Does the program REALLY matter?

[GuP]

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Does it matter what program you train at? Let's take extremes and say one fella trained at MGH and the other trained at Brookdale/NY Methodist/Podunk U. Besides the ancillary staff and adequate equipment, will the fella from Podunk U. lack significant training? Significant enough to the point where he may be incompetent and compromise pt. care? Or will the difference only be slight - slight enough that the former fella will have no problem pulling in the benjamins working in a pp gig? Just wondering about this. Is it enough to get into any anesthesia program or should you stay away from the bottom feeders?

 

[coprolalia]

Stay away from the bottom feeders unless you are prepared to spend your career in a crappy hospital in the immediate vicinity of the program.

Name means a lot. Reputation means a lot. I'm finding this out as the job search starts to kick into high gear...

-copro

 

[numbmd]

Sorry, but I don't quite agree with Copro. A big name does have some juice, but not as much as some may think. Just my experience.

 

[Trisomy13]

I'm at what might qualify as a Podunk U. and we have very competent ancillary staff and top of the line equipment. New gas machines in every room, electronic charting, new ultrasounds for regional, big clean modern ORs, blah blah blah. So that assumption doesn't always hold true. Our alumni have no problems "pulling the benjamins in PP".
I do think, however, that location can make some difference in your marketability, in the sense that you will have more connections within the state where you are training. That doesn't imply that you will necessarily be in the local "crappy community hospital", but it might be more challenging to land a competitive CA or NY job coming from *insert midwestern state*.
Go where you feel you will thrive and become competent. Interview at a range of places and see the differences for yourself and decide how much is real and how much is branding.

 

[Dejavu]

The caseload characteristics of the program may matter.

Just an example---Say you have done 100 psoas nerve blocks and 100 femoral blocks during your residency. And say the group you are looking to sign with does a lot of total joints, you would have a leg up.

So sometimes the experiences you gain in a particular program may help.

As for program name marketability...I work at Mayo Clinic. We like to think that brand-recognition helps our residents in their job search, but we don't have any scientific data to support it. I think it might but cannot prove it.

 

[Dinkyconductor]

Does it matter what program you train at? Let's take extremes and say one fella trained at MGH and the other trained at Brookdale/NY Methodist/Podunk U. Besides the ancillary staff and adequate equipment, will the fella from Podunk U. lack significant training? Significant enough to the point where he may be incompetent and compromise pt. care? Or will the difference only be slight - slight enough that the former fella will have no problem pulling in the benjamins working in a pp gig? Just wondering about this. Is it enough to get into any anesthesia program or should you stay away from the bottom feeders?

Funny you should bring that up...I just walked home after spending my night with a 35 year old who hemorrhaged after a TAH...BP 35/12 on arrival into the OR, and my hospital doesn't do trauma or hearts, so no one was used to this type of situation. They sent two other anesthesiologists in to help me, but they weren't really very useful. I had to intubate, get two 14 gauge IV's, get the blood, a line, the usual stuff, within 5-10 minutes or so...again, no different than any standard major trauma case. I'd bet her Hgb was around 3 just before I gave the blood.

But, all I could think the whole way home was how glad I was I intentionally chose the most difficult residency program I could find. Where I trained, it wasn't unusual to get 2-3 cases like this on a single weekend night (gunshot wounds to chest/abdomen). The difference between me and the older anesthesiologists who probably hadn't seen anything like this in years was huge, to the point that I'm not sure they would have been able to save her.

So, can't comment on the value of a big name program with regards to job prospects, but I can say the difference in training between a good program and a bad program can mean the difference between life and death when you're out there practicing.

 

[nociceptor]

Funny you should bring that up...I just walked home after spending my night with a 35 year old who hemorrhaged after a TAH...BP 35/12 on arrival into the OR, and my hospital doesn't do trauma or hearts, so no one was used to this type of situation. They sent two other anesthesiologists in to help me, but they weren't really very useful. I had to intubate, get two 14 gauge IV's, get the blood, a line, the usual stuff, within 5-10 minutes or so...again, no different than any standard major trauma case. I'd bet her Hgb was around 3 just before I gave the blood.

But, all I could think the whole way home was how glad I was I intentionally chose the most difficult residency program I could find. Where I trained, it wasn't unusual to get 2-3 cases like this on a single weekend night (gunshot wounds to chest/abdomen). The difference between me and the older anesthesiologists who probably hadn't seen anything like this in years was huge, to the point that I'm not sure they would have been able to save her.

So, can't comment on the value of a big name program with regards to job prospects, but I can say the difference in training between a good program and a bad program can mean the difference between life and death when you're out there practicing.

I choose LIFE!

 

[Trisomy13]

speaking of penetrating trauma, we had the classic "arrow through the head" last night... except it was more posterior neck than actual head.

reminded me of a young Steve Martin

i think there is something to be said for training at a level 1 trauma center. of course we see more hunting accidents than drive-by shootings, and more ATV accidents than crashed Bugattis, but the human body breaks in the same way at velocity 😉

 

[mdnsw]

Funny you should bring that up...I just walked home after spending my night with a 35 year old who hemorrhaged after a TAH...BP 35/12 on arrival into the OR, and my hospital doesn't do trauma or hearts, so no one was used to this type of situation. They sent two other anesthesiologists in to help me, but they weren't really very useful. I had to intubate, get two 14 gauge IV's, get the blood, a line, the usual stuff, within 5-10 minutes or so...again, no different than any standard major trauma case. I'd bet her Hgb was around 3 just before I gave the blood.

But, all I could think the whole way home was how glad I was I intentionally chose the most difficult residency program I could find. Where I trained, it wasn't unusual to get 2-3 cases like this on a single weekend night (gunshot wounds to chest/abdomen). The difference between me and the older anesthesiologists who probably hadn't seen anything like this in years was huge, to the point that I'm not sure they would have been able to save her.

So, can't comment on the value of a big name program with regards to job prospects, but I can say the difference in training between a good program and a bad program can mean the difference between life and death when you're out there practicing.

Did you find her a nursing home bed that will turn her several times a day to delay the onset of bedsores, infection, death for a few months or years? I guess the social worker and ICU team will do that for you...

 

[lushmd]

Did you find her a nursing home bed that will turn her several times a day to delay the onset of bedsores, infection, death for a few months or years? I guess the social worker and ICU team will do that for you...

WTF is this comment about?

 

[mdnsw]

WTF is this comment about?

Yeah. Sorry. But seriously, did she turn out ok?

 

[dhb]

Does it matter what program you train at? Let's take extremes and say one fella trained at MGH and the other trained at Brookdale/NY Methodist/Podunk U. Besides the ancillary staff and adequate equipment, will the fella from Podunk U. lack significant training? Significant enough to the point where he may be incompetent and compromise pt. care? Or will the difference only be slight - slight enough that the former fella will have no problem pulling in the benjamins working in a pp gig? Just wondering about this. Is it enough to get into any anesthesia program or should you stay away from the bottom feeders?

I think it's important to be realistic about your program and understand it's advantages/disadvantages strength/weakness and adapt to it.
No program will give you the complete and perfect package so you'll have to be proactive to compensate.
With that being said a high volume high acuity center where you don't have to compete for cases is certainly better that a place where you do b & b cases all day.
Procedures and technical ability you can't learn from a book so i'd value that over teaching/didactics but it's nice to have some balance. If you can get 100 lumbar plexus blocks like mentioned above you'll be a stud even if you don't know the action of local anesthetics on the squid's giant axona