Program Director Insight

[doctor712]

Hi All,

I emailed an anesthesiologist to inquire about shadowing him and unfortunately his school doesn't allow students not attending that institution into their OR. When the doctor called me back to give me this news, the conversation spiraled into an hour long advice discussion. It turns out he is the Program Director at his Anesthesia Residency. (And a REALLY friendly and helpful person.)

Anyway, I was able to ask some really frank questions, and some of the answers were kinda interesting being that I want to go into anesthesia after medical school. After I get into. and complete. med school. that is. Some of this must be known by all here, but I thought I would share as you guys have been very cool to me:

I asked about ageism, in ranking candidates for programs in general. and whether he thinks ill come up against this? (im 35 and will be 41 when i apply to residencies if the world aligns). he said, yes. and for one reason only...call. when he was a resident, the weeks were 120 hours, even so, he said that some PDs will be concerned about the 41 yo kicking as$ during overnight call. nothing i can do about it, it is what it is. he DID say that nobody will NOT rank you because of age, though. only scores and letters of recommendation.

i asked what he looks for in med students when he ranks them for his residency: a) call competency b) board scores c) LORs. The call issue is simple, "will this person be good enough so that when they take call i know that HE/SHE will be competent enough to get the job done and let me not worry all night. b) he said, unfortunately, the success of programs is determined by residents passing the boards, and that is correlated with USMLE step I scores. so, if a resident has a 195, he's worried about how they will pass anesthesia boards, and thus potentially hurt the program is they fail. with a 225, he's not worried. he said people tell him all the time, "i know i have a 195, but im hard working, and dedicated, etc etc" it doesn't sway him. much. if at all. he's got to keep his program in good standing. c) do i want to work with this person? does his deans' letter say he/she stays late? leaves early? helps on holiday, is a slacker bla bla bla. you get this part.

he also said that you live once, and that if this is my passion, go for it. despite the late age and loans. he said you'll make a good living and handle accordingly.

anyway, it was an interesting talk to say the least. the doc is a real amazingly giving person. what i find of note also, is that you could write a letter to the head of a movie/tv studio, my former line of work. or an email to a high powered agent at CAA, and you will NEVER hear back. but i've reached out to 3 or 4 MDs (to go on a mission, shadow, ask about observership) of the same status, and my experience is that they all want to help. and they surely all write/call back. when did hollywood convince itself that they are better than all the rest of us????

D712

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[Southpaw]

Interesting insight. I'm surprised to see "call competency" so high on that PD's list of criteria. To be honest this is the first time I've heard of this as a consideration for PDs. I wouldn't worry about this if I were you though. There are a good number of programs that have no call at all and use a night float system, and that number will very likely increase by the time you apply.

Yep, board scores and LORs are important. IF you do well your first two years (top half of your class or better) and IF you study hard and efficiently for Step 1 then you will VERY likely perform well (>220). Do well during your third year, show up on time, work hard, don't complain, take responsibility for your patients, and great LORs will follow. Good luck to you.

 

[jennyboo]

I'm surprised to see "call competency" so high on that PD's list of criteria.

It's not surprising at all -- it's the truth. I can't tell you the number of times I've sat in cases and listened to the surgical teams discussing their various applicants and what they're looking for. They don't want someone who can't get the practical stuff done. And neither do the anesthesia residencies.

 

[QofQuimica]

I asked about ageism, in ranking candidates for programs in general. and whether he thinks ill come up against this? (im 35 and will be 41 when i apply to residencies if the world aligns). he said, yes. and for one reason only...call. when he was a resident, the weeks were 120 hours, even so, he said that some PDs will be concerned about the 41 yo kicking as$ during overnight call. nothing i can do about it, it is what it is. he DID say that nobody will NOT rank you because of age, though. only scores and letters of recommendation.

Having now completed a few inpatient months with call, I think there's some validity to this concern. I'm a third year med student getting ready to turn 34, and I really do seem to bounce back less well post-call than my classmates who are ten years younger than I am. I even notice a difference in myself. As a college student, I could stay up doing whatever all night and then go to class the whole next day without much of a problem; now I spend my post-call mornings feeling nauseated and hung over without having had any fun whatsoever the night before. Even my advisor, who is a couple of years older than I am, commented once that she wasn't sure she could be doing what I am doing at our age.

That being said, it's not impossible to survive taking call in your thirties. If you have the will, you will find the way. Depending on the flexibility of your school's clinical curriculum, you can do things to help yourself, like try to alternate harder and easier rotations so that you aren't taking q4 call for several months in a row. In addition, when you do have some time off, you can use it to sleep and read instead of going out like many of your younger classmates will probably be doing. I also think that you get more accustomed to functioning while sleep-deprived over time, and you learn to compensate. For example, I never try to present on rounds post-call without using notes, because I know I tend to forget important details and not be as organized when I'm exhausted. It's never necessary to read the notes word-for-word, but I need to have something to jog my memory when under more rested circumstances I could probably get by without them. Now if I could only figure out how to prevent the post-call headaches and that nauseated feeling....

 

[jetproppilot]

Having now completed a few inpatient months with call, I think there's some validity to this concern. I'm a third year med student getting ready to turn 34, and I really do seem to bounce back less well post-call than my classmates who are ten years younger than I am. I even notice a difference in myself. As a college student, I could stay up doing whatever all night and then go to class the whole next day without much of a problem; now I spend my post-call mornings feeling nauseated and hung over without having had any fun whatsoever the night before. Even my advisor, who is a couple of years older than I am, commented once that she wasn't sure she could be doing what I am doing at our age.

That being said, it's not impossible to survive taking call in your thirties. If you have the will, you will find the way. Depending on the flexibility of your school's clinical curriculum, you can do things to help yourself, like try to alternate harder and easier rotations so that you aren't taking q4 call for several months in a row. In addition, when you do have some time off, you can use it to sleep and read instead of going out like many of your younger classmates will probably be doing. I also think that you get more accustomed to functioning while sleep-deprived over time, and you learn to compensate. For example, I never try to present on rounds post-call without using notes, because I know I tend to forget important details and not be as organized when I'm exhausted. It's never necessary to read the notes word-for-word, but I need to have something to jog my memory when under more rested circumstances I could probably get by without them. Now if I could only figure out how to prevent the post-call headaches and that nauseated feeling....

Call never goes away in this business for most of us.

I never got used to working all night. Even back in residency I deplored it.

My call schedule is very handleable now. About three 3pm-7am calls a month that I can go home if n othings going on; about every sixth weekend which is split between two docs.

Handleable, yes.

Still would rather work all day then take night call.

 

[coprolalia]

Age bias related to call schedule? That's a new one for me.

Most residents in our program are in their late 20's and early 30's. There are a couple who are in their late 30's. Our attendings take call with us, and they have to cover all the residents on with them. Most of them are in their 40's.

Now, they may not take as much call as we do, but I assure you that from their end the call is every bit as brutal as it is for us. They get called more. They have to cover more areas of the hospital. It's no cakewalk.

There is one resident in his late 20's in my program who is notorious for sleeping through his pager calls. We had to make him put the phone by his ear in the call room, turned all the way up, in order to get ahold of him. His call performance, when he actually does show up, is lackluster. He was caught one time nodding-off during a case. This has been a recurrent problem with this guy, yet he's still there.

So, I think the age-related call thing is "trumped up", personally. We have guys and gals in their late 20's and early 30's who are overweight, out of shape (etc.) in our program and those older than them who compete in triathalons, bicycle races, etc.

Furthermore, openly discriminating against someone over the age of 40, by the way, is a violation of the Federal Employment Age Discrimination Act of 1967. That's right, 1967. That law has been in effect for 41 years. Any program caught making what is tantamount to an employment decision based on someone's age is setting themselves up for a visit by the EEOC.

-copro

 

[QofQuimica]

Call never goes away in this business for most of us.

I never got used to working all night. Even back in residency I deplored it.

My call schedule is very handleable now. About three 3pm-7am calls a month that I can go home if n othings going on; about every sixth weekend which is split between two docs.

Handleable, yes.

Still would rather work all day then take night call.

I would too. I would even rather do night float than take call, even though that totally screws up your sleep-wake cycle. I just don't function as well after being up for 30 hours. That being said, what really kills me is the steady accumulation of sleep debt over several weeks when you have call more than once per week. I had one rotation where call was q7, and that was *infinitely* less painful than taking call q4. I s'pose I should just be grateful to not be taking call q2 like they did "back in the day."

 

[QofQuimica]

So, I think the age-related call thing is "trumped up", personally. We have guys and gals in their late 20's and early 30's who are overweight, out of shape (etc.) in our program and those older than them who compete in triathalons, bicycle races, etc.

We're all speaking in terms of anecdotes here. I'm sure everyone's experience is different, and of course some older students/residents tolerate sleep deprivation better than others. But as I said previously, I can notice a difference in *myself* after staying up all night now compared to how I used to be 15 years ago. Sure, I can do it, but it's just not as easy as it used to be.

Furthermore, openly discriminating against someone over the age of 40, by the way, is a violation of the Federal Employment Age Discrimination Act of 1967. That's right, 1967. That law has been in effect for 41 years. Any program caught making what is tantamount to an employment decision based on someone's age is setting themselves up for a visit by the EEOC.

Emphasis on the word "openly" here, my friend. Age discrimination is *covertly* rampant among employers who wish to discriminate, because hirings and match rankings are very subjective things. If a program flat-out rejects me because of my age, how in tarnation would you suggest I go about proving that? They're merely going to claim that they didn't rank me because I just wasn't a "good fit".

 

[Leinie]

My graduating class of 10 had 3 members over 40 years old. I had never heard of age being a factor in the match before.

 

[LonghornJPS]

Interesting. The age / call competency thing is new to me too.

... But as I said previously, I can notice a difference in *myself* after staying up all night now compared to how I used to be 15 years ago. Sure, I can do it, but it's just not as easy as it used to be.

I agree. I'm a CA3, 42 y/o, AND I have 4 kids under the age of 7.
It isn't easy. You just do what you have to do to make it all work.

There are plenty of "non-traditional" older residents out there. One of our Chief residents is over 40. We also have a CA1 who was established as a family practice Doc before coming back to residency this year. If you want it, go for it.

 

[Southpaw]

It's not surprising at all -- it's the truth. I can't tell you the number of times I've sat in cases and listened to the surgical teams discussing their various applicants and what they're looking for. They don't want someone who can't get the practical stuff done. And neither do the anesthesia residencies.

I realize it's important, but I just don't understand how to measure it other than introducing age, which would be discrimination and really not even that accurate. Are your surgical colleagues able to determine the weak from the strong during the interview day? Do they do it just by feel?

 

[Southpaw]

Emphasis on the word "openly" here, my friend. Age discrimination is *covertly* rampant among employers who wish to discriminate, because hirings and match rankings are very subjective things. If a program flat-out rejects me because of my age, how in tarnation would you suggest I go about proving that? They're merely going to claim that they didn't rank me because I just wasn't a "good fit".

Extremely easy if you see a pattern over time of rejecting everyone, or almost everyone, over a certain age.

 

[doctor712]

So am I to understand from the above posts that some anes residency programs have ONLY night float call where you work nights only for a week, or a month, while others take call at night? Isn't it usually a combination of both depending which month you are doing?

Glad you guys seemed to enjoy my contacts' words.

Lastly, I was asked whether or not I have taken O-Chem yet during pre-med and I said no. the PD said, "Well, it's AWFUL. You should be careful with your shadowing and research (the reason I was on the phone in the first place)
during O-Chem. It's like memorizing the Toledo phone book. And about as necessary as well." Ugh.

 

[AnesCoord]

Age bias related to call schedule? That's a new one for me.

Most residents in our program are in their late 20's and early 30's. There are a couple who are in their late 30's. Our attendings take call with us, and they have to cover all the residents on with them. Most of them are in their 40's.

-copro

Our chief resident several years ago was 51 when he graduated.

We often look for at least one older candidate per class, or one with a "former life" (particularly a military background). They're ususally more mature and disciplined, and the hope is that they will provide leadership and positively influence the other members of their class.

 

[seamonkey]

re: Age & Call

I'm a 34yo PGY-1, and did q4 call on the floor and ICU at my program from July 1st this year until 4 weeks ago. Straight through. 35 calls. And while it sucks, I don't think I did any worse than any of my younger colleagues. There are several of us in my age group in this TY program, and we all handle our business well. So, not sure where the issue is. I'm just as worthless at 34yo after 30 hours straight as I was at 25yo.

Don't sweat it too much. Nobody ever mentioned age to me on my interviews last year.

 

[McSnappy]

Our chief resident several years ago was 51 when he graduated.

We often look for at least one older candidate per class, or one with a "former life" (particularly a military background). They're ususally more mature and disciplined, and the hope is that they will provide leadership and positively influence the other members of their class.

While not Military, I have definitely been asked what I think I will bring to the table being an older student.

We also have a 50yo Neurosurgery resident that works 100+ easy... I mean 80 hours a week and loves it. I was on call in PICU and he was there day and night. It's all about the love!

If you have ever worked a job. Although tedious at times and frustrating, medicine beats the % eLL out of working in the weather in the midwest today (I've done it and it $ucks). I'm talking cold!!

 

[QofQuimica]

Extremely easy if you see a pattern over time of rejecting everyone, or almost everyone, over a certain age.

At risk of beating the dead horse on an issue where we will almost certainly just have to agree to disagree, the point I am trying to make is that one almost certainly cannot *ever* prove such a thing. Do you think a discriminatory program would willingly make available to me all of the demographics and stats of its applicants so that I can sue that program for not taking me and all the other "highly qualified" applicants in their late 30s/early 40s? Could I really hope to convince a judge to let my lawyer subpoena their list just based on my own "feeling" that they have discriminated against me (and maybe a couple of other older med students whom I happen to know got rejected by the same program)? Again, it's all anecdotes with no evidence.

You can see the catch-22 I would be in here: I can't prove anything about their overall hiring patterns without their records, and I can't get access to their records without being able to prove that there is some compelling reason to force them to give the records to me. Most programs are fairly small. It would be easy to interview a couple of older students, and golly, none of them happened to match here.

Maybe it's just that I'm just more cynical than many of you.

 

[Southpaw]

At risk of beating the dead horse on an issue where we will almost certainly just have to agree to disagree, the point I am trying to make is that one almost certainly cannot *ever* prove such a thing. Do you think a discriminatory program would willingly make available to me all of the demographics and stats of its applicants so that I can sue that program for not taking me and all the other "highly qualified" applicants in their late 30s/early 40s? Could I really hope to convince a judge to let my lawyer subpoena their list just based on my own "feeling" that they have discriminated against me (and maybe a couple of other older med students whom I happen to know got rejected by the same program)? Again, it's all anecdotes with no evidence.

You can see the catch-22 I would be in here: I can't prove anything about their overall hiring patterns without their records, and I can't get access to their records without being able to prove that there is some compelling reason to force them to give the records to me. Most programs are fairly small. It would be easy to interview a couple of older students, and golly, none of them happened to match here.

Maybe it's just that I'm just more cynical than many of you.

You fail to understand the history of class action lawsuits and how they come to fruition. I'd explain it but you'd rather be right.

Here's an example though. In 2001 the economy took a downturn. Many college graduates who had signed on with certain companies were eventually told they wouldn't be brought in and to seek employment elsewhere. Problem is, signing bonuses were promised initially and then companies tried to back out. I suppose if this happened to you, as you say, you'd just walk away believing your case an isolate, or that you'd be unable to prove anything since as you say you have no access to records, so you'd just kiss your money goodbye. On the other hand, it is extremely EASY to touch bases regularly with your peer group and to determine similar treatment towards them. This is how class action lawsuits develop. This is also why age discrimination is easily discovered over time if there is a consistent pattern of discrimination among applicants.

 

[QofQuimica]

You fail to understand the history of class action lawsuits and how they come to fruition. I'd explain it but you'd rather be right.

Here's an example though. In 2001 the economy took a downturn. Many college graduates who had signed on with certain companies were eventually told they wouldn't be brought in and to seek employment elsewhere. Problem is, signing bonuses were promised initially and then companies tried to back out. I suppose if this happened to you, as you say, you'd just walk away believing your case an isolate, or that you'd be unable to prove anything since as you say you have no access to records, so you'd just kiss your money goodbye. On the other hand, it is extremely EASY to touch bases regularly with your peer group and to determine similar treatment towards them. This is how class action lawsuits develop. This is also why age discrimination is easily discovered over time if there is a consistent pattern of discrimination among applicants.

Come on, there's no need to impugn my motives over my ostensible ignorance. Who would "rather be right" about the big guys usually sticking it to the little guys whenever the two conflict?

Maybe it's my failure to understand the history of class lawsuits coming through here, but I don't think these two examples are very similar. In my case, if I were interviewed by a program where I later failed to match, they haven't promised me a thing. I have no contract for a bonus that they're now trying to back out of. They haven't agreed to hire me. We haven't signed anything. I also probably wouldn't know who most of the other older interviewees who didn't match were. I suppose I could put up a notice on SDN: "Any people over 35 who interviewed at Program X and didn't match, please PM me."

Since you seem to know so much about this, please do tell me how a person with no understanding of the system like me would go about proving that a program had systematically discriminated against older applicants. I'm not being sarcastic; I'm genuinely interested. You never know when this kind of info could come in useful.

 

[doctor712]

Well, thanks for all the replies. I should definitely clarify that my question was more out of concern with ageism than my own worry about taking call and making it through. Fact is, I love when I'm in the OR observing and can't wait to experience it as a Doctor.

I have a new research position in Cardiology that begins in January and should run through to medical school. Saw a few Cardiac Cath cases (percutaneous valve repairs) and my new boss was happy to see my enthusiasm. Little did he know I was really looking at the Anesthesia machine. My standard reply for the next 12 months will be, "Yes, sir, I do love the heart. And Anesthesia. Maybe CT Anesthesia!!"

Lastly, during the valve cases, a 3D TEE was used throughout. Is that a Cardiologist running the TEE or an Anesthesiologist? Or a tech? Who's domain does that fall in during Heart cases?

Doctor712

 

[granolabar2]

For organic chemistry, take a look at Paula Bruice's "organic chemistry". I used this book in college (both when I was taking the class and as a student instructor) instead of the assigned book - due to reading it, I was able to understand the topic instead of just memorizing it, which was a lot more useful and much easier.

 

[radslooking]

here's what you need to know from organic chemistry. aromatic rings, steroids, cholesterols, long hydrocarbon chains are hydrophobic. most other things are hydrophilic, especially ions. Congratulations, you now know enough organic chemistry to be a doctor.

 

[doctor712]

thanks for the o-chem primer radslooking! hope you have a very organic
xmas!!!

doctor 712

 

[Jeff05]

a cardiac anesthesiologist both controls and reads the TEE during cardiac cases.

 

[Hockeyguy]

Heres what I interpret from that conversation - come to our program and you will be crushed with call. I can't imagine "call competency" even be used in any applicant ranking at any reputable institution. Just my two cents.

 

[doctor712]

Thanks Jeff and Hockeyguy. Wait, did someone mention hockey?!?!? So hard to be a die hard Isles fan this year. What with our team being the laughing stock of the league. Ugh!

D712