Anesthesiology FAQ (Old)

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powermd

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CHOOSING ANESTHESIOLOGY

1) What does an anesthesiologist do?

The American Society of Anesthesiologists (ASA) has prepared a FAQ to answer many basic questions of interest to a medical student who is considering a career in anesthesiology.
http://www.asahq.org/career/faq.htm

Thread on "why choose anesthesiology?" Covers lifestyle issues too.
http://forums.studentdoctor.net/showthread.php?t=79579

USF Online Residency Application Handbook -- Specialty Descriptions
Offers good description of the field, training, lifestyle, and application process.
http://hsc.usf.edu/medstud/resguide/residencyguide.htm

Regarding "isn't it boring?" questions:
This comes up somewhat frequently, probably because until you actually practice anesthesiology, it is hard to fully appreciate what an anesthesiologist does, and what that kind of responsibility feels like. Suffice to say, it is NOT a boring field if you like acute care medicine, hands-on management of patients, life-threatening problems, short but close doctor-patient relationships, the excitement of the OR, and having the best knowledge base in pharmacology and physiology in the hospital, and the skills to apply it practically every day.

http://forums.studentdoctor.net/showthread.php?t=195246

One forum member's reasoning for choosing anesthesiology:
http://forums.studentdoctor.net/showpost.php?p=1457027&postcount=10

Thread covering the issue of "boredom" in anesthesiology:
http://forums.studentdoctor.net/showthread.php?t=79579

Thread covering the issue of "respect" in anesthesiology:
http://forums.studentdoctor.net/showthread.php?t=117251

Thread covering the old and trite Surgery VS. Anesthesiology in the OR
http://forums.studentdoctor.net/showthread.php?t=198354

Thread covering "why do you love anesthesiology?":
http://forums.studentdoctor.net/showthread.php?t=71763

"So you want to be an anesthesiologist" thread:
http://forums.studentdoctor.net/showthread.php?t=71610


2) What practice settings do anesthesiologists work in?

Anesthesiologists work in a variety of practice settings. Operating room anesthesia is provided in tertiary-care academic medical centers, community hospitals, "surgi-centers", and military hospitals. This encompasses anesthesia for general, cardiac, neuro, ENT, orthopedic, ophthalmologic, pediatric, and transplant surgeries. In the obstetric suite anesthesiologists provide epidural, spinal, and general anesthesia for vaginal and cesarian deliveries. Anesthesiologists my provide, or assist CRNAs in providing sedation and airway control for psychiatric patients undergoing ECT, as well as patients in the cardiac catheterization lab, and endoscopy suites. Anesthesiologists work in pain clinics, performing pain management techniques in an office, or OR setting using fluoroscopy for needle guidance. Anesthesiologists work as critical care doctors in the MICU/SICU. So-called "office-based anesthesia" is a growing field in which anesthesiologists assist in office-based surgery by providing anesthetic care that approaches or equals the standards expected in a hospital.

Critical care and anesthesiology:
http://forums.studentdoctor.net/showthread.php?t=200572

3) How long is the training period?

After medical school, the training is four years, with the option of doing a one-year fellowship in critical care, pain management, cardiac, neuro, pediatric, obstetric, regional, or transplant anesthesia.

4) What is the lifestyle of an anesthesiology resident?

USF Online Residency Application Handbook -- Specialty Descriptions
Covers resident lifestyle issue well:
http://hsc.usf.edu/medstud/resguide/residencyguide.htm

5) What is the lifestyle of a practicing anesthesiologist?

Post by Jetproppilot regarding lifestyle, scope of practice, financial issues- one of the most informative posts I've seen from a private practice anesthesiologist:
http://forums.studentdoctor.net/showpost.php?p=2855860&postcount=19

Thead covering lifestyle issues specifically:
http://forums.studentdoctor.net/showthread.php?t=56048

This thread covers both lifestyle and what it's like to transition from residency to private practice:
http://forums.studentdoctor.net/showthread.php?t=82587

6) What opportunities exist for research in anesthesiology?
7) What are the most widely accepted predictions for the future job market in anesthesiology?
8) I heard something about competition from CRNAs. What is a CRNA, and what effect do they have on the field of anesthesiology?

CRNAs vs Anesthesiologists
An excellent post summing up this issue from Tenesma
http://forums.studentdoctor.net/showpost.php?p=1316695&postcount=23
View the entire thread here:
http://forums.studentdoctor.net/showthread.php?t=112984&page=1&pp=20
Another excellent post by Tenesma on this issue:
http://forums.studentdoctor.net/showpost.php?p=1760121&postcount=57

Two long, bitter arguments...
http://forums.studentdoctor.net/showthread.php?t=241881
http://forums.studentdoctor.net/showthread.php?t=243054

Ideas for physician-only anesthesia...
http://forums.studentdoctor.net/showthread.php?t=243916

"If you had to do it all over again would you go the CRNA route" thread:
http://forums.studentdoctor.net/showthread.php?t=205294

"Anesthesia Economics" (more about CRNAs in anesthesia)
http://forums.studentdoctor.net/showthread.php?t=198688

Anesthesia assistants (AA) vs CRNAs
http://forums.studentdoctor.net/showthread.php?t=116025

9) What do anesthesiologists pay for malpractice insurance?

http://forums.studentdoctor.net/showthread.php?t=169220


Continued in Part 2

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I'd very much appreciate the contributions of the other major personalities (tenesma, vent, 2ndyear, gasman, UTsouthwestern etc..) in this forum, particularly those who have been around for a long time and have read/posted dozens of answers to these questions this year. Please post responses to the questions in the FAQ, or links to good threads/posts that should be considered for inclusion. Also any edits/criticisms of my own responses would be appreciated.

---

12. As a Medical Student, how do I make myself more appealing as an anesthesiology applicant?

The first step is to read up on what's new for medical students within the field. You may not know this, but in October 2004, the American Society of Anesthesiologists (ASA) approved a resolution to institute a medical student delegation within the ASA itself. This will be similar to what you've seen in the AMA student organization or other national student clubs except that this is specifically for students interested in anesthesiology.

Learn more on this by visiting: http://www.asahq.org/Newsletters/20...eview08_04.html

The temporary med student website is: www.urmcaig.org

The student organization is just getting started. There are leadership opportunities available and plenty of access to the ASA where you will meet some of the "gods" of anesthesiology.

You can also private message me if you want more info on how you can get involved.
 
Members don't see this ad :)
I cranked this out a little while back. Lots of it is pertinent to interview questions and personal statements.

1) Being an acute source of comfort for my patients. One of the differences between a good and an outstanding anesthesiologist is the ability to accurately convey info to their patients while alleviating anxiety and making them feel looked after. Having your body sliced open by a bunch of strangers is an unimaginable prospect and its scary as hell...you are (should be) more effective than any sort of sedative.

2) Critical Care makes outstanding clinicians. Not applicable if you are going to be doing knees in a surgicenter, but right now thats not my direction. Good CC docs affect out post-op outcome in a most positive way. I plan on doing a fellowship.

3) Remaining connected to patients throughout surgery via monitors. Watching the hemodynamics unfold and reacting appropriately/preemptively is a highly attractive aspect of the field.

4) Procedural interventions. I was an anatomy TA and did an advanced disection course. I found satisfaction in using my knowlege in placing lines (cent/art/piv), intubation, and neuraxial/regional blocks. Non procedural interventions (fluids/pharmacologic agents) require the integration of knowlege into interpretation of patient status, not just regurgitation of facts. Cool stuff.

5) I'm attracted to the idea and practice of mainting logical thought in the face of impending chaos. It is a skill I look forward to sharpening during my stint in this field. Its important to always have a plan of action and to anticipate danger always...I don't want to be unprepared as an all to frequent "go to guy."

6) I enjoy being part of a team as I attain satisfaction in watching things run smoothly, no matter what situation I am in. I don't need pats on the back or recognition for my efforts, even from my patients (most of whom don't know/remember you are a doctor)...I could care less and so could my underdeveloped atrophied ego.

7) Ability to work with one patient at a time.

There are other reasons, but those are the main ones. I did 2 rotations. One would have been enough and I should have done another ICU month. No worries though. I did get to see just how different 2 programs could be. Best of luck and congrats on chosing a wonderful field.
 
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tkim6599 said:
I'm going to tentatively sticky this because it really looks like a lot of effort and good information went into this.

But, I'm going to leave it up to the mod of this forum - OMD, to determine permanence. Don't wanna get on his bad side - audition rotations will come up sooner than I think!

- Tae

Has anyone seen OMD on the forum lately? Been along time since I have seen him on or seen him post. His internship must be sucking him dry.
 
I know we could debate this over and over again and it is subjective, but I would put UPenn and Duke in the Best of the best category. These 2 places are world-class, they have the faculty and resources to match the others you have placed in Tier 1.
 
FAQ is up to date with everything posted so far. I added Duke and UPenn to the tier 1 list, and will leave them there unless people have significant objections. I updated #1 with Vent's post, and threads covering the issues of "boredom" and "respect".
 
Duke and UPenn have been moved to tier 1 because of one person's suggestion?
 
elias514 said:
Duke and UPenn have been moved to tier 1 because of one person's suggestion?

It was brought up in one of the threads covering rankings, and no one questioned it. I personally know nothing about Duke and UPenn except that they are well respected programs. Do you feel they are not among the other top programs listed in tier 1? Does anyone else have a problem with this ranking decision?

Eventually, when I get better organized, I'd like to do a survey of at least 10 program directors to get their input on this list. As of now, it's very subjective.
 
Taking the effort to set this FAQ up was a very kind gesture on your part Power. Kudos to you my friend. I gotta go lift some weights now.

I'm grateful this field exists.
 
I don't know anything (I'm just a future M1 who is interested in anesthesiology). I just thought it was interesting that the list was changed because of one person's input.
 
One question that I found myself asking as a med student is what is the difference between a top program and a good program? I think a lot of students wonder what the difference between a top place is and a very good program and if it even matters. I didn't fully realize the differences until I interviewed at a number of them and now am in residency. Here's what I would say it takes to be a top program (from an academic standpoint, this doesn't always directly translate into competitiveness) :
1. Must be at a top institution- in order to be a top tier program the other services that you work with need to be top as well. For example, if anesthesia is really strong but surgery is mediocre it will take away.
2. Department must have an overall superior level of excellence. This includes significant research. Many people don't care about research when looking at programs. The difference is that your attendings are the ones writing the papers, running the studies, reviewing the journals, they can quote the studies, and your grand rounds/visitiing professors are the leaders. Being at an institution like this doesn't necessarily push you to do research if you aren't interested (institution dependent) but it puts you to a high standard.
3. There should be special things about the department in which they shine, and are especially well known for, this should include advances in the field.
4. There shouldn't be any glaring weaknesses in the department.
5. Superior complexity of cases (generally comes the factors above)

I'm sure I'm missing some factors, so please give feedback and I will update.

Even though this has been stated multiple times previously, I'll say it again..
there are many programs that wouldn't be considered top tier that are excellent, produce excellent docs, and may be better fits for many residents.
 
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I'm gonna be an M1 at U Michigan this year. Is the anesthesiology residency program there considered top tier? What about the department itself?
 
Categorizing program into tiers is subjective, but here's something about Duke that's not. Regional anesthesia is an important part of training and many programs don't give residents enough exposure to it. It's a skill that is very marketable. Duke's regional experience is one of the many things that make it a top program. I think one of the reasons that Duke isn't talked about as much as some other places like JHU, MGH, & BWH is that it has more of a regional draw in terms of residents wanting to go there and the program is 12 residents a year whereas the other 3 programs have well over 20 residents a year. I don't have objective data for UPenn like I do for Duke but I've been there as well as to the other 3 and they compare.


National median (1) on regional techniques
Spinal 94
Epidural 175
Peripheral nerve blocks 45

Duke's median (2)
Spinal 107
Epidural 233
Peripheral nerve block 350 (90th percentile from above study is 136)

These numbers are based on annual training reports submitted to the anesthesiology residency review committee and the differences are statistically significant. Years CA 1-CA 3.

The number of procedures in order to achieve a 90% success rate has been estimated to be 45 for spinals and 85 for epidurals (3).

Sources:
1. Kopacz DJ, Neal JM. Regional anesthesia and pain medicine: residency training-the year 2000. Reg Anesth Pain Med 2002;27:9-14.
2. Martin G, Lineberger CK. A New Teaching Model for resident training in regional anesthesia. Anesth Analg 2002;95:1423-7
3. Kopacz DJ, Neal JM, Pollock JE. The regional anesthia "learning curve": what is the minimum number of epidural and spinal blocks to reach consistency? Reg Anesth Pain Med 1996;21:182-190.
 
3) How important is X in getting interviews and matching in anesthesiology? (X = step 1, step 2, LORs, class rank, AOA, research, alma mater, outside rotations at program of choice).


The following link may be helpful to you regarding this topic.

http://www.meded.umn.edu/students/specialties/Academic_Criteria.htm


SleepyTime
AZCOM, MS3

(PS. Thanks everybody for your useful and hard-to-find information)
 
Unfortunately, that link doesn't seem to account for the fact that many programs in all specialties, including gas (but much less so) screen on Step I scores before they look at any of those other factors.

-joshmir
 
Do you think being able to do the difficult cases (within a reasonable workload) without having to compete with fellows is incredibly important, or just icing on a cake?

Thanks!

-joshmir
 
does anyone know if the pain market is saturated in California?
 
Columbia was in Top Tier early '80's [c/MGH & UPenn] -- sad to see it's dropped in estimation.

P&S '81
Col Presbyt Anesth PGY2 & 3 '82-'84[back when it only went to 3 -- INTENSITY!]
 
Is there scope for research in international/public health in anesthesia? What kinds of topics are covered?
Also besides the doctors w/out borders type stuff where one goes for a few weeks at a time, are there other longer-term projects anesthesiologists you know of (or yourself) are working on?
thanks!
 
emtdoc2000 said:
Columbia was in Top Tier early '80's [c/MGH & UPenn] -- sad to see it's dropped in estimation.

P&S '81
Col Presbyt Anesth PGY2 & 3 '82-'84[back when it only went to 3 -- INTENSITY!]

Hey,

Did you guys have a pulse ox back then. I hear anesthesia before pulse ox was was like hell on a guerney.
"Is the patient blue...? - No"
"Is the patient blue...? - No"
"Is the patient blue...? - No"
"Is the patient blue...? - No"
"Is the patient blue...? - ..oh sh...game over"

I heard (alleged rumors of course) that people were just dropping left and right on the way out of the OR.
 
gaslady said:
Categorizing program into tiers is subjective, but here's something about Duke that's not. Regional anesthesia is an important part of training and many programs don't give residents enough exposure to it. ... I don't have objective data for UPenn like I do for Duke but I've been there as well as to the other 3 and they compare.


National median (1) on regional techniques
Spinal 94
Epidural 175
Peripheral nerve blocks 45

Duke's median (2)
Spinal 107
Epidural 233
Peripheral nerve block 350 (90th percentile from above study is 136)

... Years CA 1-CA 3.

.


I disagree that Beth Israel Deaconess is a 'tier 3' program as suggested by the thread author. The training received at that Harvard program is on par with any of the others listed in tier 1 or 2, with graduates getting top fellowships and jobs. By the way gaslady... I placed 225+ epidurals during my CA-1 year alone.... and that is the norm for BID.
 
First, I should reveal my bias in that I am currently an intern elsewhere but will be a CA-1 at BID this June.

BID is by all accounts higher than 3rd tier. The proof is in its tight comparisons to the other two Harvard hospitals (BW and MGH), which many consider to be 1st tier. A quick review of the "literature" (ie, what others have posted on this forum)

1) There were a series of good posts under the topic "MGH v BWU v BID"; here are perspectives from that thread:

According to Beantown (a boston medical student who has spent time at all three Harvard programs):

"BID TEE program is the best of the three and one of the best in the country."

He also states that in all major aspects the three programs are the same, and different in terms of atmosphere. His opinion is supported by Tenesma, an MGH gas resident, and a "made man" in this forum. Refer to their posts for the specifics.

One drawback of BID is that the pain fellows take some interventional pain procedures away from the residents more so than at the other two hospitals (but that still happens at those two). However, my perspective is that if you really want to do pain, you'll do a fellowship, and BID is considered the best *interventional* pain fellowship on the east coast. Tha pain attendings reputations will get you a good fellowship, and like most places, its a little easier to get into their fellowship if you've been a resident there. In regards to other types of fellows taking away general gas cases from you, it appears to happen no more or less than at the other 2 Harvard hospitals.

If ICU is important to you, BID has closed units, one of the other two hospitals apparently doesn't

All three harvard hospitals take FMGs and they are among the best the world has to offer, if that's important to you.

All 3 do peds at Childrens.

2) I have heard a few times (hearsay) that BID does better on the anesthesia boards than the other two programs (and I'm sure this depends on the year). I think that is irrelevant, but helps diffuse the myth that its the "3rd Harvard hospital" at least in terms of the anesthesia departments. Certainly people outside of anesthesia will think more of the BW or MGH name, but what effect are they going to have on your professional life? In terms of clinical skills there is no objective way to compare departments; popular opinion is they are broadly the same.

3) There has been a negative review recently on Scutwork.com about BID, followed quickly by a positive one that explains away many of the points brought up by the negative reviewer. Prior to that, there are about 10 incredibly positive reviews, none negative.

I encourage interviewees on the trail to ask about the points brought up in the negative post and submit their opinions back on this forum.

4) Regarding the perspectives of Gaslady, her recent post about BID was:

"The personalities I met during the interview didn't impress me. It may have been an off interview day for them, but it was too much of a risk so I put them low on my list."

in further correspondance with me, she cited that she thought the residents were casual with their responses to her questions and possibly too laid back. she also felt the interview day could have been better organized. Her other opinions actually got me more excited about the fact i would be heading to the program.

(while i feel a bit strange about revealing what someone PMd me, I feel it's probably better to shed light on her post as opposed to leaving them open for speculation. Gaslady is smart, heading to Duke, I respect her posts. ..btw, thanks for clarifying your perspectives in that PM, gaslady, see you at ASA when you're a CA-3 :)

I am open to corrections. In the end this is splitting hairs, but reputation helps/hurts fellowship and job applications, so it may be worth upholding. Sometimes positive comments are fluff but incorrect negative comments should be corrected with the quickness.
 
you seem to have a good grasp for programs. any views on the university of maryland program in anesthesia? no reviews for this one on scutwork.com, thanks!
 
Can anyone give some info on Yale's program?

Thanks
 
work hard and try to play hard in new haven. Name will always stand out. My buddy matched there and I'll ask him to pm you more info.

Welcome to medicine.
 
VentdependenT said:
work hard and try to play hard in new haven. Name will always stand out. My buddy matched there and I'll ask him to pm you more info.

Welcome to medicine.

Thanks!
 
12. As a Medical Student, how do I make myself more appealing as an anesthesiology applicant?

The first step is to read up on what's new for medical students within the field. You may not know this, but in October 2004, the American Society of Anesthesiologists (ASA) approved a resolution to institute a medical student delegation within the ASA itself. This will be similar to what you've seen in the AMA student organization or other national student clubs except that this is specifically for students interested in anesthesiology.

Learn more on this by visiting: http://www.asahq.org/Newsletters/20...eview08_04.html

The temporary med student website is: www.urmcaig.org

The student organization is just getting started. There are leadership opportunities available and plenty of access to the ASA where you will meet some of the "gods" of anesthesiology.

You can also private message me if you want more info on how you can get involved.
 
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powermd said:
I'll kick it off with a basic outline and some sub-heading questions. We see a lot of these threads over and over, so I think it's time we did this. For now we could just post links to the threads that best cover the topics listed below.


6) What opportunities exist for research in anesthesiology?
7) What are the most widely accepted predictions for the future job market in anesthesiology?

Does anyone have links or answers for these two questions??? I'd particularly like to know about #6.
 
powermd said:
I would like to add this, but the sticky is limited to 10000 characters. Maybe the moderator could extend this limit?

There's no way that I can increase the char limit. I tried to split/merge this thread to jostle the relevant post after your initial post, but merging threads seems to place each one back in chronological order. So, I had no choice but to delete the posts between your initial post and the next instance of you posting, in order for your FAQ to 'flow'. My apologies to the posters whose posts I deleted - they are still there, just not visible. If this is unacceptable, please let me know.
 
tkim6599 said:
There's no way that I can increase the char limit. I tried to split/merge this thread to jostle the relevant post after your initial post, but merging threads seems to place each one back in chronological order. So, I had no choice but to delete the posts between your initial post and the next instance of you posting, in order for your FAQ to 'flow'. My apologies to the posters whose posts I deleted - they are still there, just not visible. If this is unacceptable, please let me know.

Do you think that maybe we could have two different stickies and two different FAQ threads then? One for "Why choose anesthesiology" and another for "Anesthesiology residencies issues"? The first one would be for pre med and med students who are possibly interested in anesthesiology, while the second would be for med students and residents who had already committed to the field.
 
I've read quite a few guidelines concerning a 'good' step 1 score. I'm wondering if anybody has updated that recently. I've heard that step 1 scores have been trending up, and the 'good score' cut-off isn't what it used to be.

Bottom line question:

I got 236, is that still top tier material in 2004?
 
I dont want to beat a dead horse, but this question gnaws at me. Since it seems as though people here are in the know, with the allegations of gas being less "DO-friendly" than it once was, where does a DO with a 3.9 GPA and a 258 Step 1 fit in? Should I feel intense pressure to get publications? My school doesn't really have any "world-renowned" faculty...where would one go to do a rotation and hopefully get a good letter, if one only had a single option (I likely have three months with which to audition).

I have very high aspirations, btw. I am fairly sure that I could take the shotgun approach and match somewhere, but I would like a little more control over my destiny. Assuming that I am easy to get along with, a hard worker, and will help myself in an interview, will being a DO absolutely keep me out of top tier consideration? Thanks in advance.
 
Idiopathic said:
I dont want to beat a dead horse, but this question gnaws at me. Since it seems as though people here are in the know, with the allegations of gas being less "DO-friendly" than it once was, where does a DO with a 3.9 GPA and a 258 Step 1 fit in? Should I feel intense pressure to get publications? My school doesn't really have any "world-renowned" faculty...where would one go to do a rotation and hopefully get a good letter, if one only had a single option (I likely have three months with which to audition).

I have very high aspirations, btw. I am fairly sure that I could take the shotgun approach and match somewhere, but I would like a little more control over my destiny. Assuming that I am easy to get along with, a hard worker, and will help myself in an interview, will being a DO absolutely keep me out of top tier consideration? Thanks in advance.

You should be in good shape. Don't worry about publications but you should land a couple of solid letters. Interviewers will respect those letters even further if you get them from people who are well known in the field (if you dunno who is big ask around at the program) or locally (if you wish to stay in one area). I cannot stress the weight of an SICU rotation. It really shows your interest in this very important aspect of the field.

Apply ANYHERE you want to go, rack em up. The ERAS cost of applying to multiple programs is nothing compared to the cost of medical school. Its your future and I suggest you cover your tail. That being said applying to anything over 30 programs with that score is overkill.
 
MATCHING ANESTHESIOLOGY

1) What is the best preparation from the start of med school to match successfully?

The most important reason to work hard and excel in the first two years of medical school is to be well prepared for USMLE Step 1. Try not to worry too much about individual class grades, because a few average grades each year won't hurt you if your Step 1 score is good. Concentrate your effort on doing well in physiology and pharmacology. You may find first and second year a good time to do a basic science research project in any field that interests you. Of course, if AOA is a possibility for you, go for it! During your third year, in addition to working hard and earning good evaluations, you should carefully consider each specialty you rotate through. Not only will you feel better about your decision to enter anesthesiology, but your personal statement will reflect your thoughfulness, and this will impress readers. Eventually you may be asked on an interview how you came to choose anesthesiology, and if you carefully considered other fields, you will be able to give a well-reasoned response. Early in your fourth year you should do one or two rotations in anesthesiology at programs where you would like to do residency, or where you feel you can obtain a helpful letter of recommendation. Don't be shy about asking the chairperson of a prestigious program for a letter, they expect to be asked, and may be impressed by your initiative.

2) How competitive is anesthesiology?

USMLE Step 1 score:
There is more latitude here than some people think. If you have a good application in general, a lower score won't keep you from matching somewhere. A higher score can definitely compensate for a mediocre application. Keep the following guide in mind when setting expectations for receiving interview offers:
<200 -- community and low-mid tier academic programs
200-215 -- mid-high tier academic programs
215-230 -- top academic programs
230+ -- will get interviews at almost every top program applied to


USMLE Step 2 score:
Since people take step 2 at variable times, with variable results, it is much more difficult to determine the meaning of different scores in terms of matching or not matching anesthesiology. If you're step 1 score is 220+, and your application is at least moderately strong, you should consider waiting to take step 2 until after you receive interview offers (December or later). Alternatively, you will never be better prepared or more motivated to take step 2 than right after finishing third-year clerkships. You may want to take step 2 early if you believe you can score at least as well as you did on step 1, and want the peace of mind of not having a board exam hanging over your head until late in the year.

What if I'm really "average"?
http://forums.studentdoctor.net/showthread.php?t=115485

If you're graduating from a DO school:
http://forums.studentdoctor.net/showthread.php?t=112463
http://forums.studentdoctor.net/showthread.php?t=228909

What if I want to switch from another residency (medicine)?
http://forums.studentdoctor.net/showthread.php?t=202547

3) How important is X in getting interviews and matching in anesthesiology? (X = step 1, step 2, LORs, class rank, AOA, research, alma mater, outside rotations at program of choice)

Here is a link to a table similar to one found in Iserson's "Getting into A Residency". It might be based on the same data. This table summarizes the rank program directors from different specialties give to different attributes of the residency application. Anesthesiology programs are included in "Group C".

http://www.meded.umn.edu/students/specialties/Academic_Criteria.htm

4) What is a preliminary year, and will I need to apply for one?

A preliminary year, or internship, is your post-graduate year 1 (PGY1) experience. Preliminary year programs are offered in medicine and surgery, but "transitional" programs (variable mix of medicine, surgery, ob/gyn, peds, and critical care) are available too. Transitional year programs are often considered more desireable due to a typically easier schedule (fewer months of ward medicine, less ICU work).

Anesthesiology residency training programs are divided between "categorical" and "advanced" programs. Categorical programs give you all four years of training (PGY1-4), including the preliminary year. Advanced programs provide only the last three years (PGY2-4), so if you apply to these programs, you will have to apply and interview separately for PGY1 internship programs. Preliminary year programs in medicine and transitional year are competitive, so be sure to discuss with your advisor how many you should apply to.

Prelim Medicine VS. Prelim Surgery VS. Transition year: Good discussion at below link.

http://forums.studentdoctor.net/showthread.php?t=200019

5) What is a good strategy for planning fourth-year electives?

Pick your electives and apply VERY EARLY. Apply as soon as they begin accepting applications, and call before your application gets there to see if they will hold a spot for you until your paperwork arrives. Rotation slots at desireable programs are filled quickly, so if you leave it until early summer of your fourth year, you could be out of luck. There are a few schools of thought on doing outside electives:

Home vs. away: Some people believe you should do an elective at your home hospital first, or a program you don't hope to match. The idea being that you will learn something about anesthesiology, and do a few procedures, so that when you rotate at a program you hope to match, you will look competent. Many anesthesiologists I have spoke with when I was doing audition electives told me they expected very little of medical students except that they be enthusiastic, have common sense, and ask good questions. If you are a quick learner, it probably doesn't matter if you do a 'prep' elective first.

Audition electives increase your chance of matching: Some people believe that if you do an elective at a program you hope to match, you improve your chances because they will know you are serious about going there. Also, they have a chance to get to know you well. Of course, that can work against you. All it takes is one slip up either professionally, or socially, in front of an influential person, and you may lose your slot.

Audition "up" so you can match "down": The general idea is that by auditioning at a prestigious program you don't expect to match, and getting a prestige letter, you improve your chances of matching less prestigious programs that you have a realistic shot at. Some people use this strategy, but it's unclear whether it improves your odds or not.

The best months do do audition electives are July-October. November/December electives get in the way of interviews, and will be too late to help you with letters of recommendation.

6) Who should write my letters of recommendation?

You can submit up to 4 letters in ERAS. More valid letter writers will most likely be IM, Surg, Cards, Pulm, etc. An ICU letter will be a major bonus as well. Shows interest and understanding of a field which you will be spending quite a bit of time interacting/participating with/in. Smart move

Folks match into anesthesiology without a letter from an anesthesiologist. I am not sure how common this is. Your best bet is to have one though. Here is how I landed mine: 1st I asked residents who would be a good person to get a letter from. Then I took a call night with that physician (good experience anyways...basically let me run the case) and subsequently asked him for a letter. Just one way of approaching this.

7) When should I take step 2?

If you killed step I then you can either: A)take it early 4th year and choose to not have the score submitted to every program (MAKE SURE THIS OPTION STILL EXISTS). B) take it after/late December after the majority of your interviews will be finished. You can just go for it early and submit the scores but why jeopardize things.

If you got killed on step I then take Step II EARLY! As in early August so the scores will be out by early September for ERAS time.

For you DO's out there I suggest taking the USMLE I. If you blow it then don't submit it. If you missed the opprotunity to take that exam then take Step II CK and submit the score. PD's commented that taking the USMLE was the best addition to my application. I have heard of folks matching into good programs with COMLEX only but why risk it?

8) When should I schedule my interviews?
http://forums.studentdoctor.net/showthread.php?t=227837

9) How should I prepare for interviews? What can I expect?
http://forums.studentdoctor.net/showthread.php?t=229671
http://www.rushu.rush.edu/studentlife/career/medint.html

As you go on with the process you will get the hang of it. You'll be your worst on the first two interviews (it doesn't mean you'll blow it) and peak around interviews 4-8. After that you've heard and said everything and now its repitition. Decrease your first interview jitters by rehearsing answers to top 10 questions in the shower the morning of. Thats what I did at least and it seemed to help.

Overall there are relatively few suprises. There will be a couple of interviewers who will try to push your buttons to gauge your reaction to stress (I presume). Don't take it personal and don't get defensive. React like the calm cool and collected cat that you are.

10) Where can I find a list of all accredited anesthesiology residency programs?
http://www.asahq.org/asarc/hotlinks/programs.html#anchor70962

11) How many programs should I apply to?
http://forums.studentdoctor.net/showthread.php?t=225917
 
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12) Elite programs for subspecialties
(in no particular order...these are residencies which provide either great training or exposure to faculty of the best fellowships in those fields...keep in mind these are just one BID gas-bound intern's thoughts, based on hearsay, firsthand interview experience, and common sense...they are in NO WAY exclusive...many other programs probably belong on this list, and in retrospect this list reflects an east-coast bias, as well as a bias for programs that do one or two things well...ie, a program like UCSF may do all things so well that no one subspecialty stands out)

Trauma Anesthesia
-UWash
-UMiami
-UTSW
(all have trauma fellowships, but all of the residents are strong without doing fellowships)

Regional Anesthesia
-Virginia Mason
-St Lukes/Roosevelt
-Cornell & Johns Hopkins (lumped together b/c they both rotate through ortho-heavy Hospital for Special Surgery in NYC)
(make sure programs don't pad their numbers by counting epidurals as regional injections...apparently St Lukes/Roosevelt does this, but I'm still convinced that they have an incredible regional program...Hospital for Special Surgery/Cornell-NY Presb., Pittsburgh, and VA Mason in Seattle are offering anesthesia fellowships in this, I've heard)

Interventional Pain
-Texas Tech (used to be the undisputed best program before the two Dr. Rs left)
-Beth Israel Deaconess (BID)
-UPenn

ICU/Critical Care
-MGH, BW, BID (closed units run by anesthesia for years)
-?
(I'm pretty ignorant on what programs have the best reputations and what makes a good program...some programs may begin to offer combined Cardiac Anesthesia/Critical care fellowships...I would inquire about how many residents/fellows get TEE certified)

Pediatric Anesthesia
-MGH, BW, BID (all rotate at Children's in Boston)
-UPenn & St Lukes/Roosevelt (both rotate at CHOP-children's hospital of penn/philly)
(both Children's and CHOP offer pediatric anesthesia fellowships)

**************
joshmir
PGY-1, CA-1 '04-'05

PS- Thanks for the corrections and the inclusion in the FAQ sticky.
 
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Correcting your info.

Hospital for Special Surgery is part of the NewYork Presbyterian/Cornell program. Columbia residents do not rotate through. Hopkins residents do. It is one of the best regional experiences in the country. There is a fellowship program here in that.

St. Lukes/Roosevelt is counts epidurals as part of their regional numbers.


joshmir said:
12) Elite programs for subspecialties
(in no particular order...these are residencies which provide either great training or exposure to faculty of the best fellowships in those fields...keep in mind these are just one BID gas-bound intern's thoughts...keep in mind they are in NO WAY exclusive...many other programs probably belong on this list)

Trauma Anesthesia
-UWash
-UMiami
-UTSW
(all have trauma fellowships, but all of the residents are strong without doing fellowships)

Regional Anesthesia
-Virginia Mason
-St Lukes/Roosevelt
(make sure programs don't pad their numbers by counting epidurals as regional injections...Hospital for Special Surgery/Columbia is offering an anesthesia fellowship in this, I've heard)

Interventional Pain
-Texas Tech (used to be the undisputed best program)
-Beth Israel Deaconess (BID)
-UPenn

ICU/Critical Care
-MGH, BW, BID (closed units run by anesthesia for years)
-?
(I'm pretty ignorant on what programs have the best reputations and what makes a good program...some programs may begin to offer combined Cardiac Anesthesia/Critical care fellowships...I would inquire about how many residents/fellows get TEE certified)

Pediatric Anesthesia
-MGH, BW, BID (all rotate at Children's in Boston)
-UPenn, St Lukes/Roosevelt (both rotate at CHOP-children's hospital of penn/philly)
(both Children's and CHOP offer pediatric anesthesia fellowships)

**************
joshmir
PGY-1, CA-1 '04-'05
 
mike327 said:
I've read quite a few guidelines concerning a 'good' step 1 score. I'm wondering if anybody has updated that recently. I've heard that step 1 scores have been trending up, and the 'good score' cut-off isn't what it used to be.

Bottom line question:

I got 236, is that still top tier material in 2004?
Apply and find out for us!

Seriously, your question sounds a bid paranoid. 236 is a good score for almost any residency, anywhere. Certainly good enough for any anesthesiology program, even in 2004.
 
INFORMATION REGARDING CLINICAL BASE YEAR (CBY)

Many people, mainly those switching from other specialties, ask about what constitutes an acceptable internship and/or clinical base year for board-eligibility and for entering into an advanced placement residency program in Anesthesiology.

These are the requirements as posted on the ACGME website. Provided that a internship/base year program meets these, and most will, you will be okay:

One year of the total training must be the Clinical Base Year, which should provide the resident with 12 months of broad education in medical disciplines relevant to the practice of anesthesiology. The Clinical Base Year usually precedes training in clinical anesthesia. It is strongly recommended that the Clinical Base Year be completed before the resident begins the CA-2 year; the Clinical Base Year, however, must be completed before the resident begins the CA-3 year.

The Clinical Base Year must include at least 10 months of clinical rotations, of which at most 1 month may involve training in anesthesiology. Clinical Base Year rotations include training in internal medicine or emergency medicine, pediatrics, surgery or any of the surgical specialties, critical care medicine, obstetrics and gynecology, neurology, family practice, or any combination of these. At most, 2 months of the Clinical Base Year may be taken in electives or in specialties other than those listed above. If an accredited anesthesiology program offers this year of training, the RRC will verify that the content is acceptable. When the parent institution provides the Clinical Base Year, the anesthesiology program director must approve the rotations for individual residents, and must have general oversight for rotations on the services that are used for the Clinical Base Year.

http://www.acgme.org/acWebsite/downloads/RRC_progReq/040pr703_u804.pdf

So, a year completed in Internal Medicine, Family Practice, Pediatrics, Neurology, OB/Gyn, or a rotating internship (such as the required Osteopathic rotating internship or a Transitional Year) will count.

Some categorical programs incorporate the Clinical Base Year into their program and, in fact, will spread out the required rotations over the first three years (see Penn State's categorical [i.e., 4-year] curriculum as an example).

-Skip
 
For those of you interested this is from the American Board of Anesthesiology
http://www.abanes.org/booklet/BOI-2004.pdf

2.02 THE CONTINUUM OF EDUCATION IN
ANESTHESIOLOGY
The continuum of education in anesthesiology
consists of four years of training subsequent
to the date that the medical or osteopathic
degree has been conferred. The continuum consists
of a Clinical Base Year (CBY) and 36
months of approved training in anesthesia (CA-1,
CA-2 and CA-3 years).

A. During the Clinical Base year the physician
must be enrolled and training as a resident in a
transitional year or primary specialty training program
in the United States or its territories that is
accredited by the Accreditation Council for
Graduate Medical Education (ACGME) or
approved by the American Osteopathic
Association, or outside the United States and its
territories in institutions affiliated with medical
schools approved by the Liaison Committee on
Medical Education.

Acceptable CLINICAL BASE experiences
include training in internal or emergency medicine,
pediatrics, surgery or any of the surgical
specialties, obstetrics and gynecology, neurology,
family practice, critical care medicine
or any
combination of these as approved for the individual
resident by the director of his or her training
program in anesthesiology. The Clinical Base
year must include at least ten months of clinical
rotations during which the resident has responsibility
for the diagnosis and treatment of patients
with a variety of medical and surgical problems,
of which at most one month may involve the
administration of anesthesia. At most two
months of the Clinical Base year may involve
training in specialties or subspecialties that do
not meet the aforementioned criteria.

Thanks to Skip for the previous post!
 
NYCAnesthesia said:
Correcting your info.

Hospital for Special Surgery is part of the NewYork Presbyterian/Cornell program. Columbia residents do not rotate through. Hopkins residents do. It is one of the best regional experiences in the country. There is a fellowship program here in that.

St. Lukes/Roosevelt is counts epidurals as part of their regional numbers.

For Peds Anesthesia:

Boston Childrens
CHOP
CHOA
Pittsburgh
Texas Children's (Andropoulos is one of the great's in peds cardiac)
Rainbow Babies and Children's
Stanford
 
powermd said:
Apply and find out for us!

Seriously, your question sounds a bid paranoid. 236 is a good score for almost any residency, anywhere. Certainly good enough for any anesthesiology program, even in 2004.


Yes, I the whole process is a bit nerve-racking. I'm always looking for a bit of extra reassurance.

Of course, the fact that the CIA keeps beaming thoughts into my brain with their space station doesn't help either...
 
INFORMATION CONCERNING THE PERCEIVED COMPETITIVENESS OF ANESTHESIOLOGY

There is continuing debate as to just how "competitive" the field of Anesthesiology is, from the perspective of the applicant vying for a residency spot. Clearly, some people would argue that it is pretty easy to get a spot, especially at the lower tier programs. Others may say this is true as well, but would stipulate that at the "top tier" programs it is just as difficult to get a position as it is in any other competitive residency. While there may be no definitive way to gauge this based on the available data, there is data provided by the NRMP that shows the Match rate and the number of ranks for each position by candidates.

Taking the data (extracted from these tables) over the past five match cycles, one can come up with the overall % of spots filled in through the Match and compare year-by-year:

TOTAL SPOTS OFFERED (PGY-1 & PGY-2 SPOTS)
Year------Spots---%Filled U.S.-- % Independent --Total Filled %
2001 ---- 1,104 ----- 64.6% --------- 23.5% ---------- 88.1%
2002 ---- 1,169 ----- 77.3% --------- 17.9% ---------- 95.2%
2003 ---- 1,264 ----- 73.3% --------- 22.5% ---------- 95.8%
2004 ---- 1,289 ----- 69.6% --------- 23.5% ---------- 93.1%
2005 ---- 1,283 ----- 71.4% --------- 24.5% ---------- 95.9%

This leads to some fairly self-evident and non-controversial conclusions:

  1. Total number of spots have increased. Between 2001 and 2005, there were at total of 179 additional spots offered through the Match. However, six (6) total spots were lost in the past year (26 Advanced track spots were lost, but 20 Categorical track spots were added in 2005). This may reflect the fact that, by 2008, each and every program will have to offer at least one 4-year (Categorical) spot.
  2. The overall fill rate for 2005 was the highest in the past five match cycles. If you look at the percentage of spots filled for all combined spots, the fill rate this year was 95.9%, with the second closest in 2003, when there were also 19 fewer spots offered in the Match.
  3. Overall, the percentage of U.S. seniors taking spots versus the percentage of Independent applicants taking spots is consistent. The range of Independent applicants, except for 2002 when there seemed to be a "higher-than-normal" number of U.S. seniors choosing the field, has stayed fairly consistent between 22.5 - 24.5% of positions matched. It appears that the more U.S. seniors choose anesthesia, the more it affects the number of spots available to Independent applicants entering the field.
  4. Anesthesiology seems to be consistent over the past four (4) years in terms of overall fill rates via the NRMP.

The data reflecting "U.S. seniors" only includes graduating seniors in "allopathic", M.D.-granting schools in the United States. IMGs and DO students (among others including non-seniors and Canadian students) are, for the sake of the match, considered "independent applicants." (see definitions here) Therefore, all other applicants including DO students are lumped into the "Independent" data, not just IMGs.

There may not be a way to know the total number of applicants for the available positions. To look at the "number of applicants", one may have to correlate and cross-reference the ERAS data by looking at how many people applied to programs, how many were offered interviews, how many turned-down interviews, etc., etc. Despite the fact that no one is likely capturing that data, it would still probably become a Herculean task to compile such data that may not provide much really meaningful answers in the end anyway.

However, one can look at the "ranks/position ratio" possibly as a gauge of competitiveness. In the 2005 Match, on average there were 9.9 ranks/position (PGY-1) and 9.3 ranks/position (PGY-2) for each Anesthesiology spot offered in the Match. This seems to indicate that a lot of candidates went on a lot of interviews and ranked a lot of programs to get their matches. If we had this same data to compare for the past five cycles, it may be more meaningful in terms of perceived "competitiveness".

But, to further the point at hand, the only other non-preliminary fields in the 2005 Match with a large number of total available positions that had higher "ranks/position ratios" than Anesthesiology this year were:

  • Dermatology
  • Combined Med-Derm
  • Categorical Surgery
  • Orthopedic Surgery
  • Plastic Surgery
  • Radiation Oncology
  • Diagnostic Radiology

Therefore, the ranks/position ratio might be an overall pretty good "quick and dirty" way to judge the perceived competitiveness of a field by the applicants trying to enter that field, and it puts Anesthesiology in a fairly elite group. For what it's worth, Emergency Medicine (another perceived "highly competitive field") was right behind Anesthesiology at 9.5 ranks/position for PGY-1 spots and 8.9 ranks/position for PGY-2 spots, but they also had a higher number of spots available across the board (1,476 for EM vs. 1,283 for Anesthesiology, or about 15% more total, PGY-1 & PGY-2, spots available in the Match).

-Skip
 
Lists of the available fellowships for graduating anesthesiologists

Pain
http://www.painrounds.com/index.php?option=com_content&task=view&id=11&Itemid=25

Regional
http://www.asra.com/fellowships/regional/
http://www.painrounds.com/index.php?option=com_content&task=view&id=16&Itemid=33 (more up to date)

Critical Care
http://gasnet.med.yale.edu/societies/ascca/FellowshipPrograms.pdf

Obstetrics
http://www.soap.org/fellowships.htm

Pediatrics
http://www.acgme.org/adspublic/

Cardiothoracic
http://www.scahq.org/sca3/fellowships.shtml

Others include Neuroanesthesia, Perioperative, and Ambulatory. I cannot find extensive lists on these. Just google em.
 
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