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[kitkatgas]

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[GassYous]

"It seems like Vanderbilt has a slightly better reputation than UCLA on Doximity"

???

 

[Remxed]

If you want to live and work in California after residency, UCLA will give you the local connection for groups in the area. Both are solid programs.

 

[kb1900]

Doximity means nothing. UCLA has an excellent reputation as does Vandy. Minimal difference rep wise.

Go where you want to work posi graduation. Easy call IMO if you want to settle in California.Seems like you understand the associated COL sacrifices short and long term

Ultimately though can’t go wrong either way.

 

[kitkatgas]

Thanks everyone!! I appreciate your thoughts, you’re right the Doximity rankings are meaningless, for some reason they’re cited heavily in med student forums.

 

[Potatoman1800]

for some reason they’re cited heavily in med student forums.

They don't know any better.

 

[GassYous]

Thanks everyone!! I appreciate your thoughts, you’re right the Doximity rankings are meaningless, for some reason they’re cited heavily in med student forums.

The same med students who think doctors are paid too much and think that they would work for free to "help patients"?

 

[repititionition]

Both are producing fine anesthesiologists, but one has essentially no CRNA presence. The other is dominated by CRNAs. That difference alone should help drive a decision for anyone comparing these two places.

 

[TheLoneWolf]

I had a talk with a pretty famous graduate from Vandy a few years back. He mentioned to our group that Vanderbilt has the "golden handcuffs" as day to day has a lot of annoyances eg admin interference but they greatly reduce tuition fees if your child is in their undergrad programs. Not sure if true. Left for PP after a few years

 

[GassYous]

One of the most annoying coresidents I had ended up in vandy
CRNA run, don't waste your time

 

[IMGASMD]

Both are producing fine anesthesiologists, but one has essentially no CRNA presence. The other is dominated by CRNAs. That difference alone should help drive a decision for anyone comparing these two places.

The same med students who think doctors are paid too much and think that they would work for free to "help patients"?

Yes. The ones who will claim that you don’t play well in the sandbox with people who’re gunning for your jobs.
Those ones.

(I don’t know which one is which, but my guess is Vandy being a southern state has lots and lots crnas)

 

[vector2]

One of the most annoying coresidents I had ended up in vandy
CRNA run, don't waste your time

And I don't have first-hand knowledge but I don't think it's just CRNAs which are the only problem there. If I'm not mistaken vandy is at the forefront of creating DNP "fellowships" in multiple specialties to allow nurses to do what physicians are doing

 

[nimbus]

Another consideration is that if you train at UCLA, you are much more likely to end up at an MD only practice on the west coast. If you train at Vanderbilt, you are much more like to end up at a medical direction or supervision practice in the south.

 

[JiPo]

CRNA presence isn't necessarily a bad thing. It allows residents to do all the educational cases, and makes sure they get relieved at reasonable time, and allows for didactic during the day since you have CRNAs to relieve the residents for didactics. I went to "resident heavy" program, and I wished we had more CRNAs. This assumes that residents are protected, and the department prioritizes resident education.

I can also see it being unpleasant work environment if residents are not protected and you have militant CRNAs.

I don't know much about Vandy (I've only heard rumors through grapevines), but make sure residents get the first pick of cases and that Anesthesiologists run the board and do the schedules, not CRNAs if you are choosing Vandy.

 

[repititionition]

counterpoint: every case is educational if you choose the right mindset, and having no CRNAs means you’ll actually do every kind of case, not just the TurboMegaExLapHemiSacrectomyCraniNeonatalBaseOfTongueAAA.

 

[Maz777]

Programs that are CRNA-heavy, by and large, produce lower quality residents. Like a previous poster said, you see residents at these types of programs expect to be relieved early and rarely finish big cases, which causes them to have a low degree of patient ownership, etc. They essentially start to function like shift-work CRNAs early in training. They are the ones that show up in PP on day one and their only goal is to leave as early as possible and pass their case off to someone else. "Prioritizing resident education" is code word for crappier residents that just want to go home.

 

[DrOwnage]

I’m biased because I did residency at UCLA. No regrets. Regional is a little weaker than some programs but it makes up for it and more in other areas. Also it’s a big program so the call schedule is not as bad as some others.

 

[teacher2md]

CRNA presence isn't necessarily a bad thing. It allows residents to do all the educational cases, and makes sure they get relieved at reasonable time, and allows for didactic during the day since you have CRNAs to relieve the residents for didactics. I went to "resident heavy" program, and I wished we had more CRNAs. This assumes that residents are protected, and the department prioritizes resident education.

I can also see it being unpleasant work environment if residents are not protected and you have militant CRNAs.

I don't know much about Vandy (I've only heard rumors through grapevines), but make sure residents get the first pick of cases and that Anesthesiologists run the board and do the schedules, not CRNAs if you are choosing Vandy.

If you think that SRNAs and their CRNA leadership are content to just do the leftover cases, you’re sorely mistaken.

They want to do CT, peds, epidurals, PNBs, traumas, etc; and they’ll compete with residents for them.

 

[NVO]

Programs that are CRNA-heavy, by and large, produce lower quality residents. Like a previous poster said, you see residents at these types of programs expect to be relieved early and rarely finish big cases, which causes them to have a low degree of patient ownership, etc. They essentially start to function like shift-work CRNAs early in training. They are the ones that show up in PP on day one and their only goal is to leave as early as possible and pass their case off to someone else. "Prioritizing resident education" is code word for crappier residents that just want to go home.

Sounds a lot like some "lower quality" attendings, when I'm in a long case and 3 different attending hand-offs happen

 

[vector2]

Programs that are CRNA-heavy, by and large, produce lower quality residents.

Sounds like an overgeneralization supported more by anecdote than any particular evidence. There are many things that go into producing high quality residents beyond just what time relief comes in the afternoon.

 

[Maz777]

Sounds like an overgeneralization supported more by anecdote than any particular evidence. There are many things that go into producing high quality residents beyond just what time relief comes in the afternoon.

If you work less as a resident and start/finish less cases, you can't possibly be as strong as someone that has done twice as many cases from start to finish. It's common sense. Practice makes perfect. You will be behind the eight ball starting out in PP. Residency is time to learn and do cases. Not leave at 1pm and have a CRNA finish your exlap/pheo case. But, sure, let's coddle it up. You'll get higher evals as faculty.

 

[vector2]

If you work less as a resident and start/finish less cases, you can't possibly be as strong as someone that has done twice as many cases from start to finish. It's common sense. Practice makes perfect. You will be behind the eight ball starting out in PP. Residency is time to learn and do cases. Not leave at 1pm and have a CRNA finish your exlap/pheo case. But, sure, let's coddle it up. You'll get higher evals as faculty.

This is really just more unsupported generalizations mixed in with some silly hyperbole about relief at 1pm.

Some points to consider:

1. Working 65-70 hrs a week doesn't mean you're doing double the cases of someone working 45-50 hrs a week. Probably doesn't even mean 1.5x the number of cases.

2. Volume is not synonymous with acuity. A resident is just as likely to be clearing the trash ACS addon pile at the end of the day as they are waking up their "exlap/pheo." Sure, some people try to claim that every single minute in the OR (no matter whether it's an ASA 1 lap chole) is a precious learning opportunity, but I think we all know that becomes less and less true as the resident gets closer to the end of the training.

3. Banging out a decent number of cases is necessary to be a good anesthesiologist, but it is not sufficient. OR time has to be balanced with didactic and (primarily) self study time, because the knowledge base doesn't just magically appear from sitting endlessly on the stool. It's wishful thinking to believe residents who spend 3 yrs working 630a-5p with maybe, just maybe some occasional relief for lecture are reading or learning as much as they should be.


There is a balance to be had between OR time and reasonable relief time, but overgeneralizing and saying that unless you're in a relief-at-330pm program you'll academically suck, or that unless you're in a CRNA-barren workhorse program you'll clinically suck... is pretty useless advice devoid of any nuance.

 

[nimbus]

The goal is to get through residency and then the entire rest of your career without doing any eyeballs

 

[Maz777]

This is really just more unsupported generalizations mixed in with some silly hyperbole about relief at 1pm.

Some points to consider:

1. Working 65-70 hrs a week doesn't mean you're doing double the cases of someone working 45-50 hrs a week. Probably doesn't even mean 1.5x the number of cases.

2. Volume is not synonymous with acuity. A resident is just as likely to be clearing the trash ACS addon pile at the end of the day as they are waking up their "exlap/pheo." Sure, some people try to claim that every single minute in the OR (no matter whether it's an ASA 1 lap chole) is a precious learning opportunity, but I think we all know that becomes less and less true as the resident gets closer to the end of the training.

3. Banging out a decent number of cases is necessary to be a good anesthesiologist, but it is not sufficient. OR time has to be balanced with didactic and (primarily) self study time, because the knowledge base doesn't just magically appear from sitting endlessly on the stool. It's wishful thinking to believe residents who spend 3 yrs working 630a-5p with maybe, just maybe some occasional relief for lecture are reading or learning as much as they should be.


There is a balance to be had between OR time and reasonable relief time, but overgeneralizing and saying that unless you're in a relief-at-330pm program you'll academically suck, or that unless you're in a CRNA-barren workhorse program you'll clinically suck... is pretty useless advice devoid of any nuance.

You learn by providing anesthesia and having an attending there showing you how to do it. Simple as that.

But, no, you're right. Sitting in lecture all day learning about how DEI and physician wellness affect delivery of anesthesia care produces competent anesthesiologists. Keep coddling. The rest of us will actually take care of patients and finish those cases.

 

[NVO]

But, no, you're right. Sitting in lecture all day learning about how DEI and physician wellness affect delivery of anesthesia care produces competent anesthesiologists. Keep coddling. The rest of us will actually take care of patients and finish those cases.

Physician wellness is extremely important in the formation of a competent anesthesiologist. Especially noting recent resident and fellow suicides.

 

[vector2]

You learn by providing anesthesia and having an attending there showing you how to do it. Simple as that.

But, no, you're right. Sitting in lecture all day learning about how DEI and physician wellness affect delivery of anesthesia care produces competent anesthesiologists. Keep coddling. The rest of us will actually take care of patients and finish those cases.

Right, monkey-see-monkey-do. Probably what the CRNAs say too.

I see you're more interested in spouting off non-factual hyperbole about relief at 1pm and all-day lectures about wellness..... which is all well and good if your goal is to just stoke your own confirmation biases as opposed to hearing out other viewpoints. Carry on.

 

[abolt18]

Physician wellness is extremely important in the formation of a competent anesthesiologist. Especially noting recent resident and fellow suicides.

What recent resident/fellow suicides? I haven't seen any recently. (not challenging you. Sincerely want to know.)

 

[GassYous]

The goal is to get through residency and then the entire rest of your career without doing any eyeballs

I love doing eyeballs
Until they start v taching out of nowhere

 

[NVO]

What recent resident/fellow suicides? I haven't seen any recently. (not challenging you. Sincerely want to know.)

Go-Fund-Me for Deceased Pain Fellow

Please consider donating in honor of one of our own. Funds are being used to help support his family: https://www.gofundme.com/f/mick-bies?utm_campaign=p_cp+share-sheet&utm_content=undefined&utm_medium=social&utm_source=twitter&utm_term=undefined

forums.studentdoctor.net

 

[anaesthetic]

You learn by providing anesthesia and having an attending there showing you how to do it. Simple as that.

But, no, you're right. Sitting in lecture all day learning about how DEI and physician wellness affect delivery of anesthesia care produces competent anesthesiologists. Keep coddling. The rest of us will actually take care of patients and finish those cases.

The attending who disappeared as soon as they saw ETCO2 and never showed up again until you’re ready to induce the next patient? But, no, you’re right. Sitting in a room all day and night banging out lap choles is the way to be a competent anesthesiologist.

It’s a balance, and this is coming from someone who trained at one of those “workhorse” programs. Get over yourself.

 

[dannyboy1]

Physician wellness is extremely important in the formation of a competent anesthesiologist. Especially noting recent resident and fellow suicides.

Oh please. There is nothing about anesthesia residency (certainly in this “enlightened” day and age) that should drive anyone to kill themselves. Those that did likely had a combination of bad $hit going on in their personal life and mental illness….

 

[dannyboy1]

You learn by providing anesthesia and having an attending there showing you how to do it. Simple as that.

But, no, you're right. Sitting in lecture all day learning about how DEI and physician wellness affect delivery of anesthesia care produces competent anesthesiologists. Keep coddling. The rest of us will actually take care of patients and finish those cases.

Agreed. The more cases you do, the better you will be. Studying helps you pass the boards. It is next to useless for real life.

 

[thinkorswim]

Oh please. There is nothing about anesthesia residency (certainly in this “enlightened” day and age) that should drive anyone to kill themselves. Those that did likely had a combination of bad $hit going on in their personal life and mental illness….

This is comment is so f*cking out of touch. Working long and irregular hours in a stressful and sometimes hostile environment most certainly does play a huge role in mental health.

 

[dannyboy1]

This is comment is so f*cking out of touch. Working long and irregular hours in a stressful and sometimes hostile environment most certainly does play a huge role in mental health.

It’s work. We all work. There are an TON of jobs that are far more stressful than anesthesia much worse pay. The job is not the reason people kill themselves.

 

[thinkorswim]

It’s work. We all work. There are an TON of jobs that are far more stressful than anesthesia much worse pay. The job is not the reason people kill themselves.

Please show me another job that pays $25/hour, demands 50-60 hour work weeks with pressure to study outside of work, requires working nights/weekends/holidays, and frequently deals with life or death situations. And I’m not even touching on the culture of a program, some of which are known to humiliate and marginalize a few unlucky trainees.

Even corporate America pays more and feeds their interns, only asking them to spend long hours in front of Excel or PowerPoint.

I never said residency was the main reason for suicide. But for you to say nothing about anesthesia residency contributes to it is just ridiculous.

 

[gunnershow]

Please show me another job that pays $25/hour, demands 50-60 hour work weeks with pressure to study outside of work, requires working nights/weekends/holidays, and frequently deals with life or death situations. And I’m not even touching on the culture of a program, some of which are known to humiliate and marginalize a few unlucky trainees.

Even corporate America pays more and feeds their interns, only asking them to spend long hours in front of Excel or PowerPoint.

I never said residency was the main reason for suicide. But for you to say nothing about anesthesia residency contributes to it is just ridiculous.

Anesthesia residency is a joke. "Relief", "breaks", and "calling out sick" are all foreign concepts to the surgical residents across the drapes.

 

[dannyboy1]

Please show me another job that pays $25/hour, demands 50-60 hour work weeks with pressure to study outside of work, requires working nights/weekends/holidays, and frequently deals with life or death situations. And I’m not even touching on the culture of a program, some of which are known to humiliate and marginalize a few unlucky trainees.

Even corporate America pays more and feeds their interns, only asking them to spend long hours in front of Excel or PowerPoint.

I never said residency was the main reason for suicide. But for you to say nothing about anesthesia residency contributes to it is just ridiculous.

And at the end of three years you can easily find a job for 500k. Residents are young people working their way up. Making a living wage working 50 -60 hours a week for a big payday after 3 years is not a tragedy. PLENTY of people would change places.

 

[ucladoc2b]

I’m gonna push back on this. It’s not about whether you can stand for 12 hours straight, how long you’re in the hospital, or even how many nights you do the job.

The fact is that anesthesia is a strange job where you have the highest acuity events happening on a semi regular basis. Most of surgical residency is just slogging through rounds and show and tell from attendings who deny most residents any sort of autonomy these days.

A decent anesthesia residency isn’t like that. The stress of actually having patients lives or livelihoods in your hands without immediately available backup is fundamentally different than what surgical residents deal with. In most cases, there is not a break from this, as we’re in the OR basically every day. Even surgeons get plenty of clinic time and their operations are only dependent on how careful they are, where mistakes are relatively infrequent. It’s very rare for a surgeon to be doing something with time pressure to save someone’s life, even in residency.

Compared to anesthesia, where things like codes, emergencies, or patient deaths are relatively common, and complications are much more frowned upon and typically more devastating, then you have a recipe for stress. Time/production pressure and Unpredictability of really bad events is much more stresssful in the aggregate than what most surgeons do day to day.

Some people have iron constitutions to do this every day. A lot of people don’t, and don’t understand what it will mean to be in anesthesia and cope with the stress in maladaptive ways. Those are the ones who are vulnerable to self harm and addictions.

And I know plenty of surgical residents whose entire program essentially called out sick for months or did absolutely nothing during Covid (maybe some floor rounding), while my cohorts saved the entire city/country from a deadly disease. So spare me the stuff about anesthesia being easy or child’s play compared to surgery.

Not so sure that’s an accurate portrayal of surgical residency. They had trauma and SICU to run. They had critical surgeries to perform. They had bad call. And they certainly didn’t call in sick during COVID.

 

[pgg]

The nature of our specialty is that we train to handle acute/time-sensitive but rare events. If you want to see some while you're in residency and have backup readily available, you've got to be present. There's no substitute for time in the OR and number of cases.

Granted, some hours and cases are more valuable than others, and I did my share of YAOTE I'm-just-there-to-be-labor cases. But time in the OR is the metric that matters most.

 

[GaseousClay]

There’s more surgical residencies than just general surgery. The vast majority of most surgeons’ cases are elective and were cancelled during the hard parts of Covid.

Anesthesia ran the sicu at my place, and every other place I’ve been.

I worked pretty damn hard in residency but i wont pretend that it was anywhere near my friends general surgery residency. they worked their asses off and were pretty miserable.

 

[soccerboy2288]

UCLA graduate and now working in SoCal.

If you want to find a job in socal/LA after graduating, no doubt pick UCLA. The network and ties you and your attendings have will be the most important factor when looking for a job.

Whether or not living in LA is good vs bad is a whole different story due to cost of living.

Otherwise its a solid program with very good support from PD.

 

[medicine2wallstreet]

Programs that are CRNA-heavy, by and large, produce lower quality residents. Like a previous poster said, you see residents at these types of programs expect to be relieved early and rarely finish big cases, which causes them to have a low degree of patient ownership, etc. They essentially start to function like shift-work CRNAs early in training. They are the ones that show up in PP on day one and their only goal is to leave as early as possible and pass their case off to someone else. "Prioritizing resident education" is code word for crappier residents that just want to go home.

What a clown. Would love to work with a guy that makes grandiose generalizations without evidence at all to back it up. Probably insufferable in the OR.

 

[deleted875186]

Wow this thread is ridiculous.

Pick a program, probably doesn’t matter, pick where you want to live or practice long term.

Number of CRNAs in your training program isn’t the issue, it’s the culture, who makes the schedule and how much do they cater to resident education versus appeasing the attendings and CRNAs, which is impossible to tell based on interviews, you have to talk to a recent graduate. I will say, if there are SRNAs, they will compete for cases. If there are CRNAs working at an academic center, they will want to do big cases because that’s why they took the job, otherwise they would be doing an easier outpatient surgicenter or community hosptial with healthier patients.

 

[vector2]

Wow this thread is ridiculous.

Pick a program, probably doesn’t matter, pick where you want to live or practice long term.

Number of CRNAs in your training program isn’t the issue, it’s the culture, who makes the schedule and how much do they cater to resident education versus appeasing the attendings and CRNAs, which is impossible to tell based on interviews, you have to talk to a recent graduate. I will say, if there are SRNAs, they will compete for cases. If there are CRNAs working at an academic center, they will want to do big cases because that’s why they took the job, otherwise they would be doing an easier outpatient surgicenter or community hosptial with healthier patients.

One more important point to consider regarding programs with SRNAs is what happens with addon cases. Even in programs where the anesthesiologist makes the assignments and residents get first dibs on cases, the residents are frequently assigned to one particular room for the whole next day. On the other hand, SRNAs may have an "assigned" OR, but in reality they're paired with a CRNA no matter where they're at.

Which means the SRNA doesn't necessarily have to stay in their OR the entire day because they can just go pair up with any other CRNA in another room. Even in programs where the MD runs the board and makes the assignments, it's frequently considered bad form to "poach" cases mid-day by moving a resident out of his room to displace the SRNA in the room that's getting a good case. And that can lead to situations where the resident finishes his first start good case and then is stuck with mediocre ones the rest of the day. Meanwhile the SRNA freely hops on addon sick inpatients/traumas that need big vascular, thoracic, neuro, abdominal surgeries etc.


tldr: programs with CRNAs are fine. avoid programs with SRNAs if you can

 

[pgg]

You just need departmental leadership that prioritizes resident education over SRNAs.

At my old job we had a residency program and SRNA program. The CRNA faculty frequently asked to get the SRNAs into more complex cases. (Naturally they should be advocating for their students.) Thoracic, craniotomies, NICU patients, etc. We (schedulers) just said no, unless all of our residents were better occupied. We routinely pulled residents from other assignments if something good popped up as an add-on ... actually occasionally got scolded for taking them from PACU or preop or ASC or regional rotations because they had to check those boxes. And we had a couple of anesthesiologists who'd moan and groan if they lost the resident they were covering 1:1 and had to actually sit in a room.

But the program just needs the will to prioritize residents. Sometimes it helps to remind the board runner that the ACGME has a dim opinion of resident surveys that complain about losing cases to other trainees.

 

[anaesthetic]

You just need departmental leadership that prioritizes resident education over SRNAs.

At my old job we had a residency program and SRNA program. The CRNA faculty frequently asked to get the SRNAs into more complex cases. (Naturally they should be advocating for their students.) Thoracic, craniotomies, NICU patients, etc. We (schedulers) just said no, unless all of our residents were better occupied. We routinely pulled residents from other assignments if something good popped up as an add-on ... actually occasionally got scolded for taking them from PACU or preop or ASC or regional rotations because they had to check those boxes. And we had a couple of anesthesiologists who'd moan and groan if they lost the resident they were covering 1:1 and had to actually sit in a room.

But the program just needs the will to prioritize residents. Sometimes it helps to remind the board runner that the ACGME has a dim opinion of resident surveys that complain about losing cases to other trainees.

This was my experience as well, and we had many RNs in hospital leadership that catered to the CRNAs/SRNAs. That being said, our leadership made sure that resident training never took a backseat to the SRNAs. We always got the best cases, no questions asked.

Also, we rotated through many different hospitals locally throughout training, and the challenge to adapt to different hospital settings, cultures, attendings, surgeons, and pace was an overall positive experience for me. I’ve had to show up to a new hospital and EMR system to do big cardiac cases in private practice, and having that “adaptability” mindset is an important key to mitigate stress. Nothing I hadn’t done before.

 

[nimbus]

There’s more surgical residencies than just general surgery. The vast majority of most surgeons’ cases are elective and were cancelled during the hard parts of Covid.

Anesthesia ran the sicu at my place, and every other place I’ve been.

Not at our hospital. We had a plan to be backup but our trauma surgeons and pulm/CC stepped up and never called us. Our ICUs were full with overflow to PACU but the intensivists still rounded on them, did all the intubations and lines, and took care of them. The only times we got involved were when they came to the OR for their trach/PEGs.

 

[GaseousClay]

Clearly not the point I made. Maybe you guys complaining about residents dealing poorly with stress all should’ve been surgeons so you could puff out your chests about how hard you work. There’s always time to retrain so you aren’t a softie.

what is your point?

 

[IlDestriero]

Do you want to work on the west coast or the south east? That’s where your connections will help get you jobs. If not go to MGH, then you’re good all over.

 

[epidural man]

Hi everyone, I'm hoping to get some thoughts and advice on ranking Vanderbilt or UCLA at the top of my list. I'm from the NY/NJ region, but I would be open to living anywhere during residency. My spouse wants to live in CA after residency and right now that is our plan. For residency, I think we would enjoy either location, my spouse fortunately has a good (remote) job so affording housing in West LA wouldn't be impossible, but we could certainly have a larger/nicer home in Nashville.

I think it really comes down to quality of life, program culture, and ability to find work after residency (academic or PP job, not sure yet). It seems like Vanderbilt has a slightly better reputation than UCLA on Doximity, being the #11 vs #16 program, respectively, but I'm not sure how much that matters. I would like to find a place where residents are very supported by faculty and also have great job prospects and QOL during residency.

I really appreciate any advice or help, especially if you have experience at either of these programs. Thank you!

Go with free food and parking.

Everything else is somewhat meaningless....and I'm not kidding. You will learn to be a great anesthesiologist at both.

If neither offer free food and paid parking, find somewhere else.