IN2bait said:
Regardless of what some residents at these types of programs have to say, anesthesiology is NOT competitive in general (no pun intended). Even at the BEST programs in the country (of which there are about 15 or so), a reasonable applicant has a decent chance. Attendings who work at large indigent-care medical centers only stay there because they can be super lazy and no one else wants the job. It's not a place where you would want to train to become a competent anesthesiologist.
If you can at all help it, try to train at a program that doesn't have a 100% indigent patient rate and that actually does have faculty who frequent the ORs (and are well-known in the field). You'll also want a program with regional anesthesia opportunities.
Unless you want to be severely limited in what type of group you'll be able to join (like VA)...it's better to apply to the well-respected, well-known programs, rather than to settle for any available spot. You'll thank me later...
Never said anything about the competitiveness of the positions. It is simply a matter of timing and LR's isn't the best since a great number of CA-1 spots have already been filled for fall '05 and some fall '06 spots have already been filled by transfers.
Large indigent care medical centers are also where you will find the sickest patients and the majority of major trauma. If you want to forego that type of training in depth, do so at your own peril. Our program is fortunate to be the only one in the DFW region and our experience ranges from the major indigent care center (Parkland) to multiple private medical centers where we hone our timing and learn the tricks of the private practice world. The type of cases we see at the indigent care center, however, borders on the ridiculous ranging from ASA IV diabetic, heart failure, vasculopaths getting a tooth pulled to elephant trunk thoracic aortic replacements on deep hypothermic circulatory arrest.
You may never see those cases or patients in private practice, but you can be damn sure that you will be prepared for anything near that level of complexity.
Indigent care and regional anesthesia are NOT mutually exclusive and faculty quality is NOT uniformly low at major academic centers. If so, you have to turn a blind eye to all of the best and brightest minds in academia. Most faculty actually like to teach and some who are just physically unable to endure the rigors of private practice gravitate back to academia for the opportunity to make a good living while teaching what they have learned from years of hard hands on experience. My advisors are academic faculty at Parkland who manage to not only publish research, but also take time to chair national ASA committees and preside over national anesthesiology organizations in addition to spending countless hours teaching residents one on one in and out of the OR.
LR, you are in a precarious situation that you will have to work through by contacting as many programs as you can over the next month. Since you would like to start in the fall of '05, you need to contact as many programs as you can just to see who has a position available. Even if a program does not have a spot available, ask to be allowed to continue to communicate with the PD or program coordinator to keep abreast of any possible openings. You never know when a resident may have an unforseen situation force them to be pulled from a class for an unknown amount of time (example, one of our residents was laid up for six months after a major car crash which compelled us to take an extra resident via transfer).
The scramble in March will only apply to fall '06 CA-1 positions leaving you with one year of time to either continue your surgery residency, find another field to study in, or take time off.
I agree that you should lay low with your intentions as you don't want to be left with neither option. Applying through the match next year for a fall '06 CA-1 position is something you could do, but probably won't provide as many opportunities as applying through this year's match for fall '06 CA-1 positions would have. If this year is a wash, you should go ahead and apply through next year's match, but you should also repeat the exercise of contacting the programs outside the match and staying in contact with them to keep apprised of their numbers situation.
When I was applying, I kept an e-mail list and every two weeks to four weeks, blind carbon copied a generic letter asking about any possible new vacancies and reiterating my strong interest in their program, as well as providing any updates on my personal situation that I felt was notable (i.e. scoring the highest score on an in-training ICU examination, working with a private anesthesiologist in preparation for the imminent switch, etc.).
Your level of determination will dicate not only if you will be able to transfer, but where you will have the opportunity to transfer to.
Good luck.
