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New Faculty Perspectives on Becoming a Critical Care Anesthesiologistby Beth M. T. Teegarden, MD, FASA; Lindsay D. Nowak, MD; Lopez Valencia, MD, PhD
After years of residency and fellowship, the day finally comes: you’re officially the attending. No more “presenting to the boss”—because now, you are the boss. To those still in training, this moment can feel like the finish line, the day you finally get to call the shots and follow your own plan. But what does it really feel like when you step into that role for the first time? I reached out to two former trainees, now finishing their first year as critical care anesthesiology faculty, to hear how the transition looks from the other side.
Dr. Nowak reflected: “The most striking change after training is realizing you are now the bottom line. When ICU residents turn to you for guidance on a patient’s swollen extremity, when transplant attendings ask your advice on a difficult extubation, or when you’re the one who has to tell a surgeon to abort a case for an intraoperative cardiac event—you recognize the responsibility rests with you. That weight never fully goes away, but it becomes easier and more comfortable with time. While trainees often long to create and follow their own plan, as an attending the real goal is to craft a safe, patient-centered plan that also allows proceduralists to do their work—or to make the difficult call to delay or cancel if conditions aren’t right. Training in the ICU uniquely equips us to make these complex decisions, both inside and outside the OR, and to facilitate critical conversations among subspecialists when timing or patient readiness is in question.”
Dr. Lopez added: “Balancing responsibilities across two distinct clinical settings—ICU and OR—can feel like needing two different brains. Yet that dual practice is what makes us stronger physicians. It gives us a broader set of tools to provide the best possible care. In training, I worked with over 100 intensivists from varied backgrounds. The best among them combined deep ICU knowledge with leadership finesse and extraordinary communication skills—empathy, collaboration, and the ability to build consensus. Our training allows us to translate different perspectives into a unified plan, benefiting patients across ORs, ICUs, and non-OR settings with radiologists, cardiologists, and gastroenterologists. This flexibility and understanding of logistics directly serve our patients, and as one of my mentors taught me, the ICU environment cultivates the leadership skills that define outstanding physicians.”
Both physicians agreed that fellowship training enhanced their clinical confidence and broadened their skill sets. Dr. Nowak highlighted how ICU training builds comfort with invasive lines, vasoactive medications, and perioperative ultrasound—skills that improve patient care in and out of the operating room. Dr. Lopez emphasized the ability to provide seamless perioperative care, manage acute decompensation, and stabilize even the sickest patients through mastery of vascular access, airway management, and anesthetic expertise. Together, their reflections underscore how critical care training expands the anesthesiologist’s role far beyond the OR.
Finally, both offered advice to those still “in the weeds” of training. Dr. Nowak encouraged humility and openness: “Don’t be afraid to ask for help. Our patients deserve our best, and sometimes that means putting ego aside and seeking guidance—whether from senior or even junior colleagues. We must also commit to evidence-based practice and continue learning throughout our careers. Be the role models you wanted as a trainee, and show grace—to others and yourself. And don’t forget your mentors; even years later, they remain invaluable sources of perspective.” Dr. Lopez echoed this sentiment, reminding future colleagues that critical care anesthesiologists carry not only a unique skill set but also the responsibility to lead with collaboration, empathy, and resilience. Authors
Beth M. T. Teegarden, MD, FASA Lindsay D. Nowak, MD Lopez Valencia, MD, PhD
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