. It’s definitely going to be way different than anything you’ve ever experienced before.

Samantha Mellinger: Well great, so earlier you talked a little bit about having a tough application cycle. A part of that being obviously deciding late in the game that you wanted to even go to medical school, but were there any other factors that you think contributed to that that you could share with students, maybe walking through some similar situations?

Dr. Alex Tripp: Oh yeah absolutely I mean so a lot of it stems from me from the late decision but like basically education was the problem, like I didn’t really know what was expected of me. I didn’t know like what deadlines  there were like when you could start applying. Like for reference I took my MCAT in May/late spring at some point, and I just had no clue when the application season started. So I was just kind of like yeah I’ll send some applications out  like I just knew nothing about it. I knew nothing about the process, and  if I had known in advance, like the GPA requirements. For instance, my GPA was really low that well low by med school standards. I think it was like a 3-2 or something, but if I had known that I would have kind of gone out of my way to take some classes that I knew I could get A’s in and  sort of artificially increase my GPA which don’t hate the player hate the game right. I mean that’s not the best thing to do for your education but  if you have the goal of going to med school, and your GPA is suffering then  you do what you got to do but if I had known that yeah I would have changed that. I would have changed how I  wrote all of my essays like all my secondary essays, my personal statement, and things like that; so, yeah it was really sort of just like a haphazard kind of approach to be honest with you. It just happened to work out so I’m thankful for that but yeah all of you guys on student doctor network are way way ahead of where I was. You guys know not to do the things that I have done and you’ll be much better for it

Samantha Mellinger: Well great, so based on what you experienced, what is some advice you would have for students so that they don’t go through those same struggles?

Dr. Alex Tripp: Well it certainly helps if you can decide like if you narrow it down to medicine in your first or second year of college or something that. That makes life way easier because you can sort of plan accordingly, and not get a physics major that you’re not going to use for instance. But yeah again, just being on student doctor network which I did not find until like well into my application season. I didn’t know about it until like a couple months after I’d actually applied, and I was just sort of like polishing a turret at that point. But anyway yeah like just knowing about this website is a huge huge step towards avoiding those pitfalls. You have to do a bunch of reading to figure out like exactly what is going to be required of you for specific schools and like there’s all the differences in like certain schools value research certain schools like want you to tell them that  you want to go into primary care and all of that stuff and  they value different like volunteer or work experiences differently, and you again have to play the game to a certain extent and again. Being on SDN like that’s your resource for all of that information. So if you think if you think that you want to go to med school, just act like you’re going to because all of the things that you need to do to get into med school are going to set you up really well for any other career that you decide. Like having a really good GPA, having relevant experience, having good like life experiences, all of those things are very important to any job that you’re going to get. Right so like okay you decide last minute you don’t want to go to med school fine; so you get out with a 3.8 GPA and biology some science or whatever you choose and you’re good to go. You can go to grad school. You can go into the field or get corporate jobs whatever you want to do. So yeah just behave like you’re going to do it. If that’s something you’re interested in, just fire away is my advice.

Samantha Mellinger: Yeah that’s great. It’s a great way of thinking about it; so switching gears back to shadowing, we’ve got another question about that. So what is it like to shadow a physician?

Dr. Alex Tripp: Okay so I’ll answer that in terms of what it’s like to shadow me and what it was like for me shadowing because that’s really all I have experience with. So for me shadowing was very like informal and just kind of like I don’t know what a good word for it was I mean basically like I mentioned these were family friends. I only shadowed family friends, and they’re like my parents’ high school friends; so they like all party together, and like I’d known them like my entire life so I showed up and they’re like, “Hey Alex, what’s going on? Let’s go see this guy. He’s got a huge chest tube. It’s going to be awesome. We’ll go check it out.” So it’s very like very casual, and they were more than willing to answer questions like personal questions even like what’s your income like, what can I expect to make if I go into this career. I would not suggest being quite that blunt with people that you shadow unless you’re in the same situation knowing these people for 15 plus years, and they’ve seen you go from diapers to driving.

But so what it’s like to shadow me. I try to get people as involved as possible like so obviously there’s  some rules about how involved a shadowing student could get because you clearly don’t have privileges at the hospital; so you can kind of be all up in it but you can’t like actually do any procedures. Like for reference, the last guy that shadowed me who I mentioned was a high school student. Just coincidentally we had a redo heart surgery which is a really big deal especially at a small kind of medi-ish community hospital like I have, and he was like I thought he was going to pass out, I was like man if you feel faint you just sit. Don’t go anywhere, like just sit down man. But yeah like I had him all up in there. I was showing him how you play central lines and explaining like why the heart surgery is a big deal. Well I was like hey, if they might actually saw through this guy’s heart when they open his chest, it’s kind of terrifying but like just if somebody’s going to bother again to contact me I want them to like have a useful experience. I treat everybody as like they’re an adult learner. They’re using their time to be with me, and I want them to like have a good time and have an informative experience like I want them to show up and be like well I actually learned a lot about going into medicine today. So yeah I try to throw them in the deep end as much as possible. I really don’t know if other doctors do that. Some do I know. One or two of my partners do that, but as for anyone else, like I couldn’t say. But I would say if you/when you shadow, push for that because if you’re going to use your day to shadow.

So make that decision as best you can beforehand; so yeah like advocate for yourself. Make sure that you get in involved as much as possible.

Samantha Mellinger: So what surprised you most about your studies whether that was undergraduate preparing for med school/medical school studies?

Dr. Alex Tripp: What surprised me the most about my studies, that’s a really good question. Wow, I think what surprised me about med school in particular is how much of what I learned that I actually use all the time. Like when you’re in college you have these classes, and you just sort of have this like gestalt that like everything that you’re learning is just like 100 useless, unless you’re trying to like win some sort of like bar trivia night or something. Yeah like med school, we started off so the curriculum at UAMS was organized by organ systems so you’d learn like all the anatomy, physiology, and pathology for one system at the same time, but the first two months were cell biology and biochemistry. Of those classes, I basically use nothing on a day-to-day basis like less than one percent easily, and like if I run across something that was in those classes exclusively I’m like yeah, I’ll just look that up because I don’t remember any of it. But like other than that, like physiology, anatomy, neuroscience, and all of that stuff, it comes into play constantly for me. Like there’s very very little that I don’t like have to draw on all the time which is awesome. Like at the time it feels kind of crappy when you’re like learning all these like buzzwords and stuff to do well on tests, but in the like in my actual practice since anesthesia is so like kind of generalist like that’s that stuff comes up constantly which makes me feel really good about that time investment.

Samantha Mellinger: Yes all right, is CRNA taking over anesthesiology? Is that really happening?

Dr. Alex Tripp: No absolutely not. That’s the big concern for medicine in general right? It’s like mid-levels are taking over. So a lot of sort of like rural outlying places with like one or two ORs or something will employ CRNAs because it’s just a cost-efficient thing to do and like they don’t have people getting big surgeries usually it’s like totally healthy to moderately unhealthy people having very small surgeries, the acuity is very low. They don’t need somebody who’s like an intensivist on the level of an anesthesiologist, and that’s cool like why not do that it’s just cost effective like anybody who’s going to need more thorough care than that gets shipped to the nearest trauma center or hospital or whatever as appropriate.

So I can’t think of a way to say this without sounding like a real jerk, but like a CRNA can’t do my job.  It’s that the training differential is just huge. The sort of like trope is that CRNAs know what to do and doctors know what to do, and why I don’t find that to be totally true. But I’ve definitely walked in on a few sort of tenuous situations where I’m like, “Oh my god. Oh my god. What are you doing? Please don’t do that. Please please let me fix this.”

That’s not to disparage CRNAs like that. I work with tons of really good CRNAs that I would absolutely trust with my care, no questions asked, but like they are not a replacement for a physician, and my experience is that a lot of these little outlying places that are kind of like near a city like I can think of two places in particular that I’ve actually done locums at. They choose to have an anesthesiologist there  despite the extra cost because they’ve had  questionable experiences with their hired local CRNAs. So one thing I didn’t mention is most of the time these places don’t have full-time CRNAs, but they use a locum’s agency to staff or at least that’s the case here. I don’t know if that’s universally true, but they just prefer that level of care than to the tune of 300 000 extra dollars. So they vote with their cash, and like in hospitals that it’ll never change with people who are just super sick and have tons of comorbidities and really complex medical conditions, you just can’t in my opinion get away from the care team model or at the very least like MOD only case management. It’s just it’s not safe. It’s better patient care to have two people overseeing cases like that. So yeah, short answer is no. That’s never going to happen.

Samantha Mellinger: Right have you ever worked with AAs or Pas?

Dr. Alex Tripp: Yeah, we actually have mostly AAs, and we have 15 anesthetists. I think only two of them are CRNAs. There’s a school that rotates through our hospital, and so that’s a very convenient way to get new staff. I have excellent experience with them. There’s sort of a turf war between the AAs and the CRNAs, and I personally don’t notice a functional difference. I think they’re very good.

Samantha Mellinger: Great; so Amanda has been shadowing and has volunteer activity since high school, but is now in her late 20s. Should she only list those activities or list everything?

Dr. Alex Tripp: Oh well, I mean your life experiences don’t have like a time limit on them, right. Like they don’t stop being your life experiences because they happened ten years ago; so, yeah absolutely list everything that you’ve done like if you can discuss the things that you’ve done in a meaningful fashion then why not? If you’re just going to say yeah, I shadowed and then somebody asked you about your shadowing, you’re like meh, then obviously that’s not going to do you any favors. But if you’re prepared to talk about it, then it was influential for you. Absolutely yeah put it down.

Samantha Mellinger: So what’s the bread and butter of anesthesiology?

Dr. Alex Tripp: Well my bread and butter is everybody else’s bread and butter; so like whatever the various surgical subspecialties like to churn out, then that’s what we also like to turn out, so total joint replacements, hernia surgeries, gallbladders, epidurals, labor epidurals for OB patients, and what else  cystoscopies all of that. All of the like basic fundamental kind of like quick outpatient surgery stuff that’s what we thrive on. GI procedures there’s another one. Yeah because I mean without proceduralists, like we wouldn’t have a job basically. Like we’d all just be like ICU doctors; so, whatever floats their boat also floats ours.

Samantha Mellinger: Great so this is a pretty specific question, but if gastro is what you want to do. Do you think it’s worth the school stress of med school in residency?

Dr. Alex Tripp: Ah no, so I think generally speaking I think no. For me, I’m glad I did it for all of the reasons that I kind of mentioned earlier regarding like why I wanted to be a physician, like I want the authority. I want the independence and like control over what I’m doing, etc., but if you’re just doing it because you think the subject matter is really cool, medicine is a freaking ridiculous opportunity cost. Right so I was actually talking about this on my stream, maybe a month and a half ago, when the Medscape physician like average physician salary stuff came out from the, what is it? Ah I can’t remember. The national organization that like figures out what physician compensation is anyway. So in this area at least AA’s or CRNAs are in about 180 grand a year, and that’s a two and a half year program. AA school is two and a half year master’s program so that’s at least five years of opportunity cost. In my case, I came into college with like 40 something hours of credit; so I theoretically could have finished college in two years and gone to a school and so it would be seven years of opportunity cost, so seven times 180 000 plus compound interest  from whatever you invest over those years is a lot of money. So if  that you want to do anesthesia and it’s not really all that important to you to be like at the top of the food chain in terms of like rank and authority, then yeah go with AA for sure man. That’s a sweet deal especially if that early on it’s a really good job.

Samantha Mellinger: Great, do you feel like there is bias against older applicants for residency and anesthesiology?

Dr. Alex Tripp: No, I don’t. That said, I have never been on a residency selection panel so take that with a grain of salt. Anecdotally speaking, I had a 40-year-old guy in my residency class who actually happens to live like two blocks from me and be a really good friend of mine now. I did not notice that there was any bias against anyone for any reason. To be honest, I feel like my program in particular chose people who were going to be hard workers and were intelligent and would be a good part of a team. I guess that probably happens. I guess there’s some ageism somewhere, but I mean 35 is not that old man, or at least I keep telling myself that me as well. But yeah. I don’t think you’re going to run into any problems with that, and if you’re already that far along like, why not apply like what do you have to lose?

Samantha Mellinger: All right, what’s your least favorite part of your worker specialty, and then what’s your most favorite?

Dr. Alex Tripp: Oh least favorite part, hmm this is going to sound real sappy, but I actually really really enjoy my job. I would say my least favorite part is the call volume, and part of that is like job specific just because we are a small group. There’s only seven or well there’s eight of us, but seven who take calls so I’m going to call q7. That sort of sucks. Like I’ve mentioned, I have a four and a half year old, and it’s  kind of bummer to be away from him for a whole day every week. So like the unpredictability I guess. I’ll be more general and just say the unpredictability of the schedule is very hard because I never know like.  So we do like an appeal system where there’s five of us who show up every day because there’s eight people, two are on vacation, and one person’s post call; so whenever we just like stop needing somebody, they go home. That’s potentially at like 7 30 in the morning, but it’s also for the first person to leave. I’ve left as late as 5 p.m. as the first person to leave; so I mean that’s very rare, but the point is like we don’t have a schedule. You just show up to work, and you work until the work’s done; so that kind of sucks with a family. But you get through it, and it’s compensated with a whole crapload of time off to be fair so  it’s give and take. But it’s just kind of something you have to adjust to, and it’s not ideal. There are options like if you want to work at like a surge center or like one of the small rural hospitals or something, they don’t have that sort of situation going on.

I think most favorite is like when it’s when somebody’s like life is in danger, and you’re the man. Like everybody looks to you with certain maybe situational exceptions, but like if somebody’s crashing on the table, like you’re up. It is like massive adrenaline rush, and everybody in the room just like looks at anesthesia like oh god. So you have to keep it together and like organize everything, and I think that sort of like specialization is really cool. Nobody else wants to mess with somebody who’s like actively dying but you’re the guy.

Samantha Mellinger: So actually you mentioned this prior to medical school, you knew that you wanted to do anesthesiology. How did you know that was the right specialty?

Dr. Alex Tripp: So yeah, so I knew that like anesthesia was something that I could like do and that I was interested in before med school. I actually in my first rotation, so for those of you who don’t know your third and fourth year of med school, well if you’re in a traditionally structured med school, your third and fourth year of med school are your clinical years. So my first rotation of my third year was surgery, and we had three months of surgery in Arkansas. And like I just sort of happened to be with surgical teams that were like, “Oh you’re interested in anesthesia. Yeah get up there, like you’re going to be a hand retractor for this case so just like go up there. And we’ll like get you scrubbed in. Whenever we need you to hold stuff.”

So yeah, I got to do like a whole bunch of anesthesia  like intubating people, placing IVs, and stuff like that; so I got very heavily involved in it early on in my clinical years, and I was like this this is awesome. This kicks ass, and I can totally do this. I considered other things like I considered orthopedics and very briefly considered family medicine with like maybe a sports medicine focus. But like anesthesia just checked all the boxes man, like it highlights all of the things that I’m interested in. The lifestyle’s pretty good, and it’s pretty flexible too. I just really like it. I mean I’m still a work to live kind of guy, but I do enjoy going to work. I like what I do, and I like my work environment. For all those reasons like the subject matter is cool, the pace of the work is cool, and I’m really good at like clustering tasks and getting things done. So I can go and like bust my ass for an hour and then I get like half an hour to just kind of cruise, because I finished everything really efficiently and got to like release my brain for a second and then get back to it so it’s very like burst oriented

Samantha Mellinger: So what would you advise someone who withdrew from a different health professional career to apply to medical school do to to maximize their success of getting accepted?

Dr. Alex Tripp: Okay well, I think I think you need to have a pretty good story set for why exactly you withdrew from that professional program, because obviously you’re going to get asked that. Like that one of one of the like key things for preparing for any interview, and med school acceptance is no exception like there are some questions that you absolutely know you’re going to get asked. Right and like “where are you from,” “why medicine,” “tell us/me about yourself,” and that kind of thing. This is one of those questions like you will absolutely get asked this; so have a response prepared that makes you sound good. Basically like I decided that I wasn’t ready for this for these reasons, but now I’ve reevaluated, and I think medicine is a better fit for these reasons. I mean yeah just basically knock that out of the park, and like do practice interviews because like if you don’t answer that question, well that’s a huge red flag right. Like people will be like well, are they going to drop out of my program? So yeah. nail that and do practice interviews, like talk to your friends, family, and if you know anybody with interview experience, like talk to them and get a good response for that for sure.

Samantha Mellinger: So how do you explain the career of an anesthesiologist for someone who may not know what that even is?

Dr. Alex Tripp: So that depends on their interest level. So if they’re just like what it’s like some party talk or something and they’re like what do you do, I’m like well. I basically put people to sleep, and I’m there when they go to sleep and when they wake up. If they try to die, then I try to fix that, and that’s that. But if you’re interested in actually going into medicine, it would be sort of that but in more depth and basically would explain that I’m the one who has to evaluate all of these people for their multiple comorbidities, and like how their surgery is going to affect those if it will. How anesthesia will affect those core comorbidities, and how they’re going to recover post-op. How their follow-up is going to be and all of those sorts of things because the reality of it is a lot of surgeons just kind of like sign people up for surgeries and sort of leave it to other specialties to figure out if that’s a good idea or not, especially in private practice, and sometimes if they like recognize that those people are like total train wrecks, they’ll come and like talk to you, and be like hey this guy’s a train wreck. But most of the time, that doesn’t happen; so you have to be on top of it. Like the easiest way to think about what I do is that I’m the person who makes sure that everybody is safe. Comfort is sort of a secondary priority, but ultimately like anesthesiologists are the people in the hospital who keep you safe and save you from dying. So I think that’s probably the best way I can think about putting it in a nutshell.

Samantha Mellinger: But yeah great. So does the work-life balance allow you to be happy and pay you enough money for your time?

Dr. Alex Tripp: Mine in particular, yes I would say so. So I was kind of talking briefly about my schedule earlier; so I’m on call a lot. But our calls are generally pretty like tame. I would say we get called like maybe once or twice overnight. But typically there’s always a chance that like everything goes to hell, and you’re up all night, but generally we’re up for like one or two labor epidurals per night. Your day off, I mean your post call day, is like a true day off so that’s what every seven days. So that’s like 52 extra days off per year, plus I get 10 weeks of vacation. Pay is regional median for me which is pretty good, but yeah I mean there are specialties that have better lifestyles and better pay, and there are certainly careers that have better lifestyles and better pay. But yeah I mean I’m rocking it man. Like I have a great house in an awesome neighborhood and like plenty of time off get to stay with my family, a whole bunch of vacation. Yeah it’s good, and I’m perfectly happy.

Samantha Mellinger: Great, would you consider anesthesia part of the road residencies?

Dr. Alex Tripp: Well, isn’t anesthesia the a? So yes I guess. But yeah, it’s as answered earlier, yeah it’s a good lifestyle.

Samantha Mellinger: Are there any prejudice against osteopaths and anesthesiology?

Dr. Alex Tripp: Certainly not in my experience, so my practice in particular let’s see, there’s one, two, I think three DOs. We have three osteopaths; no just two. We have two osteopaths, and one of them is a certifiable badass. He’s the only one of us that’s like cardiothoracic trained in anesthesia, did a cardiothoracic fellowship at Texas what is the Texas heart institute, whatever the one giant part place in Houston is. Yeah he is. He is freaking hardcore. That guy can resuscitate anything; so yeah in my experience, not at all.

Samantha Mellinger: So what advice do you have specifically for underrepresented minorities in the application process?

Dr. Alex Tripp: For med school in particular, leverage your advantage honestly. If you have some sort of like life experience related to your minority status that like influenced your decision to practice medicine, which in my experience a lot of them do like a lot of the underrepresented minorities that I went to school with grew up in very poor communities in Arkansas and wanted to go back home and like take care of those people. So if you can say anything even remotely close to that, truthfully then 100 do it because that is solid gold. Again this is kind of a game that you have to play. I’m not saying lie, but you have to figure out the responses that they’re looking for and that will help you. That is that is awesome awesome awesome application fodder if you can totally tell them that. That your like minority status has influenced your decision to practice medicine in some way, then you are set. You are good to go.

Samantha Mellinger: So what tips would you give to be successful during residency?

Dr. Alex Tripp: Well residency man, these are awesome questions by the way. You guys are really kind of nailing this. I like it, and the iso concentration in that room is point two as I’m speaking. Oh man hilarious. Okay I haven’t been reading the comments but apparently I should. What tips would you give to be successful during residency?

Residency in my experience is way too unpredictable to like have a plan for. Basically just accept that you’re going to get beaten down in. The earlier that you understand that, the better off you’re going to be, and just kind of go with it. It’s so hard man, residency is so hard in so many ways. You will just be like pushed to the brink physically and mentally all the time, and just do the best you can to like learn what you can from your cases. If you’re going to be there anyway like you’re going to be in the hospital, try to get involved in some like high level stuff, like if you go to the board runner. Say, “Hey, I want to be in this craney instead of this anesthetist.” They’ll generally be pretty sympathetic to that and let you get that learning experience, and I mean you’re not going to be like costing yourself any extra time because you’re going to be there for 12 hours anyway. So screw it, you might as well like do something interesting.

So get sleep. Get as much sleep as you can, and prioritize yourself as much as you can because that’s going to be super hard with like just the demands. It’s like I feel like my residency was sort of on the light side of workload, and we averaged like upper 60s mid-upper 60s work hours per work week. That’s what I’m trying to say. And you’re expected to study outside of that too; so that obviously kind of crunches your free time pretty substantially. But yeah, make sure you’re well rested as much as possible. Make sure that you set aside some time for yourself, so you don’t go utterly insane, whether that means time with your family or your significant other or your kids or whatever. Just be like aware that you are a person, and you need to maintain that as much as possible.

Samantha Mellinger: What’s been your most challenging case?

Dr. Alex Tripp: Oh god, well so my most challenging case was in residency, and the fact that I responded so quickly to that should tell you a lot about how challenging it was. So this was a patient who had she had like literally dozens of abdominal surgeries. I can’t remember how many, but like 50 plus and  extremely unhealthy as you might imagine, and she was having yet another abdominal surgery. To keep this from getting very long, this ended up being like a 10 hour case, and to keep a very long story short, basically she ended up with no IV access even though she had a port. We couldn’t get any more, and the surgeon ruptured her bowel in like seven places like her intestines were just like this giant ball of scar tissue. He just like totally blew up her bowels, and I mean not through any fault of his own, like she was just a disaster. She started decompensating, and we couldn’t resuscitate her because we had no iv access. I was of course working with the most ball busting hardcore attending that my residency had to offer, and he was giving me [ __ ] the entire time just like on me constantly. Yeah so that fun experience mercifully ended at about 5 p.m., and I got to go home and then go to a journal club at his house immediately afterwards. Yeah that was good. it was really fun.

Samantha Mellinger: All right. So if someone wants to continue their entrepreneurship passion while being a doctor, is anesthesiology a good specialty for that?

Dr. Alex Tripp: Because of maybe some of the work-life balance, yeah I mean I think that’s reasonable.  So I personally actually own a business that does like botox and IV’s and stuff like that basically just like concierge cosmetic recreational medicine for lack of a better way to put it. So yes from personal experience, I can tell you that this is a decent job to be at, and it also gives you a bunch of skills like that. Like being able to give people injections and IVs and stuff that are marketable, so yeah good choice, definitely good choice.

Samantha Mellinger: In PP is the lack of support from a hospital with regards to staff and other things a big deal in Anesthesia?

So in private practice, it’s the lack of support from a hospital regards to staff. and other things that are a big deal in anesthesia are not for me. So like I said, we are totally independent from the hospital, like we just contract with the hospital, and I would say that sort of the balance of how things go is like somebody says that they want something, then somebody goes and complains to like the hospital board or like the administration or whatever, and they say hey we want this in the operating room or from anesthesia specifically. And then they come to us, and they’d be like, they’re like hey give these people this. We’re like, yeah yeah we can’t necessarily do that and so then they like they sort of come on strong. Then we negotiate with them and stuff; so, I wouldn’t say that they don’t support us. It’s just a matter of like understanding like there’s like people who don’t really understand what’s going on in the operating room or trying to like call shots in the operating room which is a bit frustrating sometimes. But we have a relationship with the hospital that is such that we can make a phone call and like explain the ins and outs of those requests, and it’s basically okay.

So the place where we have issues because anesthesia staff are expensive is when we need more staff, and it’s kind of hard to go to a small hospital and say hey we need another six hundred thousand dollars to hire two anesthetists. They don’t like that very much as most corporations wouldn’t, but again if we sit down and we’re like hey like these are the numbers we’ll be able to give you, this much throughout with these additional people like here’s the national work hours for anesthetists and stuff, and we’re exceeding those so we need to knock it down blah blah blah. Like you can support your argument with data, everything becomes a lot easier, but the short answer is no. Not really a big deal like it’s pretty much just standard negotiations. Nobody’s like breathing down our necks for the most part.

Samantha Mellinger: So do DOs still face difficulties matching into their preferred residencies as opposed to their MD counterparts?

Dr. Alex Tripp: I don’t think so- not in this region at least. Keep in mind that so the midwest is where I have most of my experience, and where I applied for residency predominantly. So in my experience, no.  Once you kind of like get your scores out of the way and stuff like that, everything’s equal in terms of degree, but I get the impression that maybe some of the like more elite schools- your like east coast and west coast schools- maybe have some sort of prejudice still existing there. But yeah again not in my experience though.

Samantha Mellinger: Great so this may be one of our last questions. So if anyone else has any last additional questions, this is your time to get them in, and we will try to get through as quickly as we can. But in your position now knowing what you do now, what would you say to yourself back when you started medical school?

Dr. Alex Tripp: Oh when I started med school, it’s a great question. Hmm, I would well for if when I first started med school, I would tell myself to not go to class because it took me a while to figure that out. And like I know that’s questionable advice for those of you going into school shortly here, but like in our case, all of our lectures were posted online. I would tell myself all of the like good resources to know because I didn’t really know those. I hadn’t delved into SDN quite enough yet at that point, but yeah I’d be like here’s USMLE world. You should do these questions and do them a lot so like that and like don’t go to class to save yourself a lot of time. Read all the powerpoints and all that stuff on your own, but yeah I would basically give myself like efficiency pointers on how to improve quality of life.

Samantha Mellinger: All right, what’s your advice for students that are interested in pursuing anesthesiology?  

Dr. Alex Tripp: Well it depends on where you are in your student career, where are you yeah where you are in your education. The English is really hard guys sorry. So yeah like I mentioned earlier if super early on that you want to do anesthesia, being an AA or CRNA is a really good option. I would personally choose AA just because it’s less schooling. But if you want to be an anesthesiologist proper, basically the same just sort of generic advice like get good grades, shadow an anesthesiologist, try to get as much out of those experiences as you can, and prepare yourself as much as possible for being on the spot because  like I was saying earlier like you’re kind of on the ball when everything is going wrong. And you have to be prepared for that reality, but yeah like try to contact some anesthesiologists like me and ask questions about specifics of the career and things like that. It’s all about education, right. Like the more you can educate yourself about what you’re going to do, the better off you’re going to be.

Samantha Mellinger: Absolutely, so has medicine changed from back when you started to now being an attending?

Dr. Alex Tripp: The response to why medicine has changed, the actual why medicine has not. So I definitely did not mention any of the things about like wanting to be independent and like respected and things like that like just because of my profession because that sounds like really arrogant and jerky, but  it’s not a very proper interview response. But no honestly, like I like the fact that it’s sort of like you’re just figuring out how the human body works, and you get to like manipulate it essentially like with anesthesia. Especially you like to be it’s nice to be somebody who’s like trusted, to like know what they’re doing, and  to help people. Like as stupid as that sounds, like it’s one of one of the things that I like the most is placing labor epidurals. I strongly prefer when it is not at two in the morning but  that’s one of the few things that we do when you show up, and you like make a difference in somebody’s life. They’re in like terrible pain, and then 10 minutes later, they’re like, “oh man you are my best friend. This is freaking awesome.” So it’s really satisfying to like have that skill.

Samantha Mellinger: All right, I think this will be our last question. Did your residency program give you a stretch of syllabus to follow so you could be up to date with what you were doing?

Dr. Alex Tripp: No, no not at all. So my class was the first one, so I’ll give you a little background information here. So historically, anesthesia has had two board exams, so one written exam that you did at the end of your residency and an oral exam that you did like a year after the end of your residency. My class was the first one for which the written exam was split into two, and the first part you did after the second year of your residency, and so my program was like don’t know what the hell’s going on but like study as much as you can, and we’ll try to like get you some tutorial sessions in here. And we hope this is what you need, but like no that’s the short answer. We had no idea how that was going to go down. It was just a total cluster basically. So yeah pretty much all we had in regards to a syllabus was something that the ASA gave us that was or a BA I guess, board of anesthesiologists, gave us. That was like well we’re generally going to be testing these questions, so I guess you should probably know this stuff, and yeah we just kind of did the best we could. And it was not super fun.

Samantha Mellinger: But okay, last question for real this time. Okay, so Amanda is asking I’ve had, Amanda’s on fire tonight yes, several shadowing opportunities in the past. She knows she wants to be a physician so should she do some more current shadowing for the application process, or is historical shadowing good enough?

Dr. Alex Tripp: So if I recall correctly, you were the one who asked about shadowing in the distant past, so if that’s the case I would. I would do some more to sort of refresh your perspective. I think that will be  maybe a minimal good for your application, but it will be more good for you. I guess if you’ve decided on medicine, then it won’t affect your decision in that regard, but it might affect like how you view the specialties, like you might decide that you think clinical medicine sucks, or like medicine in a clinic sucks or that it’s awesome. Or that you want to like take care of people all the time or you might decide that you want to do surgery or something like that; so basically, it’ll inform your decisions down the line. So yeah, I think you should get involved again. It’s not going to hurt right, maybe it’s a day out of your time.

Samantha Mellinger: Well thank you doctor so much for your time tonight. Then thank you everyone else for attending this ask me anything, and if you did join us late, just a reminder it will be available for viewing on Youtube. And again we would just like to extend our gratitude to Dr. Tripp for taking this time to answer your questions, and lastly, we would like to remind you that we have many online tools and resources available at studentdoctor.net to help you on your journey to becoming a healthcare professional; so, please check those out again. That’s studentdoctor.net, and then our next webinar will actually be next Wednesday evening July 28th at 8 pm eastern time and will be a panel discussion about the pharmacy job market. So if that is something you are interested in as well, please join us for that, and again thank you so much. And have a great evening.

Dr. Alex Tripp: Can I interject real quick?

Samantha Mellinger: Yes, go ahead.

Dr. Alex Tripp: Sorry sorry to ruin your outro there, but yep and you’re welcome everybody. I see a quick Alex do something. I’m doing something; so, if you guys have any more questions that didn’t get answered, I am actually live streaming right now on twitch.tv milkman l1 if you’d like to ask me a couple more questions. I will be around for a little while, and I’m happy to field those. So thanks thanks everybody for showing up. I appreciate you coming out, and have a great night. Thank you again, cheers.

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