Celebrating Physician Anesthesiologists Week: Q&A with Dr. LaKesha Legree

Despite an estimated 33,500 anesthesiologists in practice in the United States, some regions of the country face a shortage. This Physician Anesthesiologists Week, we’re celebrating these dedicated members of the medical team who are uniquely qualified to lead patient care.

We are honored to feature anesthesiologist LaKesha Legree, MD, who practices with VitalSolution at Samaritan Medical Center, a 290-bed community hospital in Watertown, N.Y., about an hour outside Syracuse, N.Y.

Dr. LaKesha Legree’s Journey as an Anesthesiologist

Q: Where did you train?

Dr. Legree: I earned my bachelor’s degree in science pre-professional studies from the University of Notre Dame and my medical degree from the University of Iowa. I completed my anesthesiology residency at New York Presbyterian Hospital Weill Cornell Medical Center and was awarded a fellowship in regional anesthesia at Duke University.

Q: How long have you been practicing, and why did you choose anesthesia?

Dr. Legree: I’ve been practicing since 2012. I chose anesthesia because it allows me to be both a proceduralist and an in-the-moment internal medicine doctor or intensivist. I like instantaneously seeing the results of my clinical decisions. Being an anesthesiologist also allows me to have a very good work-life balance. It allows me to be the best mother to my daughter, which is my ultimate priority.

Q: Tell us more about how you find work-life balance.

Dr. Legree: As an anesthesiologist, once you leave the job site, there is no after-hour charting or patients to call. At work, I intensely focus on my patients and give them the very best of me and then I can leave work and focus on my child and show up as my very best for her. This is extremely important to me as a mom. It also allows sufficient time to focus on my mental and physical well-being. When those things are optimized, I can show up for my family as my best self, and I can also show up for my patients as my best self.

VitalSolution is unique in that the company listens to me, respects me as a physician, and values my work-life balance just as much as my clinical contributions. This is a rare phenomenon in today’s healthcare climate. The company understands that when a physician has work-life balance and feels heard and respected, loyalty and clinical excellence will follow.

Challenges and Rewards in Rural Anesthesiology

Q: What is the state of anesthesia care in rural communities like Watertown?

Dr. Legree: There is a shortage of anesthesiologists in rural areas, which probably has to do with location. In addition, there is a decline in medical school admissions. Unfortunately, some young adults don’t perceive the years of training and sacrifice as a worthy investment. Healthcare has changed on multiple fronts; it’s not what it used to be. Priorities have shifted throughout the industry. You have to truly want to do this because the path toward becoming a physician is not for the weak or faint of heart.

Another factor contributing to the shortage is that some states passed legislation that allows nurse anesthetists (CRNAs or certified registered nurse anesthetists) to practice autonomously. This model can work well in specific scenarios. VitalSolution’s goal is to serve the needs of communities where a gap exists between the demand for services and the supply of clinicians. We collaborate with the client to identify the gaps and prohibitive measures that stand in the way of operating and optimizing anesthesia services within a hospital setting. The outcomes of this unique approach are increased surgical productivity and satisfaction, exceptional perioperative patient metrics and improved patient safety.

Q: How do anesthesiologists practicing in rural areas help address healthcare disparities?

Dr. Legree: As an anesthesiologist, you are the patient’s advocate during surgery from start to finish. In rural and inner-city areas, many patients either don’t have access to primary care physicians or have minimal or restricted access because of physician shortages, lack of health insurance and/or financial hardships. When a patient needs surgery, our pre-anesthesia assessment will often uncover medical issues the patient didn’t know they had or weren’t managing properly due to a lack of medical attention for various reasons.

For example, a patient who comes to the emergency room with severe pain and needs her appendix removed. I conduct a thorough medical work-up before we take her to the operating room, only to discover that she has elevated blood glucose and elevated blood pressure on multiple assessments. This may indicate undiagnosed or poorly managed diabetes and hypertension. As anesthesiologists, we are often the first line of defense for patients. We can educate them about their conditions and encourage them to seek follow-up care after discharge. Sometimes, we are the first to point out issues to the surgeon, who can inform the referring physician and request additional work-up, such as a rapid heartbeat with an abnormal underlying rhythm discovered during the pre-operative anesthesia assessment.

A Day in the Life of an Anesthesiologist

Q: What’s a typical day like for you?

Dr. Legree: I get to the hospital at about 6:45 a.m. and see which rooms have been assigned to me. Because New York requires physician supervision of CRNAs, sometimes I supervise multiple nurse anesthetists, and other times I do my own cases.

If I’m supervising three nurse anesthetists, I need to see all three of those patients and develop anesthetic plans of care for each one based on his or her medical history and surgical consent. I then discuss the plan with each respective CRNA, and together we decide how to best care for the patient. Throughout the day, I am there for each patient and CRNA at the beginning of the case, in increments throughout the case and at the conclusion. If you multiply three nurse anesthetists and three operating rooms with multiple surgeries scheduled per room, some days are quite busy.

I also perform ultrasound-guided regional anesthesia blocks for post-operative pain management for orthopedic surgeries, as well as place epidurals for labor and delivery. Sometimes there are C-sections, or a two-year-old who needs ear tubes placed and tonsils removed, or a 91-year-old who comes in with a broken hip. That’s the fun aspect of anesthesia: you never know what you will get, like Forest Gump and his analogy of life being a box of chocolates.

Q: What challenges do you face at work?

Dr. Legree: I think the challenges for me personally are also the fun part. I like that no two days are the same. This is also challenging because you can get complex patients, healthy patients, extremely ill patients with acute issues, young patients and old patients. You need to quickly understand that patient’s history, assess all relevant risks and devise the best plan for them—along with many backup plans. A great anesthesiologist will have the foresight and fortitude to have a plan of action for every possible scenario related to a single surgery, then multiply that by however many patients you are managing simultaneously within the care team model.

Another challenge, and a reason why I fell in love with anesthesia, is that you have a short time to build rapport with an individual and gain their trust. From their perspective, you are a stranger who will literally be in control of their life for the next several hours. It’s very rewarding to build rapport and gain trust in such a short time. At the end of the case, when the patient wakes up in the recovery room and smiles and thanks you, that’s the feel-good part of the job. It’s a big part of why I continue to do what I do.

Q: Are there any misconceptions about anesthesia that you’ve heard either from patients or other doctors?

Dr. Legree: Absolutely! I think some people believe that we simply push a “start” button and a “stop” button and then kick up our feet. This is such a gross misrepresentation. We are the silent captains of the ship. When rough waters come, everyone looks to us in the operating room to steer the ship. A great anesthesiologist is always working and always attentive. We tap into multiple senses within the operating room to ensure the patient’s safety. Visual, tactile, auditory and olfactory stimuli collectively tell the story of how a patient is doing during surgery, and we respond accordingly.

Advice for Aspiring Anesthesiologists

Q: What advice would you give medical students considering a career in anesthesiology?

Dr. Legree: Seek experiences to shadow so you know what you’re getting into. Also, be very introspective about why you’re going into medicine and why you like anesthesia because to become a physician, you truly have to want it in your heart and soul. Wanting to care for patients is paramount because the compensation isn’t necessarily what it used to be. In general, money shouldn’t be the driving force for pursuing a career in medicine.

Historically, the route to becoming a doctor was high school, college, med school, residency and fellowship, but that’s not necessarily the optimal route anymore. I think having some life experience is more desirable, whether that means taking a gap year, being an exchange student or traveling the world first. In fact, some institutions prefer students to have some life experience.

Looking retrospectively at my own life, I think it’s better to have life experiences—particularly life challenges—because it makes you a better physician. You don’t get rattled by a lot. You keep your cool more often; you’re focused and organized because you’re not afraid of challenges or what-ifs because you’ve already been through some. In times of perceived failure, it’s important to change your perception and think of it as a lesson—and an opportunity.

Are you inspired by Dr. Legree’s insights into the world of anesthesiology? Whether you’re a seasoned physician or early in your career, VitalSolution is here to support you! View our career opportunities to explore the diverse opportunities that await you in the field of anesthesiology.