Anesthesia Advice

[lady_south]

Hi! US MD M3 here, quickly approaching the time to finalize my specialty choice. I am pretty set on anesthesia. However, my institution (state school) does not have an anesthesiology residency , and it has been extremely hard to find an advisor within the field. I’m just looking for direction / advice as far as applying, competitiveness, making the most of 4th year, standing out in applications / interviews, etc. Any advice?

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[2010houston]

- have you set up at least one rotation that you will have done prior to interviewing? I don’t think it will be a big deal if it’s not at your home school, but you do want to at least have enough experience with the field to speak to “why anesthesiology”.
- competitiveness is probably going to depend mostly on USMLEs... I think the standard is currently to ideally have your step 2 score by the time you apply.
- standing out on interviews- I know it sounds ridiculous, but seriously- be pleasant, display a good work ethic, be friendly, be someone we would want to hang out with on call and you will be fine. Good luck with everything!

 

[IMGASMD]

You need to to some anesthesia rotations, that’s the bottom line. Your dean, your school, anesthesia group at your home institution...

 

[AdmiralChz]

The school I’m currently affiliated with doesn’t have a residency, either. It’s imperative those students go and do an away rotation to get a better idea of the day-to-day life of an anesthesia residency and exposure to subspecialties (or at least conversations about them).

We have students rotate with us, and I love teaching, but we have zero academic opportunities for them and minimal lasting connections at good programs. Unless they do an away rotation, it’s hard for students to stick out.

 

[IMGASMD]

The school I’m currently affiliated with doesn’t have a residency, either. It’s imperative those students go and do an away rotation to get a better idea of the day-to-day life of an anesthesia residency and exposure to subspecialties (or at least conversations about them).

We have students rotate with us, and I love teaching, but we have zero academic opportunities for them and minimal lasting connections at good programs. Unless they do an away rotation, it’s hard for students to stick out.

It is a shame with some of these schools. Pay someone or something to have the students be able to expose to all specialties they want to learn about. Say whatever we want about the Caribbean schools sometimes they’re much more aggressive than some of the American schools in this regard.
Back to op, I know money is tight, but pay if you have to for at least one if not more than one rotations. Your school “should” have some leads. Or you may have a week or few days built in within your surgery rotation. (But you need much more, IMO) Our practice don’t really have a medical student anesthesia rotation, but if anyone wants to spend time with us on the other side of the drape, we never say no. A lot of New York, New Jersey programs do have affiliation with SGU or Ross, maybe that can be another jumping point.

Good luck.

 

[getdown]

Do an away at a program(s) you want to go. Just remember it's a double edged sword. If you do great, great, but if you slack off/piss off the right people then you aint matching there.

 

[studentofsdn]

Have you done any 3rd year rotations? Those are important to solidify your reasons for wanting to do it. This is important for interview talking points, personal statement, and maybe even gathering a letter if u can swing it.

You need at least 3 letters, at least one being from anesthesia and another ideally being from medicine or surgery, so plot out how you're going to get those now. Let that guide your rotation scheduling prior to ERAS submission. Talk to your school/alumni about how to set up anesthesia rotations for 4th year. Try to get in an away rotation during 4th year (start searching on VSLO for this). Apply for aways at programs in your competitiveness range (use FRIEDA for a rough guide, or PM me if you want help with this. I did an away so I have some insight). It's really important you have at least one 4 week anesthesia experience to get a solid letter. An ICU sub-i early 4th year is also a good idea for the letter. Application tactics vary if you're USMD, DO, or IMG and your score ranges, u can get a good idea from searching SDN.

Stand out in interviews like the person above said. Just be yourself. Know your application inside and out. Have spiels for your experiences, "why anesthesia?", and "tell me about yourself". Be prepared for basic behavioral questions. It's really not bad at all, most interviewers are genuinely trying to get to know you.

I never had an advisor even though I have a residency program at my home school. All the attendings are notoriously unhelpful to students at my school. So I feel your pain. It's not a big deal though, you'll figure it all out and be fine. You're doing great by seriously gameplanning at this point. Good luck!

 

[<(^_^)>]

Step 2 is helpful before submission but not a necessity if you have a great (240+) step. Note some programs require step 2 to interview but they are a minority. UCSF and wake forest being notable examples.

You need aways, both for your application and also for you to personally to decide whether this field is right for you.

It is getting increasingly competitive, apply broadly.

 

[nimbus]

Step 2 is helpful before submission but not a necessity if you have a great (240+) step. Note some programs require step 2 to interview but they are a minority. UCSF and wake forest being notable examples.

You need aways, both for your application and also for you to personally to decide whether this field is right for you.

It is getting increasingly competitive, apply broadly.

A USMD with average or even below average board scores and no red flags will match so OP has nothing to worry about imo. Agree she should do 1 away if there’s no home program. Anesthesia is still average competitive.

 

[<(^_^)>]

A USMD with average or even below average board scores and no red flags will match so OP has nothing to worry about imo. Agree she should do 1 away if there’s no home program. Anesthesia is still average competitive.

Agreed, but applications to anesthesia increased 8-15% a year the past 3 years. People these days are putting fields with controllable lifestyles above fields without controllable lifestyles.

 

[nimbus]

Agreed, but applications to anesthesia increased 8-15% a year the past 3 years. People these days are putting fields with controllable lifestyles above fields without controllable lifestyles.

Speaking as an anesthesiologist, outpatient primary care or any outpatient office practice is much more controllable than anesthesia. Many anesthesia jobs, including my own, have extremely uncontrollable and unpredictable schedules. The only way I can guarantee I’ll make it to a haircut or the dentist is to take a vacation day and that needs to be scheduled 2months in advance. I’ve missed many many appointments and events during my career.

 

[<(^_^)>]

Speaking as an anesthesiologist, outpatient primary care or any outpatient office practice is much more controllable than anesthesia. Many anesthesia jobs, including my own, have extremely uncontrollable and unpredictable schedules. The only way I can guarantee I’ll make it to a haircut or the dentist is to take a vacation day and that needs to be scheduled 2months in advance. I’ve missed many many appointments and events during my career.

It’s definitely not the most controllable lifestyle, but there’s a reason it is growing so much in popularity. One of the largest increases in applications this year. I think people were more scared of anesthesiology before mid-levels showed up throughout medicine. There are close to 30,000 NPs graduating a year now.

 

[lady_south]

Thank you guys so much for the advice! I definitely plan on participating in two away rotations. Another question - since my Step 1 is below average (216) would it be more beneficial to take a "Step 2" review class offered by my school to bump up my Step 2 score or would it be more advantageous to take an "anesthesia" elective (we do not have a residency program and only have one anesthesia attending that will help students when he is available) instead so that I would know more going into my away rotations. Thus far, I have had some shadowing experience during my OBGYN rotation and a week of anesthesia during my surgery rotation.

 

[studentofsdn]

Thank you guys so much for the advice! I definitely plan on participating in two away rotations. Another question - since my Step 1 is below average (216) would it be more beneficial to take a "Step 2" review class offered by my school to bump up my Step 2 score or would it be more advantageous to take an "anesthesia" elective (we do not have a residency program and only have one anesthesia attending that will help students when he is available) instead so that I would know more going into my away rotations. Thus far, I have had some shadowing experience during my OBGYN rotation and a week of anesthesia during my surgery rotation.

Making sure you have a good step 2 score is important. People arent really evaluating your anesthesia knowledge as much as your personality and work ethic on aways. If you just read nightly and know whats going on for the next days cases during your aways, you'll be fine knowledge-wise.

 

[IMGASMD]

Thank you guys so much for the advice! I definitely plan on participating in two away rotations. Another question - since my Step 1 is below average (216) would it be more beneficial to take a "Step 2" review class offered by my school to bump up my Step 2 score or would it be more advantageous to take an "anesthesia" elective (we do not have a residency program and only have one anesthesia attending that will help students when he is available) instead so that I would know more going into my away rotations. Thus far, I have had some shadowing experience during my OBGYN rotation and a week of anesthesia during my surgery rotation.

Is the average now 220? I don’t know for sure anymore. If that’s true and you have no other red flags and you’re attending American Medical school, I think you will be fine for lower tier programs. If you’re gunning for something better (location, prestige) and/or you have any red flags then you will need step 2.

Ask though before you apply, some may require you to have step 2 score before they even look at your application.

 

[studentofsdn]

Is the average now 220? I don’t know for sure anymore. If that’s true and you have no other red flags and you’re attending American Medical school, I think you will be fine for lower tier programs. If you’re gunning for something better (location, prestige) and/or you have any red flags then you will need step 2.

Ask though before you apply, some may require you to have step 2 score before they even look at your application.

avg is closer to 230 these days. it was 229 specifically in 2017

 

[lady_south]

Also, any good programs for away rotations?

 

[anbuitachi]

It’s definitely not the most controllable lifestyle, but there’s a reason it is growing so much in popularity. One of the largest increases in applications this year. I think people were more scared of anesthesiology before mid-levels showed up throughout medicine. There are close to 30,000 NPs graduating a year now.

I can tell you most med students applying into Anes prob have no idea what they are getting themselves into. Not saying it's a bad field just that most decide based on a Anes rotation 4 weeks in length and like it cause it's chill. Gets let out by the resident early and have no expectations. Probably sees the attending on the phone in the OR etc.

I'm not sure why there's a such huge increase in applicants. Does it correlate with the increase in med students ? A lot of new schools opened lately

 

[<(^_^)>]

I can tell you most med students applying into Anes prob have no idea what they are getting themselves into. Not saying it's a bad field just that most decide based on a Anes rotation 4 weeks in length and like it cause it's chill. Gets let out by the resident early and have no expectations. Probably sees the attending on the phone in the OR etc.

I'm not sure why there's a such huge increase in applicants. Does it correlate with the increase in med students ? A lot of new schools opened lately

You may be right about anesthesia rotations fueling it somewhat, but that isn’t anything new. Applications are up in general, but not nearly as much as anesthesia is up. It’s up about 30% over the last 2 years.

I also can’t think of a field that doesn’t end up being worse than the rotation. Anesthesia might be slightly better in a way - a lot find it boring if the person does 0 intra-op teaching.

There is a lot of doom and gloom on anesthesia boards - but people don’t realize that’s the general mood within medicine on the whole. 30,000 NPs graduate every year, as well as 8,000 PAs. Internal med, emergency med, peds, family med, dermatology etc. are all being swamped with mid-levels.

Anyway I’m not arguing people should be more enthusiastic about anesthesia - only that relative to other fields at least anesthesia is growing in popularity.

 

[anbuitachi]

You may be right about anesthesia rotations fueling it somewhat, but that isn’t anything new. Applications are up in general, but not nearly as much as anesthesia is up. It’s up about 30% over the last 2 years.

I also can’t think of a field that doesn’t end up being worse than the rotation. Anesthesia might be slightly better in a way - a lot find it boring if the person does 0 intra-op teaching.

There is a lot of doom and gloom on anesthesia boards - but people don’t realize that’s the general mood within medicine on the whole. 30,000 NPs graduate every year, as well as 8,000 PAs. Internal med, emergency med, peds, family med, dermatology etc. are all being swamped with mid-levels.

Anyway I’m not arguing people should be more enthusiastic about anesthesia - only that relative to other fields at least anesthesia is growing in popularity.

Bit different in doom and gloom. if you are fam med/IM, you can open your own practice and be your own boss. people today still prefer to see MDs over NPs if possible. And they have many fellowship options.

 

[deleted171991]

Bit different in doom and gloom. if you are fam med/IM, you can open your own practice and be your own boss. people today still prefer to see MDs over NPs if possible. And they have many fellowship options.

That's an incredibly important thing to consider. In anesthesia (or critical care), one can be the best thing since sliced bread and most of the patients wouldn't know (and possibly most of the surgeons either). All that matters is how good one is at smoke and mirrors, and kissing butt.

Most patients have NO idea that an anesthesiologist is an independent consulting physician. They think we are some monkeys directed by surgeons, because that's what they see on the TV. Hence they are perfectly OK to be cared for by nurse anesthetists. Fewer than 1% of them will protest, and even fewer will cancel their surgery.

 

[lady_south]

Also, any good programs for away rotations?

 

[lady_south]

Anyone have opinions on the HCA programs like Kendall Regional or Largo? They seem like good programs but extremely new.

 

[Mman]

Bit different in doom and gloom. if you are fam med/IM, you can open your own practice and be your own boss. people today still prefer to see MDs over NPs if possible. And they have many fellowship options.

the ability of a FP or IM doc to open their own practice out of residency is almost zero.

 

[anbuitachi]

the ability of a FP or IM doc to open their own practice out of residency is almost zero.

i must know special people

 

[AdmiralChz]

Anyone have opinions on the HCA programs like Kendall Regional or Largo? They seem like good programs but extremely new.

These are the absolute lowest of the low programs out there, to be honest. Minimal academic opportunities and most complex cases will be sent to real academic centers in the state like Miami, Gainesville, heck even Orlando Regional or Tampa General. I'd recommend this program only for very, very marginal candidates who are deadset on the specialty, have minimal aspirations for a fellowship (at least not Peds or cardiac), or have family ties that make them want to stay there. Unfortunately, the majority of their applicants (matriculants?) will be IMGs (mostly US Caribbean grads) and low-tier DOs (from brand new, rural schools) who have no success elsewhere.

If you can go anywhere, and I do mean anywhere else, then do it.

 

[Mman]

i must know special people

It is quite possible that you do.

The upfront cost alone is usually prohibitive between finding and renovating office space, hiring staff, being able to implement EMR and the fact that you basically have zero patients on day 1 and slowly build up from there. Nevermind that you aren't even credentialed by any commercial insurers so can't even really collect for anything.

Successful solo docs that have their own practice are almost always someone that branched out from a previous group and brought a large number of pre-existing patients with them.

 

[IMGASMD]

It is quite possible that you do.

The upfront cost alone is usually prohibitive between finding and renovating office space, hiring staff, being able to implement EMR and the fact that you basically have zero patients on day 1 and slowly build up from there. Nevermind that you aren't even credentialed by any commercial insurers so can't even really collect for anything.

Successful solo docs that have their own practice are almost always someone that branched out from a previous group and brought a large number of pre-existing patients with them.

There was someone on IM board recently talked about this. They were relatively new attending, worked for maybe a little over a year as hospitalist. They were talking about some challenges about saving enough operational costs for the first few months and sunk cost, shady practices regarding insurance companies. Overall, they were very excited. I suppose different people have different take on this endeavor.

 

[lady_south]

Anyone have suggestions for good anesthesia away rotations?

 

[anbuitachi]

Anyone have suggestions for good anesthesia away rotations?

what area are you looking at?

 

[lady_south]

My goal is to stay in the South East, although I know that my stats are going to require me to apply more broadly. I just want to go to aways where I can get decent letters as my home program has no anesthesia program.

 

[lady_south]

One more thing... my school approached me today due to my step score of 216 and recommended that I apply to primary care instead. I have no other red flags, but they want me to back up apply to family medicine or internal at minimum because “the 2019 match was harder than prior years.” Once again, this is coming from a random faculty advisor as we have no one in the feild of anesthesia that actually does advising. Do you all think that this will actually be necessary?

 

[hununuh]

One more thing... my school approached me today due to my step score of 216 and recommended that I apply to primary care instead. I have no other red flags, but they want me to back up apply to family medicine or internal at minimum because “the 2019 match was harder than prior years.” Once again, this is coming from a random faculty advisor as we have no one in the feild of anesthesia that actually does advising. Do you all think that this will actually be necessary?

Prob not necessary. Looks like this year was more competitive than my year (last year), but there are plenty of lower tier programs and community programs that would be happy to take a US graduate (MD). Be realistic, apply broadly, and you will be fine. Your best bet would be your home program, so when you do your anesthesia rotation, work hard and get to know the faculties.

 

[nimbus]

Prob not necessary. Looks like this year was more competitive than my year (last year), but there are plenty of lower tier programs and community programs that would be happy to take a US graduate (MD). Be realistic, apply broadly, and you will be fine. Your best bet would be your home program, so when you do your anesthesia rotation, work hard and get to know the faculties.

Unfortunately OP does not have a home program.

 

[Consigliere]

One more thing... my school approached me today due to my step score of 216 and recommended that I apply to primary care instead. I have no other red flags, but they want me to back up apply to family medicine or internal at minimum because “the 2019 match was harder than prior years.” Once again, this is coming from a random faculty advisor as we have no one in the feild of anesthesia that actually does advising. Do you all think that this will actually be necessary?

Yes.

 

[IMGASMD]

One more thing... my school approached me today due to my step score of 216 and recommended that I apply to primary care instead. I have no other red flags, but they want me to back up apply to family medicine or internal at minimum because “the 2019 match was harder than prior years.” Once again, this is coming from a random faculty advisor as we have no one in the feild of anesthesia that actually does advising. Do you all think that this will actually be necessary?

Why not? I think you will get in some lower tier programs, if you are normal and interview well. If not, need a few “just in case” options.

 

[hununuh]

Infortunately OP does not have a home program.

oof, totally missed that. That's tough. You will definitely need an away rotation. Also, see where prior graduates matched at. I would start looking at those programs for potential away rotations.

 

[jthedestroyr]

My rec, do pulm-ccm or cards and kill it.

My buddy doing pulm ccm has more money then he knows what to do with it. They bought him his own ultrasound machine no questions asked as a new grad meanwhile my academic program is doing more blocks than the program ever has and we can't even get 2 consistently working ultrasounds at anyone time despite them billing a ton.

That should show you how much value they think we are. You will thank us later.

 

[Twiggidy]

My rec, do pulm-ccm or cards and kill it.

My buddy doing pulm ccm has more money then he knows what to do with it. They bought him his own ultrasound machine no questions asked as a new grad meanwhile my academic program is doing more blocks than the program ever has and we can't even get 2 consistently working ultrasounds at anyone time despite them billing a ton.

That should show you how much value they think we are. You will thank us later.

I endorse this response.

 

[jthedestroyr]

One of the pulm guys in town is killing it, I've heard he is pulling in >600k. I know for fact my buddy is doing around that much as well, but he is working hard (55-65hr).

Another interesting point, at this private practice hospital, this ICU guy is the surgeons go to guy in SICU and CVicu.

Yes, you have to go through IM. I thought this was dreadful hence I went anesthesia to ccm, but if you saw how the IM people treat their own compared to anesthesia you'd be envious.

During hours of 12-1330 they have protected time DAILY IE not in clinic, if you're on call you don't have to return pages(yes you can't page IM resident on call during this time).

Want to know why anesthesia programs put their lectures in AM(majority)? It's because they can't afford to be without your warm body in the OR.

I'm sure more people can give you examples.

Anesthesia is nice because you don't have to think about your work at the end of the day, but what medical students don't understand, nor did I, is having your own patients makes you harder to replace.

 

[lady_south]

Hi guys! It’s so funny that you all have recommended this. I actually came to medical school to be a pulm/cc doctor, but got tied up in all the beurocracy and let what I really wanted drift aside for what I thought would be a better life. I think that’s the route I am going to take, as I already have pulmonary research, etc. I appreciate the reminder from you guys!

 

[hununuh]

One of the pulm guys in town is killing it, I've heard he is pulling in >600k. I know for fact my buddy is doing around that much as well, but he is working hard (55-65hr).

Another interesting point, at this private practice hospital, this ICU guy is the surgeons go to guy in SICU and CVicu.

Yes, you have to go through IM. I thought this was dreadful hence I went anesthesia to ccm, but if you saw how the IM people treat their own compared to anesthesia you'd be envious.

During hours of 12-1330 they have protected time DAILY IE not in clinic, if you're on call you don't have to return pages(yes you can't page IM resident on call during this time).

Want to know why anesthesia programs put their lectures in AM(majority)? It's because they can't afford to be without your warm body in the OR.

I'm sure more people can give you examples.

Anesthesia is nice because you don't have to think about your work at the end of the day, but what medical students don't understand, nor did I, is having your own patients makes you harder to replace.

How does being an intensivist that change every week different from anesthesia? They are just as easily replaceable as ER docs staffing the ER. It's not like patients will choose a hospital because they hear "Dr. Intensivist at this hospital is amazing." They get whoever is available. I don't understand how being an intensivist makes you harder to replace when it still doesn't "bring in" patients as opposed to surgeons or cardiologist.

 

[Dr.Jekyll75]

Apply broadly , do at least 2 2 week aways , especially If you are a Do. Icu let would be good like everyone says. I do recommend you do a back up. Not matching sucks more than matching to back up imo. The soap this year was terrible

 

[jthedestroyr]

How does being an intensivist that change every week different from anesthesia? They are just as easily replaceable as ER docs staffing the ER. It's not like patients will choose a hospital because they hear "Dr. Intensivist at this hospital is amazing." They get whoever is available. I don't understand how being an intensivist makes you harder to replace when it still doesn't "bring in" patients as opposed to surgeons or cardiologist.

1) If you're actually good at your job, people in surgery world will want you (see private practice person I quoted)

2)medicine side, they just dump people off, so they're also your patients also unlike surgery world which is still open unit versus rare closed. No such thing as an open unit in micu.

3) youre right, they don't choice a hospital because of Mr ICU doctor(sicu), but see number 1. Also MEDICINE side typically do pulm on top which also brings in patients which means they do come to the hospital expecting to see you.

I'm sure other people can chime in, but the pulm-ccm guys are doing much much better than surgery-ccm/anesthesia side.

For the life of me, I don't know why the trauma guys do ccm. Work trauma call --> unit for a week --> back to general surgery (no time off).

That to me is insane.

 

[hununuh]

1) If you're actually good at your job, people in surgery world will want you (see private practice person I quoted)

2)medicine side, they just dump people off, so they're also your patients also unlike surgery world which is still open unit versus rare closed. No such thing as an open unit in micu.

3) youre right, they don't choice a hospital because of Mr ICU doctor(sicu), but see number 1. Also MEDICINE side typically do pulm on top which also brings in patients which means they do come to the hospital expecting to see you.

I'm sure other people can chime in, but the pulm-ccm guys are doing much much better than surgery-ccm/anesthesia side.

For the life of me, I don't know why the trauma guys do ccm. Work trauma call --> unit for a week --> back to general surgery (no time off).

That to me is insane.

Thanks for the insight. Another follow up question.

Is it easy for Anesthesia CCM trained intensivists to join MICU or a closed ICU? Or, are they mostly limited to open-CTICU and open-SICU?

 

[jthedestroyr]

@FFP can give insight to this

Closed ICU I've heard are maybe becoming a thing in such but I wouldn't hold my breath for more sicu to be closed. By default MICU is closed.

 

[deleted171991]

Thanks for the insight. Another follow up question.

Is it easy for Anesthesia CCM trained intensivists to join MICU or a closed ICU? Or, are they mostly limited to open-CTICU and open-SICU?

No. Yes.

It's not the open vs closed that's the problem. It's MICU vs SICU. Medical intensivists are afraid of surgical intensivists being better and taking over, hence the former tend to not hire the latter. Surgical intensivists don't like to function as primary (and some are too incompetent to run a MICU).

 

[Twiggidy]

Anesthesia is nice because you don't have to think about your work at the end of the day, but what medical students don't understand, nor did I, is having your own patients makes you harder to replace.

This. Part. Right. Here.