Private MDA advice: Choose your residency wisely!

[residentphysici]

I've been fortunate in the past 7 months to interview candidates for a position with my group. I've also had the opportunity to discuss the candidates with the rest of my colleagues. The common theme was the prestige of the program the applicants trained at was VERY important. 4 of the last 5 hired anesthesiologists at my group were residents coming out of Johns Hopkins. The guy we hired who was not from JH was hired out of desparation because we couldn't wait until July. If all applicants are equal, we will choose the person from JH, Duke, UCSF, MGH, and Penn because we know we are more than likely to get a quality anesthesiologist. I am just telling you the facts because I may be seeing your CV in the future.

The market is getting more competitive in the large cities and groups are starting to cherry-pick who they want and don't want. Top programs recruit quality students and produce quality residents. Research money is important because these institutions are discovering new techniques that will be part of the standard of care soon. You will be getting learning it at its infancy. The attendings there are the ones giving CME lectures around the country. I listed the top sites on my web site for the past 5 years, and employers go to the site and recruit directly from the list (they've told me this).

So, if you have received invitations from the top programs, visit them! IF you can tolerate the higher expectations, the higher stress level, and the longer hours there, do it. When the market is tighter and I see your CV, I will put it at the top of the pile and call you. Remember, 100% of the residents coming out of JHH (and I am not trying to promote JHH) got jobs even when the market was tight in the 1990's.

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[DrDre']

What other programs would you include in this tier? Virginia Mason make the cut?

 

[residentphysici]

Virginia Mason does, but is better known in the Northwest and major academic centers. Oregon is another great one because the chairperson, Dr. Kirsch, is well connected and respected by his former Hopkins residents. I don't want to leave any good programs out, but for the past several years of ranking anesthesiology programs, the ones I mentioned in my original posting were consistently ranked top 10.

 

[GuyuteJr]

Residentphysici,

Thanks for your advice. Here's a question though to you and everyone else for that matter: You mention some very high quality programs in your post -- JH, Duke, UCSF, MGH, Penn. These seem to be the same programs that everyone brings up when discussing top anesthesiology programs and for good reason. However, when looking at your website's list of top programs based on NIH funding, Albert Einstein is ranked #1 and no one really ever seems to mention them as a top, or even upper-tier program. Granted they may not have the national reputation like JH or MGH, but it's an impressive stat nonetheless. I was just curious what your and everyone else's impression of the Einstein program was. Thanks.

 

[Himanshusingh]

What about the notion that most people do residency where they want to practice? Is your practice in or near the Baltimore area and therefore you look favorably on JH graduates? If a resident wanted to practice in a certain area, would he or she be better off doing residency there as opposed to at a more highly regarded program across the country?

 

[voltron]

Plus, how many of these top programs have residents that are all ball and just go out and spit tight game? Where does that fit in the rankings?

 

[residentphysici]

I have posted the NIH rankings for 5 years, and this is the first year that I can remember that Albert Einstein was in the top 10. Speaking to several research attendings, they mentioned that if a big grant is awarded, it could bump a previously unranked program to the top 10. Even worse, some programs may have researches that aren't even in that field under the anesthesiology department. At my medical school, one of the top researchers did cardiology research in the surgery department because they had the laboratory space. But the surgery department received credit for it. I can not comment on the quality of AE program, they may be very good. But the reputation these programs get is from consistency and representation in the literature.

Someone made a good point about choosing a residency where you want to practice and if I look favorable to JHH residents because I am in that area. Actually, my group is in the Midwest. I actually completed my residency at JHH. One guy from JHH was hired in my group and impressed everyone. The next spot, they interviewed many people including a JHH graduate. Once again, they were impressed and hired that one. And so on. The one big selling point of the JHH program is that they have graduates in 46 of the 50 states. Almost any state I was interested in, I picked up the phone and called a graduate who gave me the facts and/or wanted to give me an interview. Choosing a residency where you want to practice does help because the overwhelming majority of graduates will stay within 90 miles. However, in a competitive market, you have to be willing to travel. The moment you start traveling, the employers need name recognition and an assurance of quality. I interviewed in Houston, Florida, Vegas, Chicago, and a few other locations and it was obvious that my place of residency got me the interview.

I had no plans of practicing in the Midwest. It was dead last on my list. But I could not pass up the offer or the opportunity to work with people I knew. I am so glad I didn't do my residency where (Florida) I wanted to practice.

 

[Himanshusingh]

What other programs are considered by your group to be "quality"? (Brigham, Columbia, Cornell, etc.) And what about West Coast Programs other than UCSF (Stanford, UCLA, UCSD, UW, etc.) Thanks.

 

[Gator05]

residentphysici,

What was wrong with doing residency in Florida? UF, by many accounts, seems to have a very strong program. I can vouch for the amazing caseload, and the PD really looks out for your education as well. So, was it the state, the programs or the humidity?

 

[residentphysici]

My comment had nothing to do with the programs in Florida. I've heard great things about the Gainesville program even way back in 1998 when I was considering residency. My comment had everything to do with the business of medicine in Florida. Reimbursements are way down in Florida, malpractice is way up, and the patients tend to be older and sicker. I know from my CME classes in Florida that our primary care colleagues talk about doom and gloom in Florida. Doctors are leaving Florida. If I did a residency in Florida my chances are greater that I would have ended up practicing there. I remember from my inquiries to some of their programs, that the overwhelming majority of residents practiced in-state. That is the complete opposite at JHH. More than half the class will practice away from the DC/VA/MD area. Florida is still the state I want to live in, but the medical economic environment needs to change before I move.


As for West Coast programs: UCSF, UCLA, UW, Oregon, and Virginia Mason have good name recognition. MGH (of course), Brigham in Boston, Cornell, and Yale also have good name recognition. The most important thing you need to know is where are those residents going. These are future partners you will be calling for a job. If they are all over the country, then you know you can at least look to them for your job. If they are just in your residency area, you will be limited.

 

[gaseous]

Please do not generalize the "residentphysician" thoughts on getting a job post graduation. He is obviously JHH centric and therefore feels that any resident not from JH et al, will be unemployed following completion of residency training. This view is simply incomprehensible.

The residentphysician's example shows that the people in the group attract people from the same residency because they know that they have similar training. Like attracts like!!! Just in case you all didn't know, there are grads from every program around the nation. (Some more regionally centered - therefore its not a bad idea to go to a place where you want to live as another person mentioned. Again like attracts like)


I can understand some point that your CV "might" get looked at ahead of someone else if you go to a top school. But to narrow that list to MGH, JH, UCSF, PENN is ridiculous...

But you cannot tell me that if I go to Brigham, Stanford, UAB, Wake, Columbia, etc. that I will not get the position of my choosing. You could definitely go to U of Nowhere and still get a job. Especially if the group is made up of Nowhere grads as the residentphysicans group seems to be.

In the end, my advice is to go to the best place that you fit in and don't let some yahoo discourage what you all are trying to do!!!!!!!!!!!!!!!!!!!!!!!!

Good luck to everyone...


Edit: I stand by my thoughts but the clarification in the post above probably should have been written with the original post.

 

[doc_strange2001]

I agree with gaseous. Residentphsy comments would lead you to believe that JH grads are the only people getting jobs. Right now the market is hot none of us will go unemployed.

 

[residentphysici]

Sorry for the misunderstanding. I did not mean that only JH graduates are getting jobs. That would be such a ridiculous thing. I am being careful to write my comments based on my experiences and the discussions I've had with recruiters over the past 5 years. I personally know classmates who graduated from 6 other programs. But I really don't want to speak for them and give wrong information. Gaseous is correct that people in groups attract people from their residency and vice versa. And this is very important when you may want to leave your area and go to another coast. It is so much easier to call someone from your residency and get the interview. As a 4th year medical student, my proposed ranking of residencies were

1.MCV (easier lifestyle)
2. George Washington (great location)
3. JHH (great name, but longer hours, bad location)

In 1998, I got on the phone and called about 10 recruiters and 10 groups listed in the Anesthesiology employment section and asked them where I should go. I thought I should at least listen to the people who were responsible for hiring. The overwhelming response was that I should go to JHH. And then they listed other programs I should look at, they were all the typical top 10 programs. It was a bitter pill to swallow, but during medical school I saw anesthesiology residents who couldn't find jobs (1995-1998). So, although JHH was not going to be my top choice, I made it my top choice in case the market was still that bad when I got out. Hey, I thought I should at least listen to the advice of people who were hiring. The market is now hot, but it wasn't when I got into anesthesiology and no one can guarantee it will be hot 5 years from now. I hope it remains hot forever!

As for my group members are from MGH, 2 Miami, Penn, 4 from JHH, Emory, 2 UCSF, 2 from Cleveland Clinic. 10 are fellowship trained.

The best anesthesiologist I've ever seen went to a program that doesn't even exist anymore. My point is that, name is an important part of the hiring decision. It shouldn't be. But it is. And if it opens up more opportunities for you, especially in bad times, then you may want to seriously consider going to a top program.

I hope I didn't cause any further misunderstanding.

 

[Tenesma]

since we are throwing around numbers (and in a lame attempt post-call to point out my dept's spending habits), the NIH list is not accurate in how it portrays spending of research money because it doesn't reflect dispersed programs.

For example, the anesthesia dept at MGH has its fundings under MGH and not Harvard University and the NIH does therefore not make a breakdown by dept - our research grants from NIH are close to 9.5 million per year (which are 2 million more than #1 on the list) - and i think Brigham is about 7 million or so.
ERGO - using your list is false and misleading if you are trying to make an NIH ranking of anesthesia departments.

Now your ranking for Top Medical Schools is ALSO inaccurate because you are not including all the funding for the Harvard system: 1) Harvard: 270,000,000 2) MGH 243,000,000 3) Brigham 205,000,000 4) Beth Israel 99,609,000 5) Dana Farber 98,907,000 6) Children's 68,537,000 which totals One BILLION dollars of NIH funding which is double of Johns Hopkins for 2002 (they were awarded 500,000,000) - these are all referenced from fiscal 2002 summaries from NIH website.

And THIRDLY, while i respect 99% of your posts, I find it kind of absurd that recruiters would base their recruiting techniques based on NIH funding for programs....

I hate to point this out but your email sounds like you are very proud of the fact you went to Johns Hopkins - and I am glad that you were able to join a group based on where you went for residency.

 

[Doctor&Geek]

Mr. Resident Physician,

You plagarized your data from

http://grants1.nih.gov/grants/award/awardtr.htm

and should

1. Acknowledge and cite the original source of your data.

2. Request permission from the NIH webmaster to repost their data on your website.

3. Remove your copyright statement, as it itself may be in violation of some copyrights.

Also,

A. NIH grants measure research grants for a department only, and not the quality of their residency program. These are two different things.

B. NIH grants also leave out other sources of grants, i.e. Howard Hughes Medical Institute or even endowment funding. FYI there are many people at Harvard without NIH grants, just because they're famous enough to work only with Harvard endowment proceeds. This further inflates Harvard's iadvantage in research funding.

B. If you have a problem with the way this ranking was done, it's not Resident Physician's fault. It's the NIH's"problem" (if there even is one). FYI, USNews combines Harvard affiliated hospitals in their ranking.

Yours,

 

[residentphysici]

Actually the home page does state that the information is directly from NIH data. It also turns out that since this is public federal information, no permission is necessary to publish the information. You will find no copyrights on public Federal documents. The copyright we have is for the home page. And the home page can be copywritten because it is something we came up with. There should not be any copyrights for any of the data pages.

I do have a problem with the way the rankings were done. We found that ALL of these programs had fundings from other places (pharmaceuticals, equipment companies, grants, donations, etc.) that in many cases double, tripled, and even quadrupled the NIH amount. Unfortunately, that information is WELL guarded and we could not publish it without ending up in court. We tried very hard to get that information. And when we did find the information, we could not get the permission we needed in order to publish it. It's a shame because MGH, Brigham, and Mayo doesn't get represented in the NIH ranking. So, NIH awards were the only thing that we could publish and backup that information.

We had a problem with the USNews rankings because they did not reflect the training and sometimes were no longer valid. Faced with these problems, all we could do is just post the NIH totals and leave it at that. And trust me, when we first started, we had a lot of upset departments because they didn't want people to know how much money they were or were not getting. To make those programs happy, we stopped publishing historical NIH data on the departments. IWe had 10 years worth of data for each specialty department to show you the trends per program. We had data on the amount of published articles per department and we also had board passing rates per program. The boards stopped publishing the passing rates per department stopped within 2 months of our publishing. So, we had to stop that.

The recruiters did not based their hiring on the NIH rankings. They based it on the programs that they've recognized and their clients recognized as top programs. Those programs also happened to be the same ones that consistently show up in the NIH top 10 + the Harvard and Mayo affiliates. I urge you to contact groups, recruiters, and your future employers and ask for their opinions about this. I am only telling you what they've told me.

 

[Doctor&Geek]

Gee, if I remember correctly, didn't my mom teach me to put a whole citation when referencing data, regardless of whether or not it was federal data or not? Because at first glance, it appears that your website is the primary or even only source of information in this regard. I also have problems in your ranking of *residency* programs using a research statistic - it misleads those who read your webpage, thinking that research funding should be the ONLY correlation with quality of residency. I don't really care about what excuses you might have in regards to unavailablity of data - just that the final result is unacceptable.

Yours,

 

[sferdow]

Would you please give your opinion for those residents graduating from vandy's gas program, in terms of being marketable in the future.

 

[andrew_still200]

just wanted to thank residentphysici for sharing your opinion. Seems like some people in this form disagree with you and feel then need to attempt to discredit you. I mean the guy from Alabama isn't hasn't even graduated from med school yet.

Residentphysici thanks for the honest opinion

 

[riddler7777]

I believe that stability is very important

Johns Hopkins: Within last year
1) Lost Program Director, Kirsch, to Oregon
2) Chair left

Brigham: Within last year, new Chair

PENN: Within last year
Interim Chair was Dr. Muravchick lost out to a faculty
member from Hopkins


There are few top notched programs that have not lost a Chair or a Program Director. Some programs have lost both the Chair AND Program Director. For those who argue that the institutions are machines that churn out anesthesiologists, think twice before you jump into a 3 year commitment. Dr. Kirsch had a LOT of pull at Hopkins.

I am a Hopkins alma mater, but I did not rank Hopkins, Brigham, and PENN highly. Stability is very very important.

 

[cajunflower]

riddler7777
Would you happen to have anymore input about the Hopkins' program? It is just so hard to evaluate any place in just one day, and I don't have any good resources to find out more about Hopkins. If you have the time, I would appreciate any info you might want to share. THANKS!

 

[Aykroyd]

residentphysici,

You have two physicians in your practice from CCF. What is your groups take on CCF grads, and what is your overall opinion about the program. Thanks

 

[juddson]

Yea, I'd like to know that too. Why isn't CCF on any of the lists? Surely the 5th best hospital in the world ought to be recognized somewhere, no?

Judd

 

[gaslady]

Stability is important to a program. However, top programs that have consistently been top will remain that way regardless of shift in faculty members. They will naturally attract individuals who will keep up the standard of excellence that the institution is known for.
There is a lot of movement in academic anesthesia because there aren't enough people to fill all the positions. With private practice positions so lucritive right now, there is less draw to academics for people who might otherwise have considered it. This isn't just a problem at top institutions, it's a problem at many programs.