Prestige vs. Location

[moonlight2000]

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Which factor would you rank higher for a residency program? (e.g. a decent program in southern california vs. an Ivy-league affiliated hospital in New York?)

 

[ripped cheese]

Which factor would you rank higher for a residency program? (e.g. a decent program in southern california vs. an Ivy-league affiliated hospital in New York?)

i'm in the same boat (texas as location and east coast as prestige) and i've been leaning toward the prestige. from talking to residents at interviews and at my home program, the most important thing is getting the knowledge base and feeling comfortable when you're done with residency. i'm starting to think that learning from the best at the ivies or mgh, even with the bitter winters, might be my rank list order.

 

[davvid2700]

as far a knowledge is concerned... most programs will make you competent... IF you want the name (I never cared) go to the big name programs with all the big wigs.. but whats in a name. Most of the time these programs are more of a pain in the ass to get through. they make you do all this BS that is really not even relevant... The key is.. churn out as many cases as possible to get the experience.. put in as many epidurals as possible.. thats why i say the private practice programs may be the best.. You dont get the name though

 

[Monitor]

as far a knowledge is concerned... most programs will make you competent... IF you want the name (I never cared) go to the big name programs with all the big wigs.. but whats in a name. Most of the time these programs are more of a pain in the ass to get through. they make you do all this BS that is really not even relevant... The key is.. churn out as many cases as possible to get the experience.. put in as many epidurals as possible.. thats why i say the private practice programs may be the best.. You dont get the name though

Another aspect of private practice setting programs is that Acedemic settings will have much less focus on the business model of medicine. Some might say it ain't important when learning anesthesia, but I say learn Anesthesia in a business while you learn to administer it.

Private practice = feeling the pressure of surgeons wanting to squeeze in another case, not wanting to wait for the room to turn over, less chitty chatty Cathys standing around patting each other on the back for last month's paper.

I say show me the papers with Benjimans printed on them brother and I'll buy a nice leather couch to kick back on while I read your journal publications.

 

[lvspro]

Another aspect of private practice setting programs is that Acedemic settings will have much less focus on the business model of medicine. Some might say it ain't important when learning anesthesia, but I say learn Anesthesia in a business while you learn to administer it.

Private practice = feeling the pressure of surgeons wanting to squeeze in another case, not wanting to wait for the room to turn over, less chitty chatty Cathys standing around patting each other on the back for last month's paper.

I say show me the papers with Benjimans printed on them brother and I'll buy a nice leather couch to kick back on while I read your journal publications.

Research is critical to anesthesia, and its future. I hope my other colleagues are interested in the welfare, and advancement of our noble profession through increased funding in, and participation in research. If I had the choice to sit in the most comfy lazy boy vs participate in research which could result in a safer/smoother anesthetic agent, you can bet I'd burn the damn lazy boy. btw, it's not just huge academic centers that conduct research... most small programs have at least a minor interest in it too, and have some sort of allowance for residents to be involved. It's just that the bigger centers tend to have much more research opportunity which is reflected in the greater number of publications.
JMHO

 

[adleyinga]

Research is critical to anesthesia, and its future. I hope my other colleagues are interested in the welfare, and advancement of our noble profession through increased funding in, and participation in research. If I had the choice to sit in the most comfy lazy boy vs participate in research which could result in a safer/smoother anesthetic agent, you can bet I'd burn the damn lazy boy. btw, it's not just huge academic centers that conduct research... most small programs have at least a minor interest in it too, and have some sort of allowance for residents to be involved. It's just that the bigger centers tend to have much more research opportunity which is reflected in the greater number of publications.
JMHO

Yes- smaller places have research also that you can get invovled in
BUT back to the question
If you are intresed in a high powered research career than go to the big name and plan on a fellowship and additional time for research.

If you are planning on private practice than it makes no difference.

Remember- you may get prestige but in northeast will live in tiny apartment and fight traffic daily vs smaller program. If you have a spouse or significant other than make sure their happiness is part of your equation.

 

[aredoubleyou]

Research is critical to anesthesia, and its future. I hope my other colleagues are interested in the welfare, and advancement of our noble profession through increased funding in, and participation in research. If I had the choice to sit in the most comfy lazy boy vs participate in research which could result in a safer/smoother anesthetic agent, you can bet I'd burn the damn lazy boy. btw, it's not just huge academic centers that conduct research... most small programs have at least a minor interest in it too, and have some sort of allowance for residents to be involved. It's just that the bigger centers tend to have much more research opportunity which is reflected in the greater number of publications.
JMHO

Hey Ivspro - are you practicing for your interviews, or do you really think that most people who go to big name programs are actually there to do research and advance this "noble" profession?

I'm just a cynical bastard, so dont mind me too much 😀

 

[davvid2700]

Research is critical to anesthesia, and its future. I hope my other colleagues are interested in the welfare, and advancement of our noble profession through increased funding in, and participation in research. If I had the choice to sit in the most comfy lazy boy vs participate in research which could result in a safer/smoother anesthetic agent, you can bet I'd burn the damn lazy boy. btw, it's not just huge academic centers that conduct research... most small programs have at least a minor interest in it too, and have some sort of allowance for residents to be involved. It's just that the bigger centers tend to have much more research opportunity which is reflected in the greater number of publications.
JMHO

yawn.... yawn.. yawn... obviously spoken by someone who is early in their training...

what will advance our profession is gettin those damn crnas off our backs and making our presence felt. our jobs are dwindling.. not no damn research.. Not that its not important.. IT is. IF all we do is research who is gonna do the cases.. the crnas? Thats why they say they dont need doctors..

 

[Trisomy13]

yawn.... yawn.. yawn... obviously spoken by someone who is early in their training...

early or late, certain people are (thankfully) drawn to research, others are not. you either enjoy it for whatever intangible reason, or you don't. no need to look down your nose. research moves us forward.

 

[lvspro]

Yo
I was replying to monitors post that seemed to gloss over the importance of research, and yes my post was a little idealistic, as well as tangential to the op.

 

[jc237]

Going back to the original question in the thread, I'm also in the same dilemma of choosing prestige in northeast over nice weather in SoCal. I'm from the northeast. As of right now, without having been to SoCal for any interviews yet, I would rank northeast programs first. However, as the winter is approaching quickly here in the northeast, I have a suspicion that when I go to SoCal for the interviews and experience the surf, beach, the nice weather, I'm going to change my mind... I know every program in SoCal is going to tout their weather as a selling point, and you know what, I'm buying. However, the programs still need to at least have their act together... meaning responsive administrators, happy residents, enough didactics/case variation, enough time to read, blah blah blah.

 

[Laryngospasm]

Lets see, beautiful Socal weather, terrain, people and stuff to do outside all year long (sitting on the beach studying, man that would be great) or a big name? Its all in your priorities. I think you will get a decent education at most places, and you might find the big name programs to either be not that different or more malignant than the smaller programs. So if you go to the big name realize that at most places you will just be going for the name and your future partners wont give a damn where you trained unless it was in Mexico.

 

[E'01]

I think at this point, most of us are unsure of whether we want to do academia or private private for the rest of our lives. People switch, and I think the name and associated reputation of a program can only help at the end of the day in terms of networking support, fellowships, and advancement in general. I mean, even now, I still get asked where I did undergrad and believe me, it makes a difference in terms of doors being opened, so I assume the latter holds true for residency. Just my 2 cents...

Ps - you can always do an east coast residency, and if still yearning for some sweet weather, do locum tenums for a while so you can travel and make $$, although I heard this may not be the best route if you're trying to get into academia....but if you're unsure about what you want to do, it sounds like a good opportunity

 

[aredoubleyou]

Going back to the original question in the thread, I'm also in the same dilemma of choosing prestige in northeast over nice weather in SoCal. I'm from the northeast. As of right now, without having been to SoCal for any interviews yet, I would rank northeast programs first. However, as the winter is approaching quickly here in the northeast, I have a suspicion that when I go to SoCal for the interviews and experience the surf, beach, the nice weather, I'm going to change my mind... I know every program in SoCal is going to tout their weather as a selling point, and you know what, I'm buying. However, the programs still need to at least have their act together... meaning responsive administrators, happy residents, enough didactics/case variation, enough time to read, blah blah blah.

What I still dont get -what is the value of prestige to you - and be very honest with yourself (not necessarily on this forum). If it is to advance mankind by doing research you can do that anywhere and you should rank according to whose research project you'd be most interested in joining. If its because it makes you feel good about yourself to have been affiliated with Harvard (I'm really not tying to be judgmental here -just a little bit of intellectual honesty), then you should go to Harvard. If the weather and feel of the city is important to you, then you should let that be a major consideration in your choice - for some people it might be Cali, others Boston, and still others rural Texas. If you've got a kid, maybe a place where its cheap to live is the driving force, etc, etc, etc. Theres about a handful of private docs on this forum, all of which seemingly unanimously say that any university program is about as good as any other when it comes to finding a job. Despite what anyone says, I'm inclined to strongly believe that if you know you want an academic career your better of at a prestigious program - but otherwise it probably matters significantly less in the real world. I personally know that I'd take good weather over prestige any day of the week, but we are all different - and for reasons I'll never completely understand -some people truly love cold weather. So -if prestige is really important to you and your gunna regret not going to Harvard, or wherever, then suck it up and spend 4 more years in Boston and move to california afterwards.

 

[adleyinga]

Going back to the original question in the thread, I'm also in the same dilemma of choosing prestige in northeast over nice weather in SoCal. I'm from the northeast. As of right now, without having been to SoCal for any interviews yet, I would rank northeast programs first. However, as the winter is approaching quickly here in the northeast, I have a suspicion that when I go to SoCal for the interviews and experience the surf, beach, the nice weather, I'm going to change my mind... I know every program in SoCal is going to tout their weather as a selling point, and you know what, I'm buying. However, the programs still need to at least have their act together... meaning responsive administrators, happy residents, enough didactics/case variation, enough time to read, blah blah blah.

ALways regretted not going to Univ. of Utah so I could go skiing post call or for even 1 hr if finished early on any given day
🙁

 

[davvid2700]

Umm,, why would you think the programs in the northeast are any better or prestigious then some programs out west.. I can't think of a program any more prestigious then UC san francisco.. That is pretty much the end all be all.. stanford, UCLA, USC.. UC irvine.. there are some great programs out there and I have never even been out there.. I trained at a crappy ( I mean crappy) program in the northeast, and honestly i dont feel inferior at all to the columbias and cornells.. Honestly!. I took my boards and passed them( I may have had to study a hell of a lot more) the first try. My residency was not very difficult, no didactics to speak of, poor instruction in the OR. We had to constantly beg for instruction for 3 years. We taught each other. My point is. you can get great training anywhere, and sometimes if you go to the big name programs you have to deal with all these attendings who are board examiners and they can make your life difficult.. just malignant. I mean they will like put you on probation if you do poorly on the inservice and stuff.. I did well on the inservice because i wanted to. So me personally I would avoid the major programs at all costs..

 

[militarymd]

Although all programs will get you board certified and trained, the academic ones will truly expose you to all the aspects of anesthesia that differentiates the anesthesiologist from the CRNA.

A well-trained and experienced CRNA call do 99.9 percent of what an anesthesiologist can do in the OR. That is a plain and simple fact. Anyone who disputes that is someone who is fortunate enough to never have met well-trained and experienced CRNAs.

However, CRNAs do not function outside of the OR...at least they do not have the license to do so....

My 2 cents, go where R. Miller, and all the other board examiners are practicing. I wish I did.

 

[toughlife]

yawn.... yawn.. yawn... obviously spoken by someone who is early in their training...

what will advance our profession is gettin those damn crnas off our backs and making our presence felt. our jobs are dwindling.. not no damn research.. Not that its not important.. IT is. IF all we do is research who is gonna do the cases.. the crnas? Thats why they say they dont need doctors..

and how do we do that?

 

[Laurel123]

My two cents:

Before residency, I went prestige all the way. And then I took my MD with honors, AOA membership, and 255 Step 1 score and went to a non-prestigious program. Why? location, family and friends. The program was good - Level 1 trauma, very sick patients, lots of experience. The teaching was fine - but ultimately I passed my boards after my CA-1 year because I studied. I knew I wanted to do private practice in the city I chose - and all the private practice groups in the area come to our program to recruit. And they said they would rather hire one of us rather than a newbie from Harvard, John Hopkins or whatever, because they work with us, and they know us.

Now, had I been interested in research or academia, I probably would have chosen UCSF - because there is great weather and prestige.

So, it depends what you want. Also, sometimes you don't know what life will bring you, and its three years of your prime years in life, so I knew that nothing was worth being miserable for three years.

 

[davvid2700]

Although all programs will get you board certified and trained, the academic ones will truly expose you to all the aspects of anesthesia that differentiates the anesthesiologist from the CRNA.

A well-trained and experienced CRNA call do 99.9 percent of what an anesthesiologist can do in the OR. That is a plain and simple fact. Anyone who disputes that is someone who is fortunate enough to never have met well-trained and experienced CRNAs.

However, CRNAs do not function outside of the OR...at least they do not have the license to do so....

My 2 cents, go where R. Miller, and all the other board examiners are practicing. I wish I did.

IF you are saying that a crna can do almost everything we do in the OR save .1 percent then why are we training anesthesiologists?? Maybe they have a point? WHy is residency 4 years? maybe it should be 2? maybe we should get rid of our specialty if you are saying we exist for activities outside the OR because most of us DONT do critical care or pain.. IF you wanna do critical care.. you dont have to be an anesthesiologist to do that.. You can be a surgeon or an internist. you can also do pain very effectively as a physiatrist or neurologist.

I dont agree with you. I think you need a medical degree to assess a patient preoperatively and risk stratify them and come up with an anesthetic plan.. IF you dont have a medical degree and you are doing these things you are just winging it.. I dont care how loud you yell about how much you know or read!!!

 

[militarymd]

I dont agree with you. I think you need a medical degree to assess a patient preoperatively and risk stratify them and come up with an anesthetic plan.. IF you dont have a medical degree and you are doing these things you are just winging it.. I dont care how loud you yell about how much you know or read!!!

I believe you just stated that it takes a doctor to "preoperatively" assess and "risk stratify" a patient....which is what I say we do....something outside of the OR.

We decide if the patient is ready for the OR (almost 100% of the time they are), but we make the decision....once the decision is made to proceed....I believe that any well trained anesthetist (MD or CRNA) can do the job.

Things that occur in the OR ....are very simply....all of the decisions are fairly dichotomous....more or less fluids.....blood or no blood......more information or not.....essentially if we avoid hypotension and tachycardia...things will be OK.

 

[militarymd]

....... come up with an anesthetic plan.. IF you dont have a medical degree and you are doing these things you are just winging it.. I dont care how loud you yell about how much you know or read!!!

Geee....come up with an anesthetic plan.....you get a spinal.......or you go to sleep.....

It really takes 4 years of training to pick between 1 of 2 choices....Perhaps, we should increase this to 6 years.....chooosing between the 2 IS really hard.

 

[davvid2700]

Geee....come up with an anesthetic plan.....you get a spinal.......or you go to sleep.....

It really takes 4 years of training to pick between 1 of 2 choices....Perhaps, we should increase this to 6 years.....chooosing between the 2 IS really hard.

ok fair enough!! you want to dumb down anesthesia for arguments sake.. That is ok with me... but let me ask you this.. How does one do a complete physical exam on a patient and document findings, which by law is required prior to anesthesia. if you have not completed a physical exam course and cant differentiate between findings. Its subtle.. Using your argument you can say why do you need a medical degree to take out someones appendix.. Belly pain cat scan.. operation... easy right? femur broken.. IM RODDING..
why mentally masturbate yourself?
the answer.. its not black and white.. there are subtleties and finer points to consider..

How does a nurse prescribe medications? are we going to give all nurses prescription pads..and dea numbers..

you have to draw the line somewhere.

 

[militarymd]

ok fair enough!! you want to dumb down anesthesia for arguments sake.. That is ok with me... but let me ask you this.. How does one do a complete physical exam on a patient and document findings, which by law is required prior to anesthesia. if you have not completed a physical exam course and cant differentiate between findings. Its subtle.. Using your argument you can say why do you need a medical degree to take out someones appendix.. Belly pain cat scan.. operation... easy right? femur broken.. IM RODDING..
why mentally masturbate yourself?
the answer.. its not black and white.. there are subtleties and finer points to consider..

How does a nurse prescribe medications? are we going to give all nurses prescription pads..and dea numbers..

you have to draw the line somewhere.

Dude,
You're making my arguements for me. All of what you describe are things that occur outside of the OR...before the propofol goes into the IV and after the tube comes out at the end of the case.

 

[davvid2700]

Dude,
You're making my arguements for me. All of what you describe are things that occur outside of the OR...before the propofol goes into the IV and after the tube comes out at the end of the case.

well you a cuppla posts ago said.. gees anesthetic plan spinal vs general.. any monkey can do that.. and i disagree with you

 

[militarymd]

well you a cuppla posts ago said.. gees anesthetic plan spinal vs general.. any monkey can do that.. and i disagree with you

That is correct...any monkey can pick spinal vs general.....and we ALL know that it really DOESN'T matter whether a spinal or a general is done.

The peroperative assesment decides whether a patient is ok for surgery and what MEDICAL therapies will improve outcome for the patient ....not what anesthetic....spinal or general....

 

[AlexCCRN]

Which factor would you rank higher for a residency program? (e.g. a decent program in southern california vs. an Ivy-league affiliated hospital in New York?)

Location, location, location...

 

[davvid2700]

Location, location, location...

actually this does not hold true for our field.. you go where the best fit is..

we are not opening up a restaurant.. so location location location is not appropriate in this setting