Why obstetric anesthesiology is the next frontier in medicine

There’s a lot of fear and anxiety about the job market with recent medical school graduates. The 2008 crisis almost collapsed the housing market and many of our large banks, prized institutions, and beacons of financial stability, dissolved overnight.  If you combine these events with the financial burden of student loans that many graduates have, it’s easy to see why many medical students are somewhat skeptical of the job market.

In anesthesiology, the influx of mid-level providers has forced many residents to add an extra year of training. In most cases, job stability plays a big role in the decision to pursue a fellowship. With the average cost of medical school nearing 250 thousand dollars, its not difficult to see why many anesthesiology residents (and residents in other fields) are looking to further their training.

Which is why it is perplexing that many attending physicians are discouraging anesthesiology residents from pursuing obstetric anesthesiology, one of the most protected jobs regarding job security. I cannot tell you how many times attending anesthesiologists have disapproved of my decision to pursue OB anesthesia.

“Why are you wasting your time? You don’t need a fellowship!”

“You are going to spend a year learning how to do epidurals and spinals, you don’t need a fellowship for that!”

This could not be further from the truth.

Needless to say, it was a waste of time (and exhausting) to explain myself and list the reasons why a hospital would benefit from having fellowship trained obstetric anesthesiologists on board.

New medical student graduates and anesthesiology residents deserve to learn about one of the most exciting, dynamic, securest and fastest changing fields in anesthesiology. Obstetric anesthesiology, as I will explain, may be one of the most exciting and fastest growing fields in medicine altogether.

An evolving field

At this year’s annual Society of Obstetric Anesthesia and Perinatology meeting, Dr. Alicia Dennis, world-renown anesthesiologists and expert in cardiovascular diseases in pregnancy talked about the evolution of obstetric anesthesiology.

“The future is an integrated obstetric critical care and echocardiography curriculum.”

Maternal mortality, it turns out, has been steadily rising since the late 20th century. An increase in cardiovascular disease, including congenital heart disease, cardiomyopathy, and congestive heart failure has been shown to be the leading cause of maternal mortality in developed countries.

Its no wonder Dr. Alicia Dennis made such a direct and poignant statement signaling a shift in the direction of our field. Obstetric anesthesiology, it turns out, is at a crossroads. The training, education, and curriculum of this evolving field will be up to the next generation of physician anesthesiologists to determine.

Obstetric anesthesiologists, and future doctors considering this field have a unique opportunity to care for a changing demographic. Anesthesiologists, having long championed patient safety and advocacy, have another opportunity to take a lead in caring for the critically ill parturient.

Levels of maternal care: A gold star for OB-trained anesthesiologists

Our obstetric colleagues have recognized the increasingly complex nature of pregnant patients and have classified hospitals based on the availability of maternal care medical services. In 2015, the ASA Committee on OB Anesthesiology and the Society for Obstetric Anesthesia and Perinatology (SOAP) provided support for a document created by the American College of Obstetricians and Gynecologists (ACOG) and Society of Maternal-Fetal Medicine (SMFM), which outlines different levels of obstetric maternal care. Similar to NICU classifications, this document now stratifies levels of maternal care provided by hospitals. The levels go from birth center (basic) to Level IV, which is a “regional perinatal health care center.” Of particular importance, the availability of OB anesthesia services follows the order of these levels.

Level III and IV, for example, the two highest levels of maternal care, require a board certified anesthesiologists with “Special training or experience in OB anesthesia in charge of OB anesthesia services.”

These levels of maternal care have solidified the value of the obstetric anesthesiology fellowship. The language could not be any more direct. If you want to consider yourself a top tier hospital in terms of maternal care, you need obstetric anesthesiologists on staff. Hence, the job security of obstetric anesthesiologists is at an all time high. This is in contrast to our colleagues specializing in pain medicine, who are seeing their field chipped away by neurologists, physical medicine doctors, and psychiatrists.

Looking ahead

A second revolution of safety, research and innovation is upon us in obstetric anesthesiology. Diseases such as sepsis, cardiomyopathy, and congenital heart disease have long puzzled experts in our field. With exciting new research and leadership, obstetric anesthesiology has the opportunity to become one of the most transformative fields not only in anesthesiology, but in medicine all together.

Cesar Padilla is an anesthesiology resident and president, resident component, Society for Obstetric Anesthesia and Perinatology.

Image credit: Shutterstock.com

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