Applying to Anesthesia as a Backup

[Mariah246]

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Trying to choose between two desired fields and I just can't.

Anesthesia is the less competitive of the two. So I was planning on making it a backup.

The problem is, I can only get one rotation in and it won't even be by September which means

1) no record of my ever taking an anesthesia rotation and
2) no anesthesia LOR.

Is this too risky? Would I be better off just ditching the more competitive option and going with anesthesia right off the bat?

Or would it still be possible to match into anesthesia this way if my stats were solid enough? (I'm not looking to get into a top 3 program or anything. Just a solid place with preferably a nice location)

 

[lord_jeebus]

I don't think you should pick your career based on what is more or less competitive.

Pick one, and figure out what you can do to maximize your chances. Unless the specialty is derm or your numbers are really low, you should be able to find a way to a residency program somewhere. You might need to do a year of research or something like that.

What kind of exposure have you had to anesthesiology? Even if you can't do a rotation, you should have free days during the week - contact an attending at your school, explain the situation, and ask to take some call.

 

[amyl]

september isn't too late for an anesthesiology rotation at all. i got my anesthesia letter after a sept. rotation...no big deal. you should do an anesthesiology rotation, absolutely. first, a letter will help, some experience will help but the main thing is anesthesiology is not for everyone...seems like most people either love or hate it. you need to do rotations in whatever you think you might want to do...pick one and go for it. apply to whichever specialty you like better and add some prelim meds or TYs to the end of your list.... you can always reapply after intern year... go for your first choice....maybe after a rotation your first choice will be anesthesia maybe not...

life is too short to do something you don't want to.

 

[Mariah246]

I was told by school officials that rotations after Sept are fairly useless because the programs you are applying to won't see your grade. And I was also told that letters submitted after this date usually don't make it to the system in time.

As far as anesthesia goes, I had a brief anesthesia elective rotation early in my 3rd year and loved it. I did get honors in it but seeing as it was so brief (under a month) and it was a 3rd year elective, I'm not sure how much it would actually count.

 

[huktonfonix]

I did my anesthesia elective in October and did fine. Dont forget you can also get LOR from a critical care rotation that looks pretty good when applying.

 

[Bertelman]

I was told by school officials that rotations after Sept are fairly useless because the programs you are applying to won't see your grade. And I was also told that letters submitted after this date usually don't make it to the system in time.

That's silly. No one really gives a flip about 4th year grades, anyway.

As for the letter, you can submit one after your official app has been submitted. Kind of a bonus letter. You'll be interviewing Nov-January, so I'm quite sure they'll have access to your letter.

 

[nociceptor]

That's silly. No one really gives a flip about 4th year grades, anyway.

or 3rd year grades. whoops who said that.

The OP, GAS requires COMMITMENT. You are either all the way in or all the way out. You don't marry the second best. You marry the first best and stick with her no matter how much she ruins your life.

 

[drofgas]

Sorry, maybe I am too intense at this time of day but I am a little offended in an Anesthesia forum to hear one say how one applied to Anesthesia as a back up, and how Anesthesia is a less competitive specialty.
I love this specialty, and I fought like crazy to get into it!
So, please just go for your other choice!

 

[amyl]

this year on the interview circuit no one commented on my 3rd or 4th year grades. only one place commented on my class rank, a few commented on my board scores, only one place commented on one of my LORs (it wasn't even from anesthesiology...was from chief of surgery that interviewer knew personally).
not having an anesthesia LOR will not cost you interviews...but you may be asked about it at the interview. you should ask whoever gave you honors to write you a letter. even if they didn't get to know you that well they will write you a generic letter and that is better than nothing. if you get a better one later use it instead. I got a lot of interview invites before ANY of my letters were in...much less my anesthesiology letter.
and i agree go for your first choice...don't settle for anything.

 

[Dejavu]

Sorry, maybe I am too intense at this time of day but I am a little offended in an Anesthesia forum to hear one say how one applied to Anesthesia as a back up, and how Anesthesia is a less competitive specialty.
I love this specialty, and I fought like crazy to get into it!
So, please just go for your other choice!

I'm with you drofgas, don't come into my specialty just because nobody else wanted you. We probably don't want you either if other specialties turned you down. Don't take a slot in an anesthesia program from someone who truly wants it.
If you don't really want to be an anesthesiologist, you will not be a good one (at worst) or will not be a happy one (at best).

 

[Mariah246]

I'm with you drofgas, don't come into my specialty just because nobody else wanted you. We probably don't want you either if other specialties turned you down. Don't take a slot in an anesthesia program from someone who truly wants it.
If you don't really want to be an anesthesiologist, you will not be a good one (at worst) or will not be a happy one (at best).

I'm pretty sure applicants who want to go into derm/integrated plastics/radonc are more than competitive for an anesthesia slot........

That's not to say I don't respect anesthesia. It just isn't my first choice. If it comes to having to resort to this backup plan, there's no doubt in my mind I would still be a very good and very happy anesthesiologist.

 

[m3unsure]

Don't worry if people dog you for making gas your backup. Backup is common these days since people choose specialties for more than one reason, and some of those reasons are legitimate. For example, I liked a lot about various fields except psych and ob/gyn.

It was actually my backup, but I ended up liking it better than eyeballs after doing both rotations. I ended up canceling the SF Match stuff though I was sort of guaranteed eyeballs at NWMH (because I saved a faculty member's a## when he was a fellow at my institution like $10K out of his own pocket).

Hope I won't regret it in the end when I go through the residency.

 

[Leverage]

I'm pretty sure applicants who want to go into derm/integrated plastics/radonc are more than competitive for an anesthesia slot........

That why you need a backup???

 

[Mariah246]

I'm pretty sure applicants who want to go into derm/integrated plastics/radonc are more than competitive for an anesthesia slot........

That why you need a backup???

Does it matter?

 

[polkadotcap]

I think part of the issue, at least from my perspective is this....

Anesthesia is EXTREMELY different from radiology, derm, rad onc, ophtho, etc.....the way you think, what you think about, what you are doing....all EXTREMELY different in this field compared to the others. Most people do not have a clinic in anesthesia (and are happy about that!) compared to derm, for example, which is ALL clinic for most people. This barely even scratches the surface of the differences, but you know this, at least I hope so.

The issue is that when you are using anesthesia as a "back up" to derm, rad onc, or what have you, people start to smell a "lifestyler" and that doesn't go over well on this board. But what you should know is that it goes far beyond just this board- residency directors, attendings, fellow residents, all are not too keen on those that have chosen this field for #1 perceived lifestyle and #2 that they think they would be a "very happy" anesthesiologist (but what you really mean is an "even happier" radiologist/dermatologist/whatever). And this is for good reason- because this is a tough business....it's not all cookies and laptops in the OR....AT ALL. Serious stuff goes down each and every day and you need to keep your cool and get **** done. Very different day-to-day than shave biopsies and reading rooms. Not saying harder or more stressful (no flames for me, please!), all I'm saying is they are different. And when you're sitting in a residency interview, believe me, they will want to make sure you not only know this, but are ready and salivating for it!

From a logistical standpoint, I would be careful about using anesthesia as a back up and applying to your first choice program at the same institution. People talk, you just never know who might find out, and it might kill your chances in that gas program.

 

[Jeff05]

a backup specialty should have something in common with the primary specialty, should it not?

ophtho, for example, using gas as a backup makes NO sense and it sends up red flags. the only things they have in common is the PERCEIVED lifestyle/financial benefits of the 2 specialties...

the backup for plastics should be GS
the backup for radonc should be radiology/interventional rads
the backup for derm should be medicine

these are my thoughts and they make sense to me.

again, if your specialty choices have nothing in common, but the PERCEIVED (mostly incorrectly) lifestyle and financial motives - you don't look very sincere in your desire to pursue the practice of your specialty, which is what you're going to be doing.

these are just some thoughts. i may be completely wrong though.

 

[amyl]

I'm pretty sure applicants who want to go into derm/integrated plastics/radonc are more than competitive for an anesthesia slot.........

maybe but not necessarily....in some places the numbers get you in the door for the interview but then it is all about personality and fit for the program and the people that are there. no one wants an as-hole with great board scores but this is especially true in anesthesiology where it is more of a team sport than some other specialties....

 

[Mariah246]

From a logistical standpoint, I would be careful about using anesthesia as a back up and applying to your first choice program at the same institution

Definitely wouldn't. This thread has made me seriously re-consider and I'm currently thinking I would make anesthesia my 1st choice.

I was originally planning on applying to 10-15 anesthesia programs as a backup (programs that I wasn't concurrently applying to for the other field) but the more I think about it, the more I think I would feel comfortable a) being an anesthesiologist and b) not spending all of my 4th year worrying whether or not I could get into the original specialty.

 

[lushmd]

Amy, you bring up an interesting point, one that my med school buddies and I have discussed a bit. Going into the interview process I bought into the idea that paper qualifications (scores, grades, etc...) determine whether or not one is granted an interview and that interview day performance determines the rest (i.e. going into the interview, all prospective interviewees are fairly comparable in the eyes of the residency program). However, after having gone on a number of interviews, I'm of the impression that many/most programs have a pretty good pre-conceived idea of where they're going to rank many/most candidates and only an extreme interview performance (either way, great or awful) will substantially change that. After all, most people are fairly reasonable (IMO) and how much can really be conveyed during 2-5 20-30 min interviews? Anyway, just a thought; certainly not meant to minimize the importance of interviews. We'll see how the match turns out...

EDIT: Sorry for the threadjack.

 

[amyl]

depends on the program: for example -
at CCF the residents told me that they pretty much already knew where they were going to rank us and the interview was just to make sure we "didn't have a personality disorder." That said if i match there i think it will be because i felt like i had a pretty good interview with the PD as my scores were in the 220s, not the 250s like everyone else that applied there.
at Houston, the residents told me that if you get the interview your numbers are good enough and everyone starts over -- it becomes all about the interview and the fit with the current personalities there.
a resident here, copro maybe?, said they take everything into account at his program, you get points based on your interview, board scores, grades, etc. most programs are probably this way I would guess.
If you don't give at least a decent interview, i don't think you will get in most places even with awesome board scores....and i think this sets anesthesiology apart from other competitive specialities like rads and derm.

 

[fakin' the funk]

no one wants an as-hole with great board scores but this is especially true in anesthesiology where it is more of a team sport than some other specialties....

y'know, you guys keep saying this - about how personality is so important in anesthesiology and it's a "team sport."

and i'm curious about what the "team" aspect is of sitting in the OR for hours on end by yourself...and how that's more of a "team sport" than working with several different attendings, junior and senior residents, and patients (and their issues) the way you would as a surgery resident.

seems to me like anesthesiology is one of the residencies where personality and teamwork matter little in your day-to-day medical setting.

 

[Ferdie]

Mariah - I would take some time to really think about which you would like to do (it sounds like you have been). If you think the "more competitive" specialty is really what you'd rather do FOR THE REST OF YOUR LIFE (!) (and not because it has a more competitive reputation, but because you truly enjoy doing it more), then you should do everything you can to get into that specialty. Your backup plan should NOT be a LIFETIME of working in a specialty that isn't your dream, it should be a YEAR of research in the specialty you really want to do, making you more competitive the next year.

Best of luck, these decisions are difficult to make, and very stressful! Try to think about what you you think your priorities to be down the road, and what your personality is best suited to. Gas is a great specialty, perfect for me I think, but not perfect for everyone.

Again, good luck.

 

[Ferdie]

seems to me like anesthesiology is one of the residencies where personality and teamwork matter little in your day-to-day medical setting.

I think part of what some people like about anesthesia is the "feel" of it - at least where I'm at it's a group (mostly) of relatively laid-back, informal people who are super smart and sharp and on top of their game when they need to be. They seem to get along well, there's very little drama, and they like it that way. In the interviews, they look for people who will contribute to that atmosphere. If you don't love what you're doing, you're not going to be happy at work, and you won't add to that warm and fuzzy feel.

I'm on a medicine rotation right now, and I've gotta say, what we're doing is way more "team" than what I did on gas. I mean, the resident, intern, and I are like one symbiotic creature, putting out GI bleeds and kicking liver disease's butt left and right... On the other hand, I've never been at an airway emergency or a code yet, and I imagine that seamless TEAMWORK is absolutely imperative in that situation.

 

[173291]

Sorry, maybe I am too intense at this time of day but I am a little offended in an Anesthesia forum to hear one say how one applied to Anesthesia as a back up, and how Anesthesia is a less competitive specialty.
I love this specialty, and I fought like crazy to get into it!
So, please just go for your other choice!

.

 

[173291]

Mariah - I would take some time to really think about which you would like to do (it sounds like you have been). If you think the "more competitive" specialty is really what you'd rather do FOR THE REST OF YOUR LIFE (!) (and not because it has a more competitive reputation, but because you truly enjoy doing it more), then you should do everything you can to get into that specialty. Your backup plan should NOT be a LIFETIME of working in a specialty that isn't your dream, it should be a YEAR of research in the specialty you really want to do, making you more competitive the next year.

Best of luck, these decisions are difficult to make, and very stressful! Try to think about what you you think your priorities to be down the road, and what your personality is best suited to. Gas is a great specialty, perfect for me I think, but not perfect for everyone.

Again, good luck.

Ferdie makes some very important points in this post. I don't understand the concept of settling. Go for what you really, truly want to do.

 

[Bertelman]

y'know, you guys keep saying this - about how personality is so important in anesthesiology and it's a "team sport."

and i'm curious about what the "team" aspect is of sitting in the OR for hours on end by yourself...and how that's more of a "team sport" than working with several different attendings, junior and senior residents, and patients (and their issues) the way you would as a surgery resident.

seems to me like anesthesiology is one of the residencies where personality and teamwork matter little in your day-to-day medical setting.

You have a big surprise waiting for you when you enter private practice. Managing an operation takes teamwork from the time the patient checks into the hospital, to the moment they are wheeled back to their car. And the last I checked, the anesthesiologist isn't in the OR alone. When we talk about the team sport, we don't refer to residency. That's just a prelude to the rest of your life.

For starters, don't forget that on the day of surgery, the anesthesiologist has as much face time or more with the patient than anyone else. The surgeon will pop in for a quick how-do-you-do in pre-op, but in general they won't arrive to the OR until the patient is gassed, prepped and draped. There are no med students, no residents. There is an anesthesiologist, a scrub nurse and a circulator.

The team player aspect involves dealing with every personality that is involved in the operation. You have to coax the pre-op nurses into having the patient ready for OR time. IV should be in. Work with circulators to get room turned over, because you have to wait to bring the patient in until they say yes. You've got to work with the personality of the surgeon during the case, then you have to take the patient to PACU when it's over and talk to those nurses, as well.
You think nurses on the floor have attitude? Try begging the OR charge to get another room so you can flip-flop cases. That b**ch runs the show.

I'm sure as a med student you've been to a few operations. If you're at a traditional academic hospital, the OR is run like a JV squad. An efficient PP hospital is the major leagues. And believe it or not, the surgeon does little to help the pace of room turnover, which at the end of the day is the most important outcome, second to mortality. That falls into the hands of the anesthesiologist.

Now just think about managing two or three rooms if you are working with CRNAs.

 

[fakin' the funk]

You have a big surprise waiting for you when you enter private practice.

I sure hope 2013 doesn't sneak up on me so fast I'll be "surprised"...but thanks for the heads-up.

Anyway, the reason I was only asking/talking about residency in my post is because I know teamwork is far more important in PP than it is at a big academic center during residency (see: surgeons throwing instruments). But I would think PDs are not nearly as concerned with your PP affability than your residency performance.

 

[Bertelman]

I sure hope 2013 doesn't sneak up on me so fast I'll be "surprised"...but thanks for the heads-up.

Anyway, the reason I was only asking/talking about residency in my post is because I know teamwork is far more important in PP than it is at a big academic center during residency (see: surgeons throwing instruments). But I would think PDs are not nearly as concerned with your PP affability than your residency performance.

Graduating anesthesia residents are of little use if they can't obtain jobs. Believe it or not, when good Anesthesiology PDs choose residents, they choose residents that they would want to work with. It reflects poorly on a program if their residents have difficulties finding work. Few other fields of medicine have the teamwork aspect of anesthesia. If I'm in an 8 hr case and need a break, I need to trust the person coming in to relieve me. See Noy's thread on trusting others.

Sure, surgery has to be part of the team, but the surgeon is the captain of the ship. Folks tolerate their shenanigans. Anesthesia has to walk the line, so to speak.