Anaesthesia

Nature of the work

Anaesthetists work in many different areas of the hospital. Foundation anaesthetic skills are learned in the first few years of training, but after that many anaesthetists develop a particular expertise. Anaesthetists care for patients by choosing the appropriate anaesthetics, monitoring their wellbeing during operations and painful procedures, supervising their recovery and providing further medical support if needed. The majority of their time is spent in the operating theatre but they also work in areas such as:

• obstetric units
• critical care services for intensive care [1] and high dependency patients
• resuscitation services
• emergency departments
• chronic pain management
• acute pain teams
• dentistry
• perioperative [2] clinics
• research
• psychiatry – for patients receiving electro-convulsive therapy [3] (ECT)
• radiology – anaesthesia for CT scans [4] and MRI [5], especially in children
• inter-hospital transfers of critically ill patients

Anaesthetists offer four stages of patient care for a routine anaesthetic:

• preparation – assessing the patient’s fitness for anaesthesia and agreeing on an anaesthetic plan
• induction – initiating anaesthesia
• maintenance – continuing anaesthesia and monitoring the patient’s condition including checking the activity of the heart, blood pressure, oxygen and carbon dioxide levels, breathing, body temperature, depth of anaesthesia and the body fluid balance
• recovery – reversing anaesthesia and supporting the patient’s recovery

The modern specialty of anaesthesia has come a long way since its earliest days. Every patient has a needle inserted in their vein, and in more complicated cases, arterial or central venous lines (ie inserting a line via a thin catheter [6]). Airway management is also important. This may involve face masks, laryngeal [7] mask airways, endotracheal intubations [8] or tracheostomies [9]. Common regional anaesthetic techniques include the epidural [10] and the spinal block [11].

"I love communicating with patients and making a difference to their lives. Working with such friendly colleagues as part of a highly supportive team is very enjoyable".

Read Sarah's story [12]

Common procedures/interventions

The word 'anaesthesia' means 'loss of sensation'. Common procedures include:

• general anaesthesia – putting the patient into a reversible state of unconsciousness. Anaesthetic drugs are injected into a vein, or anaesthetic gases are breathed into the lungs
• regional anaesthesia – blocking pain in a large area of the patient’s body (common in day surgery or where a general anaesthetic may be risky). Regional anaesthesia is when local anaesthetic drugs are injected near to the bundles of nerves which carry signals from that area of the body to the brain. Regional anaesthesia is commonly used as the sole anaesthetic agent in caesarean sections
• local anaesthesia – blocking pain in a small area of the patient’s body. It is used when the nerves can easily be reached by drops, sprays, ointments or superficial injections

Sub-specialties

There are three CCT [13] sub-specialties:

• pre-hospital emergency medicine
• pain medicine
• intensive care medicine [14] (which is a specialty in it's own right)

As their career progresses, many anaesthetists develop an interest in a clinical or research sub-specialty.

Want to learn more?

Find out more about:

• the working life [15] of a doctor in anaesthetics
• the entry requirements [16] and training and development [17]

• Pay and conditions

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  This section provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.

  Find out more about the current pay scales for doctors [18], and there's more information on the BMA website [19].  

  NHS employers [20]  provides useful advice and guidance on all NHS pay, contracts terms and conditions.

  Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.

• Where the role can lead

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  Read about consultant and non-consultant roles in anaesthesia, flexible working and about wider opportunities.

  Consultant roles

  You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training [21] (CCT [13]). You will receive your CCT [13] at the end of your anaesthesia training.

  Managerial opportunities for consultants include:

  • clinical lead - lead NHS consultant for the team
  • clinical director - lead NHS consultant for the department
  • medical director - lead NHS consultant for the Trust

  Most NHS consultants will be involved with clinical and educational supervision of junior doctors.

  Here are some examples of education and training opportunities:

  • director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
  • training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training [22] programme director. This role will be working within the LETB/deanery
  • associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery

  Approximately 25 per cent of anaesthetists undertake responsibility for intensive care [1] medicine (ICM) as well as anaesthesia.

  As an anaesthetist, you may lead or manage various departments, playing a major role in day surgery, operating theatres, recovery units, critical care services, high dependency units and resuscitation services. Anaesthetists are widely involved in the teaching and training of medical students, postgraduate doctors in training, nurses, midwives and paramedics. There are also some opportunities to do research.

  SAS doctor roles

  SAS doctors (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.

  Further information on the SAS doctor role [23]is on this site.

  Other non-training grade roles

  These roles include:

  • trust grade
  • clinical fellows

  Academic pathways

  If you have trained on an academic anaesthesia pathway or are interested in research there are opportunities in academic medicine.

  For those with a particular interest in research, you may wish to consider an academic career in anaesthesia. Whilst not essential, some doctors start their career with an Academic Foundation post. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.

  Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) and may progress to a Clinical Lectureship (CL). Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.

   Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC). [24]

  There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine [25].

  The Clinical Research Network [26](CRN) actively encourages all doctors to take part in clinical research.

  Other opportunities

  There are opportunities to be employed by the NHS, academic institutions, private sector, universities, the armed forces, organisations and national governing bodies.

• Job market and vacancies

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  This section provides useful information about the availability of jobs, finding vacancies and where to find out more.

  Job market information

  Anaesthesia is a popular career choice among doctors and is the largest department in most hospitals. A recent survey showed that on average, 8% of doctors chose anaesthesia at one and three years after qualification and most were still working in that specialty ten years later.

  6,811 consultants work within anaesthesia, 6,303 as consultants in anaesthesia and 508 intensive care [1] medicine. 2,956  and 666 as medical registrars in England (NHS Digital, 2016 [27]). Anaesthetists come into contact with two-thirds of all patients admitted to UK hospitals, and they are increasingly being called upon as perioperative [2] physicians. Female consultants make up around 30% of the workforce compared with 76% in the healthcare sector overall (CfWI, 2015 [28]).

  In 2016, the competition ratio [29] CT1 for anaesthetics including ACCS Anaesthetics) was 2.09 and for ST3 anaesthetics it was 1.29 (NHS specialty training 2016). [30]

  Read the Centre for Workforce Intelligence’s in-depth review of the anaesthetics and intensive care medicine workforce [31](CfWI, 2015). CfWI predicts that at current levels of provision, patient demand will outstrip staffing down to 2033. (The work of the CfWI does not necessarily reflect the views of the Department of Health.)

  Opportunities exist for locum work [32], job-sharing and permanent part-time work.

  As a consultant anaesthetist in the NHS, you may also find opportunities to work in the private sector.

  On this section we have information for England only. For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland medical and dental workforce data [33]

  NHS Wales medical and dental workforce data [34]

  Department of Health, Social Services and Public Safety workforce information for Northern Ireland [35]

  Where to look for vacancies

  All candidates apply through the online application system Oriel [36] to the Anaesthetics National Recruitment Office.

  All jobs will be advertised on NHS Jobs [37].

• Further information

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  Organisations

  The Royal College of Anaesthetists [38]

  The Association of Anaesthetists of Great Britain and Ireland [39]

  Association of Cardiothoracic Anaesthetists [40]

  The National Institute of Academic Anaesthesia [41]

  Real-life stories

  Starting in anaesthetics (BMJ) [42]

  The secret life of an anaesthetist (The Guardian) [43]

  Video case-studies

  About anaesthesia (HEWM) [44]

  Dr Zulfi Sadiq, anaesthesia (HEEM) [45]