Points to Consider about CCF

[DOAnestMan]

The CCF is just one of those places that inspires strong feelings...one way or another. I detested it personally but one of my classmates loved it more than anything on this mortal coil and did everything he could to match there. Put it on and see how it fits is my advice.

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[Kid Sister]

it is not the universal rule. Every program I rotated relieved their residents between 3-5 pm, either by SRNA/CRNA or on-call residents.

on the flip side of that, when i interviewed at other programs that had a "surgical powerhouse" reputation, many had their residents regularly working until 8 or 9 pm WITHOUT extra pay. when i asked the interviewers about that, they'd respond with, "well, that's to be expected if you want to go to a place that has a reputation like ours."

... right.
with an attitude like that, at that point, i was trying to decide whether to put that particular program dead last on my list or next to last.

a comment to the forced rexing- at another program that had in-house moonlighting, i commented on how that's really nice and a good way to get a little extra pay for staying late. then a resident responded with how a lot of times they're forced to moonlight simply because people just don't care about the extra $50-$60/hr and just want to go home. so if everyone feels that way, well someone has to do the gas for the late cases. again, better to get paid than not.

as for the hijack about whiny med students- well the students at my med school were super whiny. but the students at my current program (many states away) don't whine at all. all about where you are i guess.

 

[geogil]

On a slight side note and I dont intend this to jack the thread but.....

Has anyone noticed that med students are becoming softer and whinier these days (not all but this has in my opinion become a trend)? It seems like a lot of people are complaining about their hours lately. Now, a lot of hospitals seem to be shifting to less and less call for med students. One med student was even whining about having to stay post call while the night float resident got to go home. Christ, when I was a student we did 80-100 hour weeks on some clinicals. As a resident, we worked 400 hours a week and we were grateful dagnabit!. I dont think not having students take overnight call is doing them any favors. Do you really want the first time you stay up overnight to be when youre an intern and actually are responsible for patients? I think the hours while rough are needed, and especially in anesthesia decrease appropriately as you go along (80-100 as student, 60-80 as intern, 60's residency).

.

I bet when you went to the hospital it was uphill both ways too? Boy, sonny, they sure don't make 'em like they used to. Sorry, I just thought your post was reminiscent of generic old timer griping.

 

[Kid Sister]

on the flip side of that, when i interviewed at other programs that had a "surgical powerhouse" reputation, many had their residents regularly working until 8 or 9 pm WITHOUT extra pay. when i asked the interviewers about that, they'd respond with, "well, that's to be expected if you want to go to a place that has a reputation like ours."

... right.
with an attitude like that, at that point, i was trying to decide whether to put that particular program dead last on my list or next to last.

a comment to the forced rexing- at another program that had in-house moonlighting, i commented on how that's really nice and a good way to get a little extra pay for staying late. then a resident responded with how a lot of times they're forced to moonlight simply because people just don't care about the extra $50-$60/hr and just want to go home. so if everyone feels that way, well someone has to do the gas for the late cases. again, better to get paid than not.

as for the hijack about whiny med students- well the students at my med school were super whiny. but the students at my current program (many states away) don't whine at all. all about where you are i guess.

oh and another thing- in regards to the program administrator, i flat out told her she scared the crap out of me and she laughed, told me not to worry, and assured me that her bark is worse than her bite (her words. no, i'm not comparing her to a dog). see what a little honesty can do? gave me peace of mind.

 

[amyl]

it is not the universal rule. Every program I rotated relieved their residents between 3-5 pm, either by SRNA/CRNA or on-call residents.

i would argue that this is the rare exception...especially amongst even decent programs. a program i rotated at got its residents out in between 3-5pm. in general, the residents at this program did not have the knowledge base or clinical skill that residents at other programs did.
i would argue that a program that has the reputation for turning out great anesthesiologists with great skill sets will be somewhat of tougher program in terms of hours, relatively speaking....but this is still anesthesiology and we still have it better than most residency specialties.

 

[TrustMe]

At our program each resident is required to take one late call (2 residents per night stay until 9 - 9:30 in addition to the call people) per month in addition to our 24hr calls, but we get paid for 4 hrs of "moonlighting" for that shift even if we are only needed until 7 or 8 to finish a room or do an add-on case. After every one signs up for one late call then you can sign up for additional late calls for the left over shifts if you desire and get paid at the same "moonlighting" rate. Nobody enjoys staying late anywhere but it is easier if you are getting paid and if you have something coming up that you need some extra cash for it is nice to be able to sign up for extra shifts and make a little extra something. With this system at least we know the nights that we will be there late as opposed to being held late to finish a room when you assume you will be done at 5.

 

[Chopsticks]

....

 

[beezar]

I spent a year at CCF doing anesthesia (not for residency) and thus interacted with a fair number of residents daily. Here are my opinions, take it or leave it.

Positives
- Wide variety of cases with many sick patients. Does that mean you will do a wide variety of cases? Not necessarily.
- Tons of liver transplants, AAA's. Though some residents (a minority) don't do many of either of these. Seems to be hit or miss.
- The program administrator, who probably rubbed some people the wrong way, did seem to care about the residents.
- TEE rotation is very good.
- The cafeteria is awesome for a hospital cafeteria.
- Cleveland isn't THAT bad.

Negatives
- You are treated like crap as a resident IMHO. Most residents I interacted with were not happy. I wouldn't say they were all miserable, just not happy.
- You work very long hours.
- A universal complaint is that residents don't get enough breaks, or get relieved for lunch often around 2pm or later.
- Anesthesia has very little power and does little to stand up against surgeons. This is a huge negative.
- CRNA's often get relieved before residents. And yes, some anesthesia staff give the big cases to nurse anesthetists over residents.
- There doesn't seem to be a logical way they divide up residents. One month, there might be 2 residents on vascular, while another there might be 5, thus diluting the number of good cases you get.
- The hearts rotation as a CA-2 is a joke. You are not allowed to be alone in a room by yourself; there is always a fellow with you. You are pretty much like a med student in the heart room. Though you can take hearts again as a CA-3 and sometimes have your own cases.
- There does seem to be quite a bit of animosity between nurse anesthetists and residents.
- They have this weird lecture system where some classes (or all, not sure) have lectures once a week from 5-7pm. A common complaint is that why the hell would you want to go to 2 hours of lecture after working your butt off.
- Efficiency is penalized. If you are efficient with turnover, etc., you just get more cases and work harder. A very common complaint amongst residents.


Bottom line: I would never apply to CCF for anesthesia residency knowing what I know about the place. You are treated very poorly, work long hours, and anesthesia is crapped on, much more so than other places. To me, the variety of cases is just not worth it; you can get that variety elsewhere and actually be treated like a human being. My 2 cents.

 

[bobg504]

Tell that to the Mayo graduates.

I too would echo this sentiment as I rotated a Mayo Clinic Rochester. Residents were relieved between 3-5 daily and were amongst the smartest and most clinically competent around. Most score in the 80-90th percentile on the inservice exam, shown to me by the program director. I agree that there is something to be gained from working more during residency, however, it is also benificial to work SMARTER as well and Mayo is a GREAT example of that

 

[badgas]

i would argue that this is the rare exception...especially amongst even decent programs. a program i rotated at got its residents out in between 3-5pm. in general, the residents at this program did not have the knowledge base or clinical skill that residents at other programs did.
i would argue that a program that has the reputation for turning out great anesthesiologists with great skill sets will be somewhat of tougher program in terms of hours, relatively speaking....but this is still anesthesiology and we still have it better than most residency specialties.

Keep in mind that getting out between 3-5pm is not THAT cushy of a schedule. I'm typically in between 5-530am. By 5pm, I am pretty much wiped out. Anything later than that and I barely remember the drive home. That is fine except when you try to factor in reading time. If you are leaving at 7pm or later every night, then you are not reading a thing. Doing an extra belly or ortho case after 5 pm does not increase your knowledge base in any way. No matter what program you pick, there will be some level of slavery. IMHO, picking a program with a good balance of slave labor and education would be in most applicants best interest.

 

[gasmd99]

I am a Cleveland Clinic anesthesiology resident. There are several things that I complain about on a daily basis to anyone who will listen - I think a lot of us like to complain -, but I am also satisfied that I signed up for this program knowing full well what it meant and that I am receiving exactly that.

Re: “forced rexing”. Our surgical resident colleagues when we complain about our hours; they can’t understand it since we are at least getting paid extra ($60/hr as mentioned in other responses). Perhaps if we only had 20 or less ORs to run in general anesthesia we would need less folks to work, but with over 40 ORs just for general anesthesia we require a larger workforce. Again, at least we are getting paid for our time past 1700. Note- this is only applicable to our months in the General ORs. Our other rotations have much more predictable – and often shorter - hours.

Re: slave work force – what residency is not “slave labor”? I think most residents in all specialties consider themselves “cheap” labor given our salaries and the hours that we work (even with averaging less than 65 hrs/wk).

Re: Nurse supervision in PACE Clinic– The nurse manager runs the office. The Attending Anesthesiologist oversees the residents regarding patient care and management. We get 30 minute lunches just like in the ORs.

Re: Nurse case preference – neuro, vascular and ENT have always been areas of contention. After this complaint a year ago, there was an investigation into the case distribution and it was found that the majority of large neuro and vascular cases go appropriately to CA2-3s and less are given to CRNA/SRNAs. However, the number of large vascular cases is decreasing as the number of endovascular surgeries increase.

Re: Program Director- Our PD is rarely if ever in the ORs. He is mainly in the PACE clinic– pre-anesthesia clearance clinic – and the PACU. As attending for these locations, he directly supervises residents.

Re: OB – this is usually thought of as one of our favorite rotations because it is generally thought of as a pleasant environment that is less stressful and less hours that the general ORs – we get Non-clinical Reading days during this rotation ! Many CA3s elect to take an extra month of OB.

Re: Huron – this is our trauma rotation – a 1-month rotation as a CA3 that is a work in progress. I cannot speak to the personalities or characters of the attendings.

Re: Program Administrator- She is demanding of respect, and has a lot of influence because she has been in her position for years. However, residents who took LOAs this year had broken bones and family emergencies. Our resident who left did so to be with her family with the support of the PA and PD.

Re: cherry-picking residents- Residents who are not in the General ORs are typically more likely to come to the lunches and the dinners because their hours are lighter and they do not need to be relieved from the ORs to get lunch. Interns are also more likely to come to the lunch because again they do not need to be relieved from the ORs. Even with over 100 residents, it can be challenging to get residents to come to the dinners simply because they have lives outside of residency and would rather spend their non-working hours on a Sunday night living them. Residents who aren’t happy with the program are even less likely to sacrifice extra time to promote it.

CCF program - We have a large caseload in the general ORs. We work hard in the general ORs, but often our hours are less outside of the general ORs (M-F 40hrs/wk with 3-5 overnight calls on other rotations like Pain (4 months), SICU (4 months), PACE/PACU (4 months), OB (2-3months)). Our internship may be one of the nicest out there with most of the rotations being 40hrs/wk or less with no call.

Many of us are enthusiastic about our new Chair, Dr. Brown, who appears very interested in the issues that have been raised over the last few months. We are hopeful that some of the systemic problems are not only being investigated and evaluated, but will also be resolved. Nonetheless, if you don’t want to work a lot during the CA years, don’t come to CCF.

 

[bigdan]

gasmd:

Thanks a bunch for your post. As much as I appreciated the opinions of the original poster, it's nice to see a resident standing up for the program as well.

dc

 

[coprolalia]

Positives
- Wide variety of cases with many sick patients. Does that mean you will do a wide variety of cases? Not necessarily.
- Tons of liver transplants, AAA's. Though some residents (a minority) don't do many of either of these. Seems to be hit or miss.
- The program administrator, who probably rubbed some people the wrong way, did seem to care about the residents.
- TEE rotation is very good.
- The cafeteria is awesome for a hospital cafeteria.
- Cleveland isn't THAT bad.

Negatives
- You are treated like crap as a resident IMHO. Most residents I interacted with were not happy. I wouldn't say they were all miserable, just not happy.
- You work very long hours.
- A universal complaint is that residents don't get enough breaks, or get relieved for lunch often around 2pm or later.
- Anesthesia has very little power and does little to stand up against surgeons. This is a huge negative.
- CRNA's often get relieved before residents. And yes, some anesthesia staff give the big cases to nurse anesthetists over residents.
- There doesn't seem to be a logical way they divide up residents. One month, there might be 2 residents on vascular, while another there might be 5, thus diluting the number of good cases you get.
- The hearts rotation as a CA-2 is a joke. You are not allowed to be alone in a room by yourself; there is always a fellow with you. You are pretty much like a med student in the heart room. Though you can take hearts again as a CA-3 and sometimes have your own cases.
- There does seem to be quite a bit of animosity between nurse anesthetists and residents.
- They have this weird lecture system where some classes (or all, not sure) have lectures once a week from 5-7pm. A common complaint is that why the hell would you want to go to 2 hours of lecture after working your butt off.
- Efficiency is penalized. If you are efficient with turnover, etc., you just get more cases and work harder. A very common complaint amongst residents.

DAMN! You just completely and perfectly summarized my program.... except there is no TEE rotation and the cafeteria sucks... and where I'm at geographically IS that bad.

Bottom line: I would never apply to CCF for anesthesia residency knowing what I know about the place. You are treated very poorly, work long hours, and anesthesia is crapped on, much more so than other places. To me, the variety of cases is just not worth it; you can get that variety elsewhere and actually be treated like a human being. My 2 cents.

Yeah, and if I had it to do all over again, I wouldn't have come "here" to do my training either. Sad. I'm just counting the days... already...

-copro

 

[coprolalia]

Oh, yeah... and, after hours/overtime pay? Nada. Zip. Zero. Zilch. "Suck it up and work" - actually heard by a co-resident from our program director.

(A**hole).

-copro

 

[BubbleHead]

if you don't want to work a lot during the CA years, don't come to CCF.

If you don't want to work hard during your CA years, change your mind about Anesthesia and maybe any career in the field of Medicine

 

[coprolalia]

Medicine is not an easy career, mind you. The difference is you are master of your own time. If you want to work hard, you can make a sh*tpile of money. If you don't, you won't.

I have a female friend who is a hospitalist internist. She only does admissions and takes care of patients in-house. It's feast or famine for her, but she gets a huge performance bonus in her practice when it gets really rough (that is, nights when she gets 16-17 admissions). Averaging about 50-55hrs/week last year, she pulled in $260k. That's without a fellowship. That's without having to do clinic time. And, that's having a pretty good life outside the hospital. She and her husband (who's not medical) have plenty of time to spend with their two kids, as well.

-copro

 

[Aykroyd]

As a recent graduate of the Cleveland Clinic I would like to contribute my two cents. Let me preface this by saying, I personally don't care where you train. Whether you train at the Cleveland Clinic or another program, if you work hard and study like it really matters, you will do well in both your residency and your career. What bothers me in reading this thread is that there are some individuals that feel entitled to being pampered, like it is the obligation of the program to make life easy. I could name few individuals at my program who would have posted the original thread. And let me say they are not the people I would recommend for a job with my group.

In all honesty, if you are a whiner or in anyway feel entitled like I mentioned you won't do well at the Clinic or for that matter anywhere. You will be miserable and will make not only yourself look bad, but the program as well. Those who have issues with Shelly Sords the program coordinator are those who cause her problems by not logging hours or case totals, etc. I will admit that she does have a big personality, that is a bit hard to swallow, but she is harmless. Those that really do well seem to be individuals that have had some previous life experiences, who can relate to people, and are responsible, i.e. not self absorbed and do what is asked of them.

Life is not perfect as a resident at the Cleveland Clinic and sometimes the general ORs run late and you have to finish your room and you make a little extra money. Sure sometimes residents are tired and it doesn't seem like the money is worth it, but just imagine staying late and not getting paid!

Overall I was happy at the Clinic, and my training fully prepared me for life in private practice. I feel most fortunate that because of my training at the Cleveland Clinic I was able to obtain my dream job! On more than one occasion while interviewing for my current position I heard the comment, “Being from Cleveland Clinic will help you get a job here.”

Aykroyd

 

[coprolalia]

Sure sometimes residents are tired and it doesn't seem like the money is worth it, but just imagine staying late and not getting paid!

Yeah, welcome to my world.

-copro

 

[toughlife]

As a recent graduate of the Cleveland Clinic I would like to contribute my two cents. Let me preface this by saying, I personally don't care where you train. Whether you train at the Cleveland Clinic or another program, if you work hard and study like it really matters, you will do well in both your residency and your career. What bothers me in reading this thread is that there are some individuals that feel entitled to being pampered, like it is the obligation of the program to make life easy. I could name few individuals at my program who would have posted the original thread. And let me say they are not the people I would recommend for a job with my group.

In all honesty, if you are a whiner or in anyway feel entitled like I mentioned you won't do well at the Clinic or for that matter anywhere. You will be miserable and will make not only yourself look bad, but the program as well. Those who have issues with Shelly Sords the program coordinator are those who cause her problems by not logging hours or case totals, etc. I will admit that she does have a big personality, that is a bit hard to swallow, but she is harmless. Those that really do well seem to be individuals that have had some previous life experiences, who can relate to people, and are responsible, i.e. not self absorbed and do what is asked of them.

Life is not perfect as a resident at the Cleveland Clinic and sometimes the general ORs run late and you have to finish your room and you make a little extra money. Sure sometimes residents are tired and it doesn't seem like the money is worth it, but just imagine staying late and not getting paid!

Overall I was happy at the Clinic, and my training fully prepared me for life in private practice. I feel most fortunate that because of my training at the Cleveland Clinic I was able to obtain my dream job! On more than one occasion while interviewing for my current position I heard the comment, “Being from Cleveland Clinic will help you get a job here.”

Aykroyd

It is the lifestylers who are joining anesthesia that ones who usually complaint about work hours. Remember it is residency you are going through, so it is expected you will work hard.

Just concentrate on learning and being good at what you do and the rest will take care of itself.

 

[beezar]

As a recent graduate of the Cleveland Clinic I would like to contribute my two cents. Let me preface this by saying, I personally don't care where you train. Whether you train at the Cleveland Clinic or another program, if you work hard and study like it really matters, you will do well in both your residency and your career. What bothers me in reading this thread is that there are some individuals that feel entitled to being pampered, like it is the obligation of the program to make life easy. I could name few individuals at my program who would have posted the original thread. And let me say they are not the people I would recommend for a job with my group.

In all honesty, if you are a whiner or in anyway feel entitled like I mentioned you won't do well at the Clinic or for that matter anywhere. You will be miserable and will make not only yourself look bad, but the program as well. Those who have issues with Shelly Sords the program coordinator are those who cause her problems by not logging hours or case totals, etc. I will admit that she does have a big personality, that is a bit hard to swallow, but she is harmless. Those that really do well seem to be individuals that have had some previous life experiences, who can relate to people, and are responsible, i.e. not self absorbed and do what is asked of them.

Life is not perfect as a resident at the Cleveland Clinic and sometimes the general ORs run late and you have to finish your room and you make a little extra money. Sure sometimes residents are tired and it doesn't seem like the money is worth it, but just imagine staying late and not getting paid!

Overall I was happy at the Clinic, and my training fully prepared me for life in private practice. I feel most fortunate that because of my training at the Cleveland Clinic I was able to obtain my dream job! On more than one occasion while interviewing for my current position I heard the comment, “Being from Cleveland Clinic will help you get a job here.”

Aykroyd

Well put. I agree that after residency, it doesn't really matter where you trained, but just what you did with your time in training. Some people are lazy and complain; some people shut up and work hard. And guess which ones succeed...

However, this thread is just to let prospective candidates know what they are getting into. You won't complain that you don't get enough cases or sick patients at Cleveland Clinic, or that your training was poor. But you might complain that the system wears you out and beats you down. My feeling is to go to a place where you get the clinical experience and good training, but that treats you more humanely.

Of course, my perspective is only comparing my residency, along with residencies of my close friends, to CCF. I worked hard in residency, and at the time thought that a lot of things could be improved; but in retrospect, I now realize we were treated very well compared to the residents at Cleveland Clinic.

 

[rarelyposts]

These are some common complaints among CCF Gas Residents. These are opinions, nothing more. Take it or leave it. Hope it helps you.

FORCED REXING: Residents are forced to Moonlight at CCF. The Program Director claims the REX program (paid Resident Experience Program) is voluntary. When you mention “Mandatory Moonlighting” OR “Forced Rexing” he will tell you that you can stay and work as a resident under the 80 hour/week ACGME mandate or you can VOLUNTEER to get paid for the time you are here. Either way you are going to stay and work. If people complain, he threatens to keep the moonlighting pay and work residents into the ground.

Residents are a slave work force: This is Anesthesia, not Surgery, but Residents relieve CRNAs and SRNAs in the OR, so they can leave on time. Contract this with the MANY, MANY, MANY programs that use CRNAs to get Residents out of the OR on a daily basis to provide reading time to residents.

Resident Physicians supervised by Nurses at CCF: You are directly supervised by an RN and a LPN in the PACE clinic. They reprimand you, nag you about productivity, and find any reason to scold you if you tolerate it… they even try to tell you when you can go to lunch and monitor your lunch breaks down to the minute. They offer NO EDUCATIONAL VALUE to Physicians’ training… it is just easier for the Residency to have Nurses in charge of you, because the Anesthesia Staff Physicians don’t want to be involved.

CRNA/SRNA get Case Preference: Many times on big important rotations like Neuro, Vascular, ENT, and Cardiac you will be assigned to trivial cases while SRNAs and CRNAs are given the best learning cases. Expect to get an AV fistula while the SRNA gets the open AAA, the Control Desk says “This is a CRNA training program too”. There is a large and profitable CRNA presence here at CCF. These Nurses are treated as royalty. Residents ALWAYS relieve Nurses in the ORs, so they can go home and Residents finish the cases. Often the Nurses leaving at 3:30 PM go home while Residents are left in ORs without getting a break or lunch that day. Look for a better residency program that gives preference to Physicians in Training and not Nurses.

Pro-CRNA Program Director: Most of his very limited OR time is spent supervising CRNAs, 2 at a time, instead of teaching Residents… CCF is a RESIDENT TRAINING PROGRAM, so why does the Program Director work with Nurses over Residents. He is not alone, the immediate-past-Chair of Cardiothoracic Anesthesia ONLY works with Nurses and will never allow a resident in his OR. Find a better program where the Physicians will work with the Resident Physicians preferentially and not the Nurses.

Patients often refuse Resident Care at CCF: On the OB rotation RNs have an adversarial relationship with residents. Nurses talk patients out of Resident care and into only allowing Attendings to perform epidurals and spinals. This occurs 20-25% of the time, which sadly is a big improvement since efforts have been made to correct the problem.

Residents work for CRNAs: Huron Hospital is the realm of the CRNA. The attendings there tell residents to do whatever the CRNAs say. The attendings are private practice minded, not Acedemics. They tolerate residents because the must and allow CRNAs to run the show because it is profitable and the Attendings are lazy.

MALIGNANT: The Program Administrator is an unstable, unpredictable, and malignant person. She demands complete obedience then she berates, humiliates, and degrades Physicians at the Resident and Staff level openly and has never received even a word of caution from the Program Director. She has forced Residents into LOAs at least twice this year and “caused one Resident to quit Anesthesia all together”. She expects, even demands respect. She will tell you how much power she has, threatens to ‘lose your paperwork for vacation, reimbursements, etc… and GIVES ABSOLUTELY NO RESPECT WHAT SO EVER TO PHYSICIANS. The PD has encouraged this behavior and attitude for two decades and there is no change in sight.

When you visit the Cleveland Clinic, ask yourself about which residents you are ALLOWED to meet. The Program Director tells the Chief Residents to invite Residents to dinner that will portray the program in a positive light, the Anesthesia Control Desk arranges lunch relief for the applicant lunches only for Residents that will portray the program in a positive light. But, if you can’t find a better place to match you will learn first hand the truth of this program.

I'm not much of a blogger, so I'm coming to this conversation quite late. I'm also a CA3 resident at Cleveland Clinic. All I can say is that I really like my program and have had an overall good experience here. I heard about this posting (obviously people around here have been talking about it). I would just point out that sometimes when people have such extraordinarily strong opinions about something, they may not represent the norm.

With regard to "rexing"--which is our overtime program--it's weird to feel so strongly about this. We are DOCTORS, not nurses. We are professionals, and we should expect to stay until the job is done or there is someone available to take over--another reason we are worth bigger bucks when we are finished. I'm not questioning anyone's work ethic at all. But perhaps the person's perspective might not be optimal.

And our program administrator is not a maniac, as the initial post suggests. She is smart, capable, and quite caring. She has a strong personality, but no one would even think twice about it if she were a man.
Just my opinion.

Overall, this is a good program. It is a BIG program, so there is not always a steady stream of TLC flowing all over the place. But if you are a fairly hard working, well-intentioned person, it's not a tough place to like. I have always been treated professionally by my staff anesthesiologists. On the occasions where I have gotten into tussles with surgeons, they back me up. I have as much autonomy as I would like. etc. etc.

I feel so sad that this person has trashed my program in this way. I like CCF anesthesia. I don't plan to work in academics, but I have so much respect for those who do work here. Every place will have its drawbacks as well as its highlights. To applicants: please keep an open mind about CCF and ask lots of questions to anyone you can. And no, I'm not one who will be "cherry picked" to meet you, because that's really not my thing.

 

[Taurus]

Explain to me why there are no AA's working at CCF main campus. There are over 150 CRNA's on staff there as well as a nurse anesthesia program. Yet, no AA's. Across the street, CWRU has one of the oldest AA programs in the country. There are AA's working at Metro and UH, the other large hospitals in the region. Why doesn't the Clinic open an AA program? If the anesthesiologists and residents at the Clinic are serious about this profession, why aren't they lobbying the chair and CEO Cosgrove to hire AA's and open an AA program? Do the CRNA's at CCF have that much power? Maybe the OP isn't that far off from the truth.

 

[rarelyposts]

Explain to me why there are no AA's working at CCF main campus. There are over 150 CRNA's on staff there as well as a nurse anesthesia program. Yet, no AA's. Across the street, CWRU has one of the oldest AA programs in the country. There are AA's working at Metro and UH, the other large hospitals in the region. Why doesn't the Clinic open an AA program? If the anesthesiologists and residents at the Clinic are serious about this profession, why aren't they lobbying the chair and CEO Cosgrove to hire AA's and open an AA program? Do the CRNA's at CCF have that much power? Maybe the OP isn't that far off from the truth.

Most places don't have AAs; I'm not sure this is as big an issue as you suggest. People go crazy about CRNAs vs MDs/DOs in anesthesia, but there is flexibility for choosing the practice environment you want. I'm looking for jobs right now--private practice only. One practice is MD only, one uses CRNAs for giving breaks, and one uses a model of 1/3 CRNA done cases and 2/3 MD cases. There are way too many sick people on this earth to practice anesthesia w/o CRNAs right now. Nor do you want to be doing some of the cases that they get assigned to in private practice (ERCP, colonoscopies)--these cases are pretty boring for an MD.

That's just the way it is, and it doesn't mean your future salary is threatened. Of course, your future salary (and mine) may be threatened by the collapse of our ability to pay for health care, but that's a bigger issue to get our hands around.

The best way to out-compete with CRNAs is to provide excellent care and demonstrate your superior knowledge consistently with your surgeons. You know they frequently read magazines in the OR, so you DON'T do that. Even if it's a boring case, this communicates a certain level of apathy to a surgeon. Remember that you are a provider of SERVICE to your patients and your surgeons. When you see your surgical colleagues, ask them about their tough cases--"how's our lady w/ the perf doing; is she septic?" Better yet, see them yourself. That's something a nurse is just not going to do. Going to medical school doesn't make you excellent. Believing in and delivering on excellence daily does. And then you don't have to worry about anyone competing for your job. This is something that anyone with even a sliver of a business background intuitively understands--and something that so many of us in medicine just fail to grasp because we think being smart is enough and people should love us for it.

Even at a place as huge as CCF, staff and resident surgeons know me by name and request my opinion for periop management of their patients when I'm doing their cases. Bet they don't do this for the CRNAs.

Ok, this is WAY too much out of me. I'm going to shut up now, and leave the rest of this alone.

 

[Taurus]

Most places don't have AAs; I'm not sure this is as big an issue as you suggest. People go crazy about CRNAs vs MDs/DOs in anesthesia, but there is flexibility for choosing the practice environment you want. I'm looking for jobs right now--private practice only. One practice is MD only, one uses CRNAs for giving breaks, and one uses a model of 1/3 CRNA done cases and 2/3 MD cases. There are way too many sick people on this earth to practice anesthesia w/o CRNAs right now. Nor do you want to be doing some of the cases that they get assigned to in private practice (ERCP, colonoscopies)--these cases are pretty boring for an MD.

That's just the way it is, and it doesn't mean your future salary is threatened. Of course, your future salary (and mine) may be threatened by the collapse of our ability to pay for health care, but that's a bigger issue to get our hands around.

The best way to out-compete with CRNAs is to provide excellent care and demonstrate your superior knowledge consistently with your surgeons. You know they frequently read magazines in the OR, so you DON'T do that. Even if it's a boring case, this communicates a certain level of apathy to a surgeon. Remember that you are a provider of SERVICE to your patients and your surgeons. When you see your surgical colleagues, ask them about their tough cases--"how's our lady w/ the perf doing; is she septic?" Better yet, see them yourself. That's something a nurse is just not going to do. Going to medical school doesn't make you excellent. Believing in and delivering on excellence daily does. And then you don't have to worry about anyone competing for your job. This is something that anyone with even a sliver of a business background intuitively understands--and something that so many of us in medicine just fail to grasp because we think being smart is enough and people should love us for it.

Even at a place as huge as CCF, staff and resident surgeons know me by name and request my opinion for periop management of their patients when I'm doing their cases. Bet they don't do this for the CRNAs.

Ok, this is WAY too much out of me. I'm going to shut up now, and leave the rest of this alone.

You miss my point. My question is why CCF anesthesiology staff and residents allow this situation to perpetuate where not a single AA works on the main campus at CCF. There has been an AA program at CWRU for something like the past 40 years. UH and Metro hires AA's. Yet, none at CCF. Why do you suppose that is so? Let me give you an idea. The CRNA's at CCF are so well organized and powerful that they can block out a competitor completely. The CCF CRNA's are terrified of having AA's around. Why is the anesthesiology staff afraid of hiring AA's at CCF? Is it because they are worried about pissing off the CRNA's? Is the anesthesiology staff that beholden to CRNA's at CCF? Don't you think CCF could support both a CRNA and AA training programs?

The OP's original point about how CRNA's can get better cases than some residents shouldn't be so simply dismissed. The CRNA's at CCF main campus have a lot of clout.

The staff and residents should push hard for the hiring of AA's and opening an AA training program at CCF. This will send a loud and clear message.

 

[Southpaw]

Most places don't have AAs; I'm not sure this is as big an issue as you suggest. People go crazy about CRNAs vs MDs/DOs in anesthesia, but there is flexibility for choosing the practice environment you want. I'm looking for jobs right now--private practice only. One practice is MD only, one uses CRNAs for giving breaks, and one uses a model of 1/3 CRNA done cases and 2/3 MD cases. There are way too many sick people on this earth to practice anesthesia w/o CRNAs right now. Nor do you want to be doing some of the cases that they get assigned to in private practice (ERCP, colonoscopies)--these cases are pretty boring for an MD.

That's just the way it is, and it doesn't mean your future salary is threatened. Of course, your future salary (and mine) may be threatened by the collapse of our ability to pay for health care, but that's a bigger issue to get our hands around.

The best way to out-compete with CRNAs is to provide excellent care and demonstrate your superior knowledge consistently with your surgeons. You know they frequently read magazines in the OR, so you DON'T do that. Even if it's a boring case, this communicates a certain level of apathy to a surgeon. Remember that you are a provider of SERVICE to your patients and your surgeons. When you see your surgical colleagues, ask them about their tough cases--"how's our lady w/ the perf doing; is she septic?" Better yet, see them yourself. That's something a nurse is just not going to do. Going to medical school doesn't make you excellent. Believing in and delivering on excellence daily does. And then you don't have to worry about anyone competing for your job. This is something that anyone with even a sliver of a business background intuitively understands--and something that so many of us in medicine just fail to grasp because we think being smart is enough and people should love us for it.

Even at a place as huge as CCF, staff and resident surgeons know me by name and request my opinion for periop management of their patients when I'm doing their cases. Bet they don't do this for the CRNAs.

Ok, this is WAY too much out of me. I'm going to shut up now, and leave the rest of this alone.

This is just an absolutely fantastic post filled with gems useful for someone in my position (M4 applying into anesthesiology). I realize you don't want to "out" yourself but when you're out on your own I hope you'll post more. You seem to represent the best of anesthesiology. Thanks.

 

[Kid Sister]

And our program administrator is not a maniac, as the initial post suggests. She is smart, capable, and quite caring. She has a strong personality, but no one would even think twice about it if she were a man.
Just my opinion.

ain't that the truth. she actually told me she was worried that i'd get trampled on by the less favorable personalities in the ORs because 1. i'm female, and 2. i'm small. she's just being a strong woman and encouraged me to be one as well. some people just don't recognize that in her and assume the worst.

 

[amyl]

sad that when you are a woman who stands up for yourself, demands respect, or speaks your mind you are labeled a bi_ch but if you are a man with the same qualities you are labeled ambitious or driven. even in this day and age the double standard exists.

bottom line on ccf: its a great program with a great reputation and great fellowships.

 

[coprolalia]

sad that when you are a woman who stands up for yourself, demands respect, or speaks your mind you are labeled a bi_ch but if you are a man with the same qualities you are labeled ambitious or driven. even in this day and age the double standard exists.

Not necessarily.

Point is, if you are a "pain in the ass" (PITA), people will object - man or woman. Others will try to make your life difficult. This goes doubly-so if you actually suck at what you do.

I think PITA people are not liked regardless of sex, but tolerated, provided they are good. If they suck, they are removed from the equation as rapidly as possible.

Think about family members of patients who are PITAs compared to those who will let you do whatever you want without asking any questions. Who do you spend more time with? And, why is this? Because they ask tough questions, they want to know what's going on, they are a little skeptical of what you're doing, and they generally don't inherently trust you.

Same holds true with employees. And, generally, most managers are lazy and want someone who is easy and whom they don't have to deal with regularly. It's much easier if someone just shows up, keeps their mouth shut, and goes with the flow regardless as to how they're actually being treated.

-copro

 

[New2Midwest]

A little off topic-but anyone at CCF know what they pay their attendings to start? How do they keep their attendings there?

 

[amyl]

it is my understanding that ccf attendings are paid very well for academic anesthesiologists. i have heard rumors that starting salaries are around 280 but i haven't heard that from anyone that would really know.

 

[pgg]

sad that when you are a woman who stands up for yourself, demands respect, or speaks your mind you are labeled a bi_ch but if you are a man with the same qualities you are labeled ambitious or driven. even in this day and age the double standard exists.

Actually, most of us refer to those kind of men with terms much worse than bitch. No double standard here.

 

[ccfalum2008]

I graduated from CCF in July and started in a private practice. I was told about this post from a friend still at CCF.

Forced Moonlighting: Yes, they do ask for volunteers. I never once volunteered for moonlighting, but ended up moonlighting a lot. It is an issue of semantics. The director states there is no “forced” moonlighting. By the letter of the law he is correct. No one forces you to take the money. You will work, but you are not forced to accept the money and therefore, there is no forced moonlighting. It does not take a genius to figure out that you will take the money since you will have to work anyways. You can be forced to work because you are, on average, under the 80 hour week.

Relieving CRNAs/SRNAs: Absolutely true! You will relieve the nurses. There are rare occasions where they do relieve you, but the vast vast majority of the time it is the other way around. When you are training is there really a benefit to doing another 3 hour cysto add on that starts at 4pm as the urology residents dinks around?? Or is it better to be relieved and go read? In my opinion the residents should be relieved.

Supervised by Nurses: True. In the preoperative clinic you are supervised by RNs. When I did it as an intern it was 4 weeks and as a CA1 it is 8 weeks. This supposedly is being revised.

CRNA/SRNA case preference: I did not see this as a problem. There are literally so many cases at CCF that you get experience with them all.

Program Director in the OR: Never once worked in the OR with him. I rarely recall him ever being in the OR, but the few times I would see his name on the board he was with the CRNAs.

Refusal of care in OB: This was not an issue that I came across.

Working for CRNAs at Huron: Huron is the “trauma” rotation for CCF. It is level two and has more trauma than the ccf main campus, but is by no means a trauma center. You do a month there as a CA-3. In my month I did one trauma…and 80 year old subdural. They gave me really really interesting cases of tendon repairs on pt. that were trauma patients who were admitted to the hospital yesterday because they got stabbed in the arm. Not really the trauma you are looking for as a resident. This issue aside I had no issue with CRNAs at the hospital.

Malignant program administrator: She plays favorites. If you are on her good side it is easy, if not she can make life difficult. She does degrade residents and other staff behind their back.


This is my take. I did the four years there and now am in private practice at a hospital that does all cases with the exception of transplants. I can say the program has problems. I am not sure if they are being addressed. They were repeatedly brought up during resident meetings and “retreats” when I was there, the director was aware, and yet nothing ever seemed to change. I do feel that the training I got was outstanding. The simple fact that you are in the OR dealing with ridiculously sick patients, often times in cases that are over your head, teaches you how to deal with them. I do not feel I had much “in OR teaching” but I learned a ton just from dealing with the patients and the fact that you are in the OR so much. You are certainly prepared when you leave CCF to handle any case that comes your way. The day to day crap is annoying and you could definitely be treated better as a person and as a professional. However, I don’t know if you will find better cases or patients to learn from though.

 

[radslooking]

looks like that last poster is likely the "middle ground" that everyone was searching for. that's probably closest to the truth.

 

[jennyboo]

This is a fantastic thread. I am not a CCF resident, but as a resident in general this is what I would say to the M4s who are looking here and applying this year.

I'm a resident at what I think is a great program.

At the aforementioned great program, I also sometimes don't get relieved from my cases at the end of the day at all but am expected to finish them, and sometimes they run until 6pm. During a couple of our rotations we are expected to finish certain types of cases (major vascular and thoracic cases, for example) even if they end at 9pm. I occasionally relieve a CRNA so she can go home. I also occasionally get relieved by a CRNA, either so I can go home or so I can go to lecture at the end of the day. The occasionally hysterical OB patient will refuse a resident epidural. We also have a couple of crazy administrative assistants who show up for work at 9:55am, take a two hour lunch, Facebook for an hour, take an hour smoke break, and then go home at 2:55pm -- and are randomly "out of the office" seemingly at least one or two times a week -- and who give you attitude if you're lucky to catch them during the 20 minutes they're at their desks.

Many of the complaints you've read about in this thread which are attributed to a certain residency program (CCF) are not avoidable in any residency. In the real world, all hospitals and all anesthesiology departments are rough-and-tumble. Realize that all anesthesiology residents in programs all over -- whether or not the programs are known as "cush" -- deal with all of these issues to some degree. If, for example, you ask a bunch of residents at any program -- whether the program is strongly anti-CRNA or not -- you will get a colorful variety of answers, some of which are "they're OK" and some of which are complaints, no matter what program it is. The same with work hours, relieving CRNAs or being relieved by them, feeling like you're just a warm body filling a room in the OR, etc.

It's hard to figure out whether a resident is "happy." As you can see, I'm happy doing some of the same things that make other people very unhappy. I don't like it when my case which is "almost done" at 4:45pm because the surgeon claims to finish in 15 minutes -- then ducks out and lets the intern close in 60 minutes -- doesn't get assigned a relieving anesthetist and then I'm stuck staffing it until the intern actually finishes at 5:45pm and I drop the patient off in the PACU at 6pm, do an inpatient preop and then end up leaving the hospital at 6:40pm. But there is some intangible combination of being around enough people who really like anesthesiology, seeing a few unusually complex referral cases, having 3 free weekends a month during general OR rotations and working 60-65 hours a week, having a little bit of pride in eventually being able to say "I trained at [insert residency program name]," occasionally going to the bar with residents and attendings after work, and sharing my somewhat crowded and messy apartment with my significant other in a city where we like living which eventually adds up to making me a resident who is "happy" with where I'm working.

Happiness is not going to be determined by who relieves who at the end of the day or even by whether you get out of the OR at 3pm or at 6pm. I guarantee you there are 3pm programs with incredibly low morale among both faculty and residents, bitter complaints about case distributions, scrambling to get enough numbers, etc. There are also 5-6pm programs (like mine) where both residents and faculty have good morale and are reasonably content with their jobs. Unfortunately, this doesn't give you M4s any easy answers about which of many residency programs on your ERAS list you can cross off right away. But just because you hear a little bit of bad stuff doesn't necessarily mean it's all bad.

 

[coprolalia]

As you can see, I'm happy doing some of the same things that make other people very unhappy.

Give it time, Jenny. Give it time.

-copro

 

[fakin' the funk]

This is a fantastic thread. I am not a CCF resident, but as a resident in general this is what I would say to the M4s who are looking here and applying this year.

I'm a resident at what I think is a great program....

Great post. Great food for thought during this interview season. Cheers.

 

[eroicamadeus]

about the program administrator/coordinator: she does seem very powerful, maybe even has some impact in the selection committee

about case assignment: not by chief residents, by some administrative staff instead. not even sure if this person is an anesthesiologist

about new chairman: very nice and low key, seems to have huge potential to improve the program. but i would wait until i see the improvements to join the program, not during this transitional period.

about residents: can't say they look miserable, but can not feel the happiness or enthusiasm neither.

 

[Taurus]

I've been told by a friend who has rotated through there and has interviewed there that CCF will start to hire AA's at main campus soon. Woo hoo!

 

[amyl]

I've been told by a friend who has rotated through there and has interviewed there that CCF will start to hire AA's at main campus soon. Woo hoo! [/QUOT

really? who did they hear this from? any plans for AA students to rotate at ccf?

 

[AK_MD2BE]

My apologies if this question has been answered...I don't have time to read the entire enormous thread. This question goes out to all of you savvy vets and/or people in private practice that are looking to hire new grads...

If the training that you receive at CCF is significantly more brutal/difficult, does it make you that much better of an anesthesiologist? Or do you reach a point of diminishing returns (i.e. you can learn as much at another program working 60 hours/week compared to working 70+ at CCF)?

Personally, I would take the rigorous training if I know that at the end of four years I am going to be an exceptional anesthesiologists and have my pick of excellent private practice opportunities. Thanks for any insight/advice.

 

[drgopoos]

My apologies if this question has been answered...I don't have time to read the entire enormous thread. This question goes out to all of you savvy vets and/or people in private practice that are looking to hire new grads...

If the training that you receive at CCF is significantly more brutal/difficult, does it make you that much better of an anesthesiologist? Or do you reach a point of diminishing returns (i.e. you can learn as much at another program working 60 hours/week compared to working 70+ at CCF)?

Personally, I would take the rigorous training if I know that at the end of four years I am going to be an exceptional anesthesiologists and have my pick of excellent private practice opportunities. Thanks for any insight/advice.

I think there are two things here.. I have heard from many anesthesiologists that if train from CCF then you wont have any difficulty in getting into a position anywhere... People know that u work hard and and had a good exposure to most of the difficult stuff...

The second thing, which i think is more important, is that you will be a more confident anesthesiologist and in your every day practice when u face those critical situations this is what might help u.

The difficulties mentioned about CCF anesthesia program is something that most of the anesthesiologist face in daily practice and that is the way things work....

 

[amyl]

My apologies if this question has been answered...I don't have time to read the entire enormous thread. This question goes out to all of you savvy vets and/or people in private practice that are looking to hire new grads...

If the training that you receive at CCF is significantly more brutal/difficult, does it make you that much better of an anesthesiologist? Or do you reach a point of diminishing returns (i.e. you can learn as much at another program working 60 hours/week compared to working 70+ at CCF)?

Personally, I would take the rigorous training if I know that at the end of four years I am going to be an exceptional anesthesiologists and have my pick of excellent private practice opportunities. Thanks for any insight/advice.

average work weeks at ccf are not 70+. average is like around 61-62h/week, just fyi

 

[WindyCityGasMan]

I heard about this blog from a classmate. I interviewed at Cleveland Clinic and think some of these things ring true from talking with residents. This is bad, to think CRNAs have so much pull at such a large program. Also, there are too many FMGs and DOs at this program. I don't bash either group, but other programs I am interested in have far fewer of each.

I was interviewed by a DO resident and another DO resident was interviewing that day too. I'm sure they must be exceptions to the stereotype, but I didn't kick ass on the MCAT, Step I, and Step II to have someone who couldn't get into an Allopathic Medical School quiz me about why I'm a good pick.

Given the blog starting this chain, the power of CRNAs, and the FMG and DO numbers at Cleveland Clinic I think I'm losing interest. Does this make any sense or am I over-analyzing the whole thing?

 

[McSnappy]

I heard about this blog from a classmate. I interviewed at Cleveland Clinic and think some of these things ring true from talking with residents. This is bad, to think CRNAs have so much pull at such a large program. Also, there are too many FMGs and DOs at this program. I don't bash either group, but other programs I am interested in have far fewer of each.

I was interviewed by a DO resident and another DO resident was interviewing that day too. I'm sure they must be exceptions to the stereotype, but I didn't kick ass on the MCAT, Step I, and Step II to have someone who couldn't get into an Allopathic Medical School quiz me about why I'm a good pick.

Given the blog starting this chain, the power of CRNAs, and the FMG and DO numbers at Cleveland Clinic I think I'm losing interest. Does this make any sense or am I over-analyzing the whole thing?

1 post and 1 ban coming up!

 

[WindyCityGasMan]

1 post and 1 ban coming up!

Look, Stanford has never accepted a non-MD and is a well thought of place. Right? High standards, good training, but they also have a high power CRNA group.

My only interest is finding a really good place to train, where peope who match will be more like myself (hard working and not just lately on Step I or II). I also want a program that looks after residents first and will train me to protect the specialty in the future from giving any more of it away.

Now, If that is BAN worthy, then my second post will be my last post. Otherwise go easy buddy.

 

[McSnappy]

Look, Stanford has never accepted a non-MD and is a well thought of place. Right? High standards, good training, but they also have a high power CRNA group.

My only interest is finding a really good place to train, where peope who match will be more like myself (hard working and not just lately on Step I or II). I also want a program that looks after residents first and will train me to protect the specialty in the future from giving any more of it away.

Now, If that is BAN worthy, then my second post will be my last post. Otherwise go easy buddy.

You dig your own hole.

"peope who match will be more like myself (hard working...)" - i.e., D.O's are lazy and dumb and therefore won't protect the speciality b/c... I don't know what you're thinking. I smell CRNA plant looking to stir dissent within ranks.

Now, I'm an MD to be and I'm sure I wouldn't want someone that only wants people like themselves to train with.

 

[WindyCityGasMan]

Quote:
Originally Posted by McSnappy

I kinda feel like an undergrad after a very long night of beer before whiskey who wakes up next to something you don't want to be seen with and go coyote and chew your arm off before 'it' wakes up so you can leave.


Your misogynistic thoughts and blog here is somehow acceptable, but my concerns are unfounded? You're shortsighted man.

 

[DOme2009]

windycitygasman - naming programs who don't take do's sounds like a fun game, let's name some programs who have taken do's: ohsu, uw-seattle, unc, utsw, utmb, etc.

i guess the quality of training at all these programs is piss-poor now that they have taken a bunch of lazy ass do's

a qualified candidate should be evaluated based on the merits of their application, not the initials after their name. but some people are just old-fashioned, i guess. best of luck, though

 

[beavis]

Look, Stanford has never accepted a non-MD and is a well thought of place. Right? High standards, good training, but they also have a high power CRNA group.

My only interest is finding a really good place to train, where peope who match will be more like myself (hard working and not just lately on Step I or II). I also want a program that looks after residents first and will train me to protect the specialty in the future from giving any more of it away.

Now, If that is BAN worthy, then my second post will be my last post. Otherwise go easy buddy.

CRNAs at Stanford? Not the last time I checked. I think the residents are the workforce.

 

[WindyCityGasMan]

You dig your own hole.

"peope who match will be more like myself (hard working...)" - i.e., D.O's are lazy and dumb and therefore won't protect the speciality b/c... I don't know what you're thinking. I smell CRNA plant looking to stir dissent within ranks.

Now, I'm an MD to be and I'm sure I wouldn't want someone that only wants people like themselves to train with.

Snappy,

In high school, I studied/worked hard to get into a good college. At that college, I studied/worked hard to get into a good medical school. At that medical school, I have studied/worked hard to get into a good residency. At that residency, I will study/work hard to get a good job.

Yes, I want others with my pedigree. Not that DOs/FMGs cannot run fast and keep pace or set the pace, but they obviously have not been doing it as I have for as long as I have (and there are a ton of both DOs & FMGs at Cleveland CLinic). The same is true for CRNAs; I do not want a place, like Cleveland Clinic, that gives priority in training or relief to CRNAs over Residents.

I'm simply thinking that Cleveland Clinic isn't making the grades I'm looking for... Has anyone else seen this during interviews/rotations? Does anyone agree with me, or am I really off point like Snappy thinks??