Need a University?

[FreddyJ]

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Hey guys, long time listener, first time caller. To start, I'm a third year med student at Upstate in Syracuse, NY and I'm interested in anesthesia for residency. I scored a 228 on step I and have a couple things like international work and being a well-rounded person that will hopefully make me stand out.

At this point I'm not quite sure how to start looking for programs other than by geography and reputation (which ultimately not be all that crucial since the field is getting pretty competitive). But it seems like a basic divergence is University-based versus community (or U. affiliated) programs. I like the idea of a smaller, more one-on-one teaching style at community program but I'm afraid the exposure to parts of the field like SICU, pediatric, pain management, very sick patients, etc.. would inherently be less. University hospitals would seem to provide exposure to all of those, and a lot of it. Ultimately I would like to do a pediatric fellowship although I will probably change my mind. A large University program would also include greater fellowship opportunities, if only at the same school.

I would appreciate anyone's insider view on which type of program they chose and why. Generally speaking, there seem to be benefits to each...and that's where my dilemma is. But gotta start narrowing the search and then decide on aways.

I am definately looking at Midwest and Pacific rim schools (cuz that's where my people are) so if anyone has an opinion of places in Chicago, OHSU, UW etc... Ventdependent, I noticed you have been at both Masionic and Rush so you may have a unique perspective on the differences between community and university--would appreciate how you found them. Two of my current top choices, by the way.

Thanks in advance. Congrats to everyone who just matched.

 

[Bertelman]

I'd say you shouldn't limit your apps to ONLY university v. community. We can tell you all kinds of unique perspectives, but it has to feel right to you. You should at least try to interview at a few of each, and understand for yourself. I interviewed at a few community programs, and the clinical experiences/fellowship opportunities/etc. varied between them. Likewise for university programs.

I think you understand overall the differences between these places, but subtleties can make or break your decision. One university program I visited had NPs running the units. Sounds great, but if you really want to understand how to run an ICU, that means you have to get your hands dirty. I would have gotten better exposure at a community program.

Also understand that some community programs cover a very wide geographic area, thus you will still see a pretty good patient population.

Just throw a few of each into your interview pool, and go from there. If you have decided on a certain geographic area, and remain flexible during December-January, you should be able to batch many of your interviews into a few good road trips. I did 4 plus a Prelim in ten days with a rental car, spanning Cleveland to Maine. Great times. Even better if you can find a jobless friend to share the memories.

 

[jennyboo]

Assuming you have the strong board score which you've already shared, combined with average grades, I think you can expect invitations to interview at many programs, including some "top" academic programs.

Start with the parts of the country where you want to live. Once you've narrowed down your geographic locations, start choosing programs (it will be easy once you get your ERAS login and password -- all you do is click and unclick boxes). Start with the ones you've heard are good, then add a few more as "safety" choices until you hit your magic number of programs to apply to. (My magic number is 20. Others seem to think it's 30.)

I don't think "community vs academic" really makes the big difference between programs. My (large, academic) program has what I think are some absolutely phenomenal one-on-one teachers. I interviewed at a few small, community programs where the one-on-one teaching seemed nonexistent. Large does not necessarily equal impersonal -- sometimes at a small program, people's desire to just go home at the end of the day can make every day a dull (and teaching-poor) one.

 

[VentdependenT]

You've got the right idea by starting with locations that you'd be interested in living in. I would apply everywhere in the northwest and in illinois. Also check out some of the programs in the midwest to compare against your ideal geographic locations. I suggest U Wisconsin, U Indiana, U Iowa, U of Michigan. Thats plenty o' big time university juice to make you happy. Compare places, see where you fit in. Thats the most important. If you go somewhere where the residents or the program vibe doesn't fit your personality then why the hell go there?

As far as University vs Community goes there are only a handful of community programs. As far as exposure goes you have to make your numbers in order to graduate. Thus you are going to HAVE to have ICU exposure and peds exposure. Otherwise you can't graduate. As far as the quality goes take a look at Virginia Mason (easily on of my favorite programs on the trail) in Washington State. Its community based but does its SICU and Trauma at Harborview (the county hospital). It also does its peds and obgyn at private hospitals I believe. You may think thats bizarre but when you have folks that are specialized teaching you about their respective specialties then thats as good as it gets.

Tertiary care centers (major academic centers) will always get the bizarre and the super sick (not to say that NON university based practices dont see disasters either). You'll get used to doing people that are just totally friggen UNHEALTHY just waiting to get transfused, thrown on pressors, and begging for vent support. As I get higher in my training sometimes I just beg for a friggen routine case. Whatever doesn't kill you....anyways.

Ultimately I wanted to be in Chicago. My family is here. All my friends are here. I met a hot obgyner who I'm marrying. It just was what I wanted. So I ranked shytown places high. The best program is the one that you fit into and the one where you could see yourself being comfortable at for both personal and professional reasons.

 

[Celsus]

So would you base your number of applications on your board score? If so how many would you recommend for each range?

 

[FreddyJ]

Thank you all for the input! I think Ventdependent has a good point that regardless of the program there will be a minimum of ICU, peds and so forth. Taking care of really sick patients at a large county hospital sounds like good training but I can see how that could be draining after awhile. So I guess I'll apply broadly within my geographic areas and hopefully find a few good fits during the interview season.

Celsus, not exactly answering your question...but the NRMP "charting the match" data (on the nrmp site) shows that someone who contiguously ranks 8 or more gas programs has a nearly 100% chance of matching. Under the pyramid scheme I plan on applying to roughly 25 gas programs, interview at 10 or so and rank most of them. This info is old, though. I hope they make another chart with this past year's results--the chair of anesthesia here said competitiveness may peak next season!

 

[jennyboo]

Freddy is actually about right -- based on previous match data (keep an eye out for updated data), the average number of programs ranked by a matched candidate is 8 and the average number ranked by an unmatched candidate is 5 (presumably because they either didn't rank enough because of family/ geographical restrictions, or because they weren't a competitive candidate and only got 5 interviews). Based on that, if you rank 8-10 programs, your chances of matching somewhere are excellent.

So for the average candidate (average board scores, average grades) I would aim to interview at enough places so you can rank 8-10 residency programs (and maybe 5 or so prelims). I started out deciding I would apply for 20 programs (which in retrospect was the right number for me), then freaked out and applied to 30. 80% of them invited me to interview with them (way too many, which is why I regret wasting the extra money to apply to the extra programs). Out of about 24 interview offers, I turned down or cancelled 10 and interviewed at 14, then ranked 8.

I would interview at a few more than the number you want to rank, as you will probably find that some of the programs depress you and you wouldn't want to rank them. Of the 6 I did not rank, 4 programs were too depressing to rank and 2 were not located in places were I wanted to live.

 

[VentdependenT]

So would you base your number of applications on your board score? If so how many would you recommend for each range?

no

If you bombed the USMLE then apply WIDELY. Go nuts on the visa.

If you did ok or better then apply WHEREVER YOU WANT. There is NO PENALTY to applying to big hot shot names. You are already in 100+K in debt so screw the visa bill (again) and go nuts with the apps.

Now if you want a rough estimate:
Bad USMLE SCORE = A LOT OF PLACES
GOOD USMLE SCORE = uhhh 30 places?

Its just not that black and white.