Anesthesiology Residency: Chances and Advice for Future

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SaltyDog said:
I think somebody got into @Noyac ’s martinis.
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No, just high on dopamine.

Don't you know that surgical saying, never wake a sleeping... anesthesiologist?

P.S. Anyway, time to turn my hypomania off. The troll was not a troll, and I am breaking off-topic records here.
 
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Woke up in the elementary school (maybe middle school since there are some big words being thrown around) playground.

It’s the internet, don’t believe everything you read. Some people claim they have stellar MCAT and step scores and in other specialities (probably not anesthesia) can come to anesthesia forum and take a dump.

Medicine in general is a practiced field. More experience and knowledge you have the better. Without one or the other, it’ll be hard to be an excellent physician.
 
FFP said:
Because I am arrogant, but I mean well.
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Too much to process here, but I'm going to pick a response you gave and roll with it.

Make a 220+ on step 1 or 2 = passing anesthesia boards = anesthesiologist (no matter what grade you make)

Let me explain:

1) do I care about colonic polyp screening schedule? no....Do I care about when to do PAP smear? no...Do I care how to recognize abuse? no....do I care about what kind of depression they have? no (except for the drugs)...there's your 220

2) when you have a vignette that's about a page long and you finally arrive at 2 answers. One is correct, and one is more correct...which do you pick? correct one of course!!...well, sometimes in anesthesia you have to do both. MCQs limits the scope of your considerations, and I have seen too many times on rounds when med students reply: "but uworld says..." The point i'm trying to make here is the whole point of these BS tests is to assess how well you can take in massive amount of info and understand it because in residency, with more exams and working at the same time, you have to demonstrate that ability to pass your boards. Anes does not require you to know too much. Physiology, pharm, and pathology are probably the 3 most important concepts anesthesiologists need to know. Pathoma and sketchy covers like 70% of it. There's a reason we have other teams working in conjunction with us to come up with plans in the ICU. You can't be this super attending that dictates what you want to do with the patient. Surgeons have their preferences, GI have theirs, Cardio, etc. They are the ones who made a 240+ on their step one, and I am happy to let them manage the patient after I stabilize them using prob 50 drugs.

bottom line: if you get a 220, don't be discouraged. Show to other programs that you didn't waste too much time in books and did something to improve yourself as a physician. You can be this guy and be a know it all OR you can be someone who is humble and realize that making 260 on step 1 and 2 is just half the battle. Cheers
 
FFP said:
In order not to become just a protocolized drone, you need to understand the WHY behind everything you do as a doctor. That means a strong foundation in physiology, pathology and pharmacology. How can you become better at them fast? Borrow a set of Kaplan USMLE Step 1 Lecture Notes, and learn the respective books by heart (I haven't looked at them in like 15 years, but I am sure they are still good).

For immunology, the best book I have encountered is How The Immune System Works by Lauren Sompayrac's. For microbiology, Clinical Microbiology Made Ridiculously Simple. These two are just fantastic. I should definitely buy the new editions for myself. Infectious diseases are the most frequent diseases in nature, and yet few doctors have a decent knowledge of them.

If you know well these 5 books, you will have a decent basic science foundation. Nothing replaces reading great books during a rotation (especially great pathology learning books), but there is no time for that. On top of these, you should develop some Terminator-strong statistics knowledge and analytical skills, but that's really the frosting on the cake. Otherwise, you will become just one of the many docs fooled by "evidence"-based medicine on a daily basis.

The best anesthesiologists I have met have the intellectual skills of internists and the practical skills of surgeons. Neither the former nor the latter are enough. (Most anesthesiologists in practice have the latter and lack the former, most people with problems during anesthesiology residency the other way round. Most anesthesiologists with the former also tend to become intensivists, but that's a different story.)

Anytime you find yourself knowing how or what and not why, you have basic science gaps to fill. The American healthcare market does not care about the why, until you get sued. That's why many of our doctors are not that impressive over a midlevel, and probably why the US has medical "schools" and not "universities", like the rest of the world. We tend to emphasize doing over thinking.

Medicine is not a trade; it should be a strongly intellectual activity. Nobody tells you that, because Big Pharma and Big Healthcare and other Big conspiracies have zero interest in having truly good doctors who think for themselves. They need brainwashed monkeys who do what they are told, and who can't even analyze a research paper, let's not mention bayesian decision making. In a capitalist healthcare system, one gets hired based on what one can do, not what one knows. Still, one can't excel at being a doctor if one doesn't understand deeply why one does the what, or why this how is better than that how.

Good luck! The first step in fixing a problem is acknowledging you have one.
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I can't agree more with your message about physicians needing to know the fundamentals in the basic sciences. But can I quibble with a few of your book choices? I thought for physiology Costanzo is gold. For pathology Pathoma and actually I liked (small) Robbins too. But I admit I have never really read Kaplan so I can't compare on any informed basis. Is Kaplan physiology and Kaplan pathology really better than these?

I love the other books you mentioned Clinical Microbiology Made Ridiculously Simple and How the Immune System Works. Moffet's Pediatric Infectious Diseases is actually good at ID and despite its name most of it is relevant to adults too. Also I didn't read all of it but I liked Lilly's Pathophysiology of Heart Disease and West's Respiratory Physiology and Pathophysiology (heart and lungs, since this is anesthesia). That is a lot of reading but I like reading. 🙂
 
BLADEMDA said:
That’s a lot of reading when our Nurse Anesthesiologists simply turn a blue knob or a yellow knob for $135 per hour
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LOL. Nurse Anesthesiologist. Now they have PhDs and can say I'm Dr SoandSo from anesthesia and I'll be taking care of you today. Talk about misleading. And I dont think the state licensing board can do anything about it. CRNAs in Ohio did that years ago when the got their Dr of Divinity through the mail and were introducing themselves as such. The State Boardade them stop
 
Hash Slinging Slasher said:
After a great deal of soul-searching and deliberation, I've finally decided on anesthesiology as my specialty of choice. However, I have little idea of how competitive I given my stats. I've looked over the NRMP match outcomes, and it appears as though I have a decent chance at anesthesia. What I'm not as sure of is if that's still true given my other stats AND the fact that will be couple's matching as well.

My stats:
  • Step 1: 224
  • Clinical Grades: High-Pass (Family, Peds, Neuro), Pass (OB/GYN), Honors (none 🙁)
  • Preclinical Grades: Organ-based curriculum with modules lasting 1-2 months each. First year was P/F with all P's. Second year had a D, several C's, and finally a B. I remediated the module with a D in the M2/M3 summer up to a B
  • Research: One poster presentation
  • Current GPA: 2.52
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This will be tough to overcome. Lots of bad advice on this thread. The one guy who is actually giving the best advice kind of went off the deep end. He's normally a great poster with lots of good contributions. Pay no attention to his attempts at humor, but the other parts are actually pretty good.
The D and several C's will get you put on the inactive list of ERAS at most programs as soon as they open your application. The lack of an above average step I to counteract the poor grades hurts. A step 2 above 240 may salvage things, but you will already be on the inactive list when it arrives unless you already have it. Honors in a few (like half) of your 3rd year clerkships could help but may not. It is rare to make big jumps in class rank between your first two years and when you finish your clerkships. If you struggle in the first 2 years, you almost always struggle in the third year as well. You are likely in the bottom 5% of your class based on your grades you shared. Program directors will be able to discern that, even if no class rank is shared until the Dean's letter comes out.
I recommend a strong backup plan.
No intent to offend.
 
AAMM21 said:
You are still eligible for the majority of programs and will have a leg up, regionally speaking, if you do aways. It also shows dedication to the field to do 1 or even 2 aways in 4th year.
On a personal note:
What sort of candidate do you think would match into The Mayo Clinic in Rochester, MI? I ask, because this is my top choice, but it seems quite competitive. I got 241 on step and don't really have much else going for me, like at all.....any tips would be appreciated
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These two paragraphs do not add up.
How can you give advice to a struggling student on their chances in the match and then, in the next sentence, ask for advice on the same topic?
I am sure you mean well, but your advice is not correct.
 
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Gern Blansten said:
This will be tough to overcome. Lots of bad advice on this thread. The one guy who is actually giving the best advice kind of went off the deep end. He's normally a great poster with lots of good contributions. Pay no attention to his attempts at humor, but the other parts are actually pretty good.
The D and several C's will get you put on the inactive list of ERAS at most programs as soon as they open your application. The lack of an above average step I to counteract the poor grades hurts. A step 2 above 240 may salvage things, but you will already be on the inactive list when it arrives unless you already have it. Honors in a few (like half) of your 3rd year clerkships could help but may not. It is rare to make big jumps in class rank between your first two years and when you finish your clerkships. If you struggle in the first 2 years, you almost always struggle in the third year as well. You are likely in the bottom 5% of your class based on your grades you shared. Program directors will be able to discern that, even if no class rank is shared until the Dean's letter comes out.
I recommend a strong backup plan.
No intent to offend.
Click to expand...

Brutally honest response.... again. The MATCH is now much harder with more applicants than ever before. Gern is stating the facts on the ground. While it may be very unpleasant to read, the lower level applicants with below average Step scores, below average grades, etc will NOT likely MATCH into Anesthesiology.

If they want to give the very bottom type community programs (new ones) a shot by all means. But, the focus should be on Primary Care as a specialty.
 
iwanttohelpppl said:
Too much to process here, but I'm going to pick a response you gave and roll with it.

Make a 220+ on step 1 or 2 = passing anesthesia boards = anesthesiologist (no matter what grade you make)

Let me explain:

1) do I care about colonic polyp screening schedule? no....Do I care about when to do PAP smear? no...Do I care how to recognize abuse? no....do I care about what kind of depression they have? no (except for the drugs)...there's your 220

2) when you have a vignette that's about a page long and you finally arrive at 2 answers. One is correct, and one is more correct...which do you pick? correct one of course!!...well, sometimes in anesthesia you have to do both. MCQs limits the scope of your considerations, and I have seen too many times on rounds when med students reply: "but uworld says..." The point i'm trying to make here is the whole point of these BS tests is to assess how well you can take in massive amount of info and understand it because in residency, with more exams and working at the same time, you have to demonstrate that ability to pass your boards. Anes does not require you to know too much. Physiology, pharm, and pathology are probably the 3 most important concepts anesthesiologists need to know. Pathoma and sketchy covers like 70% of it. There's a reason we have other teams working in conjunction with us to come up with plans in the ICU. You can't be this super attending that dictates what you want to do with the patient. Surgeons have their preferences, GI have theirs, Cardio, etc. They are the ones who made a 240+ on their step one, and I am happy to let them manage the patient after I stabilize them using prob 50 drugs.

bottom line: if you get a 220, don't be discouraged. Show to other programs that you didn't waste too much time in books and did something to improve yourself as a physician. You can be this guy and be a know it all OR you can be someone who is humble and realize that making 260 on step 1 and 2 is just half the battle. Cheers
Click to expand...

If you want to Match make a 230+ on Step 1 and 240+ on Step 2 plus decent grades during years 1 and 2 combined with reasonable clerkship grades.

If you get below a 225 better have a backup plan especially as a DO applicant. This isn't the same MATCH as more and more Med Students are looking for a finite number of slots.
 
BLADEMDA said:
If you want to Match make a 230+ on Step 1 and 240+ on Step 2 plus decent grades during years 1 and 2 combined with reasonable clerkship grades.

If you get below a 225 better have a backup plan especially as a DO applicant. This isn't the same MATCH as more and more Med Students are looking for a finite number of slots.
Click to expand...
Also, students should realize that today's 240+ scores would have been 220+ 10 years ago. There is a score inflation of about 10%, especially for Step 2, that's also reflected in the 10% increase in the passing score. Hence a 220 is now a miserable score for Step 2.

The other humongous difference is the unification of DO and MD residencies. It should be MUCH easier for a DO to apply for an MD residency than in the past, hence many more AMG applicants even in bad times like nowadays. Many programs will prefer a good DO to a bad MD graduate.
 
tennessee2244 said:
I have about had it with your ******* comments all over this board FFP. http://www.nrmp.org/wp-content/uploads/2013/08/chartingoutcomes2009v3.pdf. That is the link to to the 2009 Charting Outcomes in the Match. The average anesthesiology matched applicant Step 1 THEN was 224. Fact. Today it IS 232. That is an 8 point increase. Hardly the 220 10 years ago is a 240 now asinine exaggeration you made. Hell 225 was the average step 1 for all matched USMD applicants across all specialties 10 years ago per the data. Yeah things have changed but it aint even close to how you presented it. I know you think you know everything as double boarded mr badass etc etc but cmon man. Get your facts straight. Todays average USMD matched applicant score is 233, 2009 it was 225. That is ACTUALLY a 3.5% increase (225/233) over 10 years. Not 10 percent. Just do your job instead of spouting nonsense without any concept of reality to people who are actually in the match game. Here's 2018s match info. Now please be quiet. https://www.nrmp.org/wp-content/uploads/2018/06/Charting-Outcomes-in-the-Match-2018-Seniors.pdf
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Dear Tennessee nobody,

I was talking about Step 2 (CK). Please see slide 19 here (and that was 5 years ago):

I hope you understand the difference between average and median.

Even without this kind of data, the fact that the USMLE increased the passing score for Step 2 from the 190s (about 15 years ago) to 209 should be suggestive. Also, most of your interviewers will remember how rare a 260 used to be back in their time, and how even a 250 was a big deal.

I would also not rush to judge things by how anesthesiology applicant scores are going. The specialty is on its way to becoming seriously unpopular again, like in the 90s.

And because I doubt you will learn manners soon (although using this tone with your attendings will definitely speed up things), welcome to my ignore list. I advise you to use that forum function for my posts; it may do miracles to your mental health. It may even create a safe space for you.

Btw, this is not "my job". This is just my voluntary time wasting, to release some pleasant dopamine in my stupid brain. Most of the people on this forum wouldn't have even bothered to consider you for an answer.
 
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BLADEMDA said:
That’s a lot of reading when our Nurse Anesthesiologists simply turn a blue knob or a yellow knob for $135 per hour
Click to expand...

Bingo!! and that’s the real problem. We are expecting the smartest and the brightest to enter a field that requires so much testing hurdles but at the end of the day someone with a fraction of the training and adversity gets to make just about the same amount of money. Sorry to say it but Anesthesia will continue to attract candidates with poor step scores and grades like the OP. No one is saying, I scored a 220 on my step 1 and barely passed a bunch of classes, what are my chances at dermatology or neurosurgery?
 
FFP said:
Dear Tennessee nobody,

I was talking about Step 2 (CK). Please see slide 19 here (and that was 5 years ago):

I hope you understand the difference between average and median.

Even without this kind of data, the fact that the USMLE increased the passing score for Step 2 from the 190s (about 15 years ago) to 209 should be suggestive. Also, most of your interviewers will remember how rare a 260 used to be back in their time, and how even a 250 was a big deal.

I would also not rush to judge things by how anesthesiology applicant scores are going. The specialty is on its way to becoming seriously unpopular again, like in the 90s.

And because I doubt you will learn manners soon (although using this tone with your attendings will definitely speed up things), welcome to my ignore list. I advise you to use that forum function for my posts; it may do miracles to your mental health. It may even create a safe space for you.

Btw, this is not "my job". This is just my voluntary time wasting, to release some pleasant dopamine in my stupid brain. Most of the people on this forum wouldn't have even bothered to consider you for an answer.
Click to expand...
What happened in the 90s that made it so unpopular if you don't mind me asking?
 
NicMouse64 said:
What happened in the 90s that made it so unpopular if you don't mind me asking?
Click to expand...
Salaries dropped to around 100K (that would be around 200K in today's dollars, and not so far from what some academics/VA docs make). Some residency programs were so desperate they paid even for the candidates' plane tickets. Many of the FMGs in the specialty date from back then.

I foresee a similar job market again for any anesthesiologist who can be replaced by a CRNA.
 
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NicMouse64 said:
What happened in the 90s that made it so unpopular if you don't mind me asking?
Click to expand...



Page 13-14 offers a pretty concise description. I finished in 1996. Not a single one of my class was even offered an interview by the biggest local PP group, the one I work for now. They were very busy but worried about the effects of a new development called managed care and just weren’t hiring. We all had to leave town to find work or stay on as junior faculty which our department graciously offered. My own department was able to obtain a full complement of residents with the aid of a small German wave (3/11 residents). By 2000-2002, the private practice groups were back on a hiring binge and many people who left town returned. Things turned around very suddenly.

The WSJ article referenced in the link described the plight of a recent Stanford anesthesia graduate who couldn’t find any permanent full time job and was driving hundreds of miles all over Northern California trying to piece together a living.
 
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nimbus said:

Page 13-14 offers a pretty concise description. I finished in 1996. Not a single one of my class was even offered an interview by the biggest local PP group, the one I work for now. They very busy but worried about the effects of a new development called managed care and just weren’t hiring. We all had to leave town to find work or stay on as junior faculty which our department graciously offered. My own department was able to obtain a full complement of residents with the aid of a small German wave (3/11 residents). By 2000-2002, the private practice groups were back on a hiring binge and many people who left town returned. Things turned around very suddenly.

The WSJ article referenced in the link described the plight of a recent Stanford anesthesia graduate who couldn’t find any permanent full time job and was driving hundreds of miles all over Northern California trying to piece together a living.
Click to expand...
So there was an oversupply? Not enough surgeries? Reimbursements down?

Edit: realized it's somewhat answered in the article but doesn't give a full picture. Looks like there was a report about supervision ratios that kept a lot of residents from wanting to enter the match.
 
This was from 2001:

"In 1994, the American Society of Anesthesiologists (ASA) commissioned a comprehensive assessment (undertaken by Abt Associates, Inc) of future anesthesia personnel requirements in an increasingly challenging environ-ment.1 At that time, the new administration in Washington, DC, had begun a far-reaching, although ultimately unsuccessful health care initiative aimed at fundamental changes relating to care compensation and utilization. Even without central government intervention, however, “managed care” organizations grew, fueled by payer concerns over rampant increases in health care expenditures. Surgical and diagnostic procedures were especially vulnerable to reduced utilization under managed care, as new tools such as practice guidelines, administrative preapproval procedures, and utilization review were applied to medical practice. Recruitment to fill anesthesiology as well as other specialty position vacancies decreased dramatically as physician groups braced for the expected impact of these changes.2

Abt Associates based their analysis of demand for anesthesia care from 1994 through 2010 on 1991 government data, as well as on assumptions about future efficiency. It took into account overall population growth and provided several scenarios based on the degree to which the anesthesia care team model, as opposed to solo practice of anesthesiologists or nurse anesthetists (NAs), would be adopted. (“Anesthesia care team” refers to physician anesthesiologists working with anesthesiology residents, certified registered NAs, NA students, or anesthesiologist assistants [AAs].) On the whole, the Abt report painted a grim picture of an imminent anesthesiologist oversupply. In the NA-intensive team care model, the annual training need for anesthesiologists was predicted to be virtually zero through 2010 unless anesthesiologists would retire younger than age 65 years or started to work fewer than 62 hours per week.1 The Abt study's other scenarios predicted the need for slight increases in anesthesiologists.

The Abt report itself clearly states that it would not be possible to predict which of the many scenarios actually would describe the future demand for anesthesiologists. Few would argue now that its dire predictions were inaccurate, even if one selects the scenarios under which greater needs for anesthesiologists were predicted. What proved truly unfortunate was how anesthesiologists, medical school advisers, and medical students interpreted its meaning and what actions they took as a consequence.

Underestimation of demand for anesthesiologists in the Abt study may have resulted from several assumptions in their analysis. First, Abt Associates based their calculations on anesthesiologists' working full time, which does not take into account the rising number of part-time anesthesiologists. Furthermore, the Abt study assumed across-the-board scheduling efficiency increases culminating in a projected 90% average personnel utilization rate. However, rather than a concentration of surgery in existing operating suites, new operating facilities in the outpatient and office settings have proliferated, which generally results in overall scheduling inefficiency for anesthesiology groups. While a 90% anesthesia personnel utilization rate may be achievable theoretically in isolated facilities, we believe that surgical and patient convenience and variations in operative load will prevent such high utilization rates. The Abt study also assumed that average surgical procedure times will have decreased 20% by 2010. New surgical techniques (such as minimally invasive surgery) are continually being introduced, which, at least early during the experience curve, increase procedure time. It seems that estimation of demand for anesthesia services was too heavily influenced by the assumption that managed care would curtail the demand for surgical care and increase efficiency. Furthermore, the report did not and perhaps could not anticipate the added demand for anesthesia care imposed by the fast-growing but poorly quantified pain management and office-based surgical markets.

Extensive publicity surrounding a feared anesthesiologist oversupply caused the number and overall quality of residents entering US residency programs to plummet during the mid 1990s.3 Medical students avoided anesthesiology as a specialty,4, 5 in part because of adverse press coverage such as a Wall Street Journal article that described how difficult it was for anesthesiology residency graduates to find work in the California of 1995.6 Moreover, medical school faculty advisers and deans echoed the apparent plight of the specialty of anesthesiology and persuaded many a promising student to choose an alternative career in one of the primary care disciplines. This was done in concert with a 1994 Council on Graduate Medical Education recommendation to limit the total number of residents to 110% of the prior year's US medical school graduates and to limit the number of specialists to 50% of all physicians.7

At the threshold of a new millennium, indications mount that an insufficient number of anesthesiologists and other anesthesia providers exist to satisfy the demand for anesthesia services across the United States. For today's graduating anesthesiology residents this situation has created one of the most favorable employment climates in the history of anesthesiology. Medical students are beginning to appreciate this positive trend and are showing a renewed interest in the specialty."


And now, we finally do have an oversupply. To those who don't believe me, just a reminder: in a true undersupply, anesthesiologists would basically write their own contracts. Instead, they are mostly presented with "take it or leave it" situations. One can't negotiate a contract even with a crappy AMC, because they know there is a sucker born every minute.
 
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The mid 1990s was a bad time for our specialty, but saying today’s environment is the same is little more than fear mongering. No, salaries won’t plummet down into the mid 100s anytime soon unless President AOC comes around in 20 years (and even then, ALL of medicine would face the same issues). The market is strong, MGMA continues to go up each year and it’s harder than ever to match into a program as an MD student. By no means is everything all sunshine and rainbows but - spoiler alert - no field or job is. I’d encourage those interested in the specialty to speak with real-life anesthesiologists.
 
AdmiralChz said:
The mid 1990s was a bad time for our specialty, but saying today’s environment is the same is little more than fear mongering. No, salaries won’t plummet down into the mid 100s anytime soon unless President AOC comes around in 20 years (and even then, ALL of medicine would face the same issues). The market is strong, MGMA continues to go up each year and it’s harder than ever to match into a program as an MD student. By no means is everything all sunshine and rainbows but - spoiler alert - no field or job is. I’d encourage those interested in the specialty to speak with real-life anesthesiologists.
Click to expand...
OK, I hate fighting over this, but please do realize that a dollar today would have been worth about 50 cents back in the 90s. So the 220-250K salaries on the East Coast are not far away from those times. There are some truly miserable markets out there, especially close to the sucker factories residency programs.

Of course one can still make 450K... by working 65-80 hours/week, and/or supervising a ton of rooms. Look at the big picture: there is already a lot of sh-t on the fan, and more is coming. The AMC cancer is extending, and it's infecting even the previously decent PP and academic groups.

The fact that somebody can make a good living in BFE is irrelevant. Most of us don't want to or can't live in BFE. We have spouses and kids. It's also irrelevant that one can make good money by doing a ton of nights and weekends. I am not sure I would call that "life"; that's how people get divorced.
 
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iwanttohelpppl said:
Make a 220+ on step 1 or 2 = passing anesthesia boards = anesthesiologist (no matter what grade you make)
Click to expand...

Fam ... Here to tell you this aint a good attitude. Dont know where you are in your training, but I am thoroughly into CA 2 year at a major academic institution. From personal experience, the oral boards examiners will see through you. Quickly.

Honestly, the basic exam isn't a cake walk either. Especially if you are in a program that doesn't set aside a ton of time for board prep.

CRNAs aside, this is a very humbling profession. The best attendings at my institution have a way with phys, pharm and path, but also a real appreciation for medicine, training -- being in the literature.
 
OP, make sure you do Anesthesia for the right reason. Picking a specialty for wrong reasons and spend your whole career being miserable wishing you were doing something else is miserable and pathetic.

Also be flexible to move, you won’t need to be in BFE to make a living but if you are hellbent on the the glamorous NY, SF, LA, it will be low pay. You cant have it all.
 
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