HCDM 35 | Anesthesiology Career

 

Welcome, 2021! To start the new year on a positive note, Richard Marn, MD, shifts gears by sitting in the guest chair and sharing the highlights of his anesthesiology career. With his wife, Jessica Marn, DDS, standing in as the host of the show, Richard details his life within the medical industry, breaking the misconception that anesthesiology is a boring field compared to other specializations. He explains what an anesthesiologist can do outside the perioperative surgery period and even the surgery room itself. Richard also looks back on his experiences as a medical student and helps set every aspiring anesthesiologist’s expectations out there.

Listen to the podcast here:

New Year Episode: Richard Marn, MD, On The Lessons And Experiences From His Anesthesiology Career

Anesthesiologist/Pediatric Anesthesiologist/Podcaster

We have a whole bunch of awesome interviews lined up and guest interviews and panelists. I’m excited that we’re going to start this fresh new year and leave 2020 in the rear-view mirror. I’m excited that we’re going to start with this fresh new session with the best guest ever, myself. In one episode, my wife was interviewed for her career as a pediatric dentist, as an author and writer of a book. This session, it will be myself talking about my career, and my wife is going to interview me. I was thinking to do it where I would talk about myself, but I didn’t want to. We didn’t think that was a good idea. That was not my style. My wife has a question that I usually go through, and who knows what else she might ask? Without further ado, I’m going to let you take the stage and interview me and my career as a health professional.

How are you? I have the privilege of now putting him in the hot seat. There are questions that you normally ask. We’re going to turn the table to you. Give us a quick bio in chronological order and highlights that you think are the most important.

I was born and raised in Hawaii. I went to college in St. Louis at Washington University. I got my medical degree at the University of Hawaii in Honolulu. After that, I thought I was going to be a urologist. I did a one-year internship in surgery at the University of Colorado in Denver. I found myself doing anesthesia at NYU Medical Center. That was followed by a one-year pediatric anesthesia fellowship at Johns Hopkins University. After that, I was at Mount Sinai Hospital for over a decade as one of their pediatric anesthesiologists and left to go into private practice in 2016. That’s what I’ve been doing, pediatric dental sedation and plastic surgery anesthesia. That’s my new niche, and being a podcaster.

Can you tell us a bit about your job title and what do you do? You have three different jobs.

I’m a board-certified anesthesiologist. I am also a board-certified pediatric anesthesiologist. As a healthcare professional, I provide anesthesia to patients that need a procedure or surgery done for them. I do it with a combination of medications using different equipment and supplies. We deal with anatomy, physiology, biology and pharmacology. That’s what we do and taking care of patients in a perioperative period.

I’m fortunate to see what you do, and I know a lot of your colleagues. You’re an amazing anesthesiologist. How do you help people? Give us an example.

By providing anesthesia in different scenarios. Over the years, I’ve done emergency surgeries on children. Maybe they had a foreign body that they swallowed and it stuck in their throat. I’ve also done cases with kids who have tonsillectomies and adenoidectomy. You provide anesthesia so that they’re unconscious and comfortable before, during and after that procedure. I’ve also taken care of adults where they have weight-loss surgery. We provide anesthesia to keep them safe and provide airway management to make sure they get enough oxygen. We help with their temperature management, blood pressure control, and heart rate control as well. There are lots of different factors, but I guess that’s a general overview of some of the stuff I’ve got to do over the years.

What is the best part of your profession?

Getting people safely through anesthesia when it can be nerve-wracking, anxiety-provoking, and sometimes dangerous, depending on the situation.

What is the least favorite part of your profession?

Sometimes it can be a little slow. Things can get a little monotonous in terms of being in the room, especially when things are going smoothly, which is sometimes a good thing. That’s the least favorite part or part of the least favorite parts of my job.

The most rewarding part of anesthesiology is helping patients get safely through medical procedures, no matter what. Click To Tweet

What are the misconceptions people have about your profession?

One of them is that these anesthesiologists have no personality, but yours truly does.

Tell me what you do on a day-to-day basis in your profession.

As an anesthesiologist, I can tell you a bit what academics was like and what private practice was like. Academics before, you get into the hospital. You could be working with residents if you’re in an academic setting or working by yourself. Either way, you’re there at about 7:15, 7:30, then cases start at 8:00. It gives you enough time to get ready to see the patient that you’ll be taking care of. You interview them because that’s the first time you will be seeing them. You review their history and make sure there are no issues. When all the appropriate paperwork are done, the surgeon showed up, and the nursing team has seen the patient, we escort the patient to the room. We often place an IV and other monitors, and we initiate the anesthesia. That’s what we often call the induction.

After that, you tailor the anesthesia to the patient at the right moment and get them safely through the surgery. Based on your assignment that day from the clinical coordinator, you could do one case a day that could last many hours or sometimes do ten cases a day. It depends on where you’re often assigned or what cases you’re supposed to be doing that day. The day could end anywhere from 4:00, 5:00, 6:00 in the evening, plus or minus an hour. It could go up to 7:00. Sometimes it could end at 3:00. Every day can be variable. It depends on your caseload for that day and where you’ve been assigned.

With me in private practice, I can arrive at the office as early as 6:30, depending on which location I’m at. I could take care of one patient or it could be four patients a day. It’s the same principles. I provide an IV and anesthetize the patient with appropriate medications tailored to their underlying health issues. In private practice, we tend to be more hands-on with the patients. We often will call the patients the night before, if not several days beforehand, so that they have a much more intimate understanding of who their anesthesia personnel is. It is different than academics, where sometimes you don’t see your anesthesiologist until minutes before they started the procedure.

What misconceptions do people have about your career?

I mentioned one before, which was about how people think that we have no personality. I have debunked that misconception. Other people believe that anesthesia can be boring. There are some mundane parts of it as many professions, but there are some parts where it’s exciting, exhilarating and dramatic. For example, when I was at Mount Sinai doing a pediatric case, I was taking care of a young neonate who had this disease called a tracheoesophageal fistula. This child had surgery at about a week old and weighed about 3 to 4 pounds. It was stressful, but it even got more stressful because with the surgery, you open up the thoracic cavity for part of the surgery. During that part, right in the middle of surgery, the breathing tube came out.

As they say, you grow some gray hairs that day, but I was fortunately there present and right at the head of the small patient and was able to successfully put the breathing tube in the patient laying on his side. That’s not easy, but it was fortunate that I had the proper training and good fortune to get us through that situation and got that breathing tube in quickly. With children that young, their oxygen level will drop precipitously within seconds. That’s some of the drama.

I remember that other case you spoke about because the surgeon came up to me. It was like you won. You beat up Rocky and get on the Apollo at the same time. He was like, “Do you know what your husband did?” I’m like, “What did he do?” They said, “He was amazing.” I remember that because I was in the OR also and I was waiting in the PACU. I was recovering my patient as well. I know which surgeon it was that you were working with.

There was another time where it was 2:00 in the morning. I got paged from home. I ran to the hospital. This two-year-old kid was getting a craniotomy done. He had fallen and had to open up his brain. A craniotomy is when they open up the cranium, the head, and search on the location where they think there might be some bleeding. This kid had some bleeding going on in his brain. It was tenuous. The child’s blood pressure was going low. We give medications and it would go up and then drop down. The kid ended up getting a bunch of blood transfusions. This is early in the morning. Fortunately, I had a great resident, Dr. Menachem Weiner. He’s still at Mount Sinai. He’s a great resident. We got that kid safely through that case. Thank God. That was a scary period. We also had some other team members that were helping out, but he and I were the main people assigned to the case. There are also other cases where you do one surgery and it lasts a long time. Maybe a laparoscopic hernia on an adult.

HCDM 35 | Anesthesiology Career

Anesthesiology Career: If you choose one of the ROAD specialties, you could theoretically do well financially and have a nice work balance.

 

Can you tell me what that is?

You put these little sharp instruments that go into the abdominal area and they insufflate air in and around the bowel and other parts of the abdomen so that they can see the inside of the abdomen without having to make a big incision. Sometimes these procedures can be long and not exciting. You’re still watching the patient the whole time, monitoring and watching them carefully. That’s fine. Sometimes you want those periods where it’s relaxed and a controlled situation. One analogy with anesthesia is it’s like flying a plane. The takeoff and landing can be dramatic and intense. There may be some periods where there’s some turbulence but 98% of the time, it’s a smooth flight. I’m not sure if that’s the best analogy, but that’s the one I can think of. That’s some of what I do as an anesthesiologist, both adult and pediatrics.

I see you more or less as the non-anesthesiologist at home. I’m listening to you and I’m like, “What an exciting job.” That’s what I’m thinking. What would you say is the most rewarding part of your job and least favorite part of your job?

The most rewarding part is getting through patients safely through these procedures, whether it’s a liver transplant or a foreign body that a young four-year-old child swallowed, and it went down the trachea inappropriately. It could be a standard colonoscopy, which is straightforward for the most part. The rewarding part is getting patients through that successfully, and patients having no complaints afterwards. They are saying, “Thank you for the anesthesia. You did fantastic.” That’s good. That means you perfected a skill and you’re getting them through it with minimal or no side effects. The least rewarding part, sometimes not being recognized for the work you’re doing. That’s part and parcel with what we do.

A lot of times, people do not know their anesthesiologists until minutes before the procedure. Even if they do, they often don’t see the anesthesiologists afterwards. Our profession is to get people through these periods that can be critical, with little recognition from the patients and their family, but recognition from their colleagues, whether it’s surgeons or nurses. They do know who the good ones are, who tends to be on their game, and some who maybe are not, or not as versed in the skillset.

The people that appreciate you, for the most part, are pregnant women. Those are like, “What a saint my anesthesiologist is.”

There are a lot of different things you can do in anesthesia besides doing what we described, which is providing anesthesia in the perioperative period. There are different specialties within anesthesia. There’s obstetric anesthesia, where they provide anesthesia for patients who are pregnant, and get them through with the delivery, keeping their child or newborn safe. There’s also the pediatric anesthesiologist like myself. We take care of young children, sometimes small and sometimes old, and kids who have autism or special needs. There’s a cardiothoracic or cardiac anesthesiologist who do a lot of anesthesia for thoracic and cardiac surgery. There’s a neuroanesthesiologist. There’s regional and pain management, which helps people through pain. They also do regional anesthesia sometimes where they give procedures that are either for surgery and/or for pain management, both in and out of the hospital.

There are also a lot of anesthesiologists in transplant. You can specialize in transplant as well, where you transplant kidneys, liver and lung. There are also a lot of anesthesiologists that are doing a lot of administrative roles and leadership roles in the healthcare system, and doing a good job of it. Partly because part of being an anesthesiologist is you’re used to meeting all these different people in healthcare. You know how to interact with them well that you carry over those skills into an administrative type of role. Anesthesiologists are well poised and positioned to do well in that facet.

How would you describe your work-life balance?

It’s good. There’s an acronym that I learned about when I was an attending at Mount Sinai a few years in. I was working as an attending.

You did win an attending of the year award during that time.

Like many professions, anesthesiology definitely has its mundane moments, but there are parts where it's dramatic and exhilarating. Click To Tweet

There’s an acronym called ROAD to success and I’m not sure how true this is. The R is for Radiology, O is Ophthalmology, A is Anesthesiology and D is Dermatology. Why do they call it ROAD to success? If you choose one of these specialties, you could theoretically do well financially and also have a nice life in terms of a work balance where you can have a life outside of medicine, but also do something rewarding in medicine. I can’t speak for other specialties, but for myself as an anesthesiologist, it’s balanced. There are some calls that you take as an attending anesthesiologist and as a resident. I get time to spend with my family and do things I enjoy doing like sailing and hanging out with the kids. The work-life balance is good with also the excitement and the interest that anesthesia itself provides.

Do you recommend this career to students?

It depends. Anesthesia is procedure-oriented, quick impact and quick results. With those students, it can be fun, entertaining, exhilarating and rewarding, but it’s not always meant for everybody. For example, the continuity of care is not there. We don’t see patients. We don’t have clinics. If you’d like to interact with patients on a regular basis while they are awake, this is not the profession for you unless you’re going to do something like specializing in pain management. That is a subspecialty of anesthesia. It’s not for everybody. Often, we are also hospital-based or in a surgery center. For some people, that may not suit them.

What do you think the future outlook is for your profession?

It’s great. Anesthesiologist is well poised not only as a profession. It’s one of the largest professions of all the medical specialties. As a group, we’re involved politically and administratively. It’s a career that allows you to grow in many different ways if you want to. You can take on administrative roles or leadership roles. If you want to be an anesthesiologist and just do anesthesia all day, you can do that. The need for anesthesiologists is not going to dissipate. You can go into research as well and help develop new techniques and new medications. There are a lot of potential, variety, and opportunities within anesthesia.

It seems like you love your career. As I’m listening to you, there’s a lot of passion. There are no regrets, not looking back and say, “If I could do it again, I should have been that surgeon or neurologist.” How do you describe yourself as a student in high school and in college?

I was in orchestra, but I also play volleyball and I ran track. I was into music as well and play guitar. I did a lot of different things. I was well-rounded but a bit nerdy and tried to keep up with the other smart kids. I wasn’t the smartest. I had nice and supportive friends and family, especially my dad encouraging us and believe in me and my siblings. They made us feel like we could achieve things despite whatever grades we got.

If you didn’t go into anesthesia, what’s another career you would have chosen?

When I was in fifth grade, a surgeon is what I thought I wanted to be. I carried that idea through college. I thought I was going to be some surgeon. I got into medical school and then all these other ideas start popping into my brain, “Why don’t you go and be a family practitioner?” I thought I was going to be a geriatrician, someone who specialized in geriatrics. I thought I’ll do family practice, internal medicine, but I still had this idea of doing surgery. Urology came on my radar because I did a rotation in it and I liked it. I liked the person and the people in it. I realized, only after I applied and was doing my first-year surgery internship at the University of Colorado, that I didn’t like surgery. I like the idea of it, but I didn’t like living a life as a surgery intern. I didn’t like what I was seeing how some of these surgeons were living their lives. It was the idea of somebody or the idea of someone else’s life, but being a neurologist and see what they’re doing, the diseases that we’re dealing with, on hindsight, it wasn’t that interesting to me to do day in and day out.

Let’s say you didn’t do the urology intern and you did general surgery. Would you be more interested in that?

I do not regret that. I remember that surgery internship and surveying what surgery was like, how the surgeons were and the surgery chief residents, and see how they’re living life. I’m like, “I don’t want to be like that. I don’t want to live like that.” Not to say that everybody was like that, but a lot of them were.

HCDM 35 | Anesthesiology Career

 

You were talking about the work-life balance. It’s going to be different because you’re married to that 24/7. You have to follow up with your patients.

Nowadays, it may be a little different but back then, it’s a big commitment to go into surgery. It’s a longer training period. It screens out people who are not destined to be surgeons for the most part. That’s fine. I was content with it. Professionally, I was lost. Around springtime, when I finally decided I do not want to do surgery. I was thinking about ICU surgery. I was thinking about trauma surgery. I was thinking about all these different specialties of surgery. I said, “I’m not interested in it. I didn’t want to go through that route.” Professionally, I was lost and confused. Someone mentioned anesthesia. I did a few days at the University of Colorado. They were nice to let me do that. I was like, “This is not bad.”

I got interviewed at NYU when they opened a spot, and halfway through that interview, they offered me the position. There I was. Come July 1st, I was at NYU in New York. It was interesting because when I applied for college, when I applied for medical school, even when I was applying for residency for surgery and urology, none of those programs were in New York City. I didn’t want to be in a city. I wasn’t a city person. Here I am, I married a New York City girl and went to New York City for residency and training and living here since 2001. It’s funny how things worked out. I thought I was going to be something, and I turned out to be something different.

During that first year of anesthesia at NYU, I didn’t know if I was going to specialize or not, but I had a great mentor or a preceptor. He was a role model in terms of how he did anesthesia. His name is Dr. Tom Shipley, and I thought he was so cool and awesome in how he did his anesthesia. It’s an artwork and he’s a master of it. That’s how I saw it. I wanted to be like him. That inspired me to become a pediatric anesthesiologist. The ironic thing is when I was in medical school, I did not want to do anything with pediatrics. I did not enjoy it. I did not enjoy the rotation. I didn’t want to do anesthesia. I thought I was going to be a surgeon and here I am, a pediatric anesthesiologist. It’s funny how things work out, but that’s how I came about that career choice.

What will you do differently?

Reflecting back, I sometimes wish I took a year off. I had applied to the Peace Corps during college.

That’s how we bonded.

I went for an interview for AmeriCorps and got that far. I wish I went the next step. That’s assuming I even got in, but that would have been awesome. There are many other programs out there where students can explore that in much more depth, to give me that experience of doing something different before you go into the medical career train. It’s hard to get off of it, the rollercoaster or train. Once you get into medical school, then it’s internship, residency, you start your career, you buy your house, and you meet somebody and have kids. That’s not for everybody, but that’s often the trajectory for a lot of people. That’s one thing I wish I would have done differently.

Nowadays, how we were raised versus how things are now, it’s different. We would encourage that self-reflection, self-growth versus before. We come from Asian families and we’re both firstborn, so it’s different for us. It’s different times. The way we grew up, it was harder. It was where we were the ones who had to pave the road because we have younger siblings. Looking back, we connected through the fact that we both wanted to do the Peace Corps to help other people before we went into four years of dental school, four years of medical school. We knew that once we got in there, we had to go through it. There was no, “Let me take a little scenic route here and take a little time off.” It just kept going and going.

It’s doable but challenging.

You would not have as much responsibility if we did it early on. Rapid-fire questions. This is where your readers get to know more about you. What’s your favorite word?

Whatever specialization you take in medical school, the best feeling is passing that last test. Click To Tweet

Belief.

What accomplishment are you most proud of?

Passing my boards for anesthesia. That was something like, “I finally got here.” You dream of getting to that point, whatever that specialty is in college and medical school, and then residency. You take that final test and you pass, it’s a great feeling.

Who is the kindest person you know aside from me?

Dr. Rick Hayashi who came on my episode before yours. He’s a good and kind guy. I think about family members like my mom and my grandmother.

What’s your favorite junk food?

Cookies and ice cream.

What’s your favorite car?

When I was younger, there are two cars, a two-door Porsche Roadster and Pontiac Fiero. For some reason when I was younger, I thought that was a cool car.

What is the one thing you have always wanted to do?

I’ve thought about doing it for a long time, skydiving. That would be exhilarating. I don’t know if it’s worth it now.

HCDM 35 | Anesthesiology Career

 

Cats or dogs?

Dogs.

Which do you prefer, logic or creativity?

Logic.

I would be on the other spectrum. That’s why we’re the yin and the yang. Where can the readers go to reach you or learn more about you?

I have a website called NYMedicalAnesthesia.com. Also, check out my Instagram. It’s @DrRichardMarn. You can check out some of the posts there. That’s how you can get ahold of me and reach out to me. This is 2021. We got through 2020. I’m happy about that. Hopefully, we’re off to a better start from many facets in our life. 2020 was such a curveball.

It taught us to reset and put things into perspective. Things always happen for a reason and there’s a purpose for things even if it’s terrible things. Looking back, at least for us, we utilize the time. There are a lot of things to be grateful for. We have amazing people that we are surrounded by. Our neighbors and our team are amazing.

We have a good support group which is important. We’ve been lucky even though it’s been stressful. You wrote a book. I started this show. Our son won a sailing competition. Our daughter got her poem published in a book. We’re so fortunate.

Her school won the debate.

For everybody else out there, I want to wish you a great start of the year. If there are questions that you’d love me to start asking, guests, or any type of professions you think I should bring on, please email me, DM me through social media, and let me know. Thank you for reading.

To learn more about our guest or other past guests, check out my website, HealthCareersWithDrMarn.com or HCWithDrMarn.com. If you like what you read, then please go to my website, add your name and email to my email list. That way, you can get the latest announcements and news as it arise. You can also find me on Instagram at @DrRichardMarn. Thank you for reading and I’ll catch you in the next episode.

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About Dr. Richard Marn

HCDM 35 | Anesthesiology CareerCommitted to providing professional, experienced, and compassionate anesthesia care, for children and adults, where safety and compassion is the core concern.

With an emphasis on aesthetic and dental surgeries, NYMA aims to establish itself as a premier choice for New York Office-Based Anesthetic care.

Also the host of Heath Careers with Dr. Marn – Conversations with & career advice from successful healthcare & wellness professionals