Anesthesiology Residents

Things I Wish I Knew When I Was a CA-2

There comes a time in every medical resident’s training when learning turns to action – or at least some sort of direction. While nothing is set in stone (and, in fact, you’re better off assuming it isn’t), there are a few guiding principles every anesthesiologist comes to understand sooner rather than later. In the interests of “sooner,” I’d like to share with current residents a few of my key takeaways from residency and the transition to private practice. Here’s what I wish I knew when I was a CA-2. By Daniel Hansen, MD

CA-2 is an exciting year. As you dive into the meat and potatoes of anesthesia, you start to feel more comfortable as an anesthesiologist. Halfway through the year you begin thinking about life after residency as a reality, not a hypothetical. What next? Fellowship decisions loom and career paths are debated. It is an inspiring yet unsettling time. 

As I look back on my CA-2 year, there are a few things I wish I had known then: 


  1. It’s OK to be unsure of what you want to do. As physicians we are, almost by definition, goal-setters and planners. Anesthesia residencies are a macro-exercise in creating and executing plans (and making backup plans, and backup plans for your backup plans). Personally, during my CA-2 year I was still uncertain of what trajectory I wanted to take with my career. I did not finalize my plans until well into my CA-3 year.


  1. It’s OK to change plans. Toward the end of my CA-2 year, I was offered an academic position and financial assistance to pursue a fellowship. I secured a spot in a fellowship program and began making plans for fellowship. Then, well into my CA-3 year and within a short period of time, some personal experiences led me to change plans. I withdrew from my fellowship and opted to take a private practice job in my hometown. It was the right decision for me, and I am very happy with my current situation. I also know that circumstances can change – and my future plans may as well.

    As anesthesiologists, we are expected to adapt to the changes in the operating room; we should similarly be prepared to adapt to changing life circumstances. (Word of advice: Changes of plan are expected, but don’t burn bridges. Be honest about your intentions with peers and leadership. The world of anesthesia is remarkably small, and you don’t want to develop a reputation for lack of transparency.) 


  1. Being an anesthesiologist is more than just providing anesthesia. Specifically, during residency we are sheltered from much of the non-clinical elements of being an anesthesiologist. The priority is mastering the clinical work. But with time, particularly post-residency, you need to expand your skills to include managing teams – especially if you are working with CRNAs or AAs. Learning to “run the board” becomes part of some jobs. Learning the nuances of billing and the financial elements of a practice might come into play. Stepping into group or hospital leadership roles becomes important. In short, pay attention to and engage with the full responsibilities of being a “physician anesthesiologist.” 


  1. Reputations matter. Pretty self-explanatory, but while you might have built a solid reputation for yourself during training, you are starting over post-training. Alternatively, if you struggled during residency, you get a fresh start when you transition to practice. Strive to develop a reputation for being a solid clinician, a good team player, a hard worker, and a leader. The first year or so really will set the tone, so try to establish yourself from the get-go. 

  1. Efficiency is a highly valued skill. Particularly in private practice, the pace of anesthesia and surgery is faster than most academic centers. Most residency programs are in academic centers, and thus we start at a slower pace. Learning how to prioritize patient safety AND efficiency are skills we all should develop and continuously work on. 


  1. Money goes fast. As a starving medical student, and then as an almost-starving resident, the thought of a full attending-level paycheck sustains us through many a long call night. We are fortunate to work hard and receive fair compensation for our work, but money goes fast! The lifestyle creep is real.

    It is OK to indulge yourself when you start and enjoy your new income. But have a plan. Gross versus take-home pay are very different. Educate yourself regarding finances. Student loans can’t be deferred indefinitely. Bills get bigger and multiply. Taxes are significant. Be wise financially and avoid making classic doctor mistakes. There are tons of great resources out there so consider spending some serious time learning how to manage your finances following residency. After all, we get very little business or financial education in all our years of medical training.


  1. It takes a village. Remember that you don’t live or practice in a void – relationships are critical. Remember that your professional life is only one aspect of your real Significant others, children, parents, friends, coworkers and countless others likely have invested in you during training. Make sure you take time to appreciate them and fill their tanks when able.

    In the professional sphere, remember that the entire “team” sinks or swims together. Develop good relationships with your coworkers and the OR teams. Foster good relationships with surgeons, pre- and post-op nurses, and everyone in the hospital. Be someone that builds others up, that helps out, and you will find your workdays are more enjoyable.


To all the residents out there – enjoy your residency! It is a difficult but exciting and energizing time.

For more established physicians – what valuable life lessons have you learned post-residency that you wish you could tell your younger self? Please share them in the comments section below!

Daniel Hansen, MD is a private practice anesthesiologist, husband, and father. He is lives in Reno, Nevada.


ASA Community Blog is published as a benefit for ASA members. The views expressed on this blog are those of the individual contributing writers only and do not necessarily represent the opinions of ASA.



Oct 02, 2020 08:22 PM

Indeed CA-2 is probably the most crucial part of the training of becoming an Anesthesiologist. One only hopes that residency programs would allow  CA -2 residents to take a few days off halfway into their year to reflect back on how far they have come. Once they do that, it would allow them to focus, reset and continue with more zeal and energy. Thank you for bringing up this topic.

Oct 01, 2020 02:40 PM

Thank you for this wonderful post. This is a great reminder that we are not perfect and life does not always go as planned.