The Complete Guide To Becoming An Anaesthetist
How do you become an anaesthetist? This complete guide takes explains all the essential information you need to pursue a career in anaesthesia in the UK.
Often derided as mysterious figures in the corner of the operating theatre, twiddling knobs in between breakthroughs at the crossword, anaesthetists make up 16% of all hospital consultants, making anaesthetics the largest hospital specialty in the UK.
Anaesthetics is the art of understanding ventilation, circulation, pain control, inducing unconsciousness, and, of course, inserting large cannulas into inconceivably small veins. The speciality brings together physiology, physics, and pharmacology, and the anaesthetist is responsible for keeping patients alive and their organ systems supported.
The Role Of An Anaesthetist
Anaesthetists specialise in providing anaesthetics and pain management to patients before, during and after surgical procedures – essentially the medicine that allows surgery. They monitor heart rate, blood pressure and breathing, and are on hand to manage rapidly changing vital signs if things take a downward turn.
Choosing to work in anaesthesia opens up options for a varied career, as an anaesthetist’s skills are required throughout the hospital. Being highly trained in protecting the airway, anaesthetists play crucial roles in emergency care, trauma, and resuscitation, including in the emergency department itself, pre-hospital settings and during transport of acutely ill patients. With unrivalled knowledge of sedation and ventilators, they often lead and make up a large part of intensive care units, with specialisation as an intensivist a later option in training.
A largely acute speciality, a career in anaesthesia attracts people who enjoy seeing immediate results in their work, as well as those who have a methodical mind coupled with the ability to make decisions in changing, and often stressful, circumstances. Honing skills of precision, vigilance and dexterity, this specialty is rewarding, with an overarching theme of understanding why something is necessary and then proceeding to do it.
For a career path away from the operating theatre, anaesthetists can specialise in intensive care medicine (a speciality in its own right); pain medicine and pre-hospital care.
Subspecialties within the operating theatre environment include neuroanaesthesia, cardiothoracic anaesthesia, vascular anaesthesia and paediatric anaesthesia.
A Typical Week
One of the attractions of life as an anaesthetist is the variety of work. One day you may be doing an orthopaedic theatre list, the next a day surgery list, ending with induction of an emergency laparotomy patient with a difficult airway in your on-call. Work as an anaesthetist is patient focused, with most time spent undertaking pre-operative assessments, patient induction, intra-operative monitoring, and pain relief in recovery.
A typical working week for a consultant anaesthetist is 40-48 hours or 10-12 sessions. Approximately 90% of sessions will be programmed clinical work and 10% will be for supporting professional activities (SPAs) such as administration, audits and teaching.1 Clinical work is largely based in operating theatres, with separate sessions dedicated to on-call work and pre-operative assessment clinics for high-risk cases.
The average consultant anaesthetist will have one session on-call per week and perhaps seven for theatre lists. However, the on-call commitment will vary with the level of training, with heavier responsibility as a senior registrar and no timetabled time on-call in the first three-to-six months as a trainee anaesthetist.
The work schedule will also vary according to subspecialty.
| 07:45 | Arrive at work. |
| 08:00 | Meet the consultant on the ward and discuss plans for patients on the list. Complete pre-operative assessments for each patient. This will involve discussing pain relief and obtaining consent for any procedures required, such as insertion of a central line. |
| 08:30 | Join the theatre team in the theatre department to discuss the day’s planned cases. The meeting is with the full team, which includes scrub staff, surgical consultants and trainees and, as anaesthetists, we raise any concerns and discuss any safety issues. |
| 08:45 | Check and confirm the first patient’s identity before inserting a cannula (overseen by consultant supervisor). Help the consultant to anaesthetise the patient and insert an airway . |
| 09:00-12:00 | Throughout the operation the consultant discusses the case with the trainee, covering any key learning points. This is helpful in order to complete mandatory assessments – these are called initial assessment of competence (IAC) – and prepare for upcoming exams. |
| 12:00-13:00 | Lunch. This is usually taken at the same time as the consultant, since trainees cannot be left alone with the patient at any point. This means that if a consultant had to leave during an operation, another consultant would have to step in. |
| 13:00-14:00 | Welcome the second case and start to prepare them for anaesthetic. With more cases, the trainee gains confidence and takes on more responsibility for delivering the anaesthetic (cannulating, preparing and drawing up anaesthetic drugs). |
| 14:00-17:00 | As before, discussion around learning points with the consultant during operations. Once each operation is finished, the trainee assists the consultant with extubation and accompanies each patient to recovery for handover and monitoring. Go home after the trainee's assessment is completed by the consultant. |
Training
After two years of foundation training, it takes at least seven years to become a consultant anaesthetist.
The training curriculum is overseen by the Royal College of Anaesthetists (RCOA),2 and leads to a Certificate of Completion of Training (CCT) in anaesthesia. The seven years are split into stage 1, 2 and 3.
Anaesthesia is not a run-through training programme so trainees must apply for CT1 training posts and then re-apply to enter higher training at ST4 level.
The Initial Assessment of Competence (IAC) is the first milestone in UK Anaesthetics training and is a mandatory component of Core Training in Emergency and Intensive Care Medicine.
Stage 1 (three years)
The path begins with core training, which is a broad introduction to anaesthetics and normally takes three years with passing the Primary Fellowship of the Royal College of Anaesthetists (FRCA) examination as the end goal.
The first three-to-six months of training are highly supervised and core trainees cannot perform solo work. Trainees also spend time gaining skills in intensive care medicine (ICM) and obstetric anaesthesia. Upon reaching the first training milestone – the IAC – trainees are then able to give anaesthetics as well as be added to the on-call rota. By the end of two years, trainees will also complete their Initial Assessment of Competence in Obstetric Anaesthesia (IACOA).
You can apply to enter the three-year core anaesthetic training programme directly or go via the acute care common stem (ACCS) on a four-year programme.
Who should consider the ACCS route?
All higher speciality training in anaesthetics can be reached via the three-year core training programme. However, if you are an anaesthetics trainee with an interest in the acute end of the anaesthetic spectrum you may find the ACCS an ideal starting point.3 The first two years are spent rotating through emergency medicine (EM), acute internal medicine, anaesthetics and intensive care medicine (ICM), and the third and fourth year are spent solely in anaesthetics.
Stage 2 (two years)
During ST4-5, trainees start to gain exposure to tertiary specialties including cardiac, paediatric, and neuroanaesthesia. The principle of ‘spiral learning’ is also employed to build upon core knowledge achieved in basic training by revisiting topics in greater depth. Trainees must pass the Royal College of Anaesthetists FRCA final examination to progress to higher anaesthetic training
Stage 3 (two years)
The final three years (ST6-7) are focused on preparing trainees for life as a consultant and developing specialty interests.
The final year of advanced training requires trainees to complete advanced training in up to two specialist interest areas, such as regional anaesthesia, transfer medicine, or trauma and stabilisation.
Hurdles to consider
Competition. Anaesthesia is a popular speciality and competition for training places is high at all stages. In 2024, competition to enter basic training (stage 1) meant that there were more than six applicants for every training post across the UK.4 Progression to ST4 training is also very competitive with 640 people applying for 391 posts (competition ratio of 1.64).5
Challenging training programme. Becoming an anaesthetist is a rigorous process with high standards of training and long shifts. A survey notes that 85% of anaesthetists in training are at risk of burnout.6
Top tips for medical students interested in anaesthetics
Investigate early on. Find out as much as you can about the speciality as a medical student. There are lots of resources for medical students in the British Journal of Anaesthesia (BJA) and also at the RCOA and Association of Anaesthetists.
Show your interest. As a medical student it’s also a great idea to spend time with anaesthetists. Try to organise a placement to shadow anaesthetists. Consider becoming a student member of the Royal College of Anaesthetists as well as developing knowledge by reading articles in the BJA. Medical students can choose to do a student selected module in anaesthetics. They can also spend time with anaesthetists during their surgical placements.
Choose a relevant rotation in foundation training. Apply for rotation in a relevant field during foundation training to grow experience. If not anaesthesia, look for rotations in emergency medicine and intensive care.
Taster weeks. If you were not able to secure a relevant foundation rotation, organising taster weeks in your study leave is a great way of showing commitment to the specialty. It is worth getting evidence, eg, a letter or email, to confirm that you completed a taster week for your CV.
Develop a relevant academic portfolio. Keep your e-portfolio updated and try to get involved with audits and quality improvement projects related to anaesthesia. It is also worth presenting these projects at relevant conferences, again to boost your CV. In addition, try to gain teaching and management experience in the specialty.
Gain experience through a fellowship. Consider becoming a teaching fellow for a year before you begin specialist training as often there is an opportunity to gain experience in other specialties, such as anaesthetics, alongside your teaching responsibilities.
Earnings
NHS consultant salaries are the same for all specialties but vary between Scotland (highest), England, Northern Ireland, and Wales (lowest) and increase with service (up to 19 years). In 2024, the basic salary bands range from £93,666 to £126,281. Salaries can be further enhanced with NHS excellence awards.
There are many opportunities to enhance earnings with private practice or taking on additional work within the NHS.
For more information on salaries within the NHS, please feel free to review The Complete Guide to NHS Pay.
References
1. BMA model job plans: https://www.bma.org.uk/pay-and-contracts/job-planning/job-plans-by-specialty/model-job-plans-by-specialty
2. Royal College of Anaesthetists training and careers. https://rcoa.ac.uk/training-careers
3. Acute care common stem training. https://www.accs.ac.uk
4. Core training competition ratios: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2024-competition-ratios
5. Speciality training competition ratios: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2024-competition-ratios
6. Royal College of Anaesthetists. A report on the welfare, morale and experiences of anaesthetists in training: the need to listen, December 2017. https://www.rcoa.ac.uk/sites/default/files/documents/2019-08/Welfare-Morale2017.pdf
Author
Catherine McGow , Intensive care trainee (SpR) at the Queen Alexandra Hospital, Portsmouth.
