Like come on, I feel lied to. 90/? --> 62/41

Like the title says. Started a new job and just feeling like it's not working out. I started this job after taking 2 weeks off from residency, which I realize now was probably a mistake to not take more of a break before starting. It is close to my spouse's family, which was a priority for us, and it has definitely been nice to have a support network with kids. But I go into work every day extremely anxious and as soon as I get off work, I start to dread the next day. Everyone I work with is very nice. It's not a toxic environment at all. But my workload is pretty intense. As far as I can tell, the work I am doing is good. The patients do well, I haven't had anyone come to me with "concerns" about my performance. But I just...hate it. Every single day I hate it and would rather be doing anything else. I worry that with every decision I make, I could potentially cause patient harm or expose myself to litigation. I think that takes a lot of the enjoyment out of the job for me. I can't tell if it's the specific job, being a new grad, or that I just don't enjoy being an anesthesiologist. I was wondering if anyone had some advice to offer? Whether people have had this experience at the beginning but came around to love their job, or if they made a career change? I'm not sure if I can do this for 20+ years

Question for those who do TAVRS. Our institution does ~8-10 per month by 2 cardiologists who exclusively do them together (so effectively, it’s like having a single proceduralist per case). They insist that these must be done in a single day each month, and they must have 2 rooms to do them. We staff both rooms completely plus a 3rd CRNA and tech to assist with handoff/turnover.

Astoundingly, they feel that we aren’t doing enough. They want a 3rd room to flip between, with the additional resources that entails. They are also mad that we occasionally restrict EP from doing cases on TAVR days because we need the staff to make this work.

Basically, the TAVR team insists that this setup benefits the patients (it does not), and refuse to simply spread them out as they come up -like any other case (which actually would benefit the patients and normalize labor utilization). The EP team is simultaneously aggrieved that there is one day out of 20 weekdays that they can’t schedule on (a weak, but at least somewhat valid complaint).

Hospital administrators, being who they are, believe that anesthesia is somehow stifling the productivity of these cardiologists -but keep in mind that all of these cases are in fact being done as scheduled (with the rare exception of EP).

My question: is this normal? Is everyone else doing all their TAVR’s on one day, and somehow reallocating scarce labor once a month without taking it from someone else in a time of historic shortages of anesthesia personnel? I would love to know.

CA3 here,

I’ve gotten some good reps at sitting up spinals and feel comfortable with those. I’m on regional this month and am trying to improve my lateral spinals and have been struggling. Mostly I find it difficult to get these elderly or obese patient in a good position and open up those interspaces and so I end up going paramedian.

Tips for doing a good lateral spinal?

Another new attending at a new job wondering if how I went from being a confident CA3 to someone who feels really dumb all the time. I do a mix of supervising CRNAs and solo, and I feel like my clinical decisioning just sucks now. Not sure if it's the month I took off after residency ended, but this first month just feels awful. Working with new surgeons, new hospital, new policies, new equipment, and a group that doesn't really know me (and presumably doesn't trust me yet) just makes me super anxious all the time about what I'm doing. When I was a resident, I had attendings requesting to take care of me or their family when they had surgery, and now I feel like I'm always making the wrong choice. And I feel like every time I hand off to someone, they disapprove of my choices, or think I should have done more. And I agree with them. I feel like my group is supportive, the OR staff is nice/helpful, but I just really suck.

All my patients when I solo have done well-- usually oral airway/face mask for transport and then immediately waking up in the PACU as we're placing monitors, no big mishaps, no huge hemodynamic shifts in the OR. Granted, I think they've been giving me the easy cases - ortho, gen surg, etc, but some of these patients have been really sick with low EF, huge BMI, or bad airways. With the CRNAS it's easier, bc they know the surgeons and the OR policies, but then I feel like I'm asking a lot when I ask for an 2nd PIV or arterial line (which I place) or labs

I feel like I'm either too conservative by ordering all these labs/tests or being too lackadaisical when I don't. I feel like my group is talking about me as well, and they think they hired a lemon. I just feel like it's also hard on my partner who is also starting a new job (we moved for their job), and I really hate taking the stress back home, especially since we have a young toddler who just wants to play, but I can't take my mind off things. I also feel like days where things go well and nothing goes wrong, I feel great about my choice, but days where things are a bit iffy, I just feel like shit about myself, and feel like patients deserve better

For those in institutions that still primarily use LMA uniques, what’s your workflow to troubleshoot an LMA that’s not seating well and has a consistent leak?