M3 Needing Anesthesia Advice for Next Year!

iwumd07 said:

Hi, I'm an M3 at an allopathic school in Illinois. I am needing some serious advice on what to do about my M4 year. BLESS YOU if you actually take time to answer my exhaustive list of questions. Here are my stats so far:

Step 1: 216 (unexpected upset, but oh well, I'm over it)
Step 2: plan on taking 3 weeks after end of M3; will likely do very well
Clerkships are graded P-proficient; A-advanced; O-outstanding
(in order taken)
IM--A (O for clinical)
FP--O (O for clinical)
Surg--O (O for clinical)
Ob/Gyn--O (O for clinical)
Currently on Peds, then Psych
Extensive CV
2 Poster Presentations (1 in Pain Management--2nd place, 1 in Internal Medicine); currently working on publication for Surgery.
LOR: Will get a great LOR from the Chair of Surgery, who also thinks I should reconsider my career choice and join his program, hahaha!
Also planning on 2-3 other LORs, but not sure from whom. One will be from an anesthesiologist I rotate with here during M4.

We do NOT have an anesthesiology residency at my med school. I have sought experience during this year by shadowing anesthesiologists in my free time. I am planning on doing a 2-4 week anesthesiology rotation at the beginning of my M4 year.

Questions:
1. Should I do an away rotation? If so, WHEN/where? (I have been researching some anesthesiology programs, but most seem similar, and I can't find a good source for program reviews)
2. What should I look for in an anesthesiology program?
3. Where should I apply? (I would like to stay Midwest and Southeast US).
4. What are my chances of matching at top-ranked programs (btw...what ARE the top-ranked programs and by what criteria are they ranked?)
5. Which programs should I consider my 'reach/mid-tier/safer' ones?


Again, I appreciate ANY and ALL advice that you care to throw at me. As you can imagine, I feel lost without a proper residency program here to help guide me.

Thanks!

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1. You should generally do aways only if you're interested in a specific program. But since your school doesn't have a residency, it might be a good idea to do an away at a school to get to know its PD and get a letter from that person.

As for when, you should probably do the rotation between May and August, to have time to get LORs. As for where, find a program that you are interested in applying to and that is receptive to visiting students. Unfortunately, I'm not familiar with the programs in your preferred regions.

2. This is a very broad question and it depends on your personal goals. If you want to be an academician, you might want the program with the best reputation. Otherwise, almost every program will produce a competent anesthesiologist, and location/workload/program perks and benefits or the intangibles like resident camaraderie/morale/personal fit may be more important to you.

3. Like above, this is a broad question. Basically, apply to any program you'd like to go to. Your step score is below average for anesthesia, but everything else looks pretty good--as an allopathic AMG, you should have little problem matching somewhere as long as you apply wisely (several reach, appropriate, and safety programs). You should talk with an attending about your goals to see where to apply.

4. There is no ranking for "top programs." This has been debated ad nauseum on this forum. The top program is the one YOU want to go to the most. If you want to talk academics, no one will say Harvard (MGH, BWH, BID), Hopkins, UCSF, Penn, Columbia, etc. are bad places to train. Note that this generally follows the US News rankings for medical schools, so interpret it with care.

Because of your step score, your chances at these places are not the greatest... But you never know.

5. There are lots of programs in those regions of the US you said you were interested in. Ask a friendly attending his or her opinion of the difficulty of these programs. People you work with will have better ideas of what programs are appropriate for you.

I'm sorry that a lot of this advice is "talk to an attending who knows you" but the truth is that choosing an appropriate program does largely depend on your personal goals and ideally requires a good discussion with someone who knows you and your application well.

iwumd07 said:

Hi, I'm an M3 at an allopathic school in Illinois. I am needing some serious advice on what to do about my M4 year. BLESS YOU if you actually take time to answer my exhaustive list of questions. Here are my stats so far:

Questions:
1. Should I do an away rotation? If so, WHEN/where? (I have been researching some anesthesiology programs, but most seem similar, and I can't find a good source for program reviews)
2. What should I look for in an anesthesiology program?
3. Where should I apply? (I would like to stay Midwest and Southeast US).
4. What are my chances of matching at top-ranked programs (btw...what ARE the top-ranked programs and by what criteria are they ranked?)
5. Which programs should I consider my 'reach/mid-tier/safer' ones?

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1. Yes, you pretty much have to, you need a LOR from an academic anesthesiologist as the "headliner" on your LOR package. This is easy: you're in IL, you wanna stay Midwest, so roll up to Chicago where there are >4 very respectable residencies, or head to St.Louis, or Cleveland, or Wisconsin.
2. Good clinical exposure, friendly and happy residents, program responsive to the residents' needs/desires, and placement of graduates in situations you could see yourself in (if you wanna do PP in the Midwest, you probably don't need to go to Duke, which graduates a lot of academics and North Carolina based PP'ers)
3. As above, you should have no problem matching in the Midwest, where programs that would be famous if on the coasts struggle for attention due to location.
4. There's no ranking, but generally if you think of a "famous" university/institution they probably have a kickass program. In the 2 regions you mentioned, MCW/Mayo/UChicago/Northwestern/WashU/CCF/Vanderbilt/
Emory/Duke/Wake come to mind.
5. As above.
Best of luck

Icefrog said:

4. There is no ranking for "top programs." This has been debated ad nauseum on this forum. The top program is the one YOU want to go to the most.

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Very true.

Apply broadly and then when you get interview invitations, you can then try to get more detailed information regarding specific programs. Then you can decide whether or not to go for the interview.

Or if finances & time are not a huge issue, then you should go to as many interviews as possible because there is so much to be learnt from each program that you would otherwise have no clues if you didn't go visit.

One thing that I didn't know before is how much my interview experience would influence my rank list. Name and reputation is one thing but whether or not you fit in is another. So go check them out if you can.

all i can say is audition rotation, audition rotation, audition rotation.

PulseOx said:

all i can say is audition rotation, audition rotation, audition rotation.

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What's a good number?

Here's my advice: Don't go into anesthesia.

iwumd07 said:

Questions:
1. Should I do an away rotation? If so, WHEN/where? (I have been researching some anesthesiology programs, but most seem similar, and I can't find a good source for program reviews)
2. What should I look for in an anesthesiology program?
3. Where should I apply? (I would like to stay Midwest and Southeast US).
4. What are my chances of matching at top-ranked programs (btw...what ARE the top-ranked programs and by what criteria are they ranked?)
5. Which programs should I consider my 'reach/mid-tier/safer' ones?

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1. Should you do an away rotation? At this stage of your studies, probably the best reason for you to do an anesthesia rotation is to find out whether you and the specialty are a good fit for each other. When? The earlier the better, so that if you are not happy with what you see, you have time to think about other specialties. Where? Anywhere they accept students; it will not make much difference.

2. What should you look for in an anesthesiology program? Look for happiness in the residents, a good relationship between attending staff and residents, respect for the residents, and respect for the specialty in general in the hospital. Stay away from malignant programs, whether it is an attending-versus-resident, surgeons-versus-anesthesia, anesthesiologist-versus-CRNA or any other type of conflict. Of course, some of these you will not be able to find out, but in ideal circumstances, it would be nice to know. About academic excellence, even though nowadays rules and requirements for accreditation have evened out many issues, make sure the residents are not exploited merely as cheap manpower, but that they are taught through lectures, M&Ms etc.

3. Where should you apply? ("I would like to stay Midwest and Southeast US"). Forget about your geographic requirements. Apply to the best programs, regardless of geography, at the top of your list, and put some lesser ones at the bottom as a safety measure, in case you don't match for the better ones. Forget about the distinction between "academic" and "clinical": good programs are good in everything, and you will never regret having been at one of them.

4. What are your chances of matching at top-ranked programs? No idea, I am sorry.

5. Which programs should you consider your 'reach/mid-tier/safer' ones? No idea, I am sorry.

For what I have seen in the past, the University of California programs are very resident-friendly, Beth Israel-Deaconess is very resident-friendly, and MGH is very resident-friendly, or maybe I should use the past tense, because I am talking about a somewhat distant past. In my more recent experience with new hires, Columbia is very good (it has always been). However, any of the highly ranked programs are probably equally good.

Some people think the best programs are the ones with high volume of cases, but keep in mind that there is a limit to it: you also need time to sleep and to study for your in-training exams and for the boards. Try to stay away from places where "resident" is a euphemism for "slave."

I hope this helps.

1. definitely do an away rotation. it will help you get in with the current residents at that prgm and also get to know the prgm and its directors. If they know you then that will increase your chances with a low step score.

2. figure out what kind of prgm u want. there are many anesthesia prgms each with different type of character. do u want to moonlight, do u want to work like crazy during residency to be able to handle anything when you come out. do u want relaxing calls or do u want to see truamas. Do you want a big program(20 residents per yr) or smaller one(5 residents per yr).
IN the end you will be able to bread and butter cases no matter which prgm u go to, but figure out the lifestyle u want for the next 3-4 yrs!

3. midwest and SE - chicago has 3 great prgms if u want to stay there. Ann arbor mich is a nice hosp, vanderbilt, emory, UT houston?baylor, wash U, cleveland clinic

4 with your step score - iw ould not put too much emphasis on the top 5 schools unless you really know the program directors there, do an away rotation, have profound publications.. most residents do have some sort of research in medschool/college so that is not a big advantage - kind of a necessity. some of those schools wont look at app unless u have atleast 220/230.

5. work hard and apply broadly and express deep interest and you will get in somewhere if u really want anesthesia. keep in mind - anesthesia is not as easy as you think it is as a med stud. im just ifnishing residency and i was shocked at the hrs i worked. gettin ther at 6am or earlier and leaving after 5 pm on average. worked even harder in my CA1 yr. i was expecting to leave at 3 everyday.. but definitely was not the case. Also - being in a level 1 trauma center lets you see/do great cases but your calls are busy

esp if you are a competative applicant - he feels it can only hurt you if you dont perfrom up to their expectations based on your boards, grades, recs - on the other hand if you are not a compeative applicant, you clearly have nothing to lose if you do an away rotation - anesthesia is sufficiently competative that you would need to do one - of course in the real competatiev specialities -plastics, urology. ortho, he does NOT discourage away rotations

Consigliere said:

Here's my advice: Don't go into anesthesia.

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Why is that? You think the field is going to take a complete dive with healthcare bill passing and dramatic reduction in reimbursement? Are you just totally unhappy with your choice of career?

iwumd, the responses you've received are awesome and you should do well with those. You will certainly have to apply broadly, though. Your step 1 score makes you a little less competitive than most, meaning you cannot afford to thumb your nose at any program when you apply or interview.

RedAnesthesia said:

Originally Posted by Consigliere
Here's my advice: Don't go into anesthesia.

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Why is that? You think the field is going to take a complete dive with healthcare bill passing and dramatic reduction in reimbursement? Are you just totally unhappy with your choice of career?

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I cannot wait for our generation to become fully trained anesthesiologists. We shall crush the balls of the CRNA PAC. Our generation may well be the first in years to have >90% ASAPAC membership/participation (I'm sort of simultaneously issuing a challenge here as I'm optimistically making this prediction). Let's see if we can't aggressively defend our turf and restore anesthesiology to completely being a medical specialty practiced by physicians especially in saturated markets. Perhaps then we can phase out the perception of the embattled specialty and nurses will earn what is commensurate to their training level, while physicians' reimbursement will reflect the level of expertise we (will) hold.

deuce said:

esp if you are a competative applicant - he feels it can only hurt you if you dont perfrom up to their expectations based on your boards, grades, recs - on the other hand if you are not a compeative applicant, you clearly have nothing to lose if you do an away rotation - anesthesia is sufficiently competative that you would need to do one - of course in the real competatiev specialities -plastics, urology. ortho, he does NOT discourage away rotations

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dude, your spelling really concerns me!

gasmann said:

... im just ifnishing residency and i was shocked at the hrs i worked. gettin ther at 6am or earlier and leaving after 5 pm on average...

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Hello,

Boy, your work hours are easier as a resident than mine are as an attending!

Recommend your program to the med students. It sounds great.

Eta Carinae said:

...restore anesthesiology to completely being a medical specialty practiced by physicians...

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AMEN and AMEN!

Eta Carinae said:

I cannot wait for our generation to become fully trained anesthesiologists. We shall crush the balls of the CRNA PAC. Our generation may well be the first in years to have >90% ASAPAC membership/participation (I'm sort of simultaneously issuing a challenge here as I'm optimistically making this prediction). Let's see if we can't aggressively defend our turf and restore anesthesiology to completely being a medical specialty practiced by physicians especially in saturated markets. Perhaps then we can phase out the perception of the embattled specialty and nurses will earn what is commensurate to their training level, while physicians' reimbursement will reflect the level of expertise we (will) hold.

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Thanks for having this attitude. I hope more anesthesia residents throughout the country share this same mindset.

Do as many auditions as you can. You do not have to do all general OR anesthesia rotations. you can do some pain, ICU, etc.

Any don't let anyone tell you that auditions don't matter or increase your chances because they absolutely do!

Home students get preference for a programs anesthesia spots. However if you rotated there that puts you between the home students and everyone else.

Furthermore on your interview day you will already know everyone, probably have a letter from that program, and know all your interviewers personally. It will also be very easy to tell that program you are very interested because you have rotated there for a month.

I also forgot to mention. If you do a rotation it is an AUTOMATIC interview, (unless you are a bonehead). That alone is worth it.

PulseOx ... So, would you say do auditions at a place that is more DO friendly, or audition anywhere (even real competitive programs?)

I was thinking, due to finances, to rotate 2 months at a DO program, and 2 months at an MD program. However, I may do 1 month at a DO program, 1 month at an MD program, and another 2 months at another MD program? Not sure. Advice?

Doctor4Life1769 said:

PulseOx ... So, would you say do auditions at a place that is more DO friendly, or audition anywhere (even real competitive programs?)

I was thinking, due to finances, to rotate 2 months at a DO program, and 2 months at an MD program. However, I may do 1 month at a DO program, 1 month at an MD program, and another 2 months at another MD program? Not sure. Advice?

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I only rotated at MD programs. Didnt even do the DO match even though I am a DO. So I cant help with DO programs.

However I would only rotate at MD places that have taken DO's in the past. Maybe rotate at one program that is a reach and one safety program. make sure both have taken DO's in the past.
Good luck!

RedAnesthesia said:

Why is that? You think the field is going to take a complete dive with healthcare bill passing and dramatic reduction in reimbursement? Are you just totally unhappy with your choice of career?

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Reimbursements about to plummet; CRNAs gain even more power, physicians continue to be marginalized.