Private MDA advice: Choose your residency wisely!

[aneftp]

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50% suck? that's quite a large number.

I think she means a combination of
1. Paper pusher (young or old)
2. Old docs who don’t do solo calls or solo altogether
3. Sellouts who don’t work the way they use to work and cover 1:6

Add up those 3 it’s probably close to 50%

I’m getting close to the point being at one of those 3 situations where I can keep going if the money is easy

I bailed on a 10k call yesterday and took 4k and left at 5pm cause I didn’t want to be up all night solo. Younger doc came in from his first job and got me out. He’s hungry. So even money is becoming not a big motivating factor. If I have a crna with me. I’d probably would have done it.

It becomes the long game as you get older. The harder the work. The less motivated you get since this is all play money.

 

[Gator7]

I’ll weigh in my expertise since I was a freshman in high school with this thread started. I trained in the northeast and frequently worked with IVY league trained anesthesiologists. Here’s what I remember:

Penn guy: psycho, severe personality disorder
Penn guy 2: smart, horrible procedure skills
Harvard guy: focused on corporate ladder, skills gone
Columbia guy: awesome, smart, didn’t mix well with PP docs
Yale guy: mid, reminded me he trained at Yale every day
Cornell guy: elite old school guy
Cornell guy 2: great, trained by above

Overall impression was that younger docs coming out of these programs were smart but not ready to transition to a busy PP and had a high frequency of personality disorders. Many had difficulty accepting that things are done differently in the community vs high end academic places. Would constantly hear “We would never do this at Penn..” etc etc.

 

[Lab Lover]

I’ll weigh in my expertise since I was a freshman in high school with this thread started. I trained in the northeast and frequently worked with IVY league trained anesthesiologists. Here’s what I remember:

Penn guy: psycho, severe personality disorder
Penn guy 2: smart, horrible procedure skills
Harvard guy: focused on corporate ladder, skills gone
Columbia guy: awesome, smart, didn’t mix well with PP docs
Yale guy: mid, reminded me he trained at Yale every day
Cornell guy: elite old school guy
Cornell guy 2: great, trained by above

Overall impression was that younger docs coming out of these programs were smart but not ready to transition to a busy PP and had a high frequency of personality disorders. Many had difficulty accepting that things are done differently in the community vs high end academic places. Would constantly hear “We would never do this at Penn..” etc etc.

I am guessing that you weren't a competitive candidate for all of the above.

 

[Burned_Out]

I came from a prestigious program and a prestigious fellowship. You are more likely to have access to the difficult cases that help mold you into a better anesthesiologist. Not all programs can expose you to complex cardiac, thoracic, transplants, complex peds cases. BUT it all depends on the person to take advantage of it. If you hide out doing your electives in ambulatory or OB, you may not be well-rounded enough to goto the OR and just do vascular cases for example.

Nowadays, the competition to get into anesthesia at the elite places is very high. So they are more likely to produce a motivated, intelligent product than one from a HCA or lesser program. This precludes any personality traits from the candidate.

 

[Burned_Out]

I have interviewed at PP places that desired candidates from specific programs. One place wanted U. of A grads because everyone else trained there. Not necessarily because the program was the best as I saw a variable (questionable?) range of clinical skills there. It all depends on the person, not the program.

 

[Guillemot]

I’ll weigh in my expertise since I was a freshman in high school with this thread started. I trained in the northeast and frequently worked with IVY league trained anesthesiologists. Here’s what I remember:

Penn guy: psycho, severe personality disorder
Penn guy 2: smart, horrible procedure skills
Harvard guy: focused on corporate ladder, skills gone
Columbia guy: awesome, smart, didn’t mix well with PP docs
Yale guy: mid, reminded me he trained at Yale every day
Cornell guy: elite old school guy
Cornell guy 2: great, trained by above

Overall impression was that younger docs coming out of these programs were smart but not ready to transition to a busy PP and had a high frequency of personality disorders. Many had difficulty accepting that things are done differently in the community vs high end academic places. Would constantly hear “We would never do this at Penn..” etc etc.

What type of PD do you suspect these individuals having? I most commonly encounter physicians I suspect having narcissistic or antisocial PD. Occasionally, there is some other type though.

The “we would never do this at Penn” thing is interesting to me. I hear that sort of thing a lot about wherever somebody is/came from. Whether it be an academic hospital or from in some small community hospital. The problem with it is that often people can’t justify why they actually do something. If it is just a preference about something trivial then whatever, but sometimes it’s actually something that makes a difference in a patient’s care. I find it problematic when is doing something that is not what is best patient care and justifies it by saying “this is how we do it here” as if they live in an alternate reality where evidence based medicine and society guidelines don’t apply.

 

[BLADEMDA]

I came from a prestigious program and a prestigious fellowship. You are more likely to have access to the difficult cases that help mold you into a better anesthesiologist. Not all programs can expose you to complex cardiac, thoracic, transplants, complex peds cases. BUT it all depends on the person to take advantage of it. If you hide out doing your electives in ambulatory or OB, you may not be well-rounded enough to goto the OR and just do vascular cases for example.

Nowadays, the competition to get into anesthesia at the elite places is very high. So they are more likely to produce a motivated, intelligent product than one from a HCA or lesser program. This precludes any personality traits from the candidate.

I trained at a top 10, most likely top 5, program. I have worked with many Anesthesiologists who trained across the USA. My observation is that the difference between graduates due to their training program exists for about 1-2 years. The highly motivated individual will make up those differences in practice post Residency. These days there are many lazy new graduates who are not motivated to get better, so it really is up to the program to train them well. As a whole I find the bottom 1/3 programs produce much worse graduates because they accept lower quality people to begin with. I still believe all one needs is a solid mid tier program, or better, and MOTIVATION in order to succeed as a highly qualified attending.

 

[DG51]

I trained at a top 10, most likely top 5, program. I have worked with many Anesthesiologists who trained across the USA. My observation is that the difference between graduates due to their training program exists for about 1-2 years. The highly motivated individual will make up those differences in practice post Residency. These days there are many lazy new graduates who are not motivated to get better, so it really is up to the program to train them well. As a whole I find the bottom 1/3 programs produce much worse graduates because they accept lower quality people to begin with. I still believe all one needs is a solid mid tier program, or better, and MOTIVATION in order to succeed as a highly qualified attending.

"I trained at a top 10, most likely top 5"

What does this even mean? What objective data are you basing this on?

"These days there are many lazy new graduates..."

As if the anesthesiologists who completed their training is the 90's and 2000s were all total rockstars.

I agree with you that one's own motivation and personality are the most important factors in excelling as an attending though.

 

[CopaceticOne]

I came from a prestigious program and a prestigious fellowship. You are more likely to have access to the difficult cases that help mold you into a better anesthesiologist. Not all programs can expose you to complex cardiac, thoracic, transplants, complex peds cases. BUT it all depends on the person to take advantage of it. If you hide out doing your electives in ambulatory or OB, you may not be well-rounded enough to goto the OR and just do vascular cases for example.

Nowadays, the competition to get into anesthesia at the elite places is very high. So they are more likely to produce a motivated, intelligent product than one from a HCA or lesser program. This precludes any personality traits from the candidate.

Not really. All you need is training at a high volume referral center for adults and peds to get the exposure. “Prestige” of a program has nothing directly to do with that factor.

This is why I encouraged student to ask about the current resident’s case volumes.

 

[aneftp]

"I trained at a top 10, most likely top 5"

What does this even mean? What objective data are you basing this on?

"These days there are many lazy new graduates..."

As if the anesthesiologists who completed their training is the 90's and 2000s were all total rockstars.

I agree with you that one's own motivation and personality are the most important factors in excelling as an attending though.

More like a top 5 anesthesia program.
It’s all subjective when you get into that type of program level

Residency Program Rankings – Admit.org

See Anesthesiology residency program rankings for 2026, based on admissions data, fellowship matching, and research productivity.

residency.admit.org

Agree, lazy newer generation are a dime a dozen. Most are very bright though.

Just the culture they grew up in with 80 hr work week rules etc attendings would get reported to HR for anytime of perceived abuses.

This top 3 grad showed no work ethics. Cries if she leaves before 5pm (mind u she left at 9am the day before). Literally cancels 5pm add on because she didn’t want to get stuck to 6pm. And she has crna 1:1 all day.

 

[Burned_Out]

Not really. All you need is training at a high volume referral center for adults and peds to get the exposure. “Prestige” of a program has nothing directly to do with that factor.

This is why I encouraged student to ask about the current resident’s case volumes.

You assume all academic training programs have the service lines I describe or have the requisite volumes. Prestige does attract patients to your medical center.

 

[Burned_Out]

More like a top 5 anesthesia program.
It’s all subjective when you get into that type of program level

Residency Program Rankings – Admit.org

See Anesthesiology residency program rankings for 2026, based on admissions data, fellowship matching, and research productivity.

residency.admit.org

Agree, lazy newer generation are a dime a dozen. Most are very bright though.

Just the culture they grew up in with 80 hr work week rules etc attendings would get reported to HR for anytime of perceived abuses.

This top 3 grad showed no work ethics. Cries if she leaves before 5pm (mind u she left at 9am the day before). Literally cancels 5pm add on because she didn’t want to get stuck to 6pm. And she has crna 1:1 all day.

Your anecdotal experience of 1 top grad MUST be emblematic of all elite trained grads. This coming from a guy who likes to tell people he commonly leaves before noon regularly. Maybe it's your practice that encourages this. Or maybe this colleague is a woman.

 

[CopaceticOne]

You assume all academic training programs have the service lines I describe or have the requisite volumes. Prestige does attract patients to your medical center.

No, that is why I said high volume referral center.

Prestige of a residency or fellowship program does not attract patients. It is the institutions.

 

[Burned_Out]

I think fellowship training matters more than where you went to residency. My cardiac anesthesia fellowship taught me more about handling critically ill patients than what I picked up in residency. Sure you can do cardiac without a fellowship. But a cardiac fellowship exposes you to more esoteric stuff in a high volume, prestigious referral center. Having TEE skills has helped in many ways over the years.

If you are exposed to the high acuity stuff early in your career, you are less likely to freak out and cancel cases.

 

[Burned_Out]

No, that is why I said high volume referral center.

Prestige of a residency or fellowship program does not attract patients. It is the institutions.

You're not getting what I am saying. I said prestigious institutions attract patients. Most high volume referral centers tend to be prestigious as well.

 

[CopaceticOne]

You're not getting what I am saying. I said prestigious institutions attract patients. Most high volume referral centers tend to be prestigious as well.

I’m glad you agree with me about it being the institutions.

However, you said it was the programs:

I came from a prestigious program and a prestigious fellowship. You are more likely to have access to the difficult cases that help mold you into a better anesthesiologist. Not all programs can expose you to complex cardiac, thoracic, transplants, complex peds cases. BUT it all depends on the person to take advantage of it. If you hide out doing your electives in ambulatory or OB, you may not be well-rounded enough to goto the OR and just do vascular cases for example.

 

[K-hole]

DOs from MD training programs are the most well rounded personality/skills wise and ready for busy PP. 😎

 

[Arch Guillotti]

Are you a ccf’er too?

lol no

 

[Burned_Out]

I trained at a top 10, most likely top 5, program. I have worked with many Anesthesiologists who trained across the USA. My observation is that the difference between graduates due to their training program exists for about 1-2 years. The highly motivated individual will make up those differences in practice post Residency. These days there are many lazy new graduates who are not motivated to get better, so it really is up to the program to train them well. As a whole I find the bottom 1/3 programs produce much worse graduates because they accept lower quality people to begin with. I still believe all one needs is a solid mid tier program, or better, and MOTIVATION in order to succeed as a highly qualified attending.

I know that the program I trained in, they cut the low performers out of the program. They had a reputation to maintain and didn’t want someone who would struggle to pass the boards or were slackers in the OR. They were ruthless and every year, a few people would depart. So if you proved to be UNMOTIVATED in residency there, you had no place being there. I believe you’ll get more variability in graduates elsewhere where “every resident matters” is a philosophy of that program.

 

[DG51]

I know that the program I trained in, they cut the low performers out of the program. They had a reputation to maintain and didn’t want someone who would struggle to pass the boards or were slackers in the OR. They were ruthless and every year, a few people would depart. So if you proved to be UNMOTIVATED in residency there, you had no place being there. I believe you’ll get more variability in graduates elsewhere where “every resident matters” is a philosophy of that program.

Does this really mean that your program held itself to higher standards than everywhrre else? The argument could also be made that your program was either 1) not competitive/desirable and was attracting sub par medical students or 2) your program leadership exhibited poor judgement when selecting prospective residents. Again, my argument is that the whole idea of "ranking" residency programs and using this to judge attendings is BS.

 

[Lab Lover]

Does this really mean that your program held itself to higher standards than everywhrre else? The argument could also be made that your program was either 1) not competitive/desirable and was attracting sub par medical students or 2) your program leadership exhibited poor judgement when selecting prospective residents. Again, my argument is that the whole idea of "ranking" residency programs and using this to judge attendings is BS.

There are two types of Anesthesiologists: Those that trained at (insert my program name)...and all the rest.

 

[NPJR]

I trained at a top 10, most likely top 5, program. I have worked with many Anesthesiologists who trained across the USA. My observation is that the difference between graduates due to their training program exists for about 1-2 years. The highly motivated individual will make up those differences in practice post Residency. These days there are many lazy new graduates who are not motivated to get better, so it really is up to the program to train them well. As a whole I find the bottom 1/3 programs produce much worse graduates because they accept lower quality people to begin with. I still believe all one needs is a solid mid tier program, or better, and MOTIVATION in order to succeed as a highly qualified attending.

I agree with Blade. If you wanna be better you will get better. If you dont, you wont. Anesthesia aint that hard to figure out.

 

[UscGhost]

I know that the program I trained in, they cut the low performers out of the program. They had a reputation to maintain and didn’t want someone who would struggle to pass the boards or were slackers in the OR. They were ruthless and every year, a few people would depart. So if you proved to be UNMOTIVATED in residency there, you had no place being there. I believe you’ll get more variability in graduates elsewhere where “every resident matters” is a philosophy of that program.

Sounds like a pretty malignant program combined with poor resident selection (or residents dont want to go there) Depends on the year though. Candidates are much better now on average

I would be surprised if that many residents each year wouldn't be able to ultimately pass the boards.

If i interviewed at a program, and they told me that 1-2 residents fail out each year. I would quickly cross that program off the list. Anesthesia just isn't that difficult. Sounds like the program is just abusing the residents (usually means excessive work loads )

Residents are borderline slave labor as it is. The idea that residents should be honored to work 90+ hour weeks while being paid less than minimum wage is just nonsense.

 

[ucladoc2b]

Sounds like a pretty malignant program combined with poor resident selection (or residents dont want to go there) Depends on the year though. Candidates are much better now on average

I would be surprised if that many residents each year wouldn't be able to ultimately pass the boards.

If i interviewed at a program, and they told me that 1-2 residents fail out each year. I would quickly cross that program off the list. Anesthesia just isn't that difficult. Sounds like the program is just abusing the residents (usually means excessive work loads )

Residents are borderline slave labor as it is. The idea that residents should be honored to work 90+ hour weeks while being paid less than minimum wage is just nonsense.

Most likely it was run by complete jerks who had no idea how to train residents (and were too cheap to buy a program subscription to TrueLearn).

 

[Gern Blansten]

I know that the program I trained in, they cut the low performers out of the program. They had a reputation to maintain and didn’t want someone who would struggle to pass the boards or were slackers in the OR. They were ruthless and every year, a few people would depart. So if you proved to be UNMOTIVATED in residency there, you had no place being there. I believe you’ll get more variability in graduates elsewhere where “every resident matters” is a philosophy of that program.

I agree with others. If this is the pattern of the residency program, this is terrible. A resident failing out of residency should be an uncommon occurrence. Select good quality candidates and spend the extra effort to help them become successful.

 

[cchoukal]

Most likely it was run by complete jerks who had no idea how to train residents (and were too cheap to buy a program subscription to TrueLearn).

I trained at University of Chicago back in the mid-aughts. Unlike many good-or-better programs which are often in cities that are very expensive, Chicago was cheap enough to attract faculty from all over the country. This led to training that was very diverse. You can't exactly teach attitude and work ethic, but you can teach people 5 ways to do something. The flip side is that we were infamous for "holding people back," adding either 6 or 12 months to training based on exam performance. This was based on criteria that were spelled out and transparent, but it still rubbed a lot of people the wrong way.

What I see in the institution were I was on faculty for 12 years is that it's so expensive to live there, that they can generally only recruit former residents, who are already used to the cost of living. Nobody's leaving Duke, were you can buy a 6000 sq ft house with a stable for horses to move to SF mid-career to live in a 2-BR/1-Ba high-rise condo. As a result, the training scope becomes very narrow, and residents tend to have just one way to think about a problem.

 

[TwoDogMed]

DOs from MD training programs are the most well rounded personality/skills wise and ready for busy PP. 😎

LMAO. NO, the vast majority of you are lucky to be physicians.

 

[aneftp]

I trained at University of Chicago back in the mid-aughts. Unlike many good-or-better programs which are often in cities that are very expensive, Chicago was cheap enough to attract faculty from all over the country. This led to training that was very diverse. You can't exactly teach attitude and work ethic, but you can teach people 5 ways to do something. The flip side is that we were infamous for "holding people back," adding either 6 or 12 months to training based on exam performance. This was based on criteria that were spelled out and transparent, but it still rubbed a lot of people the wrong way.

What I see in the institution were I was on faculty for 12 years is that it's so expensive to live there, that they can generally only recruit former residents, who are already used to the cost of living. Nobody's leaving Duke, were you can buy a 6000 sq ft house with a stable for horses to move to SF mid-career to live in a 2-BR/1-Ba high-rise condo. As a result, the training scope becomes very narrow, and residents tend to have just one way to think about a problem.

Plus Duke faculty anesthesia attendings are covering the VA as well which is literally less than a mile away.

And the VA there hooked up the anesthesia docs there to the the tune of 500k a year (25% retention bonus to bypass the 400k salary limit)

I know someone mentioned st Louis va has 25% retention bonus as well

So the Va places are getting more competitive if they offered these full retention bonus annually. Combine this with being new grad and wanting kids. It becomes probably one of the best paying gigs due to 12 weeks paternity leave built in.

 

[cchoukal]

Plus Duke faculty anesthesia attendings are covering the VA as well which is literally less than a mile away.

And the VA there hooked up the anesthesia docs there to the the tune of 500k a year (25% retention bonus to bypass the 400k salary limit)

I know someone mentioned st Louis va has 25% retention bonus as well

So the Va places are getting more competitive if they offered these full retention bonus annually. Combine this with being new grad and wanting kids. It becomes probably one of the best paying gigs due to 12 weeks paternity leave built in.

I told my former chief if he could reliably get me 500k on a compressed tour where I could moonlight on my off-tour day, I’d seriously consider coming back. It’s a cake job at 500k.