Anesthesiologist 349335 226023949 2008-07-16T14:13:58Z RussBot 279219 Robot-assisted fix [[WP:DPL|links to disambiguation page]] English An '''Anaesthetist''' ([[British English|English]]), or '''anesthesiologist''' ([[US English]]), also "anaesthesiologist," is a [[physician|medical doctor]] trained to administer [[anesthesia]] and manage the medical care of patients before, during, and after surgery. ==Role in Healthcare Delivery== According to the [[American Society of Anesthesiologists]], anesthesiologists provide or participate in more than 90 percent of the 60 million anesthetics delivered in the USA annually. <ref>{{cite web | title = ASA Fast Facts: Anesthesiologists Provide Or Participate In 90 Percent Of All Annual Anesthetics | url = http://www.asahq.org/PressRoom/homepage.html | format = html | publisher = ASA | accessdate = 2007-03-22}}</ref> Anesthesiologists must be certified by the American Board of Anesthesiology or by the American Osteopathic Board of Anesthesiology after completing both medical school and a residency in anesthesiology. 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 anesthetists ([[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, the American Osteopathic College 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. ==Training by country== Physician training in anesthesiology in developed countries is similar. ===Australia and New Zealand=== In Australia and New Zealand, training is overseen by the [[Australian and New Zealand College of Anaesthetists]]. ===Germany=== After earning the right to practice medicine, German physicians who want to be an anesthetist have to go through a 5-year residency, ending with a board examination. During this time, physicians are educated in all aspects of their chosen field of medicine. Usually this includes rotations serving in the operating room to perform anesthesia on a variety of patients being treated by every kind of surgical sub-profession (i.e. [[general surgery]], [[neurosurgery]] or invasive [[Urology|urological]] and [[Gynaecology|gynaecological]] procedures), followed by a rotation on various [[Intensive_care_unit|intensive-care]] and intermediate-care units. During this time of residency, many physicians choose to complete a course in emergency medicine, which once completed, enables them to be referred to as [[:de:Notarzt|Notarzt]], a physician of the [[Emergency Medical Service]], treating patients at home or on the scene of accidents, either on their own or assisted by [[paramedic|paramedics]]. ===United Kingdom=== In England, Northern Ireland, Scotland and Wales training is overseen by the [[Royal College of Anaesthetists]]. Anaesthetists 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. === United States/Canada=== In the USA and Canada, anesthesiologists must first complete a [[medical degree]], either [[Doctor of Medicine]] (M.D.) or [[Doctor of Osteopathic Medicine]] (D.O.), and then they must complete a specialty training program 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 [[medical specialty]] has historically completed a year of internship and then three years of [[medical residency|residency]]. Prior to the mid-1980s, 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. This usually includes 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, nearly every physician specializing in anesthesiology completes at least 12 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, [[Cardiothoracic anesthesiology|cardiovascular anesthesiology]], regional 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 nurse]]s who complete a [[masters degree]] program and mandatory board certification in nurse anesthesia are called "Certified Registered Nurse Anesthetists" (CRNAs).{{fact|date=December 2007}} The term "anesthetist" in the United States can also refer to Anesthesiology Assistants (AAs), who have completed a graduate-level 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).{{fact|date=December 2007}} The majority of anesthesiologists in the United States are board-certified by a specialty medical board {{fact|date=December 2007}}; 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. ==References== {{reflist}} ==External links== * [http://www.asahq.org/patientEducation.htm American Society of Anesthesiologists - Patient Education] [[Category:Medical doctors by specialty]] [[Category:Anesthesia]] [[de:Anästhesist]] [[it:Anestesista]] [[nl:Anesthesioloog]] [[no:Anestesilege]] [[pl:Anestezjolog]] [[sl:Anesteziolog]] [[zh:麻醉科醫師]]