Anesthesia Residency-Mayo Rochester thoughts

[Piolho]

Hello everyone,

I am wondering if anyone has any thoughts about the Mayo (Rochester) anesthesia residency, like culture/vibe, quality of training, hours worked weekly or any other pros and cons of the program. From my quick web search appears to be a solid program, with the only "major" con been it's location/weather.


Thank you

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[BLADEMDA]

Location- Small population Weather- Miserable 8 months of the year.

 

[Piolho]

Location- Small population Weather- Miserable 8 months of the year.

Thanks for the reply, but I want more info in regards the program itself, other than the location and weather, which indeed are less than ideal.

 

[BLADEMDA]

Thanks for the reply, but I want more info in regards the program itself, other than the location and weather, which indeed are less than ideal.

Positives- Great reputation, lots of difficult cases, referral center for many rare diseases

Negatives- little trauma, over staffed in terms of ancillary support due to mega budget which will make you "weak" in terms of being prepared for most other hospitals, limited amounts of bread and butter cases

Overall a solid program with an excellent national reputation but a place better suited for those seeking a fellowship post residency.

 

[B-Bone]

Grew up there, trained there. Amazing case volume and complexity. We definitely did lots of bread and butter cases, but were not overworked doing a bunch of lap choles on call. My first ear tube was on a partially palliated tet kid. I did seven pheos as a resident. C-section/AVR combo case. You will get multiples/orders of magnitude of all the required training numbers, and do it all while not getting killed with insane hours doing belly wash-outs at 3 am. Good sized class (18/year), but residents are absolutely not the primary workforce. It's very collegial, your consultants (for God's sake, don't call them attendings!) are great teachers who are easy to work with and personable (for the most part). It's got all the fellowships you might want to do (peds, CV, pain, CCM, regional) as well as the ones you wouldn't (trauma, neuro, OB, transplant, etc). Research is very easy to get into, if that's your thing. Weak spots are peds (low volume of high acuity in Rochester, but have easy option to rotate at children's hospital in FL if you wish, of which most residents take advantage) and trauma (lots of it, actually, but not a ton of penetrating). Rochester is pretty lame in general, but is an easy drive from Minneapolis and its international airport hub. I definitely did date nights and dinners in Minneapolis as a resident, and it's not too onerous of a drive (<90 min). If you have a family (which most Mayo residents do), it's a cheap safe place to live/raise a family. As an example, there are lots of LDS residents, and many of them have lots of kids and a stay-at-home spouse and are able to make it work in a way you couldn't in SF/LA/NYC (or even Chicago, Portland or Seattle!).

I work in a high-paced, high acuity practice where we do everything (except sick kids and transplant) including cardiac, and we hire almost exclusively from Mayo. We just hired 5 of their CA-3s for next summer. Mayo grads are very well prepared for my job, and they get great fellowships and jobs. I think it's a top program, but I'm obviously biased

 

[BLADEMDA]

Mayo residents are spoiled. Some can overcome this upon graduation while others struggle. There is probably no program in the country with more funding and staff than Mayo. They are a very profitable hospital because of the limits placed on Medicaid (very little) and no pay (even less). The profits from Mayo are used to reinvest into better equipment, staffing and solid pay for the physicians.

Overall, a great program but on the "easy side" of training and doesn't reflect the type of staff or patients you are likely to see in the majority of hospitals.

B-Bone is definitely biased because the reputation of Mayo Residents is not on par with other top ten programs. I am being critical because that is what the OP asked for in his/her post. Despite my negatives I recommend MS-4s interview and consider Mayo. They do have a lot of positives as well.

 

[chocomorsel]

@B-Bone, what kind of patient was she CSection AVR combo? You just reminded me of a very sad case I have talked about here. Thanks.

 

[B-Bone]

I retract my support for this program. Definitely don't want to train at a place with too many resources. You'll end up needing to do fellowships in patient transport, nursing home placement, and paper charting just to get a job afterwards!

There are limititations and legitimate gripes about Mayo's program (as there are at every program in the country), but having too many resources and being spoiled is not one of them. You definitely work fewer hours than some of the other big name programs, but the hours you spend at work are spent doing big cases on sick patients and learning how to manage difficult anesthetics, not getting stuck in the eyeball room/endo/diabetic foot I&Ds. If need that kind of case exposure to become a good anesthesiologist, than Mayo is probably not your program.

 

[deleted162650]

@B-Bone, what kind of patient was she CSection AVR combo?

I’m guessing a pregnant chick with tight AS?? Just a hunch though.

 

[B-Bone]

I’m guessing a pregnant chick with tight AS?? Just a hunch though.

This. Line up, GETA, femoral cannula placement, c/s, sternotomy, heparin/CPB, AVR, ICU. Pretty smooth, actually. Mom and baby did well.

 

[deleted162650]

This. Line up, GETA, femoral cannula placement, c/s, sternotomy, heparin/CPB, AVR, ICU. Pretty smooth, actually. Mom and baby did well.

Congenital bicuspid? Was she term?

 

[B-Bone]

Congenital bicuspid? Was she term?

Yes
No
I believe we did her at 34 weeks.

Remember, don't go train there, though. Too many resources.

 

[chocomorsel]

This. Line up, GETA, femoral cannula placement, c/s, sternotomy, heparin/CPB, AVR, ICU. Pretty smooth, actually. Mom and baby did well.

Unfortunately they refused to operate on mine who had IE. Said she would exanguinate on the table and die definitively. Too risky they said. They sectioned her, let her sit around for days waiting on negative cultures until she coded and they rushed her to the OR too late.
It really bothered me that they didn’t even want to take a chance on a new mom.

 

[Lurch]

Mayo residents are spoiled. Some can overcome this upon graduation while others struggle. There is probably no program in the country with more funding and staff than Mayo. They are a very profitable hospital because of the limits placed on Medicaid (very little) and no pay (even less). The profits from Mayo are used to reinvest into better equipment, staffing and solid pay for the physicians.

Overall, a great program but on the "easy side" of training and doesn't reflect the type of staff or patients you are likely to see in the majority of hospitals.

B-Bone is definitely biased because the reputation of Mayo Residents is not on par with other top ten programs. I am being critical because that is what the OP asked for in his/her post. Despite my negatives I recommend MS-4s interview and consider Mayo. They do have a lot of positives as well.

One of your better posts Blade because now I can remind bbone of his inferior training in the office tomorrow. Now if you could only settle the stanford>ucsf argument for us once and for all, I could finally rest easy.

Honestly, as far as a residency goes, Mayo is great. Residents get crazy high acuity cases when they work, work under slick attendings who are willing to teach them, and benefit from excellent didactics when not in OR. They have time for self study and academic projects as well (oh and family). The ones we hire tend to be well-rounded and internally driven individuals.

Good luck to OP.

 

[BLADEMDA]

I retract my support for this program. Definitely don't want to train at a place with too many resources. You'll end up needing to do fellowships in patient transport, nursing home placement, and paper charting just to get a job afterwards!

There are limititations and legitimate gripes about Mayo's program (as there are at every program in the country), but having too many resources and being spoiled is not one of them. You definitely work fewer hours than some of the other big name programs, but the hours you spend at work are spent doing big cases on sick patients and learning how to manage difficult anesthetics, not getting stuck in the eyeball room/endo/diabetic foot I&Ds. If need that kind of case exposure to become a good anesthesiologist, than Mayo is probably not your program.

This isn't about eyeballs. The entire Mayo culture is not reflective of most hospitals in the USA. Residents who train at Mayo may have trouble adapting to the "real world" where funding is limited and assistance like techs are sparse. In addition, the latest and greatest gadgets may not be available in every room like Mayo. Mayo doesn't follow many of the same preop testing rules most of use in private practice. They tend to order many more tests than most places.

If you interview at Mayo I urge you look at these things I have commented on and see for yourself. Compare Mayo to the other programs and see what is a better fit for you. The training itself at Mayo is very good but there are negatives and many private practice attendings have met "spoiled" Mayo residents.

I know some of the Residents of today expect a "cushy" program and want all the perks a Mayo can provide so perhaps, that is indeed the place for you.

 

[BLADEMDA]

One of your better posts Blade because now I can remind bbone of his inferior training in the office tomorrow. Now if you could only settle the stanford>ucsf argument for us once and for all, I could finally rest easy.

Honestly, as far as a residency goes, Mayo is great. Residents get crazy high acuity cases when they work, work under slick attendings who are willing to teach them, and benefit from excellent didactics when not in OR. They have time for self study and academic projects as well (oh and family). The ones we hire tend to be well-rounded and internally driven individuals.

Good luck to OP.

The training and cases are not inferior. Please re-read my posts. Criticism is sometimes hard to take even at a luxury resort hospital like Mayo.

By the way, why not tell the OP who reads the TEE in the Cardiac rooms? Too much money and assistance can be a hindrance when learning your craft even if that sounds counter-intuitive to some.

 

[BLADEMDA]

Only 3% of Mayo's medical services revenue came from Medicaid in both 2018 and 2017, or $326 million and $291 million, respectively. The system estimated its unreimbursed cost of providing services to Medicaid patients was $511 million in 2018, up from $503 million in 2017.
Mayo estimates it spent $78 million providing charity care in 2018, about 0.62% of revenue, compared with $72 million in 2017. In 2016, Mayo was near the bottom of Modern Healthcare's list of systems based on the proportion of revenue spent on charity care, at 0.76%.

Mayo Clinic latest health system to report hit by volatile equities market

Mayo Clinic's total investment returns fell 94% in 2018 year-over-year as the not-for-profit system weathers volatile markets.

www.modernhealthcare.com

 

[MoMoGesiologist]

This. Line up, GETA, femoral cannula placement, c/s, sternotomy, heparin/CPB, AVR, ICU. Pretty smooth, actually. Mom and baby did well.

This may be a dumb question, but would it have been possible to do the c/s then come back later for AVR? Why did it need to happen all at once? Seems like she got her c/s without issue then the patient turned into a regular cardiac AVR case

 

[MoMoGesiologist]

The training and cases are not inferior. Please re-read my posts. Criticism is sometimes hard to take even at a luxury resort hospital like Mayo.

By the way, why not tell the OP who reads the TEE in the Cardiac rooms? Too much money and assistance can be a hindrance when learning your craft even if that sounds counter-intuitive to some.

Who reads the TEE in the cardiac rooms?

 

[B-Bone]

Who reads the TEE in the cardiac rooms?

Whoever is the TEE person for the day produces the report. This is either a cardiologist or a CV anesthesiologist. They produce a report for all the heart rooms for the day. They have a fellow, either cardiology or CV anesthesia. The resident/attending covering the room also do TEE throughout the case, but don't need to produce a report. I'm not sure how this is a negative, as the resident (I assume) wouldn't be producing a report at any institution. Residents are required to do 4 months of CV anesthesia, and most do an additional "senior" month and/or a dedicated TEE month (where you are on the TEE team and do 10-15 TEE/per day). I did enough TEE during my >200 pump cases to pass the basic periop TEE exam and get certified. I routinely do TEE in my current practice.

 

[Lurch]

Who reads the TEE in the cardiac rooms?

They have a dedicated echo service comprised of cardiologists and anesthesiologists who do intraop tee. The reports are drafted by the fellow and signed off on by the consultant and both interpret for surgeon in real time. Not sure why this is an issue.

Blade, I disagree with your assessment of the mayo product. You characterize them as unable to hack it in real world. I have had extensive experience dealing with their graduates and they excel in our pp model. How much of your assessment is hearsay vs personal experience? If personal experience, was your n>1?

As an aside, what testing are you talking about that a mayo graduate would order that another wouldn’t?

I did not do residency there and do not consider myself biased towards their program fwiw.

Now if you could answer my question from my previous post, I would appreciate it.

 

[chocomorsel]

They have a dedicated echo service comprised of cardiologists and anesthesiologists who do intraop tee. The reports are drafted by the fellow and signed off on by the consultant and both interpret for surgeon in real time. Not sure why this is an issue.

Blade, I disagree with your assessment of the mayo product. You characterize them as unable to hack it in real world. I have had extensive experience dealing with their graduates and they excel in our pp model. How much of your assessment is hearsay vs personal experience? If personal experience, was your n>1?

As an aside, what testing are you talking about that a mayo graduate would order that another wouldn’t?

I did not do residency there and do not consider myself biased towards their program fwiw.

Now if you could answer my question from my previous post, I would appreciate it.

So how did you get into your group considering they recruit "almost exclusively from Mayo"? Good connections?

 

[B-Bone]

Dr. Lurch had the good fortune to apply with our group the year Mayo did a huge expansion and hired 17 of their 18 residents on staff. Luckily, he's a pretty good doc, and he happened to train at the second best program in Northern California

BTW, is there some way to prevent him from reading this? He's going to get a big(ger) head.

 

[ProRealDoc]

The training and cases are not inferior. Please re-read my posts. Criticism is sometimes hard to take even at a luxury resort hospital like Mayo.

By the way, why not tell the OP who reads the TEE in the Cardiac rooms? Too much money and assistance can be a hindrance when learning your craft even if that sounds counter-intuitive to some.

Doesn't sound like Mayo is as badass as the Cleveland Clinic

 

[MoMoGesiologist]

Whoever is the TEE person for the day produces the report. This is either a cardiologist or a CV anesthesiologist. They produce a report for all the heart rooms for the day. They have a fellow, either cardiology or CV anesthesia. The resident/attending covering the room also do TEE throughout the case, but don't need to produce a report. I'm not sure how this is a negative, as the resident (I assume) wouldn't be producing a report at any institution. Residents are required to do 4 months of CV anesthesia, and most do an additional "senior" month and/or a dedicated TEE month (where you are on the TEE team and do 10-15 TEE/per day). I did enough TEE during my >200 pump cases to pass the basic periop TEE exam and get certified. I routinely do TEE in my current practice.

What’s the benefit of this? The pt gets one intraop anesthesiologist to do the case and TEE and another doctor to do TEE and write a report. Why can’t the intraop doc write the report?

 

[Ronin786]

I love how the focus is on who reads TEEs at Mayo where there are plenty of programs out there where the residents aren't allowed to touch the probe because of how many fellows are around.

It's a great program in a ****ty place. You'll get name brand recognition at the very least, which is unfortunately worth more than being the best anesthesiologist out there.

 

[TrojanGopher]

One of your better posts Blade because now I can remind bbone of his inferior training in the office tomorrow. Now if you could only settle the stanford>ucsf argument for us once and for all, I could finally rest easy.

I can help you with that: UCSF > Stanford.

In all seriousness, Mayo is a great program and the residents there come out plenty ready to work in the "real world."