Importance of Residency Prestige for PP

[Green Penguin]

Hi all,

I'm looking for input from some people a little farther along in this process than I am.

Assume you have the opportunity to train at one of the most prestigious anesthesiology programs in the country (e.g. UCSF, MGH, BWH, Stanford, Duke, JHU) vs. a somewhat less prestigious but also clearly very good program (e.g. Columbia, UW, BIDMC, UCLA, Mount Sinai, UVa, UF, Wake Forest, etc).

The goal is either fellowship and then private practice, straight to PP without fellowship, or a mostly non-research "clinician track" academic job with or without fellowship. You are not trying to build a lab or get an NIH grant. You don't know what part of the country you would eventually like to practice in.

In that case, does it matter whether you choose one of the most prestigious residencies vs. a very good but not a "top" residency? Would the person who trains at MGH, Stanford, or Duke get better PP or academic clinician-track job offers than one who trains at Mount Sinai, UCLA, or UVa?

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[okayplayer]

Hi all,

I'm looking for input from some people a little farther along in this process than I am.

Assume you have the opportunity to train at one of the most prestigious anesthesiology programs in the country (e.g. UCSF, MGH, BWH, Stanford, Duke, JHU) vs. a somewhat less prestigious but also clearly very good program (e.g. Columbia, UW, BIDMC, UCLA, Mount Sinai, UVa, UF, Wake Forest, etc).

The goal is either fellowship and then private practice, straight to PP without fellowship, or a mostly non-research "clinician track" academic job with or without fellowship. You are not trying to build a lab or get an NIH grant. You don't know what part of the country you would eventually like to practice in.

In that case, does it matter whether you choose one of the most prestigious residencies vs. a very good but not a "top" residency? Would the person who trains at MGH, Stanford, or Duke get better PP or academic clinician-track job offers than one who trains at Mount Sinai, UCLA, or UVa?

No

 

[gasdoc77]

A program's name won't take you nearly as far as networking. Be a salesman. Assess what your desired practice values and then sell yourself. The slightest hint of arrogance due to your training program would be a nail in the coffin. Most PP I've seen want to mold their recruits.

 

[Planktonmd]

The only way it matters is if you end up looking for a job in the same area where you did your residency.
Some groups tend to prefer their homies.

 

[CardiacIntensivist]

You'd probably have more luck looking into the alumni network. Do a lot of alumni go to areas that you are pretty sure you want to be in? Is there a good spread throughout the country in case you do change your mind? It may help a bit to be from a prestigious program but remember, you are looking for a real job. There is no personal statement and they aren't likely to care about those 2 weeks you spent in <third world country>. This is about true networking.

It helps to go to meetings and talk to other anesthesiologists from around the country.

 

[Hockeyguy]

Yes and no. It does help get a foot in the door - at least at our practice. But then you have to put up or shut up. The worst guy I ever worked with in PP was from the Cleveland Clinic and he let you know that he trained there every day with stupid boorish stories of the glorious mecca of Anesthesia and Medicine that was the "clinic". He should have stayed in Cleveland longer because he failed his oral boards and was a total nightmare to work with. He didn't last long in our practice - but interestingly he was a favorite of the CRNAs

 

[Green Penguin]

A program's name won't take you nearly as far as networking. Be a salesman. Assess what your desired practice values and then sell yourself. The slightest hint of arrogance due to your training program would be a nail in the coffin. Most PP I've seen want to mold their recruits.

Yes and no. It does help get a foot in the door - at least at our practice. But then you have to put up or shut up. The worst guy I ever worked with in PP was from the Cleveland Clinic and he let you know that he trained there every day with stupid boorish stories of the glorious mecca of Anesthesia and Medicine that was the "clinic". He should have stayed in Cleveland longer because he failed his oral boards and was a total nightmare to work with. He didn't last long in our practice - but interestingly he was a favorite of the CRNAs

Thank you for the replies. I understand that your performance in residency (and presumably therefore how glowing your recommendations will be), networking / who you know, your attitude, and how you perform once you get the job are ultimately far more important than where you trained. I was asking more about "all else being equal", how sensitive the job market is to branding.

 

[Green Penguin]

The only way it matters is if you end up looking for a job in the same area where you did your residency.
Some groups tend to prefer their homies.

Yeah, from what I've heard the person who knows they want to practice in Alabama would do well to choose UAB over BWH, for example. I wonder if that same person were looking for a job in Oregon or Arizona, whether there would be an advantage to coming from BWH vs. UAB based on the brand alone. It sounds like maybe there would be a slight edge to get an interview, but I'm probably splitting hairs at that point.

 

[pjl]

If we were to get 2 applications out of the blue with absolutely no connection to anyone our group personally knows, the "better" program person is going to get a harder look than a lesser known program person. I am also going to trust the people in that program I call to ask about the applicant minimally more provided they give the exact same answers.
That said, this scenario is artificial, and there are always other factors that are as important or more important than where you trained. I also would choose an applicant from a regional program that I have vetted through multiple personal contacts with good feedback over someone from, say UCSF, where I know nobody personally. All feedback from strangers is suspect as I dont know if they are just trying to get a person a job or if they are being fully truthful. From friends I can at least believe that they will steer me appropriately, since we hang out and dont want me to be unhappy.
They also know that when med students who have rotated with me apply to them that I will contact them personally for strong ones and be silent when asked if I think they should pass. The anesthesia world is FAR smaller than people assume.

 

[Apollyon]

Yes and no. It does help get a foot in the door - at least at our practice. But then you have to put up or shut up. The worst guy I ever worked with in PP was from the Cleveland Clinic and he let you know that he trained there every day with stupid boorish stories of the glorious mecca of Anesthesia and Medicine that was the "clinic". He should have stayed in Cleveland longer because he failed his oral boards and was a total nightmare to work with. He didn't last long in our practice - but interestingly he was a favorite of the CRNAs

You mean the "WFCCF"? The "World Famous Cleveland Clinic Foundation"?

I did ATLS earlier this year at MetroHealth, and there was a surgical resident from the WFCCF there, and he was just like you describe that fellow in your post.

 

[Arch Guillotti]

Yes and no. It does help get a foot in the door - at least at our practice. But then you have to put up or shut up. The worst guy I ever worked with in PP was from the Cleveland Clinic and he let you know that he trained there every day with stupid boorish stories of the glorious mecca of Anesthesia and Medicine that was the "clinic".

Yeah but their training is second to none

 

[Mman]

Yeah but their training is second to none

What's funny is when I interviewed there probably 10 years ago, I think the majority of residents were FMGs or from less than stellar med schools. It wasn't very impressive. I don't even think I ranked them.

 

[floridaboy18]

I always find it funny when people come up with these lists.... Just because some program is an excellent medicine program does not an excellent anesthesia residency make (i.e. Johns Hopkins being "elite" or UF being in the top tier at all). You'll be an anesthesiologist regardless, don't get me wrong...but by no means in the top 10. UF was literally dead last on my list and I am from an hour south of it and wanted to like it. For the most part, residency training programs in each specialty have name recognition that are unique to that specialty. Generally big names do not = great anesthesia residency program.

I think unequivocally four of the top five mentioned anywhere you go are UCSF, Stanford, MGH, and B&W....for academics. I don't even know if I would list all of those in the top 10 if you are speaking strictly clinical training.

IMHO, you need to nail down what part of the country you want to be in and attempt to go to residency in the top program in that region. Why not get the best clinical training you can get if you want to go into PP?

 

[Lurch]

You might change your mind in residency and decide you want to pursue a fellowship. If so, you'll wish you chose the "prestigious" one. With fellowships becoming more and more competitive, you should position yourself for this even if you don't pull the trigger on it.

 

[Green Penguin]

I always find it funny when people come up with these lists.... Just because some program is an excellent medicine program does not an excellent anesthesia residency make (i.e. Johns Hopkins being "elite" or UF being in the top tier at all). You'll be an anesthesiologist regardless, don't get me wrong...but by no means in the top 10. UF was literally dead last on my list and I am from an hour south of it and wanted to like it. For the most part, residency training programs in each specialty have name recognition that are unique to that specialty. Generally big names do not = great anesthesia residency program.

I think unequivocally four of the top five mentioned anywhere you go are UCSF, Stanford, MGH, and B&W....for academics. I don't even know if I would list all of those in the top 10 if you are speaking strictly clinical training.

IMHO, you need to nail down what part of the country you want to be in and attempt to go to residency in the top program in that region. Why not get the best clinical training you can get if you want to go into PP?

My groupings were not intended as a definitive list, they were just there to give context. I wanted to compare programs that are commonly perceived to have an elite-reputation to those that are known to be excellent but nevertheless don't have quite the same name-brand, and I tried to give examples that fit those parameters.

The reputation of any particular program is somewhat debatable, I grouped them based on what I've heard mentioned repeatedly (yes, for anesthesiology). Opinions will differ, and perhaps one or two that I listed you would put in a different category, but that doesn't really change the question. UF and UAB are places that I would not typically think of as big names in medicine generally, but which do seem to be mentioned as top-25 anesthesiology programs. I am not blindly correlating big name = great anesthesia residency.

As far as nailing down what part of the country I want to be in and going to the top program in that region...yes in theory, but plans change. Some people might even like to use residency as a time to see a part of the country that they may never live in again.

I do plan to get the best clinical training that I can. I'm just not sure I can meaningfully stratify those programs on the quality of their clinical training, only on the quality of their brand.

 

[IlDestriero]

What's funny is when I interviewed there probably 10 years ago, I think the majority of residents were FMGs or from less than stellar med schools. It wasn't very impressive. I don't even think I ranked them.

I didn't even know that they had a peds anesthesia fellowship until someone tried to tell me how great it was. Well of course it is.

 

[deleted126335]

One never knows what might give you an edge. A name brand program certainly never hurts. A CV with big names gets a little more interest than one that doesn't.

 

[IlDestriero]

Figure out which part of the county that you think you might prefer to live in. Make a pro and con list for the various regions and try to match at the best program in that region, or at least eliminate one or two to narrow your choices. If you are a superstar applicant and really are completely geographically free, pick one of the great ones. UCSF, Stanford, Penn, BWH, etc. You may want a fellowship, as more and more do, and these more well known programs attached to major quartenary medical centers will have fellowships and connections that you can use to your advantage.
Will a top 10 program really give better training than a top 30 program, probably not, BUT if their network can make your path to your end goal easier, which I think that it can, why not train there.
The above doesn't apply to future research track people. Not the 20% research time clinicians, but the 50%+ future lab owners and tenure track folks. They have unique requirements and will be much better off getting involved in research early with strong mentorship, etc. The difference in research dollars and academic productivity between a top program and the next tier is night and day.

 

[deleted126335]

One of the reason that the big name programs are so competitive is the perception that they open doors that would otherwise not be open in some cases.

 

[Metalblade]

One thing to note is that many PP groups tend to take from local programs. For example, I worked in Dallas for awhile. Even the most competitive groups tended to take residents who trained at Parkland because they knew their training, knew people who could vouch for them, and many of the partners had trained there themselves. That being said, they would probably look at a CV with big name program next if they didn't have someone they already knew lined up. So a good program will give you an advantage if you don't know where you will settle.

 

[Consigliere]

Meh, Harvard, Stanford, Yale.....won't matter in the near future. The CRNA from the mill down the street will be getting YOUR job.

 

[Mman]

Meh, Harvard, Stanford, Yale.....won't matter in the near future. The CRNA from the mill down the street will be getting YOUR job.

Nah. They might think they will, but they won't.

 

[IlDestriero]

Nah. They might think they will, but they won't.

Not mine either.

 

[deleted171991]

Not mine either.

Because CRNAs can't do healthy peds, which are 90% of the peds cases, right? Because the parents won't allow it, right? Not even after independent CRNAs will be in almost every other subspecialty?

 

[IlDestriero]

Not where I work.

 

[deleted171991]

Not where I work.

Not yet. Never say never. When I started my residency, my program had 4 (four!) permanent CRNAs, occasionally a few travelers, and a few attendings doing solo cases. By the time I graduated, there were almost 40 CRNAs and zero solo attendings.

 

[IlDestriero]

That's a business decision. Do they practice independently? We have CRNAs. They won't be anything but very supervised here, and they know that when they're hired. I do a lot of my own cases. Economics may end that practice, but we only supervise at 2:1, so I don't think stool sitting is a big loss of income at that ratio.
I don't think we are likely to change our ratios either as the acuity is just too high.

 

[Mman]

Not yet. Never say never. When I started my residency, my program had 4 (four!) permanent CRNAs, occasionally a few travelers, and a few attendings doing solo cases. By the time I graduated, there were almost 40 CRNAs and zero solo attendings.

We employ our CRNAs and medically direct them. I practice in a state that is about as anti-opt out as you can get at the governor, legislature, and supreme court levels. I suppose politics could change over 20 or 30 years, but I'm not counting on it.

Now if you work in an MD only practice doing your own cases in a state with different politics, well then maybe you should worry.

 

[deleted171991]

Politicians change. Times change. Look where most states were 10 years ago, not just about CRNAs, but about gay marriage, marijuana etc.

Things will change much faster then we imagine.

 

[Mman]

Politicians change. Times change. Look where most states were 10 years ago, not just about CRNAs, but about gay marriage, marijuana etc.

Things will change much faster then we imagine.

Gay marriage and marijuana have been publicly supported for a long time. It just took a while for politicians to get on board. This is a completely different ballpark and getting rid of doctors and replacing them with nurses is not an issue that has been supported by the public. People still love doctors. They show up at or near the top of every survey in terms of respect.

 

[cognitus]

How about this question: if you went to a below average residency program, can it be offset by getting a great fellowship in the eyes of PP?

 

[Consigliere]

How about this question: if you went to a below average residency program, can it be offset by getting a great fellowship in the eyes of PP?

See post #22.

 

[cognitus]

See post #22.

I'm not sweating CRNAs yet. Taking them aside,if you went to a below average residency program, can it be offset by getting a great fellowship in the eyes of PP?

 

[Mman]

I'm not sweating CRNAs yet. Taking them aside,if you went to a below average residency program, can it be offset by getting a great fellowship in the eyes of PP?

PP doesn't care about the prestige of anything for the most part. The only way a great fellowship helps land a PP gig is if that particular group is needing to hire somebody with that particular fellowship at the time you are looking for a job. Then it helps.

 

[anbuitachi]

PP doesn't care about the prestige of anything for the most part. The only way a great fellowship helps land a PP gig is if that particular group is needing to hire somebody with that particular fellowship at the time you are looking for a job. Then it helps.

So lets say applying for a job is like applying for a residency position these days. There is 1 open spot, and 100 applicants apply. Assuming there is no connection going on, and most are from the area. How exactly do they choose who to hire, when they are all new grads w/o fellowship? If prestige of residency program doesn't matter... how do they choose? by appearance? With a bidding war to see whos willing to work for the lowest salary??

 

[Sirach38]

We employ our CRNAs and medically direct them. I practice in a state that is about as anti-opt out as you can get at the governor, legislature, and supreme court levels. I suppose politics could change over 20 or 30 years, but I'm not counting on it.

Now if you work in an MD only practice doing your own cases in a state with different politics, well then maybe you should worry.

What state do you work in?

 

[deleted171991]

What state do you work in?

You cannot ask that. If he says Wyoming, you already know his real name.

P.S. Just kidding.

 

[Sirach38]

You cannot ask that. If he says Wyoming, you already know his real name.

I see

 

[Mman]

So lets say applying for a job is like applying for a residency position these days. There is 1 open spot, and 100 applicants apply. Assuming there is no connection going on, and most are from the area. How exactly do they choose who to hire, when they are all new grads w/o fellowship? If prestige of residency program doesn't matter... how do they choose? by appearance? With a bidding war to see whos willing to work for the lowest salary??

1) someone has a connection. If their quality can be assessed via phone calls, they get the job unless they are really odd during the interview process.

2) bring people in for interviews and see who seems like the best fit for the job.

That's really it. Once you come for an interview, your application is nothing more than something I can look at to make small talk with about what it was like to live or train somewhere in your past.

 

[deleted126335]

1) someone has a connection. If their quality can be assessed via phone calls, they get the job unless they are really odd during the interview process.

2) bring people in for interviews and see who seems like the best fit for the job.

That's really it. Once you come for an interview, your application is nothing more than something I can look at to make small talk with about what it was like to live or train somewhere in your past.

Then, why, in your opinion are the most competitive programs so competitive? I contend that the graduates of these programs, do in fact in general have more choices, both in academics and private practice. Obviously there are plenty of exceptions, but it does help- beyond the alumni network factor.

 

[anbuitachi]

So i'm more screwed if i end up doing residency at a place that i dont want to work? Or in a super competitive place like NYC ...
What about relocating? If it's by word of mouth and my family wants to go to utah and idk anyone in utah... good chance of being jobless or one of those awful jobs listed online??

 

[Mman]

Then, why, in your opinion are the most competitive programs so competitive? I contend that the graduates of these programs, do in fact in general have more choices, both in academics and private practice. Obviously there are plenty of exceptions, but it does help- beyond the alumni network factor.

Why are competitive programs competitive? Because they are. People apply somewhere because somebody told them it was the best (or top xx whatever). The prestige is 90% contained to academics, though. If you want to work at UCSF, it's probably much better on your CV if you came from their or some other big name place.

As someone who hires people in private practice, I can assure you that word of mouth carries 100x more weight than a department name on a CV. Plenty of clinically inept people have graduated from prestigious residency programs. I know some of them and I wouldn't offer them a job.

It's all about who you know.

I won't deny that all things being equal, a residency from MGH might get you a quicker look than a residency from BID, but all things are almost never equal at least amongst people we hire.

If I was out job hunting right now, the first thing I'd do is call every single person I know in PP across the country and see if they are hiring. If I was a resident looking for a job right now, the first thing I'd do is try to get contact info for every former resident at your program in PP and see if they are hiring. Because the best jobs are never listed anywhere.

 

[deleted126335]

Agree with your post, but all things being equal and absent personal contacts, the guy with the big names on the CV has the better shot.

 

[Mman]

Agree with your post, but all things being equal and absent personal contacts, the guy with the big names on the CV has the better shot.

Sure. But that probably counts for <5% of their chances of getting a job. The mistake people make is in thinking that PP cares about the name as much as academics does. They don't. Names matter in academics.

 

[deleted171991]

PP guys seem to care more about personal recommendations and gut feeling than anything else (CV, board certification, scores etc.)

 

[Mman]

PP guys seem to care more about personal recommendations and gut feeling than anything else (CV, board certification, scores etc.)

That's because a personal recommendation can almost guarantee you that you are hiring somebody you'd actually like to work with. A good CV and interview doesn't really guarantee anything. And in PP, you hate to make a mistake and hire somebody that is a poor fit solely because they looked good on paper. You can always coach somebody up clinically if there is some relative weakness, but you can't change their personality.

 

[deleted171991]

You can always coach somebody up clinically if there is some relative weakness, but you can't change their personality.

See, that's where we disagree. IMO, somebody with significant knowledge gaps from before getting into residency (low Step scores, failed ITEs, failed writtens) will always be just a disaster waiting to happen, a house of cards. Even with the best personality.

Of course, same goes for unpleasant people.

 

[Mman]

See, that's where we disagree. IMO, somebody with significant knowledge gaps from before getting into residency (low Step scores, failed ITEs, failed writtens) will always be just a disaster waiting to happen, a house of cards. Even with the best personality.

Of course, same goes for unpleasant people.

No, because a personal recommendation covers those. You can tell from their CV when they started/finished residency and when they passed boards. It's pretty easy to see if they passed on the 1st try. It's the personality that's a disaster that is not fixable. We are on the job of keeping ORs running efficiently and surgeons happy. If you are slow and clumsy and or difficult to get along with, it's a dealbreaker.