Need some advice

[Ableton]

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Hello folks

I have recently gone unmatched in a competitive surgical subspecialty. This was my second time applying to this specialty and both times I have not matched. I am starting to think it's just not going to happen and have been exploring other options. The real only other specialty I enjoyed in medical schools was anesthesia (and critical care), unfortunately those rotations were near the end of my fourth year so I did not even consider it for residency.

A little background about myself:
240s on Step 1 and 2. All honors in clinical rotations. AOA. Multiple publications (5) and presentations (8), all in the surgical subspecialty. Did not match first time around so did a year of research, and did not match this time around.
I am also a foreign citizen, but graduated from an American medical school. While not technically an IMG, I have been basically treated as one. Applied to 90 programs this year and only received 3 interviews... and this was after the chairman at my department emailed over 40 other chairmen and program directors on my behalf.

At this time, I will be going through SOAP to try and land a prelim surgery spot. I'm currently deciding between BWH and UCSF. BWH is closer to my girlfriend in NYC and ultimately I would like to end up in the northeast. UCSF has offered greater flexibility in their prelim schedule and will put me on anesthesia and ICU rotations early in the year. I was just wondering which would be the better choice for a prelim interested in applying to anesthesia this coming year. Any insight into these programs and their respective departments would be greatly appreciated!

Sorry for such a long post. Thanks in advance!

 

[foley12]

Hello folks

I have recently gone unmatched in a competitive surgical subspecialty. This was my second time applying to this specialty and both times I have not matched. I am starting to think it's just not going to happen and have been exploring other options. The real only other specialty I enjoyed in medical schools was anesthesia (and critical care), unfortunately those rotations were near the end of my fourth year so I did not even consider it for residency.

A little background about myself:
240s on Step 1 and 2. All honors in clinical rotations. AOA. Multiple publications (5) and presentations (8), all in the surgical subspecialty. Did not match first time around so did a year of research, and did not match this time around.
I am also a foreign citizen, but graduated from an American medical school. While not technically an IMG, I have been basically treated as one. Applied to 90 programs this year and only received 3 interviews... and this was after the chairman at my department emailed over 40 other chairmen and program directors on my behalf.

At this time, I will be going through SOAP to try and land a prelim surgery spot. I'm currently deciding between BWH and UCSF. BWH is closer to my girlfriend in NYC and ultimately I would like to end up in the northeast. UCSF has offered greater flexibility in their prelim schedule and will put me on anesthesia and ICU rotations early in the year. I was just wondering which would be the better choice for a prelim interested in applying to anesthesia this coming year. Any insight into these programs and their respective departments would be greatly appreciated!

Sorry for such a long post. Thanks in advance!

Why not try to SOAP directly into anesthesia. There are quite a few spots in SOAP

 

[cchoukal]

Any way to get stats from both programs on what percent of prelims get their program of choice? I attend in one of the UCSF ICUs where the prelim surgery interns rotate, and the vast majority are trying to get ortho, ENT, and plastics. Some get spots, to be sure, but many don't. Surely the PDs should be willing to tell you what your odds are, based on past performance. Which program will put you on interview-friendly rotations in Nov-Dec?

Your case is a little different, in that you'd be doing the prelim year to try to match into a PGY2 spot in anesthesia that might pop up at some point during the year, rather than a fresh PGY1 spot in a surgery subspecialty program, but you can't be the first. For what it's worth, both UCSF and BWH are pretty big anesthesia programs, which might increase the likelihood that a PGY2 spot could open (although I am not speaking for the PD at UCSF and don't have intimate knowledge of that process; I'm just going by the numbers).

A year in SF might make you forget about wanting to end up in the Northeast.

If you DO end up at UCSF, you'll undoubtedly rotate through the ICU at the VA; say hello if you do.

 

[Ableton]

Thanks for your thoughts. Both programs seem to be similar in their success with prelim interns landing spots the following year. The consensus was it was rare to obtain a surgical subspecialty, but those who switched to general surgery or anesthesia had few problems matching.

I still have not decided, but at this time I believe UCSF seems to be a better fit for my goals (more choice in desired rotations early in the year, vacation scheduled around interview season, and supportive general surgery PD). My brother also lives in SF and I do love the city and culture!

You mentioned matching into a PGY2 anesthesia spot... is this common? I was thinking of applying for a PGY1 spot next year, but have no clue what my chances would be. I'm interested in academic programs mostly for the research and a future in academia. In addition, what sort of letters of recommendation should I be looking to secure this year?

Thanks again!

 

[Notanerd]

try and just match at one of the unfilled anesthesia categorical positions... sounds like a no brainer and the solution u are looking for

 

[Ableton]

That's probably not going to happen. I applied to them through SOAP, but no received no phone calls for interviews. I'm not surprised since my application has nothing about anesthesia even on it. At this point, going the surgical prelim route is my only option.

 

[Noegrus]

Why don't you take up a surgery (or any) prelim position this year and apply for an R0 position in the next macth? I posted the list here. As you can see, UCSF and MGH anesthesia both have 2 R0 spots for CA-1 starts, BWH has 1, BIDMC has 2, Penn has 2, and Mich has 8. The Harvard programs, combined, have 5 R0 spots, and the Harvard system tends to be generous with visa support etc. You might be a good candidate for matching into one of these spots at the Boston hospitals, or elsewhere, esp if you are in the GS program at the place that is offering the spot. Networking and being an 'internal candidate' may greatly help your cause. Good luck.

 

[prsmd]

Most programs have filled the CA1 positions starting 2014. So I would look at a prelim program which has positions open(in current SOAP). If you are looking at location I am afraid you might have to do 2 years of residency before entering CA1 anesthesia in 2015. Having said that there might be some CA1 openings for 2014(designated R in NRMP, but it will be a gamble.

 

[Ableton]

Oh wow. I didn't even know those R0/CA1 spots existed. I will definitely try to get one of those next year, but wouldn't be averse to repeating intern year if need be.

With SOAP offers starting to go out in a couple hours, I just need to decide now between UCSF and BWH for prelim surgery year. Thanks everyone for your advice!

 

[mysticfolken]

Correct me if I'm wrong, but this is the first year that all programs are required to "opt-in," i.e. cannot hold spots out of the match. That would mean that unless a programs failed to match and chose/could not fill during this current SOAP, there should be no R0 spots available for a CA-1 start in 2014.

If this is true, the only way you get a CA-1 spot starting in 2014 is if someone drops out of the program during their intern year. Which means when you apply next year, you're looking at either repeating an intern year (if you match into a categorical spot) or taking a year off (if you match into an advanced spot).

 

[Noegrus]

Correct me if I'm wrong, but this is the first year that all programs are required to "opt-in," i.e. cannot hold spots out of the match. That would mean that unless a programs failed to match and chose/could not fill during this current SOAP, there should be no R0 spots available for a CA-1 start in 2014.

If this is true, the only way you get a CA-1 spot starting in 2014 is if someone drops out of the program during their intern year. Which means when you apply next year, you're looking at either repeating an intern year (if you match into a categorical spot) or taking a year off (if you match into an advanced spot).

R0 spots offered in the present match were for a July 2013 CA-1 start. R0 spots offered in the next match (opening in 09/2013) would be for a July 2014 CA-1 start. OP can get a July 2014 CA-1 spot by SOAPing into anything for an internship year right now and applying for an R0 spot in the next match. That way, OP won't have to repeat the intern year. In the next match if the OP chooses to apply to both the R0(CA-1) start, and C/A (CA-0) start, and matches to a C program in the 2014 match, then s/he'd have to repeat internship year. If s/he matches to an A program, then either repeat internship or find an all consuming hobby for one year before the CA-1 start in July 2015.

 

[Ableton]

All of the above sound good to me. I took the UCSF spot today -- look forward to seeing you in the ICU, cchoukal.

A couple more questions -- in order to best prepare my application for next cycle, what letters of recommendation should I work for? I know I would need at least one from my general surgery PD and then also one from an anesthesia/ICU attending I'd work with. Who should the other two letters come from?
As well, does any one have any clue what my chances would be at matching into anesthesia next year? I have already gone unmatched twice and my application right now is just filled with research from the surgical subspecialty...

Thank you all for your endless wisdom!

 

[mysticfolken]

R0 spots offered in the present match were for a July 2013 CA-1 start. R0 spots offered in the next match (opening in 09/2013) would be for a July 2014 CA-1 start. OP can get a July 2014 CA-1 spot by SOAPing into anything for an internship year right now and applying for an R0 spot in the next match. That way, OP won't have to repeat the intern year. In the next match if the OP chooses to apply to both the R0(CA-1) start, and C/A (CA-0) start, and matches to a C program in the 2014 match, then s/he'd have to repeat internship year. If s/he matches to an A program, then either repeat internship or find an all consuming hobby for one year before the CA-1 start in July 2015.

I understand what you're trying to say. What I've been told though (from my own program director), is that with the new "opt in" clause, programs are no longer ALLOWED to keep spots outside the match to offer as a R0 the following cycle. Those spots have all been converted to current cycle advanced spots.

 

[Noegrus]

I understand what you're trying to say. What I've been told though (from my own program director), is that with the new "opt in" clause, programs are no longer ALLOWED to keep spots outside the match to offer as a R0 the following cycle. Those spots have all been converted to current cycle advanced spots.

Incorrect. When I was interviewing at Michigan, I met a number of people interviewing for the R0 spots there. The list I posted is for the R0 spots put forth in this year's match and was actually collected from the NRMP's list of available anesthesia programs/positions for ranking in this year's match. Your PD is likely speaking for his/her own program, not all programs. These spots were never placed in the match before this year and were given out by mutual agreement. I can't predict what will happen in the next match, how the numbers would look like, and if the spots will still be offered. I am sure some programs will offer them because they allow people switching from other specialties to skip internship year, albeit through the match process.

 

[Mr Wizard]

All of the above sound good to me. I took the UCSF spot today -- look forward to seeing you in the ICU, cchoukal.

A couple more questions -- in order to best prepare my application for next cycle, what letters of recommendation should I work for? I know I would need at least one from my general surgery PD and then also one from an anesthesia/ICU attending I'd work with. Who should the other two letters come from?
As well, does any one have any clue what my chances would be at matching into anesthesia next year? I have already gone unmatched twice and my application right now is just filled with research from the surgical subspecialty...

Thank you all for your endless wisdom!

If you are specifically looking to stay at UCSF for your anesthesia residency, I would get in contact with the PD, Manny Pardo to inquire about specifics for applying given your situation. In the past, the prior PD, Mark Rosen, did not fill all of the accredited spots so clinical training was not diluted. That always allowed for stellar applicants to transfer in to the program. I am not completely sure how the new "All-In" policy has affected this.

The policy still has work arounds outside the Match, e.g. if a Categorical CA-1 spot is open, you could fill it since the PGY-2 spot is not filled by the match. You also will be able to apply for the "Physician Only" track for next years Match into an advanced CA-1 spot. There were 1 or 2 residents in each class the past few years who were surgical interns or PGY-2 surgical residents who switched into anesthesia.

NRMP All-In Policy

 

[mysticfolken]

Incorrect. When I was interviewing at Michigan, I met a number of people interviewing for the R0 spots there. The list I posted is for the R0 spots put forth in this year's match and was actually collected from the NRMP's list of available anesthesia programs/positions for ranking in this year's match. Your PD is likely speaking for his/her own program, not all programs. These spots were never placed in the match before this year and were given out by mutual agreement. I can't predict what will happen in the next match, how the numbers would look like, and if the spots will still be offered. I am sure some programs will offer them because they allow people switching from other specialties to skip internship year, albeit through the match process.

Those R0 spots offered this year are a result of programs withholding spots outside the match last cycle. With the new "all in" clause now, programs can no longer hold spots outside the match IN THE FUTURE. Thus, no more R0 spots next cycle and beyond.

 

[ShaggyDog]

I am in a similar situation - applied for a surgical subspecialty and went unmatched despite 12 interviews. now will be doing a prelim in general surgery for next year. I am interested in applying primarily to these R0 spots that would start in 2014 but also to advanced spots starting in 2015.

I was hoping some of you could point me towards some resources where I can learn more about the field and specifically current "hot topic" areas of research. In the field I originally applied to, I was pretty invested in research having done a year in the lab between 3rd and 4th year. I would like to get an idea of the kind of research that is currently being done so I have some ideas going into residency.

 

[ShaggyDog]

another question: do anesthesiologists manage/remove airway foreign bodies at all?

 

[cchoukal]

another question: do anesthesiologists manage/remove airway foreign bodies at all?

Just teeth...

 

[ShaggyDog]

Just teeth...

hopefully not too many

 

[nimbus]

I once removed a subglottic quarter with magill forceps and a Mac4 after unsuccessful attempts by pulmonologist (with FOB) and an ENT (with suspension laryngoscopy). Their tiny graspers were just too fine to grab the quarter.

 

[dotcb]

Aim for anesthesia next year, with medicine (->critical care) as your back up plan.

 

[Gern Blansten]

another question: do anesthesiologists manage/remove airway foreign bodies at all?

I have an airway foreign body clinic every other Thursday and see patients in my extubation clinic on Tuesdays.

The wait to get into my airway foreign body clinic is about 2 months. The patients are very thankful after they see me. The first visit usually involves formulating a plan and then I have them come back in ~3 weeks for the removal procedure.

My extubation clinic is similar. Patients are sent home directly from the OR and return a week later to determine if they have met extubation criteria. It works well at our hospital, but would probably not work everywhere. Over the last 5 years, I have seen a huge increase in the number of LMA patients that I see in my extubation clinic. We also do a few other procedures such as skin tag removal and treatment of ingrown toenails.

 

[p30doc]

I have an airway foreign body clinic every other Thursday and see patients in my extubation clinic on Tuesdays.

The wait to get into my airway foreign body clinic is about 2 months. The patients are very thankful after they see me. The first visit usually involves formulating a plan and then I have them come back in ~3 weeks for the removal procedure.

My extubation clinic is similar. Patients are sent home directly from the OR and return a week later to determine if they have met extubation criteria. It works well at our hospital, but would probably not work everywhere. Over the last 5 years, I have seen a huge increase in the number of LMA patients that I see in my extubation clinic. We also do a few other procedures such as skin tag removal and treatment of ingrown toenails.

I lol'd

 

[anes]

I have an airway foreign body clinic every other Thursday and see patients in my extubation clinic on Tuesdays.

The wait to get into my airway foreign body clinic is about 2 months. The patients are very thankful after they see me. The first visit usually involves formulating a plan and then I have them come back in ~3 weeks for the removal procedure.

My extubation clinic is similar. Patients are sent home directly from the OR and return a week later to determine if they have met extubation criteria. It works well at our hospital, but would probably not work everywhere. Over the last 5 years, I have seen a huge increase in the number of LMA patients that I see in my extubation clinic. We also do a few other procedures such as skin tag removal and treatment of ingrown toenails.

You, sir, have made the best post ever. Congrats and thank you for making my day.