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Hello everyone,

A number of my medical students and residents have referred me to this message board. The notion being that there may be value to having a current program director available to answer questions and provide general guidance in an open forum. As long as the community feels it is valuable, I am happy to do my part to contribute.

For those of you in the application process, I want to congratulate you on making it through recruitment season. While there is understandably a large amount of angst right now, try to remember that the vast majority of you are just a few months away from the start of a career that will bring meaning and satisfaction to your lives in ways you won't expect. The very best is all ahead of you, and every one of you should be proud of what you've done to make it to this point.

And on that note...let me know if there is anything I can help with.
 

pgg

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Welcome

If you don't mind, tell us a little about your program (e.g. community vs academic, size, etc). No need for specifics that could interfere with being anonymous if you don't want to go there.
 
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TheNolano

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Thanks for doing this.
Do you ever wonder if academicians may have a perhaps falsely optimistic outlook on the specialty since they are isolated from many of the forces that can cause PP docs to be bearish (AMCs, encroachment and job security, reimbursements)?
 
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Welcome

If you don't mind, tell us a little about your program (e.g. community vs academic, size, etc). No need for specifics that could interfere with being anonymous if you don't want to go there.
Happy to, if it helps provides additional context that is useful. We are a large ( > 80 residents + fellows), academic program in a major metropolitan area ( > 3M people).

With apologies to those who want to know exactly who we are, the thought is that any information provided is best considered on its own with limited bias. Additionally, the standard disclaimer about thoughts and opinions expressed only representing myself and not other members of our team or institution is extremely relevant.
 
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Thanks for doing this.
Do you ever wonder if academicians may have a perhaps falsely optimistic outlook on the specialty since they are isolated from many of the forces that can cause PP docs to be bearish (AMCs, encroachment and job security, reimbursements)?
This ventures a little outside the bounds of what I can offer the forum as a member of program administration. But my general opinion is that the fewer facts a person understands about the many factors affecting any complex issue, the more likely it is the viewpoint they form will be incomplete and inaccurate. You could just as easily ask if private practitioners have a mistaken view of academic medicine because they are isolated from some of the things we are subject to.

Its hard enough for groups and departments to manage their own practices within the changing economic pressures and population dynamics of their own cities. The number of people with the broad expertise required to speak authoritatively about where the entire specialty as a whole is heading is very small. The rest of us are making educated guesses based on our understanding of our own micro-environments.
 
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Why do academic programs pressure graduates to seek fellowships when the market clearly is not calling for it?
 

dchz

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Happy to, if it helps provides additional context that is useful. We are a large ( > 80 residents + fellows), academic program in a major metropolitan area ( > 3M people).

With apologies to those who want to know exactly who we are, the thought is that any information provided is best considered on its own with limited bias. Additionally, the standard disclaimer about thoughts and opinions expressed only representing myself and not other members of our team or institution is extremely relevant.
This is perfect. I want to thank you for doing this.

I don't really have any questions. However I would urge you to have at least a few financial lectures that have nothing to do with anesthesia for your program. And also lecture on anesthesia billing. Although not of the point of a residency program, the details of the economics of being a doctor and an anesthesiologist affects us too much to not be a part of residency education.
 
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Hello, what is a competitive step 1 score for anesthesiology?
It only took about 5 minutes of research on this forum to notice that the most common questions asked all involve assessing a medical student's potential for residency based on just a few objective measures like USMLE/COMLEX scores or class rank. It looks like there are many posts already dedicated to answering some version of this question, so it may be helpful if you provide a little more detail or context to your situation if you haven't gotten an answer to your question. My own feelings about this are accurately reflected in aggregate by a number of posts so while I'm happy to clarify my own feelings about this, I wish I had a more satisfactory answer for you. But the honest answer to your question is "it depends."

The job of a resident physician is extraordinarily complex, and the ability to discharge those duties at a high level involves skills like raw retention of raw knowledge, cognitive agility, physical dexterity, and social/emotional intelligence. And within the specialty itself, the skills you need to excel in different domains differ. Being great in the OR requires different skills from being great in the pain clinic, or great in the ICU. I can assure you all that of the hundreds of PDs and APDs out there, I have met exactly zero who feel that the quality of a resident's experience during training is predictable by exams.

About about USMLE Step 1. Past threads show that many posters have correctly cited NRMP data which breaks down the percentages of candidates who have successfully matched based on their Step 1 scores. As all of you already know, candidates with sub 200 scores successfully find positions. If you pass Step 1 and successfully graduate medical school, you will more than likely be competitive...somewhere. You have the potential to get into college with virtually any SAT score, just like you have the potential to get into residency with any passing Step 1 score. But I don't think I'm going surprise anyone by qualifying this by saying programs with the ability to be more selective with their candidates will likely set higher testing thresholds than programs without the same ability to be as selective. But even if you change your question to "What is a competitive Step 1 score at Program X", you might be able to compile a range of recent match statistics, but the answer is always going to be "It depends" because scores are only a minor part of how candidates are evaluated. Every single program I am familiar with has story after story of how some of their best residents came in with lower than average board scores.

It's been said before and bears repeating again, because those exams are the only benchmark common to all student across all institutions, the scores exist as a something programs can use to differentiate between candidates with similar applications. But by no means should they be seen as a measure of your potential to provide outstanding patient care or contribute to the specialty. Wondering what Step 1 score you need to be an anesthesia resident same as asking a college football coach "How fast do you need to run to be a quarterback?" Its just one metric that contributes in a small way to a person's ability to perform an very complex task.
 
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Why do academic programs pressure graduates to seek fellowships when the market clearly is not calling for it?
Short answer, I don't think that that we do. Allow me to elaborate.

One of the things I have noticed here is there seems to be a notion that all academic programs across the country move in lockstep to push a monolithic agenda. In my experience, the reality is opposite to this. Outside of adhering to the same standards for accreditation, individual programs are allowed to and even encouraged to innovate around the strengths that make their program unique. In fact, at the annual program director meeting (the SAAA), one of the most valuable parts of the programming is seeing the number of different ways programs across the country have come up with the address the same issue. I am unaware of a mandate from the ABA to increase the number of fellowship trained anesthesiologists...if someone has that email, please forward it to me.

There is great danger in making broad sweeping generalizations based on isolated incidents...I feel it is best to address issues as specifically as possible.

To answer your question a little more directly, I need to ask what do you mean by pressure? Who is doing the "pressuring?" A faculty member telling giving a trainee their honest opinion about the benefits of fellowship training might be seen as advice by some and pressure by others. Without a little bit more context, its hard for me to give you a better answer.

Can you please elaborate about what you mean by the market not calling for fellowships? Are you implying that fellowship trained anesthesiologists are no longer necessary and that the prevailing trends are going towards generalists doing more and more advanced cardiac/pediatric cases and running their own intervention pain clinics?
 
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This is perfect. I want to thank you for doing this.

I don't really have any questions. However I would urge you to have at least a few financial lectures that have nothing to do with anesthesia for your program. And also lecture on anesthesia billing. Although not of the point of a residency program, the details of the economics of being a doctor and an anesthesiologist affects us too much to not be a part of residency education.
Thank you for the suggestions. I wholeheartedly agree that those are very important issues that I feel most residents only become aware of once they complete their training

I am lucky to have some amazing folks in our billing department and financially savvy faculty members who have volunteered their time and expertise to do exactly what you suggest. Our experience has been that there is subgroup of residents who understand the importance of these issues and find the content helpful, but residents who are primarily concerned with core resident duties aren't quite so engaged. These seem to be topics that will only resonate with trainees when they're ready.

To anyone at a program that does not offer content in these subjects, please speak to your program director about it. Asking the billing office to educate residents and finding financially literate people who want to talk about smart decisions they've made in business and investing were two of the easiest things I've been involved in administratively.
 
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gofish6060

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From your personal experience, what are some of the stresses / pressures (from anywhere) that academic faculties face, that residents don't realize? What are some things that academic faculties wish they could tell their residents?
 
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Short answer, I don't think that that we do. Allow me to elaborate.

One of the things I have noticed here is there seems to be a notion that all academic programs across the country move in lockstep to push a monolithic agenda. In my experience, the reality is opposite to this. Outside of adhering to the same standards for accreditation, individual programs are allowed to and even encouraged to innovate around the strengths that make their program unique. In fact, at the annual program director meeting (the SAAA), one of the most valuable parts of the programming is seeing the number of different ways programs across the country have come up with the address the same issue. I am unaware of a mandate from the ABA to increase the number of fellowship trained anesthesiologists...if someone has that email, please forward it to me.

There is great danger in making broad sweeping generalizations based on isolated incidents...I feel it is best to address issues as specifically as possible.

To answer your question a little more directly, I need to ask what do you mean by pressure? Who is doing the "pressuring?" A faculty member telling giving a trainee their honest opinion about the benefits of fellowship training might be seen as advice by some and pressure by others. Without a little bit more context, its hard for me to give you a better answer.

Can you please elaborate about what you mean by the market not calling for fellowships? Are you implying that fellowship trained anesthesiologists are no longer necessary and that the prevailing trends are going towards generalists doing more and more advanced cardiac/pediatric cases and running their own intervention pain clinics?
There's no official mandate to push for fellowships, it's more of a collectively understood idea that the more fellows you have for a program, the less you have to spend on faculty salary. The more fellows you have, the less subspecialty cases available for residents. The less training residents get, the more likely they feel they need fellowship to prepare for an actual job.

There's also the bias of fellowship trained docs who say they only got their job because they had a fellowship.
 

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What would you tell graduating CA3 residents are the benefits vs. aggravations of academic medicine that one should plan for if seeking that path?
 
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There's no official mandate to push for fellowships, it's more of a collectively understood idea that the more fellows you have for a program, the less you have to spend on faculty salary. The more fellows you have, the less subspecialty cases available for residents. The less training residents get, the more likely they feel they need fellowship to prepare for an actual job.

There's also the bias of fellowship trained docs who say they only got their job because they had a fellowship.
I would caution people against oversimplifying complex issues. Ascribing a program's intention to use fellows as "cheap faculty extensions" implies you have a thorough understanding of that department's financial picture. Maybe this is true are your own institution, or ones you have be at in the past. Some programs might be simply extended partial faculty privileges to fellows as a way to augment their salary and attract candidates. I have first hand knowledge of a number of programs that don't engage in this as all.

Similarly, to simply say that having fellows will negatively impact case numbers for the core residents is another gross oversimplification. It is very possible that there are more sub-specialty cases posted per day than there are core residents to do them. If the pediatric experience is done at a 40 OR, quaternary care referral hospital, it is highly unlikely the core residents are impacted in any way. Can fellows interfere with the case numbers of the core residents? Yes. Does it always? Absolutely not. Again it would not surprise me if you work or trained at an institution where this might have been the case. But to imply to medical students and future residents that this is necessarily the the case paints a fundamentally incomplete picture.
 
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How likely do you think “Medicare for all” will be a thing and lower reimbursement to 25% or whatever.
Oh wow...this one is way out of the strike zone. But I think it is pretty easy to look at the possible heads of the executive branch and the possible majorities of the legislative branch and see which combinations would result in the chances of this happening being zero and which where it's non-zero. Vote your conscience based on the things that are important to you and we will all see where the process takes us.
 
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Dantrolene FC

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My school has told us to interview at 10 programs to be safe. They also say 50% of students match their number 1 program, while 75% match at their top 3 programs.

I am curious as to how those numbers look for the programs' side of the rank list. How many residents do you take each year? How many applicants do you interview each year? And how far down your rank list do you go to fill your program on an average year?

Feel free to use round numbers for anonymity purposes. I'm just curious what the general trend looks like for programs.
 
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Dantrolene FC

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Do you ask applicants for their Step 2 CS scores? And if you found out in February, well after interviewing someone, that they failed CS on their first attempt but passed on the second attempt, would that change how you rank the candidate?

...asking for a friend
 
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What would you tell graduating CA3 residents are the benefits vs. aggravations of academic medicine that one should plan for if seeking that path?
Seeing as how this is similar to the other question about unknown pressures of academic medicine, I will combine my response here.

I've always believed giving good career advice to a resident needs to start with an honest and extensive examination at what that resident wants from his/her career. What sort of work life balance do they see for themselves? What sort of cases do you like to do? Do you have a preference for one kind of workplace environment? Where in the country to you want to live? What have been the experiences that have really bothered the resident during training? The more insight a resident has into what will lead to a fulfilling and meaningful career/life combo, the better able we are to see what's right for them. The question isn't "Is academic medicine better or worse than private medicine?" The question is, "Which is the practice model that will best help you realize your goals?"

Without starting there, all you have are the reasons the adviser did what they did. That might be helpful in some way, but unless some of those reasons resonate with factors that matter to the resident, its just interesting conversation.

As for the benefits/aggravations that are applicable to me...the main reasons I chose academic medicine were how much I enjoyed the rotations where I had the opportunity to help teach junior residents as well and being able to practice in an environment of intellectual inquiry with mentors that looked up to. I'm thankful that I continue to feel that way now that I am involved in developing a lot more than a few residents at a time.

Keep in mind that I'm someone that greatly enjoys their job. So the following gripes aren't really things that occupy very much head space on a regular basis. And to the residents reading this, I think you will be amused that they are pretty similar to yours. The talk in the faculty lounge is commonly about the promotion and tenure process, how our evaluations might not be fair/useful/punitive, being asked to do more with the same resources, wondering if our department leadership listens to us, and so on.

But like I said, for me these are minor things. I'm fortunate in that I made the right choice for me. I would advise Maverikk and GoFish to focus on finding a job that checks the most boxes in the positive column and try to avoid only the biggest items among the negatives. If you like where you are, what you do, and who who work with, the minor inconveniences that exist in every job won't really matter.
 
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epidural man

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ummm...not to have to ask again, but Jeffrey Epstein?
 

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Short answer, I don't think that that we do. Allow me to elaborate.

One of the things I have noticed here is there seems to be a notion that all academic programs across the country move in lockstep to push a monolithic agenda. In my experience, the reality is opposite to this. Outside of adhering to the same standards for accreditation, individual programs are allowed to and even encouraged to innovate around the strengths that make their program unique. In fact, at the annual program director meeting (the SAAA), one of the most valuable parts of the programming is seeing the number of different ways programs across the country have come up with the address the same issue. I am unaware of a mandate from the ABA to increase the number of fellowship trained anesthesiologists...if someone has that email, please forward it to me.

There is great danger in making broad sweeping generalizations based on isolated incidents...I feel it is best to address issues as specifically as possible.

To answer your question a little more directly, I need to ask what do you mean by pressure? Who is doing the "pressuring?" A faculty member telling giving a trainee their honest opinion about the benefits of fellowship training might be seen as advice by some and pressure by others. Without a little bit more context, its hard for me to give you a better answer.

Can you please elaborate about what you mean by the market not calling for fellowships? Are you implying that fellowship trained anesthesiologists are no longer necessary and that the prevailing trends are going towards generalists doing more and more advanced cardiac/pediatric cases and running their own intervention pain clinics?
How about that general anesthesiologists are in high demand compared to sub specialty trained in many big cities. As a resident, I’ve heard from many attendings things along the lines of: “do a fellowship to protect yourself from mid level encroachment”, “doing a fellowship will help you get xyz job”.
 
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abolt18

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How about that general anesthesiologists are in high demand compared to sub specialty trained in many big cities. As a resident, I’ve heard from many attendings things along the lines of: “do a fellowship to protect yourself from mid level encroachment”, “doing a fellowship will help you get xyz job”.
I’ve literally never had any comments like this from our 55+ faculty members at my program. If anything I’ve had more comments from the generalists saying things like “why are you applying for fellowship? You don’t need a fellowship to do anesthesia unless you want to take care of NICU babies” which obviously shows their own biases.
 
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I’ve literally never had any comments like this from our 55+ faculty members at my program. If anything I’ve had more comments from the generalists saying things like “why are you applying for fellowship? You don’t need a fellowship to do anesthesia unless you want to take care of NICU babies” which obviously shows their own biases.
I've literally heard from 90% of my residency attendings that a fellowship is a must for:

Finding a good job
Getting paid well
Getting more experience before getting a job to appear more confident and impress
 
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I hope all the trainees and medical students reading this conclude from the variance in responses that there really is no answer to fellowship vs. non-fellowship. Regional economic conditions and practice environments are far more important than any mythical national trends. As you can see, plenty of us live in areas where there are excellent jobs available to generalists. Although I do think it would be interesting to do a study and see what sort of influence the presence or absence of fellowship training has on the advice given.

I would advise all trainees who are making this decision that you are best served by focusing on the kind of practice you want to have and then doing what it takes to make that happen. That is what you've done your whole life. You all wanted to be doctors and in order to do that you went to med school, it wasn't the other way around where you just went to med school and then figured out you wanted to go into medicine. After that you've decided you wanted to be anesthesiologists and then you went to residency, you didn't do a residency first in order to decide that's what you wanted to specialize in.

So if you love doing hearts and want that to be a big part of your career, do a cardiac fellowship. If you really want to stay on as faculty in your department and your Chair tells you he has to hire fellowship trained candidates, do a fellowship. If there is a group you want to work for or a city you want to live in and you know for sure they are only hiring fellowship trained specialists, do a fellowship. It doesn't have to be more complicated than that. Doing a fellowship as a nebulous way to insure against unemployment is in my experience unnecessary. The best insurance against unemployment is to be great at what you do, a pleasure to work with, and enthusiastic about going the extra mile to help your group/department/surgeons/partners succeed. The fastest way to be replaced by a mid-level provider is to expect to be paid 2-3 times as much as one, and behave in a way that provides no additional value.

Yes, I would agree there is some merit to those that say having fellowship training gives you skills and expertise that generalists do not have. And yes, being fellowship trained doesn't mean you can't take a position that only requires general skills. But I would also say that doing a fellowship you are not that excited to do is another year of your prime spent putting off goals, a year less of partnership earnings, and a year spent being having to manufacture enthusiasm in order to avoid being known as that fellow who is going through the motions. It happens to be surprisingly easy to spot even talented residents who are just getting by.
 
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Spoken like a true wise man/woman.

I am curious what are some of the most interesting things you have heard from interviewing students that made you think "I want this student at my program!"
If you were to poll a random sample of PDs and APDs and ask them what sorts of life experiences really stand out in making a candidate someone they really want, you would be very surprised at the variability. Some people really love any kind of military service, others have a soft spots for candidates who are the first people in their families to go to college, a lot of people really like the candidate who immigrates here and makes it through medical school all while supporting their families back home.

Personally for me, the things that really catch my notice are the candidates who demonstrate the willingness to put themselves through things that hardly anyone else will in order to be elite at what they do, because just being very good isn't good enough.

Imagine this candidate. Due to family issues, this candidate had to drop out of school in order to work in the family business...after doing that for a few years rather than go straight back to school he decided to serve his country and became a combat medic in the army. But that's not enough, he wants to do more so he does what it takes to become a Green Beret. But that isn't enough, so he does what it takes to become a medic in a different unit. Which out of respect for what he did, I'll use the official rather than nickname for, the 1st Special Forces Operation Detachment-Delta. After he gets out of that, he has all sorts of civilian job opportunities, but says nah..."Being a medic was great, taking care of people is what I want to do so I'm going to nursing school." Does that, but in his first year out as a nurse he decides that being an MD and directing the care would be way more fulfilling so he grinds it out with more classes but is reaching the limit of his raw ability at the biological sciences, so his grades and MCATs aren't stellar in comparison to his other pre-med peers. But he gets it done. Struggles a little bit his first year but figures it out and has a perfectly fine medical school career with roughly median level scores and grades and decides to be an to be an anesthesiologist.

Guess what the answer is going to be if you ask a PD if they think going 231/233 is going to be competitive enough? And do you think the answer would be different at 207/215?
 
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Do you ask applicants for their Step 2 CS scores? And if you found out in February, well after interviewing someone, that they failed CS on their first attempt but passed on the second attempt, would that change how you rank the candidate?

...asking for a friend
Missed this one. But I think it's very relevant considering the amount of application review going on around the country right now. Based on what's in the rest of the application, it is not unusual to extend interview invitations to applicants with missing scores, especially early in the season. I will say that at our program, applicants we interview with missing Step 2 scores will go through initial discussion, but are not given full consideration until complete.

Your friend needs to know that there are zero circumstances where an application is better off with a missing Step 2 CS. Without question there are programs that will not rank an application because of a missing Step 2 CK or CS. While I obviously cannot speak for every recruitment committee, or even the other members of my own...I am not going very far out on a limb by speculating that the majority of programs have applications that the declined to interview or rank because of missing (not low) scores. The reality is with the number of applications we are getting, we are often in a situation where we have a number of applications that we feel very similar about. And when that happens, the application that is missing a required benchmark will go straight to the bottom of that pile.

Your friend would be very well served to contact every program he or she is going to rank the second they receive that passing score. It can only help. Speaking for myself, I would always prefer to see an application with a failed 1st attempt at CS with a subsequent pass than to see that same application with a vacant CS. Always.

As for how it how much it might change what they think about you...I mean your friend, I can't say. It depends on what's in the rest of the application and how the interview went. The relative importance of test results is an important discussion more worthy than as a final aside to an answer about Step 2 CS.

If your friend would like to discuss things in more detail, please have them message me. This place has direct messages right?
 
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Dantrolene FC

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Missed this one. But I think it's very relevant considering the amount of application review going on around the country right now. Based on what's in the rest of the application, it is not unusual to extend interview invitations to applicants with missing scores, especially early in the season. I will say that at our program, applicants we interview with missing Step 2 scores will go through initial discussion, but are not given full consideration until complete.

Your friend needs to know that there are zero circumstances where an application is better off with a missing Step 2 CS. Without question there are programs that will not rank an application because of a missing Step 2 CK or CS. While I obviously cannot speak for every recruitment committee, or even the other members of my own...I am not going very far out on a limb by speculating that the majority of programs have applications that the declined to interview or rank because of missing (not low) scores. The reality is with the number of applications we are getting, we are often in a situation where we have a number of applications that we feel very similar about. And when that happens, the application that is missing a required benchmark will go straight to the bottom of that pile.

Your friend would be very well served to contact every program he or she is going to rank the second they receive that passing score. It can only help. Speaking for myself, I would always prefer to see an application with a failed 1st attempt at CS with a subsequent pass than to see that same application with a vacant CS. Always.

As for how it how much it might change what they think about you...I mean your friend, I can't say. It depends on what's in the rest of the application and how the interview went. The relative importance of test results is an important discussion more worthy than as a final aside to an answer about Step 2 CS.

If your friend would like to discuss things in more detail, please have them message me. This place has direct messages right?
Thanks for the response. I sent you a direct message.
 

dannyboy1

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I wish I could post this in the lounge at our shop.
Please. Makes little to no difference. The bean counters who employ us neither know nor care about quality anesthesia. The minimum level service that keeps the hospital/surgeons happy and generates billing is the only thing they care about. The only thing that saves us (for now) are insurance rules and hospital bylaws. For how much longer, who can tell.....
 
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The fastest way to be replaced by a mid-level provider is to expect to be paid 2-3 times as much as one, and behave in a way that provides no additional value except acccepting all liability on the whole thing.
I fixed it.
 

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Please. Makes little to no difference. The bean counters who employ us neither know nor care about quality anesthesia. The minimum level service that keeps the hospital/surgeons happy and generates billing is the only thing they care about. The only thing that saves us (for now) are insurance rules and hospital bylaws. For how much longer, who can tell.....
Actually they do know the difference. They just hate paying up for it. Making them own their decisions in writing is one of the few effective cards that we have to play. Make the suits own it.


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Actually they do know the difference. They just hate paying up for it. Making them own their decisions in writing is one of the few effective cards that we have to play. Make the suits own it.


Sent from my iPhone using SDN mobile
With all these “telemedicine” this and that, it’s even more apparent that the suits know the differences but just don’t care. Or the benefit is much greater than risks. After all, they aren’t trained to save lives.

Worked at a remote hospital that has tele neurology, rather than have neurology on call. Also either read or heard somewhere they have tele psych on call. Much cheaper for the hospital to “staff” different specialists. And the money they save, partially goes to the war chest if they get sued. Rest of the saving.... goes not the doctors I am sure.
 

dannyboy1

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With all these “telemedicine” this and that, it’s even more apparent that the suits know the differences but just don’t care. Or the benefit is much greater than risks. After all, they aren’t trained to save lives.

Worked at a remote hospital that has tele neurology, rather than have neurology on call. Also either read or heard somewhere they have tele psych on call. Much cheaper for the hospital to “staff” different specialists. And the money they save, partially goes to the war chest if they get sued. Rest of the saving.... goes not the doctors I am sure.
I don’t think administrators/AMC suits even factor in lawsuits. Their job is to present present profits and a nice looking powerpoint at the end of each quarter. Some vague, nebulous lawsuit which may never materialize at some point in the future is not on the radar. Besides, they have insurance for that $hit. Malpractice concerns are more a problem for an individual physician on whose record it goes. For a large corporation, just the cost of doing business.....
 
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May 28, 2019
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I don’t think administrators/AMC suits even factor in lawsuits. Their job is to present present profits and a nice looking powerpoint at the end of each quarter. Some vague, nebulous lawsuit which may never materialize at some point in the future is not on the radar. Besides, they have insurance for that $hit. Malpractice concerns are more a problem for an individual physician on whose record it goes. For a large corporation, just the cost of doing business.....
Youre spot on boy danny. malpractice is Not on the suits'radar. They could give a rats ass. they have insurance. BUt what they DO care about though is publicity. SO if somehow there are well publicized bad outcomes(peds death, brain injury etc etc) and they are tied to hospital putting profit over patient safety ( sort of like what happened at the plastic surgeons office) that will keep administrators up at night.
 

Nuriko

10+ Year Member
Feb 13, 2007
130
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Over the years, there have been numerous threads (presumably from past residents) warning medical students/applicants to avoid certain programs. If there was such a thread posted about your program (and perhaps there has been), A) How would you respond to such accusations, both publicly and within your department, and B) What advice would you give to potential applicants who read threads and have doubts about your program?
 
OP
A
Jan 8, 2020
19
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Attending Physician
Over the years, there have been numerous threads (presumably from past residents) warning medical students/applicants to avoid certain programs. If there was such a thread posted about your program (and perhaps there has been), A) How would you respond to such accusations, both publicly and within your department, and B) What advice would you give to potential applicants who read threads and have doubts about your program?
Nuriko,

These are excellent questions.

A. As a general principle, I do not feel a response is necessary to these posts. After all, everyone has the freedom to post their thoughts about their own experiences. I believe this website was established more than 20 years ago, and if I am not mistaken there are more than 380,000 posts in the Anesthesiology forum alone. Times passes, programs evolve, and ultimately I do not feel it would be either a benefit to anyone or a good use of my time to chase down and respond to every perceived slight or rumor that might be out there.. Maybe I would change my mind if I was made aware of something written that is intended to deliberately harm us. But outside of something that borders on libel, it would be hard to imagine any members of our team wanting to engage.

B. To the medical students and trainees here who read those posts and use them as a basis to form opinion, the phrase "Trust but Verify" is strongly applicable. You do yourself a grave disservice by making a potentially career altering decision based on what an unknown person with unknown motivations writes on a public forum. A dissatisfied resident likely references a number of things they feel are wrong, some objectively verifiable and others being subjective feelings about their experience. Issues about duty hours, the amount of call, or how vacations are scheduled are fairly easy to corroborate. As for subjective terms like "malignant" or "unsupportive" it is wise to reserve judgement until you know the full context of what happened.

Let's say a resident describes uses those very terms in a post, "The attendings here are all malignant and the program has never supported me." Imagine these two scenarios and how they make you feel about the program.

1. This resident endured overly harsh criticism from an attending after making a common CA-1 error like intubating the esophagus, that attending then spread a bunch of rumors about how horrible this resident's technical skills and now his nickname among the faculty is "goose." The response of his program was to tell him to just toughen up and there's nothing they can do.

2. After verbal counseling, written counseling, being asked to attend institutional ethics and conduct training, and an internal performance improvement plan, this resident was deemed by his clinical comp committee as ABA unsatisfactory for professionalism and received a corrective action of probation due to continuing verbal abuse and physical harassment of hospital staff. He is informed that any issues going forward will result in either extension of his training or termination.

Clearly I'm using two fairly extreme examples, but the hope is to illustrate that context is everything.

I would also advise students and trainees to understand that not everyone makes the right choice in the match. Unfortunately some candidates make errors in self-assessment which result in match decisions that place the resident in a program or specialty not suited to them or their family. I mention this only because when I think of the unhappiest residents we've had here, our biggest administrative successes have been working with the them in finding the right place. In all the cases I've been involved in, I am glad to say that these residents have thrived.

I'd finally like to point out to the students that as a general observation, the opinions here can be somewhat hyperbolic. Understand that individual experiences may have justifiably led to some of those positions (PP vs. academics, fellowship/non-fellowship, CRNAs vs. MDs, hospital admin vs. physicians, good vs. bad programs), but those experiences are not your own and are rarely a broad representation of what happens across the spectrum of the specialty. Reality is usually more nuanced than an opposing pair of passionately held sentiments. In some ways, the debates about these issues closely resemble the sides people take in political discussions. But the good news for you is you have WAY more than two options with respect to specialties, jobs, and practice/compensation models. No, not everyone's interests are aligned with yours, but if you do your homework and know yourself well, the future is very bright.
 
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Aug 3, 2018
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How do you feel about sub specialization affecting your program and non university positions? Specifically, with respect to call, compensation, daily scheduling? At trauma centers it takes a minimum of 3 radiologist to review trauma studies in a patient. A neuro, chest and body imager. All have to be on call each night. If a post open heart patient is bleeding and returns to the OR later that night, does a subspecialist come in for the case or does the generalist on call get a field promituon to handle a cardiac patient? I personally feel sub specialization diminishes quality of life. Your comments might be useful to residents ruminating over whether to do a fellowship. Thank you for posting on this forum. Not many program directors here.
 
May 28, 2019
400
353
Status
Attending Physician
Nuriko,

These are excellent questions.

A. As a general principle, I do not feel a response is necessary to these posts. After all, everyone has the freedom to post their thoughts about their own experiences. I believe this website was established more than 20 years ago, and if I am not mistaken there are more than 380,000 posts in the Anesthesiology forum alone. Times passes, programs evolve, and ultimately I do not feel it would be either a benefit to anyone or a good use of my time to chase down and respond to every perceived slight or rumor that might be out there.. Maybe I would change my mind if I was made aware of something written that is intended to deliberately harm us. But outside of something that borders on libel, it would be hard to imagine any members of our team wanting to engage.

B. To the medical students and trainees here who read those posts and use them as a basis to form opinion, the phrase "Trust by Verify" is strongly applicable. You do yourself a grave disservice by making a potentially career altering decision based on what an unknown person with unknown motivations writes on a public forum. A dissatisfied resident likely references a number of things they feel are wrong, some objectively verifiable and others being subjective feelings about their experience. Issues about duty hours, the amount of call, or how vacations are scheduled are fairly easy to corroborate. As for subjective terms like "malignant" or "unsupportive" it is wise to reserve judgement until you know the full context of what happened.

Let's say a resident describes uses those very terms in a post, "The attendings here are all malignant and the program has never supported me." Imagine these two scenarios and how they make you feel about the program.

1. This resident endured overly harsh criticism from an attending after making a common CA-1 error like intubating the esophagus, that attending then spread a bunch of rumors about how horrible this resident's technical skills and now his nickname among the faculty is "goose." The response of his program was to tell him to just toughen up and there's nothing they can do.

2. After verbal counseling, written counseling, being asked to attend institutional ethics and conduct training, and an internal performance improvement plan, this resident was deemed by his clinical comp committee as ABA unsatisfactory for professionalism and received a corrective action of probation due to continuing verbal abuse and physical harassment of hospital staff. He is informed that any issues going forward will result in either extension of his training or termination.

Clearly I'm using two fairly extreme examples, but the hope is to illustrate that context is everything.

I would also advise students and trainees to understand that not everyone makes the right choice in the match. Unfortunately some candidates make errors in self-assessment which result in match decisions that place the resident in a program or specialty not suited to them or their family. I mention this only because when I think of the unhappiest residents we've had here, our biggest administrative successes have been working with the them in finding the right place. In all the cases I've been involved in, I am glad to say that these residents have thrived.

I'd finally like to point out to the students that as a general observation, the opinions here can be somewhat hyperbolic. Understand that individual experiences may have justifiably led to some of those positions (PP vs. academics, fellowship/non-fellowship, CRNAs vs. MDs, hospital admin vs. physicians, good vs. bad programs), but those experiences are not your own and are rarely a broad representation of what happens across the spectrum of the specialty. Reality is usually more nuanced than an opposing pair of passionately held sentiments. In some ways, the debates about these issues closely resemble the sides people take in political discussions. But the good news for you is you have WAY more than two options with respect to specialties, jobs, and practice/compensation models. No, not everyone's interests are aligned with yours, but if you do your homework and know yourself well, the future is very bright.
You ever hear people say stuff but they really arent say anything... That's the feeling I get when you talk/post.
Everyone knows a crap program. And all residents are motivated by the same things. To say, well maybe the resident chose the wrong program for their family and they did not self assess properly is absolute baloney. You sir are a FRAUD and wish people like you would step down. And most program bashing is "Spot-on". WHy? Because ive been privvy to a lot of them and the posts are usually correct..
 

User21218

5+ Year Member
Dec 7, 2014
119
39
You ever hear people say stuff but they really arent say anything... That's the feeling I get when you talk/post.
Everyone knows a crap program. And all residents are motivated by the same things. To say, well maybe the resident chose the wrong program for their family and they did not self assess properly is absolute baloney. You sir are a FRAUD and wish people like you would step down. And most program bashing is "Spot-on". WHy? Because ive been privvy to a lot of them and the posts are usually correct..
What’s wrong with you? OP is spot on here. I personally matched to a program that regularly gets bashed on here due to “malignancy.” Ranked it lower because of that. The program wasn’t malignant AT ALL. There were other shortcomings, none of which are mentioned on here but the “malignancy.” I also had a colleague that complained about our residency because CA-3s had to take call in June. This resident claimed that most other residencies don’t do that. Can you imagine what this person would say about my “malignant” program that forced us CA-3s to take call in June?
 
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Modanq

Member
10+ Year Member
Apr 7, 2005
266
240
37
Ann Arbor
Status
What do you believe is the appropriate role for CRNAs in the setting of a residency program? Resdients providing breaks for CRNAs? CRNAs providing space for resident lectures? Residents taking all call and staying late? Residents doing advanced cases and procedures or sharing everything? Teaching residents how to manage and medically direct CRNAs? Creating a future resident that's in fact a doc disguised as a CRNA?

When an applicant asks what is a typical PDs view on resident protection?
 

pgg

Laugh at me, will they?
Administrator
10+ Year Member
Dec 15, 2005
12,575
9,496
Not home
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Attending Physician
You ever hear people say stuff but they really arent say anything... That's the feeling I get when you talk/post.
Everyone knows a crap program. And all residents are motivated by the same things. To say, well maybe the resident chose the wrong program for their family and they did not self assess properly is absolute baloney. You sir are a FRAUD and wish people like you would step down. And most program bashing is "Spot-on". WHy? Because ive been privvy to a lot of them and the posts are usually correct..
Settle down -

We're all aware that your experience has been ... poor. And that you hate the field, and you hate your job. We get it, you're miserable. And of course, it's not your fault.

You're simply wrong in your assertion that residents never choose the wrong field/program for personal reasons. I've known a handful of residents, both from my program while I was also a resident, and afterwards when I was faculty, for whom this was true. One graduated and never passed boards. Each of the others who left entered a different specialty, finished residency, and AFAIK are doing fine. I'm sure there will be more in the future. This specialty isn't for everyone, it requires certain traits that come hard (or not at all) to some people.

There are malignant programs out there. I won't dispute that.

I don't disagree with anything @AnonymousPD has written here. If you want to disagree with him, be specific. Don't just hurl personal attacks.
 

D P356

ASA Member
7+ Year Member
May 2, 2011
237
62
Status
Attending Physician
What’s wrong with you? OP is spot on here. I personally matched to a program that regularly gets bashed on here due to “malignancy.” Ranked it lower because of that. The program wasn’t malignant AT ALL. There were other shortcomings, none of which are mentioned on here but the “malignancy.” I also had a colleague that complained about our residency because CA-3s had to take call in June. This resident claimed that most other residencies don’t do that. Can you imagine what this person would say about my “malignant” program that forced us CA-3s to take call in June?
There are Programs don’t make CA-3s take call in June?!? My program put us on call until the last possible moment. To me that just seems universal and just part of residency.

Felt great to saunter out of the hospital with a smile on my last clinical day of residency.
 

SaltyDog

Perpetual Try-Hard Snarky B*tch
10+ Year Member
Aug 10, 2007
4,101
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Que the repost of Zippy’s last day (night) as a resident in 5, 4, 3, . . .
 

Southpaw

Lifetime Donor
15+ Year Member
Aug 12, 2004
1,193
720
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Attending Physician
ask and ye shall receive...


zippy2u said:
last day of residency was ,without a doubt, one of the best days of my life... I was on call, 3am get a call from burn unit to emergently intubate a big guy that had been 50% burned upper torso with smoke inhalation. Half a stick of stp and 100 o' sux-- all edema. I told myself i wasn't goin' out like this. Just rammed a 7.5 where i thought it should be and it slid in. Bs bilateral and pcxr was solid. O2 sats golden and rt lady all happy. No procedure note, no charge sheet. Beeper left at or board when no one was lookin'. Slid out hospital at 0645 with no goodby's, thank you's or gonna miss you's. Got to the apt. And loaded up u-haul with 100% va disability, 100% ss disability uncle( vietnam, agent orange, ptsd--you know the bogus gig). Letter and keys in an envelope dropped in the apt. Night box. No change or forwarding of address with post office, no cares about apt. Or electric deposits. Zippy done evaporated! Roll on out at 1700 with floorboard boom box playin' "comfortably numb", and a bottle of chilled wild turkey in the ice chest. Uncle drivin' and on outskirts of town we light up a big fat doober. I told him not to shut off the old biitch until we were home. Ole hunter thompson didn't have a thing on us that night... Regards, ---zip
 
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