Funding & a second residency

Oh, that is sooo terrible!! I wonder why you feel surgeons are bad role models? I think if you kept at it for a while longer you would learn to love it again!! You sound like a great guy! Turn that frown upside down and learn to love again!! 🙂 You're the best!

Stwy said:

I completed 5 years of general surgery residency (4 years clinical and 1 year research) before figuring out that I was miserable as a general surgeon. The only thing I really liked was vascular, but after 2 separate ruptured AAA died on the table, I realized I hated being the guy who got to deliver the terrible news. Too much death in vascular for me and would wake up in the middle of the night sweating about that tie that didn't sit right on the PDA. I realized I didn't enjoy surgery, wasn't very good at it, and was generally miserable during my 3rd year, but my PD was such a cool guy and great personality, he convinced me to stay -- to no avail. I couldn't stand it anymore. Most of the attendings I knew were also miserable -- not any real role models -- so I did the unthinkable and resigned-- least I suffer their fate.

I liked anesthesia as med student, most of my buddies are anesthesiologists, and I'm hoping to change my career, but I find out I'm out of funding. Am I screwed? Is there no training money available? As a med student I got almost every interview I applied for, but was completely shut out of last years ERAS. Do I write every conceivable PD for an "outside the match" spot, or reformulate my ERAS app? What can I do to get more training? I've got the endorsement of my PD and Chairman, but it's now clear that CMS cash is king. Any ideas? Dr. Cox?

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Finish surgery. Tailor your practice according to what you like. If you dont like dangerous stuff that bothers you at night then dont take those cases. No one said you HAVE to treat every single general surgery case. You can also try and go into a more friendly life style fellowship like Colorectal or Plastic. But seriously, you can tailor your own practice to suit your style of living. You might not make as much the average surgeon but hey money is not everything.

It is not like there is NO funding for your second residency, there is LESS funding than for a resident coming directly out of medschool. How much less depends on the funding situation of the individual hospital, but typically it is about 20k less per year (so if they get 100k for a fresh resident, they get 80k for a second residency).

Look through this AAMC brochure as a starting point to understand how this thing works:
http://www.aamc.org/advocacy/library/gme/dgmebroc.pdf

Oh, and if you had 2 ruptured AAAs die on your table, you'll just have to get two more through to be par for the course.....

Usually people change residency earlier along the trajectory. Being in general surgery is actually pretty much the best position to be in. You have 5 years of full funding to your account instead of a disgruntled internist who has only 3.

Surgery is trying, and you have to want to be a surgeon to do it.

Well the good news is you'll only have to do three years of gas to finish up that residency. They are used to people switching all the time into their field. You should be able to find a spot without too much problem. You need to get busy contacting programs in your area. Does your current program have an anesthesia residency? This can be done if you really want to make the switch. What part of the country are you looking to be in?

For my money, I'd make for damn sure this is exactly what I wanted to do. The grass isn't always greener on the other side of the curtain. Someone who is used to being a "do'er" might struggle to enjoy the generally hands off nature of anesthesia. However, if you are sure this is what you want just start sending out letters/e mails to program directors at places you want to be. That should at least get some leads for you. Good luck

I'm sorry you found training so miserable that you felt forced into the position of resigning with one year to go; but FWIW, I and several of my friends have been in that position as well, although most of us stuck it out.

I also found it tough to find something I liked during general surgery residency...not much appealed to me either. Death is difficult to deal with and certainly vascular surgery sees its fair share of it, but you won't escape that in any clinically oriented field. As an anesthesiologist, I'm sure you know, you will still be in the position of discussing death and end of life issues with families.

Ok...so onto your questions...

Stwy said:

I liked anesthesia as med student, most of my buddies are anesthesiologists, and I'm hoping to change my career, but I find out I'm out of funding. Am I screwed? Is there no training money available?

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As faebinder notes above, CMS funds second residencies at a lower rate - usually anywhere from 50-80% of the first residency rate. So it does place you at somewhat of a disadvantage but for a good candidate at a well-funded hospital, it is generally not an issue.

As a med student I got almost every interview I applied for, but was completely shut out of last years ERAS.

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Hmmm....I'm confused. Did you apply for Anesthesiology through ERAS/NRMP last year and didn't get any interviews?😕

Do I write every conceivable PD for an "outside the match" spot, or reformulate my ERAS app?

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Both. First, you need to find out why your application last year was so unsuccessful. Is there any possibility that some of your letter writers or your former PD shafted you with some negative comments or "read between the lines" type of comments? Is there a problem with your USMLE scores, visa status or other application elements? Did you apply to a wide variety of programs?

Secondly, if you are going to attempt to apply for anesthesia again, please speak to some of the programs you applied to last year and see if they can offer you any suggestions as to why you weren't ranked and what you can do to improve your application. Perhaps they are questioning your motives..while it is certainly not unusual for people to switch from GS to Anesthesia, it is usually done earlier and they may wonder about how committed you are if you can quit a program with only one year left.

Frankly, I wonder the same...it seems a big move to make, without any realistic back up plan, and leaves you without being BE in surgery or any other realistic options. They may wonder how mature and insightful you are to leave a training program after 5 years and only 1 year to go. Even if you were to never practice general surgery, it gives you a lot of options - fellowship, other positions which require a BE/BC physician.

So get your name and your desires you there...tell everyone you know that you want an Anesthesia position, be willing to repeat your intern year if that's what is offered, etc.

What can I do to get more training? I've got the endorsement of my PD and Chairman, but it's now clear that CMS cash is king. Any ideas? Dr. Cox?

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Of course money is important to programs, but I think you have to impress upon them that you are such a special candidate that it is worth getting less money for you. If you are just some name on a piece of paper with nothing to make you stand-out except the decreased funding, you aren't necessarily appealing to them. Do you have an anesthesia residency at your home program because I would think they would be your best chance.