Agree, except CRNA/SRNA program has a HUGE impact. For the first 3-6 months, CA-1s double up on each case and they both count the case. This is due to the lack of cases since CRNAs have a monopoly at BTGH and the attendings don't want to stand up to them. Also, only program in Texas to not have moonlighting since cheap labor is already readily available. My other dislike, really low pay despite asking for $100/month for parking. Sub-specialty training is top-notch though and if you want Cardiac you are pretty much guaranteed a spot at THI.
I remember reading these Forums many years ago before I started residency and never could find much on Baylor, so seeing this post, I thought I would weigh in
I went to Baylor then did a Fellowship in our Texas Medical Center, now in private practice. As others have pointed out, as a Baylor resident, a Fellowship in any specialty there is mostly a given if you want it, unless you are just really unreliable (in that case, you dont deserve one anyhow)...
But in any case, unless something has changed, doubling up on cases with a SRNA is absolutely incorrect information. Never happened. Doubt it ever will.
When I was there a few years back the breakup with The Methodist Hospital occurred and during that time _only_ we were scrambling for specialty cases in residency for a few months while the breakup then the merger with St. Luke's occurred. During that breakup there was perhaps a month of sharing with other residents while things got reorganized. Then it quickly changed to sending folks home early instead of sharing for a few months, then back to normal. But that breakup is ancient history now ?four-five years back?. I liked Texas Heart better for learning hearts anyways...
As far as SRNAs are concerned, most of us residents were rather anti them for obvious political reasons. But it is really a non-issue. At the worst, they are a competitor for cases at the Ben Taub county hospital where you just start to learn your general anesthesia. But this is non-important in practice for a variety of reasons. Trust me, it isn't a big issue. After hours the senior resident on call runs the board as he/she wishes and tends to give the good cases to the juniors and the less desirable to the SRNAs, but really in the middle of the night, most folks appreciate being in the rotation with as _many _ other folks as possible so you can get rest. Ben Taub runs many cases all night long, there is more than enough to go around and the SRNA help carry the load, for good or for bad.
They are trained by their own faculty, the CRNAs that are there. The CRNA faculty know it is a touchy subject amongst the residents so they tended to steer clear of us. It is really pretty close to having two separate anesthesia groups in one large OR set up. Really, sometimes we all meet at the board to figure out what cases are being covered where and by whom and after that you don't really interact with the SRNAs too much unless you are on call as I already discussed.
CRNAs running things? LMAO! Not even. They unfort have a training program there. I wish they did not, but they do. The Anesthesiologist running Ben Taub tries to balance reasonably fairly there since there are two training programs, but really it is a moot point because Ben Taub is really the only place this is an issue, and BEN TAUB IS JUST FOR LEARNING YOUR MOST BASIC ANESTHESIOLOGY! Plus, the better stuff still went to the residents, and the current chair is definitely pro resident and not balanced between MD and CRNA issues.
Who cares if a SRNA gets to go do another fractured femur repair at Ben Taub! You learn how to do that the first four- six months of training. I remember we used to gripe in our CA-1 year that a SRNA would do a child case maybe once per month, and we thought they were stealing it from us. What a joke. The real learning of the Pediatric subspecialty in Anesthesia is not doing 1 pedi case per month at Ben Taub County Hospital. It is doing insane complex cases at Baylor's Texas Children's Hospital in your CA-2 year. It was #4 in the Nation when I was there. They were doing intra utero fetal surgeries. I did senior rotation in Pedi Hearts and did hypoplastic left hearts in infants and every type of cardiac shunt case you can pronounce. Insane stuff. So a SRNA stealing an ankle fracture in an 8 year old at Ben Taub Hospital? Go for it SRNA, I learned that already...
Look, I don't care anymore if you folks like Baylor or not because my training is completed and I have moved away. The main reason it has never been discussed much on these boards for years, is that Baylor is primarily a place to get superb clinical training, _not_ academic training. When you look at rankings of schools the research places get the highest ranks. Pretty much holds for all fields. So if you want to be on the front line of research, or pursue a hardcore academia future, go elsewhere. If you want to be on the front line of great surgeries then this is the place. That has always been the Achilles Heel of Baylor Anesthesia. We don't do research and so the name only gets out in clinical, not academic, circles. But when it comes to surgery, that is what Baylor is best known for! And we were/are their anesthesiologists
It is a hidden jewel if you want to learn to be a clinical anesthesiologist. Bar none, one of the best clinical training programs around. And we were pretty damn happy and liked it that way and didn't care if anyone put us in their top ten list or not... Other programs _do_ do better academic/research anesthesia, but Baylor has always been about the surgical programs historically. And that is still alive in the Texas Medical Center. I am not trying to be arrogant but few other places can match the high level surgeries that take place in the TMC, a few can _match_ what we do, but none pass us by much... There are just too many specialty hospitals all located in one location, and we do their anesthesia. Look up the helicopter photos of the Texas Medical Center sometime, the TMC is a city, not a hospital.
Here is the reality if you want to learn to be a good clinical anesthesiologist. You want to be at the place where the high level surgeries are taking place so you can learn to deliver anesthesia to those cases in the future. Or if you choose go out into private practice and likely never see anything like that in the future, at least during your training, you saw it
These are the fields, imho, you want to get good at (in no partic order) if you want to be a strong clinician in Anesthesiology:
Cardiothoracic
Pediatric
Neurosurgery
Trauma
OB
General cases
Now, less important, but nice skillsets to have are:
Regional blocks, etc
Out patient surgery
Pain training
The crucial point is the specialty rotations that are available at Baylor are superb. Those occur at various hospitals in the Texas Medical Center. There is no competition with SRNAs at these places. Now I am going to try and review these things for you to see how Baylor does at them. I will try to be objective, but realize I trained there and loved it, so I am biased. Otoh, I dont even live in Texas anymore so I dont have much vested interest there anymore
So the review, point by point:
Our cardiac training _was_ at the Methodist (DeBakey's cardiac hospital) and now is at Texas Heart Institute (Cooley's cardiac Hospital). Both those places are extremely good sites for cardiac. Much of American Cardiac surgery started at one or the other hospital. BiVad training, transplants, Aortic arch and thoracic aneurysm repair. Our training at THI, amazing and superb!
Pediatrics at Texas Children's Hospital. This is Baylor's Children's Hospital, many of the faculty are former Baylorites. Extremely well known hospital for Pedi. Again, crazy cases, and loads of them. Did 17 cases one day on call--Many short of course, but I was exhausted by the end of the night. Not about the numbers of course, but the _type s _ of specialty surgeries. Pediatric Craniofacial abnormalities galore. Our training at TCH, superb!
Neurosurg - here is was/?is a weak point for Baylor. Back in the day we did Nuero at St. Luke's or at Ben Taub. Note, SRNAs did _not_ steal the crani cases from whatever resident was on his/her neuro rotation there. Ben Taub cranis are frequent and good cases, but nothing extraordinary. St. Lukes as I recall is ranked nationally for neuro, so those residents who went there might have had it better. I don't know for sure, I did Ben Taub Neuro and it was good, but not superb. Probably the only surgical specialty where we were not on the front lines of the surgical cutting edge. I am not sure since I didnt go to St. Lukes for that
. If you interview at Baylor, see how they are doing the Neuro subspecialty, as I dont know anymore.
Trauma - Here is another area where Ben Taub shines. Imagine yourself at 2 am, Friday night call. The knife and gun crowd just getting outta the bars. You will be busy tonight
Ben Taub is the Level one trauma center in Houston. Machine gun injuries, machete injuries. Only places that could compete with that given how much Texans love their guns, could be somewhere in Detroit. You will see trauma that is unbelievable, my god the stories I have... Again, this is the site we share with SRNAs. Everyone is in the room helping start these cases, we are placing the stat lines as are the surgeons. If it is a good case, the senior resident usually will put a junior resident in the room to follow the case when the patient gets stabilized after the initial shock and awe phase is complete. If a normal boring case and the patient stable, an SRNA might finish it. Simply put, the senior wants someone in there he trusts, usually that would be you over an SRNA... Baylor trauma training, superb.
OB - now imho, what you want from O.B. training is numbers. Lots and lots of epidurals/spinal/stat C-sections. Ben Taub once again. County hospital. Huge numbers of deliveries to the migrant population. You will be sick and tired of doing epidurals here in the middle of the night. And there is even a Fellowship for O.B. Anesthesia here if you are interested. Really, I never thought a Fellowship in O.B. adds that much more to an Anesthesiologists training (feel free to differ in opinion that is fine-my point is that there isnt really that much more to get from a specialty O.B. hospital is there?), but it certainly doesn't hurt your training having the Fellowship there too. Also, the O.B. staff are national lecturers on difficult airways. O.B. training superb due to plenty of numbers!
General cases: This occurs throughout training, but really at Ben Taub and the V.A. Pretty standard, busy hospital. Not sure if there is such a thing as being superb in this anywhere? You want numbers, lots of cases Bread and Butter, but not so many that you aren't learning and reading when you get home. Baylor does a good job here too. You have the general cases your first year where you learn the basics. Then later you go to the V.A. and do general cases but all the patients are ASA 4 it seems. These old vets, you can't kill em, but they are all sick as heck... The V.A. training turned out to be very helpful to advance your training on really sick folks getting general surgery. But is likely no different than V.A. training at any other hospital. Although our V.A. is a really nice building, not that that matters in the O.R
Next:
Regional. Now here Baylor was/?is? weak. When I was there, we clamored for more regional training. We then set up a regional rotation, where you only put in blocks all day for a month. That was your job on that specialty rotation. No O.R. time. Nice improvement. But we aren't NYSORA when it comes to regional. Baylor regional - sufficient/good, not superb. May have changed an improved future, talk to the current residents
Outpatient surgery. In private practice there is a difference between Main OR work, and outpt surgery. in Outpt, the emphasis is many cases with quick turnover. Baylor didn't really have this. The medical center is really a super specialty area, so doing lots of knee scopes and carpal tunnel releases, etc, not really something that is done there. So Baylor would be a little weak in this kind of training. But in reality, I wouldn't want to waste more than a month of my training learning this as it isn't really advanced stuff. Just a nice skill set to have. So since Baylor didn't have that much outpatient surgery, I made it my personal training plan to work on fast wake ups from anesthesia, regardless of what type of surgical site I was at. When at Ben Taub, turn over is sloooowwww. So irrelevant if you woke someone quickly. I learned to do it though because I thought it was important to learn. I was right. So outpatient, private practice type surgery Baylor moderate/weak. But again, I dont think it was that important, and really wouldnt say drop a month of subspecialty at one of our other sites just to learn this stuff anyhow. That is unless I just really wanted a change of pace
Lastly Pain. Also a bit weak for Baylor Not really a huge pain megacenter from an Anesthesia perspective. If that is what you want, then look elsewhere. We did have a rotation at the V.A. and did lots of injections with C-arms, etc. But the high level spinal cords stims, etc. werent really a part of my training. I hated pain, so this wasnt an issue for me. The Texas Medical Center also has the M.D.Anderson Cancer Center that is affiliated with U.T.Houston. They have a good pain fellowship there as I recall. If this is your interest, it is close by, not sure if Baylor has any rotation there in Pain now or not. I did do a few rotations at M.D.Anderson-ICU which was ok. Baylor pain training, moderate/sufficient.
So I have tried to give a review of Baylors program and how it is set up. I did attend there, and am thankful for my training. In my practice there are several Mass General, UCSF, Clevend Clinic folks and I fit in fine. My only weakness in the practice at start was regional. As I said, we started doing more while I was going there so I imagine that has improved. I never cared for Pain, so if Baylor wasnt really hot in this specialty, I didnt care. Baylor is still and always will be a place for strong clinical work serving the crazy surgeries that happen all over the Texas Medical Center. A grouping of so many specialty hospitals in direct proximity to each other is a pretty rare set up, and Baylor gains tremendously from that exposure.
In terms of residence happiness. We were pretty happy. A residency is a lot of work, ours was no exception, but I thought we were pretty well off most of the time. Faculty is 90-95% very nice and non malignant. _All_ places have a few bad apples to steer clear of just like Baylor did, but being Malignant is not something Baylor should be seen as. In fact when I read this site some 8 years ago that is what I read! It was not. We were pretty darn happy, still a lot of work, but pretty happy. We did at one time try to get Moonlighting to no avail. Perhaps a downside to the program. Doubt I would have signed up for much though anyhow!
About half of us went into Fellowships. The jump to Fellowship is seen as a great option for Baylor residents and is pretty smooth going into one of our specialty sites-In breeding advantage FTW. If one wanted to go elsewhere for further training, our specialist know the other places very well and were very helpful. Baylor has always done a lot of inbreeding, the medical students become residents, become Faculty. Perhaps that is a downside for an academic place, however Texas is like a nation unto itself and Texans like to stay there
Plus the medical center draws in Faculty from all over in addition to the home grown faculty.
This was not meant to be seen as an arrogant post. Just that folks outside of Baylor seldom know what happens inside the Texas Medical Center and how it is set up. Most folks who have never seen the place think it is probably just a big hospital. It is not. It is a city of hospitals all connected via air conditioned bridges throughout. Amazing. Hope this was useful. Remember when you are looking at places to train, imho you want to be around the biggest craziest surgeries around. There are several places that have that, Baylor does too. The majority do not. I was well trained, pretty happy, and am grateful for what I learned.
Good luck in your interviews and future training, wherever it may be!
