Anesthesiologist

Overview
An anesthesiologist (American English), or anaesthetist (British English), also "anaesthesiologist," is a medical doctor trained to administer anesthesia and manage the medical care of patients before, during, and after surgery.

Training in the United States
In the United States of America, anesthesiologists are physicians (MD or DO) who have chosen to specialize in anesthesiology. The majority of anesthesiologists in the United States have completed a four-year undergraduate college degree, including pre-medical requirements. Like other physicians, anesthesiologists complete four years of medical school. However, a few medical schools offer a six-year program following high school. (In such programs, the first two years fulfill the pre-medical requirements, and the following four years are the traditional medical education.)

After medical school, a physician choosing anesthesiology as his or her specialty has historically completed a year of internship and then three years of residency. Prior to circa 1985, the residency was two years following internship. Today physician training programs in the United States without exception require four years of residency training for board certification eligibility in the specialty of anesthesiology (usually one year of general medical, pediatric, or surgical training followed by three years of clinical anesthesiology training under the tutelage of experienced anesthesiologists, usually faculty at medical school hospitals). Today, after graduating high school, physicians specializing in anesthesiology complete at least ten years of education and training prior to becoming eligible for board-certification.

Many anesthesiologists complete additional fellowship training in pain medicine, obstetric anesthesiology, neurosurgical anesthesiology, pediatric anesthesiology, cardiovascular anesthesiology, or critical care medicine. The American Board of Medical Specialties has authorized the American Board of Anesthesiology to grant subspecialty certification in pain medicine, pediatric anesthesiology, cardiovascular anesthesiology, and critical care medicine.

Anesthesiology residency training encompasses a full scope of perioperative medicine, including pre-operative medical evaluation, management of pre-existing disease in the surgical patient, intraoperative life support, intraoperative pain control, post-operative recovery, intensive care medicine, and chronic and acute pain management. After residency, many anesthesiologists complete an additional fellowship year of subspecialty training in areas such as pain management, cardiac anesthesiology, pediatric anesthesiology, neuro anesthesiology, obstetric anesthesiology or critical care medicine.

It is important to note that the term "anesthetist" in the United States usually but not always refers to nurses who have specialized training in the provision of anesthesia care. Registered nurses who complete a masters degree program and mandatory board certification in nurse anesthesia are called "nurse anesthetists" or "certified registered nurse anesthetists" (CRNAs).

The term "anesthetist" in the United States can also refer to anesthesiology assistants (AAs), who have completed a training degree program in anesthesia care. AAs must provide anesthesia care under the supervision of an anesthesiologist. In most States, federal Medicare regulations require that CRNAs be supervised by a physician (for reimbursment purposes only).{unreferencedsection|date=December 2007}}

The majority of anesthesiologists in the United States are board-certified by a specialty medical board ; either the American Board of Anesthesiology (ABA) or the American Osteopathic Board of Anesthesiology (AOBA). The ABA is a member of the American Board of Medical Specialties, while the AOBA falls under the auspices of the American Osteopathic Association. Both Boards are recognized by the major insurance underwriters in the U.S. as well as by all branches of the U.S. Uniformed Services. Board certification by the ABA involves both a written and an oral examination. AOBA certification requires the same, in addition to a practical examination with examining physicians observing the applicant actually administering anesthetics in the O.R.

Anesthesiologists in the US are among the highest paid of physician specialists. In 2007, Forbes Magazine ranked anesthesiologists as the highest paid physician specialty. The average annual salary for an anesthesiologist in the United States is around $345,000, while a typical starting salary is around $275,000. http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm BB.O

Training in other countries
Physician training in anesthesiology in other developed countries is similar to that in the United States. In the United Kingdom, anesthesiologists in are called "anaesthetists" or "anaesthesiologists." In England, training is overseen by the Royal College of Anaesthetists. Anaesthesiologists in the United Kingdom are doctors who have completed a five-year undergraduate training program. They usually enter anaesthesiology from other specialties, such as medicine or accident and emergency. Specialist training then takes at least seven years. It is overseen by the Royal College of Anaesthetists. In Australia and New Zealand, training is overseen by the Australian and New Zealand College of Anaesthetists.

Role in Healthcare Delivery
According to the American Society of Anesthesiologists, anesthesiologists provide or participate in more than 90 percent of the 40 million anesthetics delivered in the USA annually.

Anesthesiologists are highly specialized physicians certified by the American Board of Anesthesiology or by the American Osteopathic Board of Anesthesiology only after completion of many years of extensive and specialized training. The goal of this training is to provide every patient with a physician capable of managing the most complicated and difficult of medical and surgical situations with life saving skills and decision-making capacities.

Anesthesiologists are perioperative physicians ("peri-" meaning "all-around") who provide medical care to patients before, during, and after their surgical experience. This includes a preoperative medical evaluation of each patient before surgery, consultation and planning of the surgery with the surgical team, creating a plan for the anesthesia tailored to each individual patient, airway management, intraoperative life support and provision of pain control, intraoperative diagnostic evaluations as needed, and critical postoperative life support. This also includes medical management of preexisting medical conditions, care and management of medical or surgical complications, provision of pain management, and intensive care management as the situation warrants. Management, direction of, and performance of cardiac and pulmonary resuscitation, advanced life support, pain control, and stabilizing and preparing patients for emergency surgery are mandatory, essential, and critical skills which anesthesiologists have been trained to employ.

Historically in the United States there has been a shortage of anesthesiologists. In order to better serve the population, residency positions in anesthesiology for physicians have been steadily increasing the past several years. In addition, physicians supervise ACTs, or Anesthesia Care Teams, which are composed of a supervising physician with several certified registered nurse anesthestists (CRNA's) or anesthesiology assistants (AA's), working together to provide healthcare to the population. In other areas of the country, Anesthesiologists work in what is deemed a "solo" or "MD/DO only" practice, during which they provide anesthesia in a "one on one" relationship with the patient.

As perioperative physicians, anesthesiologists also work in ICU's, PACU's, Pain Clinics, infusion centers, and ambulatory surgical centers.

Anesthesiologists and Patient Informed Consent
Patient informed consent is a fundamental ethical and legal principle and is considered essential to patient autonomy. The American Society of Anesthesiologists and other professional organizations, such as the American Association of Nurse Anesthetists, support the principle that patients should be fully informed regarding the manner in which their anesthetic will be administered.

Due to medications given before, during and after surgery, a patient may sometimes not remember interacting with his or her anesthesiologist and other members of the anesthesia care team. Therefore, patients should request to know, before surgery, the identity of their anesthesiologist as well as the identity of mid-level providers, such as nurse anesthetists or physician assistants, who will be involved in their anesthesia care. The anesthetic plan, as well as alternatives, risks, and benefits of the chosen anesthetic techniques, should be discussed with the patient prior to surgery.

Patients should discuss medical conditions with their anesthesiologist prior to surgery. Medications, allergies, and any history of medical problems, particularly diseases of the heart and lungs, should be discussed with the anesthesiologist. It is critically important for a patient to disclose any family history of problems with anesthesia as well as whether the patient has had anything to eat or drink before surgery.