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Discussion in 'Anesthesiology' started by sweetdreams, 04.09.06.
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does anyone know about USF anesthesia???
program is still on probation, waiting to hear decision this month
Any word yet?
Has anyone heard anything from their own residencies about opening positions for the refugees?
Rumor has it that USF is thinking about starting a CRNA school.... ----Zip
there are some talks about adding a few srnas, but not anytime soon. that will be at least a year out. and even then, they will be spread out apparantly, so they will not help ease the workload. and besides, they would not take call or work more than 8 hours or so each shift. and supposedly they have hired more crnas at tampa general as well, but all that did was allow more cases to be scheduled.
For anyone thinking of coming here, stay away. This program sucks and is absolutely horrible. Nobody likes any of the rotations and the new "attendings" just abuse the residents. Long hours, forgotten about breaks, no teaching, dingus attendings, absolutely no time to read, call nights busier than hell every single time, along with a huge disrepsect for anesthesia on a whole at this facility...I could go on and on but will leave it at that. Hardly anyone from the old USF program is left, and of those that are, I hear they are wanting to leave. The workload has gotten so bad, even some of the gulf to bay guys are looking as well. my entire CA-1 class (except for two) is all trying to bail and find another program. I myself am looking as well. For those that cannot get into anesthesia somehow, I would choose ER for a year with only 12 hr shifts and mandatory 12 hours off in between each work period. Cush specialty.
Any more questions, refer to scutwork.com for their latest review, it sums it up quite well.
In reply to USFans, I absolutely agree with everything mentioned, and also the post on scutwork.com. If I could go back in time I would never have even listed the USF anesthesia program in the match. It has to be one of the worst in the US, and they should not be allowed to continue as a residency.
Rather than opinion I will try to simply state facts :
1) Most days they make the residents work to 6-8pm. The 10 hr rule is often broken although they claim it is not but the time for preops and postops is not included. Fridays residents can work until 11pm even if you are not on call, and this will be on elective cases, not emergencies. This is the case because they dont have to worry about the ten hour rule then. Weekends on call are the same thing. Lots of elective money-making cases rather than emergencies.
2. Most programs use CRNAs to cover the most basic cases while residents hone their skills on the more difficult ones. This does not seem to be the case here. For example, recently a CRNA was given a phaeochromocytoma. Scenarios like this are the norm. CRNAs are treated like kings and queens here. They are often treated to extravagant parties by Mangar. It was only under protest that the residents were recently invited to the 2005 Christmas party.
3. Zero intraoperative teaching - Attendings mostly have no academic or teaching credentials and could not care less about teaching. A few do teach, especially some of the old USF attendings, but I get the feeling this is almost out of sympathy. ACGME rules state they should not be covering more than 2 residents at a time, but this is broken constantly, although they cover it up by getting other attendings to sign off on charts even when that attending may have nothing else to do with the case. Many of the attendings just lie around in the doctors lounge checking personal emails or watching TV.
4. Few breaks, residents are sometimes left in rooms for 6 hours or more without a break or someone checking on them, and if one asks for a break, the attendings will act like they are doing the resident a huge favor.
5. The semiannual AKT test which was meant to be done in January was never given probably because they were nervous of the poor results that would be shown.
6. Zero evaluations except at outlying hospitals. To be fair, hospitals like Moffitt Cancer Centre and All Childrens offer an excellent learning experiance and treat residents well the problem is anything to do with TGH or Mangars Gulf to Bay private practice group. The residents have not received any evaluations since November at TGH ( just before the ROC visit) but this was pure window dressing no one sat down with the residents to discuss the evaluations, we were just told to sign off on them.
7. At a recent meeting the Dean of Medicine, Peter Fabri, warned residents against writing any thing negative on scutwork or SDN. He said that that if the ROC closed the program, USF would simply reapply for a new accreditation. Apperently Yales surgical program did this recently. He stated the ROC is on a witchhunt, and that the USF program was perfect and needed no improvements. I know most of the residents feel that if he really believes this, it officially makes him the Dean of Medicine of Fantasyland University.
8. Dr Camporesi is listed as PD AND Chairman but the majority of his salary is paid by Dr Devanand Mangar, and his group Gulf to Bay. This is an enormous conflict of interest, and it also means that for the most part he is powerless to make any changes that are not approved by Mangar.
9. Minimal didactics. Grand Rounds are mostly resident presentations, or Dr. Mangar rambling on about one of his life cases for an hour. There is hardly ever any visiting speakers as USF is scared they might report back to the ROC as occurred previously before the program went on probation. Board review once a week is done by CA-2 and CA-3 residents who are paid by Mangar. This is because the attendings have no interest in spending their time teaching. Why would they, it doesnt make them any money.
10. The OR is regularly overscheduled, even weekends are mostly elective cases with the emergencies being squeezed in. This has resulted in PACU holds with a resident sitting with an extubated patient in an OR for up to an hour no worries, just means more money for anesthesia time. This also explains the excessive amount of lines placed, many unnecessary more billing. That is the name of the game at TGH MONEY. Im sorry, what was that? M-O-N-E-Y!!!
11. No dedicated trauma teaching, and very little oversight of residents, a CA-1 and a CA2 are sometimes left alone on weekends especially in dangerous and complex cases. At night, one attending is often covering ob, ER, codes, the OR and cardiac.
12. 70% of all patients are extubated with no attending present, and most of the intubations on weekends are done with only a CA-2 or 3 supervising. This is a major ACGME infraction but no-one seems to care.
The only positives here are the few caring attendings and anything not associated with Dr. Mangar and TGH, but so much of the training takes place at TGH so it makes it difficult to focus on the few highlights. If you come here you will indeed get more complex cases in a very short period of time than most programs, but for the most part you will do them on your own. You will also get little time to read up on them ( unless you can read in your sleep.)
I thought long and hard about writing this. If I am forced to stay here, it would not be in my best interest to be negative about my program, and I should be trying to boost its image. However, there is so much that is wrong about the TGH portion of the USF program that it really needs to be subjected to some public scrutiny. Perhaps this is the only way to motivate the powers that be to effect some positive change.
What USFanes states is also true regarding current residents. Many of the CA1s and even some CA2s, are quietly and desperately trying to transfer out. This would include me.
In short, if you can complete your residency at ANY other program, including the one I heard recently started in Uzebekistan, you should take it. This program does not deserve to get any quality candidates.
So they can't train residents for sh*t and they think they can train srna's? What a joke. Even if I were a nurse wanting to do anesthesia at any cost I would avoid this program b/c when you get out you will be bounced around from job to job do to lack of skills and knowledge.
Only one thing will resurrect this program.
Commitment by administration to the program.
What does that mean????
Recruit from afar a strong, private-practice-oriented clinician who brings-in-tow more strong clinicians, who are committed to resident education.
This will, in turn, attract residents from everywhere.
Give said-HMFIC-clinician a low NFL draft-pick salary.
Give said strong-clinician full-direction-authority to weed through the already-present-rif-raff, concominantly assuring the surgeons that things will be on the up-and-up shortly.
Very similar to NFL coaching transitions.
It's official. The ROC did not lift probation for the program. There was an artical written by Lisa Greene ( she has written two others about the program) on the front page of the St. Petersburg Times May 11 2006.
Panel to USF: Close school of anesthesia. Inspectors say the program, already on probation, isn't doing enough for students. But school officials say things are improving.
There was a major meeting the other night where the PD stated they are going to step things up to get where they need to be. He also stated he did not want residents to fear attending abuse for speaking out. (This has been a problem in the past.)
My prevous post states my view clear enough, but in simple tearms, things will not truely start to get better until USF rains in Dr. Mangar and Gulf to Bay and makes it clear they are there to train residents - not work us like dogs all the while making GOBS of money off us.
Yes, the USF anesthesiolgy program will have its accreditation revoked by July 2007.
The question is whether to object to the letter, which was based on findings in September 2005, or to submit a new program, said Dr. Peter Fabri, USF's associate dean of graduate medical education.
"This program has been on a phenomenal trajectory for the past 12 months,'' Fabri said. "The problem is one of timing. Most of the items in that letter are not substantially accurate. ... The real question is, how do we demonstrate to all concerned that this is a high-quality anesthesiology program? ''
IF YOU ARE A HIGH QUALITY PROGRAM, YOU DON'T HAVE TO DEMONSTRATE IT BECAUSE IT WILL SPEAK FOR ITSELF.
This article just basically refutes what our contributing residents have stated above and calls them liars. I'd support all of the residents just walking out on that program in protest. Substandard teaching and supervision = substandard quality of care = endangering patient lives. They would be more than justified to walk away from that dump and let the private guys try to cover all of the anesthesia sites by themselves for just one day.
have any of the residents contacted the paper to tell their side of the story? I'm sure it could be done on the condition of anonymity...it would at least tell your side of the story
sad to say, the program seems to be self-destructing. Seems like nothing but boring ass meetings about getting along, and "Oh, don't worry, we'll just re-apply for another anesthesia program in 2008" from Dr Fabri. Several residents are leaving, those that are CA-0s about to start anes are worried and also questioning whether to stay. Nobody here likes it, so we will see if it is even worth saving. Dr Fabri is on a mission by himself apparantly.
And yes, I know of someone who has contacted the newspaper, but no new story yet.
And as far as hiring out of town guys to teach and work, doubt it. mangar is too greedy. Why do you think they want sRNAs here? They just want to have someone sit in the rooms for them. Most attendings here act like they don't remember how to do that themselves...all they do is sit in the lounge.
And so the bell tolls for USF anesthesia. A program with a crap load of potential spoiled by egos, greed and an inability for the faculty to truly grasp and understand the problem. Did people match THIS year into anesthesiology there? What's Dr. Fabri smoking? It is almost as if saying it, makes it so.
I wish all the best to the anesthesiology residents who are there now. I know you are good people stuck with labile, impotent, pompous leadership in the dept of Anesthesiology.
What effect will this have on all the other residencies (surgery, EM, pulmonology)?
This is absolutely sickening. This kind of thing not only hurts the residents at the program but it also hurts the field of anesthesia. Shame on Dr. Fabri for making the field of anesthesia look bad. Here you have a program that should be training and teaching their residents rather than trying to find sRNA's to do their work so they can sit in their offices and drink coffee. This just perpetuates the lazy anesthesiologist stereotype. This is also the kind of thing that CRNA's love to snicker about (and why shouldn't they). It just makes us look bad as a whole. I am glad that the residency program got revoked. The residents deserve better. I urge all of the residents there to contact the newspaper and then start contacting other programs so that you can transfer.
Lets look at this from a business standpoint.
Lets say you are The Chancellor of USF.
He (she) must know theres a problem with the anesthesia program.
A deep rooted problem.
Refractory of peripheral/local ameliorative attempts.
Said Chancellor, like I said before, if he has any business savvy, needs to think like an NFL team owner.
Fire all the top dogs.
And bring in some New Guns that have a thorough knowledge of what it takes to have a successful anesthesia group.
Pay the New Guns a low-pick NFL salary.
Said monies will be an investment that'll pay off big-time with new popularity, med-student affinity, prospective new-attending affinity, and an overall new face of USF anesthesia.
All it takes is one of the "in power" USF administrators having a vision......a vision outside the box.....
unfortunately, and incessantly, it seems administrators of potential-future-high-power-programs have a paucity of intellect when it comes to thinking outside the box.
Whadd'ya think the program would be like if "The Chancellor" would have enough foresight to bring in some clinicians that would FOSTER resident education?
One does not have to be John Tinker to problem-solve this situation.
All it takes is the nuts to say to the current, failing Chief:
"Dude, you're fired."
Then bring the calvary.
I think I'm gonna call The Chancellor.
And tell him my thoughts.
Are you sure it's that easy?
Wouldn't you at least want some verbal commitments from your "new blood" before doing something that drastic?
Seems really easy to me, Disciple, considering the condition of the program.
And I don't consider bringing in physicians that wanna foster resident education drastic , given the state of the current program.
Again, good or bad, medicine is a business.
And if you have a failing residency program,
it's time to clean house.
Think about the ramifications of not cleaning house.
Said residency may be eliminated.
Like Louisiana State University's anesthesia residency.
Which is a ghost.
Clean house, bring in some motivated Young Guns.
Look, I'm no Einstein.
And yet I find it hard to believe people in charge don't see it the way I see it.
Endangerement of losing a residency program should put fire under the "in power" administrators to make a change.
and BTW, for the record, for the most-part, I fu kk i n g despise (most) administrators.
Because most "suits" that make decisions about clinical arenas have no background, nor knowledge, to back up their deep-seeded decisions.
Exactly... you can't fire everyone at once.....and if you do it bit by bit... then the resistance is increase many many folds.
So what is the solution? You have to chop off the heads as soon as you can but you also need to know _when_ to chop off the heads or you will disable the program by doing it too soon in an effort to meet less resistance.
What's the worst that can happen? Isn't the program about to be shut down? In its current incarnation it is a hard sell. So if the "drastic' measures don't work, it won't change the fate of those in the residency, and the one that attempted the measures can go into private practice.
Drastic times call for drastic measures. Someone famous said that, right (famous other than moi )
I humbly disagree, dude.
A savvy chancellor could line up his recruits before the hammer falls.
Let the hammer fall.
Then bring in the strategically alligned milleau.
Have them already licensed, waiting in the wind.
I need to get into academics.
Cuz apparently the dudes in charge of some of these programs have their heads where the sun doesn't shine..........
know what? I just felt an epiphany....I'm callin' my buddy Allen Kaye and tellin' him of the potential opportunity at USF.
Notthin' like a dude with clout impinging on a failing program.....I'm dialing his number as we speak.
Let me know what happens with Kaye.
from my understandind there is a financial relationship between Mangar (the ceo of the private group) and the new chairman - and to boot this is being backed by the dean of the med school... so unless you change the dean and eliminate the financial pressures, you are stuck with a rotten department that falls apart and makes way for a financially lucrative CRNA program...
Alan is under the impression that the axe has already fallen and that it is too late for intervention.
That is really too bad. It really stinks when greedy people sell your field out in order to line their pockets. I don't understand why they don't just make it a private practice group and then still have residents. Rather than making them the workhorses why not let them be nonessential so that they can get the best cases. From what I understand they do something like this at Oschner, why not do it in Tampa? Although it sounds like it really doesn't matter now. It seems like someone in the administration should have to suffer some time of repercussions for this. I mean, an entire residency program (a large one) has just basically been shut down. Shouldn't someone have to deal with those consequences (other than the residents)? I guess I am a vengeful type of person.
Yes, a house-cleaning is in order since multiple attempts have been made at changing things around. In the past four years, the program has had three chairmen, Drs. Downs, Miguel ,and Camporesi -- and all have been miserable failures. The current chairman is a lame duck, a puppet with no real power. He really should be fired, but it's not going to happen. The current dean, Klasko, came riding into town two years ago with his first order of business being the floundering residency program. He installed Camporesi as chairman and merged the program with the private anesthesia group. Now he can't admit that that experiment failed. The *ssholes up top (Fabri, Klasko, Camporesi) continue to preach to the residents that everything is hunky-dory. Stay put. They'll reapply for re-accreditation. Just wait. Have faith. All that bullsh*t. Worse, they're really not helping the residents find other spots. The whole place is a big joke. Sad, really, considering the tremendous amount of clinical material available at Tampa General and that most of the residents are very competent and genuinely nice people. They are trying to start up a Nurse Anesthesia program, which is quite laughable considering how ill-equipped they are to teach residents. I could go on, but this topic is depressing.
You are obviously NOT in academics and think like a private practice physician where decisions can be made rapidly and acted upon just as rapidly. In academics things NEVER move that simply
Then again lets look at this from the chancellors point of view
1. He has 10-20 universities to control( guessing)
2. Looking at 10-20 depts and each university now gives 100-400 depts.
3. He/She can possibly know the details of what is happening at individual dept level. Must relie unpon presidents who relies upon dean.
4. Chancellor is many steps away from the anes. dept. If dean says he can fix that the chancellor will let him.
5.If one dept goes under- no big deal. He is dealing with state budgets and lack of money for whole system.
The person who is truly responsible is the dean and apparently he is involved currently in process.
Lastly, given the budget drain many state ansthesia programs require (i.e.- we loose money) if a single program actually makes money using private practice then giving up the residency isn't so bad.
NOTHING IS EASY IN ACADEMICS.
If things were easy we would solve all academic problems this way- fire whole depts and bring new people in the next day. Deans would love it. My job security would suck since 1/3-1/2 of us loose money
I am all in favor of supporting the tampa program and Dr. Camporessi and in fact WAS recommending the program to some students as a future great program- not any more until the problems are resolved
Guess I'm too realistic....kinda like Mil and his frustrating posts about military medicine.
Anyone who supports a probationary program to the point of recommending said probationary program to students has their head up their a ss and is not looking out for said students.
Like I've said before to a previous poster who ranked a probationary program,
you are a pawn in this whole process and there are things in the residency milleau that are out of your control.
SO I REPEAT:
Unless you are a martyr, why would anyone rank a probationary program? And why would any academic MD who "truly cares" about their students recommend ranking a probationary program?
You're right, Dude.
I'm not in academics. your tone is saying I should bow down to the academic way, accept it's faults, and pass it on in a cult-like fashion to unknowingly naive med students/residents.
YOUR ACADEMIC WAY SUCKS.
WANNA ACCEPT IT PERSONALLY?
FINE. I RESPECT THAT.
JUST DON'T PASS ON ARCHAIC/RISKY BEHAVIORS ONTO NAIVE MED STUDENTS/RESIDENTS THAT MAY BE SCRAMBLING FOR A PGY-3 POSITION A FEW YEARS FROM NOW BECAUSE YOU RECOMMENDED THEY RANK A PROBATIONARY ANESTHESIA RESIDENCY.
LIKE THE REST OF US, YOU'VE WASTED YOUR TWENTIETH DECADE PILLAGING THROUGH ZOOLOGY/ORGANIC CHEM/PHYSICAL CHEM/CALCULUS 3/ENDLESS STUDYING IN THE FIRST TWO YEARS OF MED SCHOOL/ SURVIVAL OF THIRD YEAR CLERKSHIPS/ CRUISED THROUGH MED SCHOOL FOURTH YEAR...
I can't emphasize the importance of selecting a STABLE, NON PROBATIONARY residency.
WHERES THE QUESTION HERE???
You are selecting the end-of-a-decade-plus commitment in your life, on the brink of making the dollars that will make you willing-and-able to pay off the student loan debt that currently makes Sallie Mae your mistress.
How many anesthesia residencies are there in the US?
How close are you to closing this in-training chapter of your life?
Why would you risk your financial future on a probationary residency program?
I'm a martyr.
It will be closing in 2008
Well, I disagree. Many good residents came from that class of 2005. Very competent and can pretty much do any case you can throw at them. 90% passed the written and so far not one has failed the orals. I can personally say that I think I am a very good anesthesiologist. Not to say that the complaints aren't true but many are exaggerated. And yes, I worked long hours(60-90 wk), like many other programs do. While I was there we went through several chairs (3) and that probably didn't help. However, the program is not as bad as many disgrungtled residents claim. I now work at a suppossed top anesthesia program and let me tell you, they cant do crap here. The training I recieved at USF was very good. Upon arriving to this new program thay were amazed at the level of training I recieved at USF and how deficient their program is.
I believe the downfall of USF is completely political specifically with the removal of Dr. Downs, who has alot of power in the anesthesia world. After the changing of the guard the powers that be were not happy with the new chief (Miguel). Eventually the private group took over at the end of my residency (last 3-4 months). Again the owner of the group was not in line with the old regime (Personal enemies) and I believe that this along with the ***** residents that cant handle the work combined to the fall of the program.
Yes, the new regime was tougher. But I'll tell you, it was not any harder than it was when I was CA-1 with Downs. Yes its true, the private group doesn't give a crap about the residents. However, the program improved with the takeover from the private group. The residents were able to go to lecture 2x a week at 2pm as they were relieved by attendings. Prior to that lectures were at 6am and nobody aver showed up. The CA-1 recieved an extra lecture every wed for ~ 5 hrs. Also, USF basically took over all the cases in the OR that they could not do before b/c they had to compete with the private group. This means all the cranies, Spine, hearts, ortho cases. My last month I personally peerformed 200 regional blocks along with the other resident on the rotation who also performed about 200 blocks. Did over 110 hearts, 120 thoracotomies, 60 anuerysms, 500 epidurals (~ 100 thoracic), 100 FOI's, and a crapload of other stuff(. So in response to your initial comments I disagree. Many fine and highly qualified residents graduated from the program in 2005 (21) with a 90% written pass rate and currentl all that have taken the orals have passed.
Furtrhermore, we had 3 residents go to several top pain programs (texas tech, cleveland clinic, duke), and 2 residents in top peds programs (Hopkins, Boston all childrens). In addition, as far as board scores the highest score on my exam was 287 and I hit 277. My class scores were 1 person 49, 3 people 46, 2 b/w 42- 44, about 3 at 41, about 5 b/w 37-38 , 5 b/w 34-35 and the other 2 above passing.
In addition, I have had several good offers for jobs in florida and no i haven't been bounced around. In fact, they dont want me to leave my current job.
And the current and incoming residents? A friend of mine matched there. I assume they will make arrangements, right?
Apparently he didnt read this post.
I spoke with some of the residents there that are trying to leave and they cant because tampa general wont release the funds they allready recieved this year for the 2007 year. They said the money is spent????? Anyway, tell your friend to get his sh*t together b/c Fabri is not going to help him.
THIS is the reason that you avoid programs in trouble. Jet is correct.
So I guess those residents will be well trained, right!
I don't understand how they cannot let them leave. If you want to leave, you should be able to leave. This is America not some Nazi slave camp. Can you elaborate on this further?
They can leave if they want. However, they must find a program that is willing to pay for thier salary. The program that takes them will not have any funding for that resident this year as the funds have been appropriated allready by tampa general hospital. With that being said, there are few if any programs that would take these residents without funding. Somebody has to pay for your salary.
There was 1 resident that actually left. He however negotiated his departure before the beggining of the new year and his funds for residency year were transfeered to his new place of residency.
Let me once again plea to future residents:
there are many parts of the residency program milleau out of your control, no matter what your board scores are/how much of a stud you are.
Yes, you emerge with training that enables you to enter practice.
But BEFORE your graduation day, while you are a resident, you are a cog in the wheel. You are a small part of a university-money-making-machine.
You are cheap labor.
They pay you 35-50 grand a year and, after the CA-1 year-learning-curve-days are gone, YOU become a money making machine.
You are being paid less than half a CRNAs salary to do whatever cases you are doing.
So the relationship is symbiotic.
And your symbiotic relationship starts when you commit to a residency program on match day.
And if you commit to a residency in trouble, well, you may have just ingested a plethora of problems for yourself at a time in your life when you don't need any extra problems/stresses...i.e. scrambling for a CA2/CA3 spot when the probationary residency program you philanthropically selected goes belly-up.
How would you like to move to a residency from med school, then have to move again to finish residency? Adjust to a brand new neighborhood/friends/location/routine/colleagues?
That in itself would be enough to deter me from (initially) ranking a probationary residency...
but heres one better...
lets say your probationary residency closes at the end of your CA2 year...
and despite your anesthesia-god skills and knowledge, you are unable to find a CA3 open spot.......
....The above are definite possibilities if you choose to rank a probationary residency when you are a med student.
Please, med students, re-read my posts above on this thread.
An ounce of prevention is worth a pound of cure.
In case you missed the message above, let me elucidate it for you:
A PROBATIONARY RESIDENCY PROGRAM MAY HAVE A PROBLEM FILLING YOUR SPOT IF YOU DECIDE TO LEAVE. THEREFORE, THEY MAY BE RELUCTANT TO LET GO OF YOU. AGAIN, YOU ARE (ALREADY SIGNED) CHEAP LABOR.
do any of you know of Dr. Massey ??
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