Lin’s hybridized schedule is a hallmark of Stanford’s combined Internal Medicine-Anesthesia Residency program, a unique five-year training program for residents interested in both specialties.

Q&A: Resident Michael Lin on Training in Anesthesia and Internal Medicine, and Finding Time to Rock Climb

Michael Lin’s daily schedule mirrors that of a normal, busy anesthesia resident: early call times, long hours in the operating room, and a flurry of patients and cases.

Once a month, however, Lin’s schedule deviates from the norm.

On these days, Lin will start early – around 6am – when he arrives at Stanford Hospital to begin preparations for his first anesthesia case of the day. By the time he gets himself prepped and situated it’s about 7am—the typical time when cases begin. He’ll spend the next five hours standing in the operating room anesthetizing patients.

At noon, he’ll leave his fellow anesthesiology residents behind in the OR, change out of his scrubs, and walk over to the Stanford Internal Medicine clinic, where he’ll spend the rest of his day treating outpatients as a medicine resident.

Lin’s hybridized schedule is a hallmark of Stanford’s combined Internal Medicine-Anesthesia Residency program, a unique five-year training program for residents interested in both specialties. Medicine-anesthesia graduates are board-certified in both fields, and are poised to become leaders in perioperative medicine. In a recent interview, Lin discussed his dual interests and his experience at Stanford.

Resident Michael Lin

Q: What initially drew you to both fields?

Lin: When I was a medical student, I was interested in critical care and I was trying to decide which training route I wanted to take during my residency. I met with a lot of anesthesiologists and pulmonary critical care doctors who said that you get certain, specific skill sets from the medicine training and the anesthesia training. I realized that I didn’t want to choose. I wanted both skill sets.

One thing that has really drawn residents into this program is the critical care component. The ICU is really the intersection of medicine and anesthesia. You’re encountering critically ill patients with severe pathologies, so you need skills in acute resuscitation and advanced medical support that anesthesiologists are accustomed to providing in the OR, but you also need to treat the underlying pathology that landed them there in the first place, which is more aligned with the work of internal medicine physicians.

Q: How is Stanford’s Internal Medicine-Anesthesia program structured?

Lin: You spend your first year, considered your intern year, as a medicine resident and then one year of anesthesia, your CA-1 year, which is kind of like the intern year for anesthesia.

After two years you generally have a good foundation in both fields, so you’ll spend your last three years switching between the specialties every three to four months. Once a month my days are hybridized, but usually I’m either an anesthesia resident or a medicine resident.

Q: How do you incorporate your training as an anesthesiologist and your training as an internal medicine resident into your practice?

Lin: They’re very different fields. With anesthesia, the main goal is to ensure patients’ comfort and wellbeing while they’re undergoing a medically traumatizing event like a big surgery. These procedures can also be psychologically difficult on patients. It’s a very acute and intense setting. You have to get to know patients very quickly, and you instantly have to form a rapport with them and gain their trust. Then, as soon as the surgery is over you have to move on to the next case and repeat the process. So patient care interactions are often short and very intense.

Medicine is different because you have to think about the whole picture. When you’re in the primary care clinic you have to think about patients holistically: What do they do at home? How is their social support? What are they eating and how are they exercising? You get to know patients over weeks, months, and years. Things happen a little more slowly. You’re not with them every minute of the day.

But I think both identities inform my practice. There are times when I’m seeing a patient in the preoperative area, or the postoperative area, when I do think about what’s going to happen to them after they leave the immediate perioperative setting. I’ll find myself thinking about how their chronic pain will be managed, or what their transition from operating room to hospital will look like, and how surgery will affect their chronic disease management.

Likewise, I’ll see outpatients in my primary care clinic or inpatients in the hospital who are going for surgery, and I’ll find myself thinking as an anesthesiologist about issues like: How are their medications going to be managed in the perioperative setting? How can we mitigate the risk of surgery as much as possible? How will they be transitioned into the care of an anesthesiologist and then back out of their care?

So, it does give me a little bit more perspective that I think is helpful in counseling patients and in my own management of those patients both on the medicine side and on the anesthesia side.

Q:  You’ve been in the program for three years. What do you enjoy most about it?

Lin: I think one of the best parts of the program is getting to know everyone in the hospital. The internal medicine and the surgical residents don’t often work with each other, so there’s not much friendly interaction between the two groups. As a medicine resident I got to know the other medical residents and the medical specialty fellows very well, but I didn’t get to know many people in surgery.

Now that I’m on the anesthesia side, I get to work next to surgeons daily. I’ve developed some great relationships – I know them well and they really know me. I also get to see how hard they work and get a glimpse of the difficult problems that they deal with. It’s really made me respect the sacrifices they make for their patients.

Since I go back and forth between my anesthesia and internal medicine training, I feel like I get to know everyone in the hospital and appreciate the breadth of problems and the scope of diseases that are treated at our hospital.

Q: Residency is such a busy and consuming time. What do you like to do outside of work?

Lin: Stanford is an institution that recognizes the importance of work-life balance. My particular hobby is indoor and outdoor rock climbing. It’s a great excuse to get outside and climb in some really beautiful places. We’re lucky to live in California, which has such beautiful outdoor scenes as Tahoe and Yosemite. I’ve also found that doctors make great climbing partners because you know they’re detail-oriented and stay calm under stress, and you can trust them with your life. The only downside is that it seems like they’re always on call.