Work Horse Programs

I'd be willing to bet it has a lot more to do with the individual and how much effort you put in than how the residency is run.

NW, WashU, CCF, UCSF, Vandy, Columbia, UAB, Baylor to name a few.

University of Washington, though I was told by residents there they are weak in regional training.

Vandy, UAB, Emory, USF, UF.

The bigger they are the harder you fall.

welcome to slave labor camp boyz and gurlz.

There are horror stories floating around about programs in NYC...
Exceeding the 80 work week on a regular basis...
Not getting 10 hours off...
Someone must know some NYC Programs...


That to me is a WorkHorse Program, when you are there doing cases in excess of all other programs. Others call it malignant, but if you want to learn and work in residency, then I would call it Workhorse too.

Yale. But they're not super malignant, only the secretary running the OR is. Anyways, you get excellent training at Yale in all areas except regional.

Chomp on the bit during the day and a pillow at night. Welcome to Rush!

I like it there. You get worked hard for sure (from tons of cases to flippen over your room this place is busy) but the majority of the dept, including your fellow residents, are easy to get along with. Makes a big difference when you like the people you work with. I enjoy going out with people in my program and am always joking around with them. In fact most people on other services are easy to work with as well. Sure there are some hard asses but that doesn't get anything I'm doing done faster...my sincere apologies.

Clinically I'd put em up there with anyone. There is no lack of cases. You will be forced to be up to speed clinically or you'll simply sink. I'm blown away by the CA-2's. Those guys are solid. Says something about what even their CA-1 year prepared them for. Didactics leave something to be desired however (2 hr lect tues afternoon, wed am conference, montly miller chapter reviews. Supposedly starting am 30 min lectures but we'll see). If you are big on lecture you'll be dissapointed here.

I suppose that doesn't matter much to me as I have always read on my own. Sometimes its hard to pick up the books but WTF this is your profession. You really have to read or you will not know WHY you are doing what you are doing. That is an awful feeling but I don't think it works different anywhere else. However I could be wrong. I'll bring up my questions in the OR and I've rarely had an attending not answer it in a thoughtful manner.

I feel like every program you hear about is a "workhorse" program. I am fine with working hard. I however think anesthesia is learned by doing a lot of reading too. You can't be a GREAT anesthesiologist without the basic science and pharm.

Thoughts?

I don't even know what a high total case number would be for a strong clinical program

I saw on MetroHealth's website (Cleveland), numbers advertised for national means (total case mean = 1250) and their program means (total case mean = 1650).

What are TOTAL CASE NUMBERS from some recent grads or Senior Residents familiar with program numbers???

What constitutes HIGH TOTAL CASE NUMBERS?? 1600? 1800? 2000?

Monitor said:

I don't even know what a high total case number would be for a strong clinical program

I saw on MetroHealth's website (Cleveland), numbers advertised for national means (total case mean = 1250) and their program means (total case mean = 1650).

What are TOTAL CASE NUMBERS from some recent grads or Senior Residents familiar with program numbers???

What constitutes HIGH TOTAL CASE NUMBERS?? 1600? 1800? 2000?

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I average 60 cases/month. This will probably be well over 1800 when im done. I really dont even work that hard 60-70hrs/wk.

I am averaging 50 cases per month. 1 day per wk in preop clinic and other 4 days with 3 pts per day on the average. call is hit or miss. I have done 8 cases during a call day.

DrDre' said:

I feel like every program you hear about is a "workhorse" program. I am fine with working hard. I however think anesthesia is learned by doing a lot of reading too. You can't be a GREAT anesthesiologist without the basic science and pharm.

Thoughts?

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Very true...You need time to decompress and read. Some programs that produce awesome clinicians have problems with the boards first time around because they work their nuts off during residency. Remember anesthesia residency by hours worked may not be comparable to some surgical fields, but the time you spend at the hospital, you are going full torque. This can be very draining in the early years of training, I remember coming home feeling like somebody beat the s**t out of me the first few months of residency. It's kinda like being an intern again, but with a hundred more ways to F'up people daily.

They work hard at UAB, but those guys are studs when they get out. In addition, they allow in house moonlighting which means even larger caseloads. I'm not sure exactly how many they get though.

If you want to work hard and not see all the tricky stuff go to CA2's and 3s USF is a good choice. They are on probation right now - party because they throw CA1's in the deepend. (They have their review in a few weeks.) I'm on the west coast, but I have a friend there who is a CA2. His complaint is the lack of teaching from the attendings. They are of the 'study hard - oh, here's your brain surgery' school.

USF is attached to Tampa General - a level 1 trauma center. So if you want the s*** scared out of you in the first few months as a CA1 and learn by doing - a lot - then USF might be the place for you.

UF is the worst ive seen, as far as work hours.

On the interview trail, UCSF, Stanford, and Northwestern seemed to workt he most hours.

on my MGH interview they said they worked hard (which they certainly do) but the call schedule seemed decent when i looked at the on call sheet the chiefs made...any thoughts by those in the know?

Lonestar said:

Vandy, UAB, Emory, USF, UF.

The bigger they are the harder you fall.

welcome to slave labor camp boyz and gurlz.

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I was wondering if you could clarify your experience/knowledge of emory. The residents I talked to seemed very happy with both the clinical and didactics as well as free time. Maybe I walked away with a different impression and was wondering what yours was.

thanks

fishtolive

MGH - you work hard, very hard... but the call schedule is pretty fair. You are on call 3 times/month as a CA-1 (after your tutorial month - which is call-free) and go home at 7a.m. on the dot post-call. As a Ca-2 and Ca-3 you will be on call between 4-5 times/month. The call as a CA-2 and CA-3 is a lot more brutal primarily because you are doing tougher cases overnight...
On OB you take 8-9 calls/month but you only come in at 3pm on your call day... and in the SICU you are on call q3 (they might have changed it to q4 by now)... SICU hours usually run very long and exhausting... but no other place can offer the same SICU experience... and PACU call is 24 hours and 24 hours off... kinda like a firefighter

usnavdoc said:

I was wondering if you could clarify your experience/knowledge of emory. The residents I talked to seemed very happy with both the clinical and didactics as well as free time. Maybe I walked away with a different impression and was wondering what yours was.

thanks

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Yeah, and at UAB they get paid for OR time after 3 PM. A little misleading, usnavdoc?

On an email sent out to all the residents of my program, the chief resident wrote "You will notice that on the call schedule you will be on-call more than anyone else." Meaning that everyone thought they worked harder than everyone else. Same thing between residencies. And comparing call schedules can be tricky between programs. Some have home call for certain months (CT, Peds, Transplant) while someone is in-house for general but then doesn't have to get up to do CT, Peds, etc. My call at the VA as a resident was almost better than being at home; I certainly got more sleep at the VA because I was so bored I went to bed early. I figure call works out in the end. Rather I say talk to residents about the quality of their lives. Are the getting out for afternoon didactics? Are they able to make plans in the evening and honor them?

As far as counting cases, I did over 900 my first year. But it declined thereafter as I did bigger cases. 1 crani = 4 hernias? 1 liver transplant = 30 hernias? And you can easily do 15 pedi PE tubes/T&A in a day. SO even overall numbers can be misleading if not broken down.

Idiopathic said:

Yeah, and at UAB they get paid for OR time after 3 PM. A little misleading, usnavdoc?

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Yeah, from my perspective it is. If anyone would like to expand on that it would be appreciated.

iron said:

As far as counting cases, I did over 900 my first year. But it declined thereafter as I did bigger cases. 1 crani = 4 hernias? 1 liver transplant = 30 hernias? And you can easily do 15 pedi PE tubes/T&A in a day. SO even overall numbers can be misleading if not broken down.

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This is a critical question to ask at each interview, regarding the number of the various of types of cases that the program can offer you. When I interviewed at one particular program, numbers like "400 regional blocks", "50 CPB cases", and "heavy OB" were thrown around. When I prodded residents about those numbers, the 400 regional blocks became 350 epidurals and spinals plus 50 peripheral nerve blocks, 10 CPB cases on your own plus 40 shared with a fellow or other resident, and 8 months of OB (way too much).

When you are looking for a job, it is also helpful to give your prospective employers an idea of what kind of cases you have done because without them, the employers may have to go only on the reputation of your program (for better or worse), letters of rec (again for better or worse), and your interview (really for better or worse). I interviewed one person by phone who had a tremendous CV and great case load, but sounded like he just graduated from high school (don't call me "dude" five times in an interview).

UTSouthwestern said:

(don't call me "dude" five times in an interview).

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Unreal. Do people really do that to themselves?? UT, I'll bet you can tell some stories.

PMMD

MD Dreams said:

Can anyone tell me which programs they think fall into this category. What I'm looking for are programs that work you hard during residency, but in return you will become the best anesthesiologist you can be. I know this may sound somewhat awkward, but I want to be worked hard in residency, I want to do the most challenging cases, I want to know my medicine cold, I want to be the guy people go to when they don't know what to do. Can you suggest programs that you think offer this type of training? Thank you.

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I've always gotten the impression from reading the threads on this forum and also due to its sheer size and patient population that Jackson/Miami would be considered your ticket to burning the midnight oil...then again, maybe things have changed for, "anesthesia in paradise."

which programs make strong residents without being workhorse?

If you want to be an anesthesiologist these days, you'd better be prepared to work extremely hard.

shaz8901 said:

which programs make strong residents without being workhorse?

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well you will have to tolerate some CRNA/SRNA influence if you want that so better ask another forum.

shaz8901 said:

which programs make strong residents without being workhorse?

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CRNA school ))))

ah, sorry, you've asked about residency??

shaz8901 said:

which programs make strong residents without being workhorse?

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None

GMO2003 said:

I've always gotten the impression from reading the threads on this forum and also due to its sheer size and patient population that Jackson/Miami would be considered your ticket to burning the midnight oil...then again, maybe things have changed for, "anesthesia in paradise."

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Jackson/Miami has much better hours than UF, and Mayo/Jacksonville has the best hours among the Florida programs. USF does not exist anymore...

UAMS... Real trench warfare S H I T
Almost no cushy "education time"
Intern year with several months of surgery
2-4 times more exposure to pediatrics than most
Plenty of gomer-ish sick patients (It is Arkansas)
Pushing the limits on ACGME work hour violations
The residents take over cases from CRNA's, not vice versa.

Consigliere said:

None

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I disagree. My program was not a workhorse program, but we got a good number of big cases without having terrible hours. I had over 100 heart cases and around 200 blocks not counting neuraxial. I'm not saying that's a record or anything, but it was a pretty solid experience. Getting good cases is probably more important than spending all your time in the hospital. I'd rather do a CABG and mini maze and go home at 3 than do hernias and choles all night in a workhorse program. If we worked all night it was usually to do a liver transplant or something, not to provide the department with cheap labor.

There's something to be said for a good volume of cases, any cases, but there's also something to be said for a balanced life.

I'm now a fellow at a program listed above as a workhorse program. It's good too. I'd just say look at case type more than hours.

GypsySongman said:

I disagree. My program was not a workhorse program, but we got a good number of big cases without having terrible hours. I had over 100 heart cases and around 200 blocks not counting neuraxial. I'm not saying that's a record or anything, but it was a pretty solid experience. Getting good cases is probably more important than spending all your time in the hospital. I'd rather do a CABG and mini maze and go home at 3 than do hernias and choles all night in a workhorse program. If we worked all night it was usually to do a liver transplant or something, not to provide the department with cheap labor.

There's something to be said for a good volume of cases, any cases, but there's also something to be said for a balanced life.

I'm now a fellow at a program listed above as a workhorse program. It's good too. I'd just say look at case type more than hours.

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Well, you probably have a vagina and not a penis.

Consigliere said:

Well, you probably have a vagina and not a penis.

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I disagree. Long hour workhorse rotations were more about survival for me. I got far more out of the rotations that were shorter and more focused on complex stuff. I did 3 months of hearts at the place where the granddaddy of hearts started it all. Incredible experiences every single day, but no nights, no weekends, and very fair about letting you come in late if you stayed late. Got more out of those 3 months than the other 33 months combined.

I don't see the educational value of mopping up for crna's to go home at 4 or 5 and finishing the late day add-on peg/trachs. It's like working out. I'll get more out of going near max heart rate for 20-30 minutes than an old lady jog for 4 hours.

.

Consigliere said:

Well, you probably have a vagina and not a penis.

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No, but I have a wife who likes to see me from time to time.
If you want to work 80 hours a week for $10 an hour then you are a dumb ass not a tough guy.

delete

yasawa said:

Not sure why people keep saying Columbia is a "work horse program" or "Malignant." Pretty sure if you ask any columbia resident they will say its the exact opposite. Maybe in NYC, we may work slightly more than NYU or Sinai but im not even sure about that. We are oncall overnight twice a month when on General, q4 on OB and Q4 in the ICUs. We are short call 1-2/week, leaving anywhere from 5-9pm. We have 25-28 residents/class which makes the call pool amazing. We work maybe 1 weekend day every couple of months. The Chiefs do a really good job of rotating the weekend shifts. We are NOT CRNA heavy, so as residents we are doing all of the work. We have maybe 20 CRNAs whose job is to staff non teaching cases, ASA-1, and eye center. They also set it up so most of the CRNAs are working afternoon shifts so that when not oncall/short call you get relieved by 4pm. Any specific questions PM me.

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Did you check the YEAR when it was said? Things change, you know

hoyden said:

Did you check the YEAR when it was said? Things change, you know

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Everyone always says to use the search function. Reviving an old thread just shows SHAZ did a search. Kind of funny though.

hoyden said:

Did you check the YEAR when it was said? Things change, you know

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Definitely did not see the year. Thanks for pointing that out . I had med students on the interview trail tell me how surprised they were about columbia after interviewing and meeting us. Apparently we had the work horse and malignant reputation last year. One med student said she almost didnt apply b/c everyone at her school said we were not resident friendly.

GypsySongman said:

No, but I have a wife who likes to see me from time to time.
If you want to work 80 hours a week for $10 an hour then you are a dumb ass not a tough guy.

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My program CCF I feel is a hard working program. Call schedules vary but as a CA-1 you take C3,C4 calls which are basically late calls where you start at 7AM finish at 10pm-midnight and get the post call day off. As a CA-1 most have 4 C3,C4 calls and one to two PACU calls which are 7AM-7AM. PACU call is nice because our PACU's are cleared out by midnight so your just covering in-house codes. Also the CA-1's cover weekend in-house call which is your standard 7am-7am calls. I know because I make the schedule. As a CA2 you take C2 and Liver call which C2 call is 10AM-7AM monday-friday and Liver call which is 7-7 and post call day off if your in-house hands on a liver after 10pm. Also, CA-3 take CA3 call which is in house 10AM-7AM and you basically help out with cases and lunches during day and at night you run the board. Also we have CRNA's and SRNA's who take call with us too they are in house 10AM-7AM. Call is not bad here I average around 60 ish hours and call can vary especially on the subspecialty rotations cardiac peds ob. We work hard but I am happy with the clinical experience we get. You want to see EVERYTHING CCF is a one stop shop. PM me with questions.

UAB is an amazing program and it is not a workhorse program. Great case load and clinical experience. We do not have a problem getting our numbers. We are relieved from the OR at 3pm. After 3pm is moonlighting and we get paid $70/hr. You can also take liver call for a week and they pay you to come back to the hospital to do liver cases. CA1s take 3 calls a month and CA2 year 2-3 calls a month on general OR. Specialty months like CV and peds call is different but the hour are great. As a CA3 your call is 1-2 a month. I have 8 weekends off in a row as a CA3. SICU is q3 with your post-post call day off. The staff is fantastic and very supportive. I am a CA3 here and this is the best program in the south by far. If I had to do it all over again I would come back here no questions asked.

outfitter said:

UAB is an amazing program and it is not a workhorse program. Great case load and clinical experience. We do not have a problem getting our numbers. We are relieved from the OR at 3pm. After 3pm is moonlighting and we get paid $70/hr. You can also take liver call for a week and they pay you to come back to the hospital to do liver cases. CA1s take 3 calls a month and CA2 year 2-3 calls a month on general OR. Specialty months like CV and peds call is different but the hour are great. As a CA3 your call is 1-2 a month. I have 8 weekends off in a row as a CA3. SICU is q3 with your post-post call day off. The staff is fantastic and very supportive. I am a CA3 here and this is the best program in the south by far. If I had to do it all over again I would come back here no questions asked.

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UAB sounds amazing. My program is nothing like that.

my friends at UW (seattle) get a ton of cases. it sounds like they're regional program is being built up, and they've hired a couple of new faculty just to do blocks. some of them have done 100+ regional procedures (not neuraxial) as CA-1s.

they're also working on a regional non-ACGME fellowship, but that may end up poaching blocks from the residents.

outfitter said:

UAB is an amazing program and it is not a workhorse program. Great case load and clinical experience. We do not have a problem getting our numbers. We are relieved from the OR at 3pm. After 3pm is moonlighting and we get paid $70/hr. You can also take liver call for a week and they pay you to come back to the hospital to do liver cases. CA1s take 3 calls a month and CA2 year 2-3 calls a month on general OR. Specialty months like CV and peds call is different but the hour are great. As a CA3 your call is 1-2 a month. I have 8 weekends off in a row as a CA3. SICU is q3 with your post-post call day off. The staff is fantastic and very supportive. I am a CA3 here and this is the best program in the south by far. If I had to do it all over again I would come back here no questions asked.

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Sounds like a great place, but I'm gonna have to challenge the bolded statement!

Glad you like it there.

Narcotized said:

I disagree. Long hour workhorse rotations were more about survival for me. I got far more out of the rotations that were shorter and more focused on complex stuff. I did 3 months of hearts at the place where the granddaddy of hearts started it all. Incredible experiences every single day, but no nights, no weekends, and very fair about letting you come in late if you stayed late. Got more out of those 3 months than the other 33 months combined.

I don't see the educational value of mopping up for crna's to go home at 4 or 5 and finishing the late day add-on peg/trachs. It's like working out. I'll get more out of going near max heart rate for 20-30 minutes than an old lady jog for 4 hours.

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I agree, there has got to be programs out there that understand this and are more intuned with resident education and less with cheap labor. Don't get me wrong, you need to work hard but its gotta be towards education in residency not for the sake of the departments survival. Any one know of such programs? I hear but OHSU is one of those but I don't know firsthand and just hear say

Is MCW still considered "work horse"? I heard they were making schedule/call revisions...