Anesthesia in Austria
Geography and Statistics
Austria is a country in the center of Europe with borders to Germany, Switzerland, Italy, Slovenia, Hungary, Slovakia and the Czech Republic. The spoken language is German. Area: 83,854 qm (almost exactly the size of Maine) Population: 7,500,000 Capital: Vienna (pop. 1,540,000) Major Cities: Graz (238,000), Linz (203,000), Salzburg (144,000), Innsbruck (118,000). There are 1291 (57.4% male, 42.6% female) specialists of anesthesia (we call them ´Fachaerzte´) in Austria. 226 of them have a private consulting ordination too, the others are only employed in a hospital.. There are 138 departments of anesthesia in Austria. Due to its special geographical site, Austria always shared contacts to all its neighbors and always was a mediator between east and west in culture, science and politics. The widest influence in anesthesia is naturally from Germany and from the United States, but many inhabitants of our neighbor countries work or worked in Austrian anesthesia departments and shared their style of working with us.
The development of surgery in the second half of the nineteenth century was very strongly influenced by the introduction of anesthetic techniques. Ether for anesthesia was for the first time used in Vienna by the Austrian surgeon Schuh in 1847. The Viennese Koller was the first to operate on a patient in local anesthesia with cocaine in 1884. In WW I and between the wars anesthesia was done by nurses or the youngest surgeon, this meant there were a lot of complications happened. With the annexation of Austria in 1938 by Hitler's troops, a very dark period had begun. Many members of the universities and many physicians were dismissed because of their Jewish origin or their political attitude, many of them died in the concentration camps, a few were able to flee and immigrated. After the war in 1947 a group of American professors did a lecture tour through Austria, Among them S. Cullen, an anesthesiologist from the Iowa Medical School. The Austrian surgeon Haid was so impressed with his presentation, that he began studies in Iowa in 1949 and returned in 1951 to Austria with a "Master's Degree of Science" (Anesthesiology). Another pioneer was Mayrhofer who did his studies in London and New York and introduced suxamethonium in Austria after trying it in an heroic self test. In the City of Salzburg, in Autumn 1951, for the first time, a meeting of young German, Swiss and Austrian anesthetists took place, most of them had done their basic training in the UK or USA. Among others, were Mayrhofer, Steinbereithner and Kucher from Vienna and Haid from Innsbruck. This first so-called congress of anesthesia laid the foundation for the modern Austrian anesthesia. The first German professional journal, "Der Anaesthesist" was founded. In 1961, the first central intensive care unit in central Europe was opened in the AKH Vienna. Our thanks belong to these men, and a lot of others not mentioned, from the postworld war times and, those who were the founders of Austria's present days anesthesia.
After finishing the study of medicine, which requires a minimum of 6 years, the residency time in a hospital takes another 6 years. Most of the adepts are spending some time in training to be General Practitioners as well. The training includes all parts of anesthesia (e.g. obstetrics, pediatric, cardiology, general and trauma surgery etc. as well as intensive care, pain management and emergency medicine). After the end of training, the resident gets the title of a specialist for anesthesia and intensive care, and is allowed to work without supervision. Normally, at this breakpoint, the anesthetist is granted one contract for an unlimited time with a hospital. The further career depends on personal engagement and luck; there is the possibility to become consultant and a few make it to become a department leader. At a university hospital, one has to submit the certificate of habilitation within 10 years, or the contract will not be prolonged.
Work and working conditions:
Doctors in the shadows is the most recited slogan about anesthetists here.
Austrian anesthetists work, as mentioned above in emergency care, narcosis and pain management. Almost all of the postoperative and many of the central ICU's are handed and managed by them. These wards are mostly in their own responsibilities. In the smaller cities, they run the rescue doctor's service at the first-aid ambulances as well. The working hours are between 40 (legally) and 100 hours per week, depending on the personnel management and financial situation of the hospital. Especially the colleagues in hospitals outside the main cities have very difficult working conditions. The number of overnight duties (24 hours and more) is from 4 to even 17 a month. It is sometimes a not very gratifying and mostly not a profitable job with rare rewards (like everywhere in the world ?). The equipment and the techniques are of a western standard, good in town or government hospitals, naturally best at the universities. Doctors should be assisted by nurses, unfortunately they are rare, and too few got the chance to register as an equivalent to a CRNA. The average payment is about the same as for a government official who has an academic degree.
There are faculties of anesthesia in the cities of Innsbruck, Graz and Vienna. Most scientific research is done at these universities. Only in these places a nurse is able to register as an anesthesia assistant nurse. The training to become specialist for anesthesia can be done in most of the bigger departments. Residents from the smaller hospitals can change the place to refine their training in a bigger one with all subjects to finish their training. The further education and the teaching for the emergency care degree is organized by the doctor's association.
Nov 1997, by G.W. Ceschka