As a medical student, do you ever wonder what it's like to specialize in anesthesiology? Meet AMA member Jill Kacher Cobb, MD, an anesthesiologist and a featured physician in the AMA's “Shadow Me” Specialty Series, which offers advice directly from physicians about life in their specialties. Check out her insights to help determine whether a career in anesthesiology might be a good fit for you.
The AMA's Specialty Guide simplifies medical students' specialty selection process by highlighting major specialties, detailing training information and providing access to related association information. It is produced by FREIDA™, the AMA Residency & Fellowship Database®.
Learn more with the AMA about the medical specialty of anesthesiology.
“Shadowing” Dr. Jill Kacher Cobb
Specialty: Anesthesiology.
Practice setting: Hospital.
Employment type: Contracted with a private practice that is part of Sutter Health in Berkeley, California. Sutter Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Years in practice: 20.
A typical day and week in my practice: Until recently, I primarily worked as the chief medical executive at a community hospital in dyad partnership with the hospital’s chief executive officer for four years. I also occasionally do shifts as an anesthesiologist. A typical day as chief medical executive begins early in the morning, often starting with a meeting at 7 a.m. or rounding on staff and patients. It brings me great joy to interact with the staff and physicians, check in and see how they are doing and, if something arises, remove barriers to help make their work lives easier.
Multiple departments in the hospital had a matrixed reporting structure to me, including quality, medical staff, pharmacy, inpatient and outpatient laboratory, and care coordination. My days were also filled with onsite, virtual and offsite meetings. These meetings included a wide variety of topics, such as quality and patient safety, pharmacy, medication reconciliation, infection control, laboratory, medical staff, departmental and executive meetings, patient satisfaction, finance, capital requests, surgery operations, hospital operations and strategy. These focused on improving care for our patients and our community. We also focused on caring for our people, those who care for our patients.
I was part of the Greater San Francisco Executive team, where we worked together to increase access to care in the community. My position also interacted with the county public health department where we partnered to improve the health and wellness of the community. I was also doing systemwide well-being work and leader and participated in related meetings that are mixed into my day.
Recently, I transitioned into a new role as the chief wellness officer for the Sutter Health system. Sutter’s mission is caring about our patients first, and our people always. This work will primarily focus on the people always portion of the mission. Our team is currently hosting listening sessions across the system to learn what are we doing well, where can we do better, what “great” looks like and how we can build it together. We want Sutter to be a place where people come and stay for their entire careers and flourish—and focusing on the well-being of our physicians and health care workers is how we will get there.
As an anesthesiologist, a typical day starts before 7 a.m., setting up equipment and medications in the operating room, seeing my first patient, learning about their history, talking to them about anesthesia and what to expect, disclosing the risks and providing psychological comfort to them. Once they are in the operating room, the anesthetic is given, and surgery begins.
In this specialty, a boring case is a good case! A boring case means that the patient was stable and did well with the anesthetic and the surgery. Once the patient is awake, I bring them back to the recovery room, share information with the post-anesthesia care unit (PACU) nurse about their intraoperative course, ensure the patient is stable and then head off to see the next patient.
My day ends when the last patient assigned to me is stable in the PACU. It is difficult to predict when the day will end, as sometimes cases are shorter or longer than expected. Also, there may be additional patients who were added on that day and need to be cared for urgently.
My typical work week is 60 or more hours in my administrative role, and it was about the same when I was a full-time anesthesiologist.
The most challenging and rewarding aspects of anesthesiology: The most challenging aspect is taking call in a large urban center and not knowing what you are walking into regarding the health of the patient in need of urgent surgery. Patients undergoing emergency surgery may be hemodynamically unstable with multiple comorbidities and often have not had a full work up. Their cardiopulmonary status may be unknown, or perhaps the last time they may have seen their cardiologist was years ago with a last recorded ejection fraction of less than 25% or pulmonary artery systolic pressure in the 70s. This means that their heart may fail during the anesthetic and the patient may go into cardiac arrest. Those cases can be stressful.
The most rewarding aspect is connecting with patients and comforting them when they are afraid. As an anesthesiologist, you have about five minutes to get to know them and for them to get to know and trust you. You need to make a connection quickly, and once you do, it’s incredibly rewarding.
The impact burnout has on anesthesiology: Anesthesiologists have a moderate to moderately high levels of burnout, which often has to do with the specialty’s high acuity of care and unpredictable schedule.
How Sutter Health is reducing physician burnout: We have a system-wide Interdisciplinary Well-being Committee and local well-being committees that focus on the well-being of all of our physicians and employees. Through these committees, we focus on departments with high levels of burnout. Luckily, our specialty has not made that list.
We also focus on overall physician well-being and work-life integration. As leaders, both at the system level and locally, we work hard to remove barriers, or the pebbles in people’s shoes, to help improve physicians’ and employees’ work lives. We take surveys seriously and make improvements based on comments and results.
We also offer system-wide and local peer support, along with employee assistance programs, and encourage everyone to reach out if they have had a challenging case or an unexpected outcome. Recognizing when you need support and utilizing these resources is incredibly important. We need to take care of ourselves during challenging times. Our jobs are not easy!
How my lifestyle matches, or differs from, what I had envisioned: I knew I was going to work hard as a physician, so there were no surprises there. How does it differ? Interestingly, when I took my first job in private practice, I thought I would be working as hard as I had as a resident. Luckily, that was not the case, and I found myself with much more free time than I expected and the ability to focus on my family. Also, I have the ability to take vacation when I’m feeling like I need to recharge. That flexibility has been incredibly important to me and helps create work-life balance.
My husband has been an amazing support and stayed home with the kids up until they went to elementary school. This has helped me immensely in my career and provided me the ability to balance work life and family life.
Skills every physician in training should have for anesthesiology but won’t be tested for on the board exam: People skills. That may sound counterintuitive for an anesthesiologist, but the ability to quickly connect with patients and gain their trust in a short amount of time is crucial. These connections bring me joy in practicing medicine as an anesthesiologist.
One question physicians in training should ask themselves before pursuing anesthesiology: There are a few questions I would ask. First, what do I want my days to look like? Also, do I want to be in a clinic, or do I want to be in a busy emergency department, or do I want to be in the operating room? Lastly, will I be excited to get up in the morning and go to work?
Books, podcasts or other resources every medical student interested in anesthesiology should be reading or listening to:
- Cutting for Stone, by Abraham Verghese, MD. This novel is a powerful exploration of the human side of medicine.
- Dare to Lead: Brave Work. Tough Conversations. Whole Hearts., by Brené Brown. I’m a big Brené Brown fan. As physicians, we are all leaders, but we do not get much leadership training in medical school. Her books and TED talks are spot on, and I’ve learned a lot about myself and how to be a leader from her books.
- Jessie Mahoney’s “Mindful Healers” podcast. She is a pediatrician, yoga teacher and coach. Her podcasts are insightful and speak to some of the challenges of being a physician. She and her cohost, Ni-Cheng Liang, MD, a pulmonologist, weave in mindfulness throughout the episodes.
Additional advice I would to give students who are considering anesthesiology: No matter which specialty you choose, be sure to consider what your day-to-day life would look like. We spend the majority of our time at work, and it’s important to envision your daily duties as you consider this important decision.
