My Journey into Anesthesia

[ccmagic32]

Pretty dead on call tonight, so I just wanted to share my experience that I had which finally ended today, when I found out I matched into anesthesia. I hope this helps those with scores that aren't so great, but really have a passion for anesthesia.

First of all, let me preface this by letting you all know I am a 2003 US MD grad with below average USMLE scores and class rank. I did 3+ months of anesthesia elective at my home school (Loma Linda) and UCLA.

I really enjoyed anesthesia as a MS and I applied to 60+ programs last year all over the country, went to 14 (anes-in all regions) & 10 (prelim) interviews, and did not match at all. 2 programs (on the East Coast) I interviewed at did not rank me at all (I know because they did not fill). There definitely is a East & West Coast bias. I remember getting that fateful email last year which said "Sorry, you did not match." I knew the odds of not matching was <10% per the NRMP website, and I was devastated. I was not able to scramble into anesthesia and ended up scrambling into a PGY-1 spot in FP on the condition that I would leave after intern year, which I am almost done with.

I never lost sight of my goal to go into anesthesiology, and my search began for a PGY-2 position for 2004 around August 2003. I thought this was best due to the craziness of new residents coming in and I figured not much turnover happened between March and July. I started by emailing almost every PD in the country explaining my situation. Many actually responded, and about 20 programs stated they DID have open PGY-2 spots for 2004. Each program had their own ways they wanted apps, some their own, and others through ERAS, and each wanted different materials. I rewrote another whole PS, CV, got new LOR's, and had to send all these applications via snail mail (painful). I was rejected for interviews for many, but was invited to about 5. I also applied for 2005 through ERAS for backup, again to 60+ programs. I did not get any of the 2004 positions, and was only able to go to 6 anes interviews for 2005. I know I am not a troll and I felt my interviews last year went well, so this year, I was more aggressive in my interview approach this year, and found out some interesting information.

Anyways, I was worried, so I did (another) 2 week anes elective at my home program at their request, and worked my behind off. I impressed the right people, and they even had me running my own room as an intern a few days. I guess they moved me up on the rank list, and I MATCHED for 2005!!! (I called the NRMP today saying that I needed to scramble for a PGY-1 spot, and they told me what state (CA) I matched for anes, 99% sure at Loma Linda, but not 100% until Thursday)

Now I just wanted to pass along some advice to those possibly in my situation, and reassure you that it CAN happen.

1) Hard work goes a long way - but make sure the right people know. Luckily for me I worked with senior residents who were vocal about my performance and talked me up to the attendings who matter. Your home school, or one you've done an elective at know you the best, so make it count.

2) When it comes down to it, SCORES are most important. Someone with a step 1 of 215 or above and US grad should have no excuse not matching, especially if you're willing to go anywhere. Interviews are only 15-30 min, and most places don't even read your app until you're sitting in front of them. When they sit down to make the list months after your interview, what do you think will REALLY make up the rank list?

3) Be persistent - if you're at a place that has an anesthesia program, keep showing your face and interest, without being too annoying.

4) Be realistic - if your scores aren't great and you really want to do anesthesia, be willing to go anywhere. There are pros and cons to every program; didactics, hrs, cases, probation etc., but you'll be an anesthesiologist in the end, right? Save your money on ERAS fees if you know you can't match somewhere. (for me, UCSF, Stanford, MGH, BWH, BID, Columbia, Cornell, JH, etc., you get the drift). And do an elective at a place just a little out of reach without one.

5) Do your own research - I used the ACGME website, scutwork, and these forums a lot during my search. You can "predict" open spots by cross referencing the ACGME approved spots per year in a program with the matched total. I targeted these programs first.

Programs I had interviews with in 2003:

UCLA, Loma Linda, USC, Harbor-UCLA, SUNY-Stony Brook, Yale, Cleveland Clinic, Case Western, Metrohealth-CRWU (did not rank), NYMC-Westchester (did not rank), St. Lukes-Roosevelt, BU, Loyola

Programs that had PGY-2 spots in 2004 in 8/2003 (many programs save spots outside match for people who want to switch) - this may vary year to year, many of these programs already filled these positions.

1)UTSW - always does yearly - variable # - rejected for interview
2)UT-Galveston - 2-3 every year, got interview - rejected for spot
3)UW - 4 this year, rejected for interview
4)UM - ?#, rejected for interview
5)UPenn - 1 spot, own app, rejected for interview
6)Stony Brook - 1 spot this year, I REJECTED them for interview (they didn't rank me in the match...bastards)
7)USF - the way their program is set up, they have 7 PGY-2 spots to fill outside match yearly, need to send app through ERAS, got interview, rejected for spot
8)Cook County - the way their program is set up, they have 5 PGY-2 spots to fill outside match yearly, need to send app through ERAS, got interview, rejected for spot
9)UAriz - 1 spot this year, rejected for interview
10)Cleveland Clinic - always does - variable #, got interview, rejected for spot, was told I was 10 spots on their list from matching, they went down to 40% on Advanced & 55% on Categorical in 2003.
11)Advocate Masonic (Chicago) - always fill some outside match, own app, no interview
12) MGH - 1 spot, what was i thinking?
13) BWH - 1 spot, ditto as MGH
13) USC - 2 spots, said they knew me from previous interview, rejected for spot.
14) UCLA - recent increase in residency size so had ?2 spots this year. PC told me I didn't have to interview, rejected for spot.
15) OHSU - 1-2 spots this year, rejected for interview
16) Henry Ford - 2 spots this year, got interview, couldn't make it
17) Baystate - 2 spots this year, got interview, couldn't make it
18) UT-San Antonio - 1 spot this year, rejected for interview
19) Carnitas-St. Eliz - 1 spot this year, rejected for interview (min Step 1 - 85)
20) UMDNJ-Robert Wood Johnson (Camden) - brand new program at Cooper Hospital, 3 spots per year, got interview, couldn't make it, they said they WILL scramble for 2005 PGY-2 spots on 3/16/04.

Programs that I interviewed at for 2005 (I was limited in time, so I went to some programs I hadn't visited before)

Loma Linda, Harbor UCLA, U Rochester, SUNY Upstate, St. Lukes-Roosevelt, UMDNJ-Newark

Did not go to but offered interviews: Case Western, BU, Henry Ford, Baystate, some others but can't remember.

Rejections: Many, but some that I remember, Loyola (not THIS year, i guess), MUSC (USMLE step 1 min 200 on 1st attempt)

I've been all over the country several times and I've visited a lot of programs these past 2 years. I welcome more specific questions about programs I interviewed at and general advice about looking for out of match positions through this forum. This post is not meant to gloat or anything, but just hope my experience can help someone. Congrats to all that matched, don't lose hope for those who didn't...

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[Fermata]

Congrats my friend on landing a spot.

 

[Tollway]

CCMagic- Thank you for the retrospective analysis of your situation. I know it must be hard to type all of that dealing with that much rejection. Let me add this- I switched from internal medicine this year to anesthesia. I luckily matched into my 1st choice for medicine, only to find out I didn't want to do GI anymore (only reason I went into Medicine-PLUS enen if I did want to do it I didn't have the scores to get a fellowship USMLE average ~235 probably). SO I went with my other love in medical school and matched into a PGY-2 spot. I am in Dallas currently, but am doing my anesthesia at Baylor. I am currently at Baylor here in Dallas for medicine. I only applied to 3 programs for PGY-2 spots here in Texas. I am from Texas and all of my friends and family live here, and I grew up in Houston and my parents live there (added bonus).
I interviewed at UT-SA, UT-SW, and Baylor. The first two places filled their spots with other applicants, but luckily I got a position at Baylor. I loved the program much more than the other two. I really felt at home. All of the residents and staff were very friendly and welcoming. Plus it is at a great institution.
It is never too late to change specialties for all the people out there who might be thinking about it or on the fence. It is initially very hard (telling your PD, staff, and fellow residents), but in the long run you have to do whats best for yourselves. Good luck with the match everyone! BTW- Intern year sucks



Tollway

 

[pickaname]

Hey that was a great post! It just shows how hard work can pay off. I am actually switching from Ob/GYN to anesthesia, but only recently made up my mind. I am still hoping that there might be some PGY-2 spot for july 2004, but I know that is probably wishful thinking. after reading your post I will make sure to call everywhere in the country that is reasonable. Maybe I'll get lucky! You never know.
Congrats to you!

 

[Jingojango]

Hey CC:

Congrats!!! I'm so happy for you. I met you @ CCF. Thanks for the ride by the way . I hope you and your wife enjoyed that bottle of wine you were saving for the occasion.

I matched as well!!! Just waiting for Thursday.

Congrats again.

 

[Rock Star]

Persistence will not be denied!!!!!

 

[Heeed!]

ccmagic32-

I'm interested in hearing how you logistacally and financially worked out the details of your globetrotting. Did you drive? fly? stay w/ friends? cheap hotels? etc. etc. Thanks!

 

[NYGasGirl]

ccmagic32,

Congrats! Thanks for sharing your story. You're an inspiration!

 

[ccmagic32]

Thanks everyone for the congratulations. Congratulations to all of you guys too.

In response to Heeed:
the interviews in southern CA, i drove to, for the ones in the midwest and east coast, i tried to group them together to save on airfare. i would take one flight, and rent a car and drive to the rest. to do this you really need to apply early to get 1st choice for the dates you need to plan ahead. i really appreciated those places that provided housing, and those that didn't, it either came out of pocket, or i stayed w/ a friend if i knew one in the area. some program coordinators are more willing to work with you if you're coming from far away. it definitely helps to be nice to them. Financially, all the traveling killed me. i have quite a bit of cc debt, but its all worth it in retrospect. the most interviews i did (to save money and time) was 6 interviews in 7 days, but it was brutal.

To jingojango:
hey man, i'm happy for you too. thanks for the meal. good luck with everything, and all the best.

FYI on some programs (i asked)
st luke's - went down to 80's on their list to fill for 2003 match

UCLA - filled in the 1st third of their list in 2003 match (~100 interviews). Dr Wald (PD) told me specifically they were looking for USMLE > 220. elective definitely helps and gets you an interview. if you do, try not to work with Dr Miller there (good teacher for residents, but old school, and hard on students with barely any procedures, and you'll be standing the WHOLE case). they have 1 DO in their whole program who i worked with, from AZ COM.

ccf - went down 55% on categorical list, 40% on advanced list in 2003 match, IMG and DO friendly. PD tells you if you'll be ranked right after interviews.

llu - looking for USMLE > 215 for interview if you're not from llu. no DO's or IMG's for many years.

UMDNJ-newark - told by chair that US MD's would be ranked above IMG's and DO's. (don't know if really true)

Harbor UCLA - they interview 20-25 ppl for each residency spot (per resident), and they will let you know if they like you (per chair)

Yale - might not rank you, even if you travel across the country to visit godforsaken new haven

 

[pickaname]

So what are your plans for this upcoming academic year?

 

[joethestuff]

Hey, I applaud you're effort and congratulate you on finally matching, but as a US IMG I cant help but resent your story in a way.

I could have never gotten into any US school (my academic background, age, and science pre-requisites don't look good on paper), let alone one as nice as you attended. However, I knew I would kick-but in medical school, went to a Caribbean school and scored 245+ on my USMLE's.

I matched at a great place, but lost out on top spot interviews because of my IMG status. Yet, with a sub-200 USMLE, you got into Medical school.

Sadly while a poor student like you always have a US medical school attached to your name, I'll always be attached to a Caribbean school. Gosh would I have loved to have the resources available that you did.

Congrats, your very lucky!

 

[yu-gi-oh]

even though he may have scored sub 200, he had to bust his chops to get into us med school. think about college days where you partied but this guy could have been studying to get the grade. i believe it is a reverse of your situation.

I think the system of giving priority to us med students is important. then what is the point of going to us med school. I think the score is important but to rely on them solely can be a mistake.

 

[joethestuff]

Originally posted by yu-gi-oh
think about college days where you partied but this guy could have been studying to get the grade. i believe it is a reverse of your situation.

I think the system of giving priority to us med students is important. then what is the point of going to us med school. I think the score is important but to rely on them solely can be a mistake.

Then you'd "think" wrong. I'm a first generation college student, paid my thru college working full-time (but went to many of them throughout the US which looks bad I'm told), failed chemistry my first semester (which looks bad).

Further, I had almost zero $$$ my last year in Med school and couldn't afford to travel much for interviews (but I put 15,000 miles on an '85 toyota). I struggled with school AND work throughout med school.

Yeah, and they had it tough....

I agree, scores are a mistake, but so is ignoring the best candidate for a job because of where they're from. I can only imagine how much better my scores would have been with the enormous resources US students have...

 

[Goober]

Originally posted by joethestuff
Then you'd "think" wrong. I'm a first generation college student, paid my thru college working full-time (but went to many of them throughout the US which looks bad I'm told), failed chemistry my first semester (which looks bad).

Further, I had almost zero $$$ my last year in Med school and couldn't afford to travel much for interviews (but I put 15,000 miles on an '85 toyota). I struggled with school AND work throughout med school.

Yeah, and they had it tough....

I agree, scores are a mistake, but so is ignoring the best candidate for a job because of where they're from. I can only imagine how much better my scores would have been with the enormous resources US students have...

Want some cheese with your wine?

There were lots of first time generation college students who got into my american medical school. One guy worked full time at a factory job finished college in 5 years with a 3.9 gpa and got into our MD-PhD program. Another guy came from India with $50 in his pocket at nothing else He drove cabs while going to undergraduate school. It is not ccmagic32's fault that it took so long for you to get your act together. Just be glad that you eventually did...

 

[sechen]

hi ccmagic,

congrad!!. you will enjoy plenty of california sunshine.

 

[ryanbeckworth]

Could you tell me about the program you matched at and the others in the area. I'm on the East Coast and a few third-years trying for anesthesia have asked about Loma Linda and UCI, UCD and USC in particular. Would you mind giving an idea of the call schedule and work hours/conditions of any of the places listed above?

Congrats on your match. It's a huge relief to know we're done with all of this crap.

-RB

 

[UTSouthwestern]

One thing you shouldn't be fooled by is the number of unmatched slots this year in anesthesia (7% vs 4% last year). More programs have found that taking PGY-1's outside the match for CA-1 spots has resulted in an acceptance of a high quality of resident transferring from other programs. For example, my institution filled in the match but only put 15 spots up for grabs.

We always keep 2-3 spots available to fill with candidates from other specialties. I transferred from internal medicine and we have residents who have transferred from neurosurgery, radiology ophthamology, ENT, urology, and general surgery.

As previous posters have said, BE PERSISTENT and show the programs you apply to that you are willing to do whatever it takes to get accepted. Always get the best letters of recommendation you can get and don't let some high ranking doctor write you an average or less LOR. That is the kiss of death and was the reason we rejected three otherwise solid looking candidates for our CA-1 spots.

 

[ccmagic32]

first of all, to joethestuff, i applaud you in your hard work through college and medical school, and congratulations in the match. i'm not going to go into the IMG vs. DO vs. US-MD debate, that has been beaten to death. i've worked with many IMG's and DO's and have to say that they've all been great. let's not forget that the most important thing in all this is patient care, which is USMLE independent. I am almost done with my intern year, and i KNOW i am a competent and good physician, and i also have much to learn. but please do not assume that you are the only one that had to overcome struggles. i worked through college, have >$200,000 of undergraduate and med school loans to pay off, and i can still respect anyone that can reach their goals.

 

[ccmagic32]

Originally posted by ryanbeckworth
Could you tell me about the program you matched at and the others in the area. I'm on the East Coast and a few third-years trying for anesthesia have asked about Loma Linda and UCI, UCD and USC in particular. Would you mind giving an idea of the call schedule and work hours/conditions of any of the places listed above?

Congrats on your match. It's a huge relief to know we're done with all of this crap.

-RB

Here's what i know about those you mentioned

Loma Linda - call schedule is 2 nights in a row, 7pm to 7am, with post call day off, about 4-6 per month, which the residents like. they also have a late call system, which means you come at about 11am and give lunches, and stay until there are only a certain number of rooms left. a lot of turnover in faculty 2 years ago, but finally settling down. great clinical experience all within 1 mile of each other with university, peds, VA, outpt, and community (lots of ortho regional). for all the other so cal programs, you need to drive to many different hospitals to get this experience. we have exposure to transplant and level 1 trauma. location not the greatest if you know so cal, but it is still california. i gotta go, but will post about others later.

 

[MariaG]

Does USC, UCI, UCLA all do thier subspecialty months outside of thier home hospitals. ie peds@childrens, ob@ceders??

 

[Skrubz]

Originally posted by MariaG
Does USC, UCI, UCLA all do thier subspecialty months outside of thier home hospitals. ie peds@childrens, ob@ceders??

mariag, take a look at this thread for some answers. i know that USC does peds at children's like everyone in/around LA but i don't remember about ob/gyn.

 

[KingHulaJack]

I'd like to respond to what happened to ccmagic32, because something very similar happened to me. I'm also a USMG graduating from Wayne St. graduating in the middle of my class in 2008. My step 1 is 230, and step 2 215. I applied to 35 programs, interviewed at 13, and didn't match at all. I was devastated when I got that same message. I picked up a prelim surgery year, and am looking ahead to next year. I really want anesthesia and will be willing to do whatever it takes. What advice do you guys have as to how to approach this process this year?

Places I interviewed at:

Cleveland Clinic
U Chicago
Northwestern
UCLA
USC
UC Davis
Loma Linda
NYU
Columbia
Mayo Clinic - Arizona
U Michigan
UT Southwestern
Pittsburgh

I don't know what happened, but I just have to move on. Any advice?

 

[lfesiam]

congrats!!!!!!!!!!!!

 

[amyl]

I'd like to respond to what happened to ccmagic32, because something very similar happened to me. I'm also a USMG graduating from Wayne St. graduating in the middle of my class in 2008. My step 1 is 230, and step 2 215. I applied to 35 programs, interviewed at 13, and didn't match at all. I was devastated when I got that same message. I picked up a prelim surgery year, and am looking ahead to next year. I really want anesthesia and will be willing to do whatever it takes. What advice do you guys have as to how to approach this process this year?

Places I interviewed at:

Cleveland Clinic
U Chicago
Northwestern
UCLA
USC
UC Davis
Loma Linda
NYU
Columbia
Mayo Clinic - Arizona
U Michigan
UT Southwestern
Pittsburgh

I don't know what happened, but I just have to move on. Any advice?

that sucks and I am sorry. When did you take step two -- was it after you got a bunch of interivews? if you don't want to get in to it thats cool but I think your step two hurt you a little bit at the caliber of the places you interviewed at. i would be prepared to explain this little slip this go around. keep your ears open for an open spot outside the match, esp. if the program you are doing surgery at has an anesthesiology program.
as always, i will recommend VCU...they have 2 spots for next year. this is a great program that I reviewed this year. awesome moonlighting, solid program, good didatics, nice COL, great residents, level one trauma center but reasonable call schedule. only downside for me was a PMR run pain program and a medicine (medicine owned) heavy intern year (which you would get to skip )

also, just curious why you didn't interview at your home program?

 

[epidural man]

I am almost done with my intern year, and i KNOW i am a competent and good physician,

Great post, thanks for sharing (4 years ago). I also remember after finishing internship, I (i know better now) thought I knew a lot and was a competent physician.

What advice do you guys have as to how to approach this process this year?

Here is my advice, but I really don't know if it is any good. I think your scores are okay it would seem. Probably not fantastic, so you need something else on your resume that looks better than the other 90% of applicants. I think a great way to do this is to write two or three case reports this year, also write a few abstracts that you can present at a meeting. Is anyone doing any clinical trials at your place of work? Get involved somehow so you can get your name on that. This is hard to do as an intern, but do-able.

 

[epidural man]

What advice do you guys have as to how to approach this process this year?

Case reports are out there, just have your ear to the floor. Pd4emergence recently posted a cool case here. Ask him if you can write it up with him. You can do all the research and write the discussion, etc and pd4 can write the case part.

See this thread
http://forums.studentdoctor.net/showthread.php?p=6544742#post6544742

If you need cases, there have been a bunch of cases I think people should write up that have been posted on this board. My guess is most of the guys don't have the time to spend writing up a case report (they take a good bit of time), so if they had someone to do the leg work for them (literature search, etc.) i'm sure they would be happy to let you help. Hell, they get to publish something and you do all the work - who wouldn't go for that?

 

[Jeff05]

how many programs did you rank?
any letters from anesthesiologists?
any anesthesia research?

perhaps, social interaction during interviews was a problem. do you feel that interviewing is not your strength? was it difficult to make conversation, etc?

just thinking.

I'd like to respond to what happened to ccmagic32, because something very similar happened to me. I'm also a USMG graduating from Wayne St. graduating in the middle of my class in 2008. My step 1 is 230, and step 2 215. I applied to 35 programs, interviewed at 13, and didn't match at all. I was devastated when I got that same message. I picked up a prelim surgery year, and am looking ahead to next year. I really want anesthesia and will be willing to do whatever it takes. What advice do you guys have as to how to approach this process this year?

Places I interviewed at:

Cleveland Clinic
U Chicago
Northwestern
UCLA
USC
UC Davis
Loma Linda
NYU
Columbia
Mayo Clinic - Arizona
U Michigan
UT Southwestern
Pittsburgh

I don't know what happened, but I just have to move on. Any advice?

 

[KingHulaJack]

Well, I took step 2 in november. It was after I got my interviews. So that could've had something to do with it. But places I called back to could'nt even recall my step 2 score. So I'm not sure how much step 2 factors in if you don't have it at interview time. I called back to a few programs and told me my interviews were great - it was just too competitive. VCU has two spots? Does anyone know the best way to approach trying to find PGY-2 spots? I didn't apply to Wayne st b/c I was sick of detroit; I guess I can't be picky the next go around.