LRingers

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I was looking through the unmatched numbers for previous years and saw that several PGY 2 Anesthesiology spots are unfilled each year. Are they easier to get into than just applying straight out of med school? I am looking to switch into Anesthesiology after several years of Surgery residency and need advice. How hard is it to scramble into one of these open PGY 2 positions?
 

MD Dreams

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I was wondering if you could elaborate on you decision to change. I'm considering both specialites. Thank you.
 

timtye78

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My program recently signed two general surgery interns as PGY-2/CA-1 to start in July. It seems to occur commonly once you guys see the light on the other side of the curtain!!

Anesthesiology programs are receptive to surgical intern as well as IM/FP transfers. The general feeling seems to be these applicants should be relatively more comfortable in the OR setting obviously so I think that puts them at an advantage.
 

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timtye78 said:
My program recently signed two general surgery interns as PGY-2/CA-1 to start in July. It seems to occur commonly once you guys see the light on the other side of the curtain!!
It's like window shopping for a Ferrari. You may never drive one, but at least you can say you saw one. ;)

--Typical surgeon response :D
 

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LRingers said:
I was looking through the unmatched numbers for previous years and saw that several PGY 2 Anesthesiology spots are unfilled each year. Are they easier to get into than just applying straight out of med school? I am looking to switch into Anesthesiology after several years of Surgery residency and need advice. How hard is it to scramble into one of these open PGY 2 positions?
You should cast your net far and wide and make sure that you stay in constant contact with the programs to determine if/when they will make a decision and if some of the spots have already been handed out.

I wouldn't say it is any more difficult to get these spots (I was also a transfer), but it may take more time (individual applications, interviews, constant contacting, etc.) to get one. Getting letters of recommendation will be the trickiest and most important thing you need to work on immediately if you are looking for a fall, '05 position. There aren't that many left at this time and your chances for a fall, '06 position will be much higher.

You should also tell the programs you contact that you are willing to enter off cycle if necessary. That helped one IM resident who wanted to come here but was denied because we ran out of spots, get in for fall, '06 but with the understanding that we would try to bring her in during the fall, '05 as an off cycle resident.

Good luck.
 
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LRingers

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Should I wait until after the March Match Day and start emailing all the programs about vacancies at the PGY 2 level as they do not fill? Or should I just apply through the Match for next year for all PGY 2 spots? It is such a delicate situation, being that these programs will want a letter from your program director. But being that anesthesiology is competitive, I'm not sure if I'll even get a PGY 2 spot and my PD will possible not renew my contract if he knows I want to leave so it's hard to make a good decision here. Do I risk losing my general surgery spot to b/c an anesthesiologist, not match and end up in some field I don't even like (FP, IM, etc.)? I'm just wondering is it VERY hard to get a PGY 2 position somewhere in anesthesia. I don't have to go to a high powered academic institution, and don't really know which program's are the easier 2 get into spots at the PGY 2 level. Appreciate the advice.
 

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UTSouthwestern said:
You should cast your net far and wide and make sure that you stay in constant contact with the programs to determine if/when they will make a decision and if some of the spots have already been handed out.

I wouldn't say it is any more difficult to get these spots (I was also a transfer), but it may take more time (individual applications, interviews, constant contacting, etc.) to get one. Getting letters of recommendation will be the trickiest and most important thing you need to work on immediately if you are looking for a fall, '05 position. There aren't that many left at this time and your chances for a fall, '06 position will be much higher.

You should also tell the programs you contact that you are willing to enter off cycle if necessary. That helped one IM resident who wanted to come here but was denied because we ran out of spots, get in for fall, '06 but with the understanding that we would try to bring her in during the fall, '05 as an off cycle resident.

Good luck.
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...
 

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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.
 

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I am one of the surgery interns TimTye78 spoke of. (Lookin' foward to working with you this summer Tim!) To those of you considering the switch I have this to say: I had my sights set on a career in surgery since high school. I spent all of my summers in college shadowing surgeons and spent most of my free time in med school hanging around the OR. I loved surgery, still do... but there were some things about the field which I did not realize I would dread until I got hip deep into my intern year--> clinic, bogus consults either to the ER or by another resident (IM, FM, Ob/gyn) who were more than capable of managing the situation themself without needing a surgery resident to lance a superficial abscess at 3:00a.m, drug seekers, cranky ancillary personel who forget to draw labs/hang a drip, or refused to give a hand during rounds (... I could go on and on). I began to look around (both figuratively and literally) for another area of medicine in which I would work more with pharmacology/physiology, work with my hands, and not deal with tasks that I felt were being sloughed off onto my colleagues and myself by other specialties. My program director was very supportive of my request to do a rotation in anesthesiology-->BAM! Not only was I loving every minute of working in the OR all day, but I was doing all kinds of things I found fascinating (TEE, RSI to name a couple). Now, I realize I won't be cracking chests and transplanting organs, but I found myself more than satisfied at the end of the day. I continue to spend time with the anesthesiologists on my days off since my rotation ended 4 months ago and cannot get enough. It's like real-time medicine! You manage acute problems rapidly with either your hands or with pharmacology and get immediate results. Not like placing someone on a diuretic and hopeing to see a decline in their BP the next AM on rounds. Regarding the switch, at my interviews the attending anesthesiology were very inviting and understanding of my desire to switch. They seemed to expressed the delight in having a surgery resident join their program since we have considerable experience on the other side of the drape in addition to ample knowledge in the management of surgical condition pre and post operatively. I wish anyone who desires to change the best of luck. I recommend it even if you have to repeat your intern year. after all we're are talking about an extremely rewarding career in which you'll spend decades.
 
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LRingers

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Well, it's been pretty slim pickings so far. The series of emails stating "all of our positions are filled" are somewhat discouraging. I'm beginning to think that I may HAVE to enter the 2006 match for a PGY 2 spot. Or maybe lucking up if all positions don't fill in the 2005 Match. It seems like it was alot easier for UTSouthwestern and qlobb to make the switch over into a PGY2 spot. I am starting out late in the year so maybe I'll have better luck beginning my pursuit for a PGY 2 position at the start of the next resident year. Though, I am keeping my fingers and toes crossed on something for 2005 to open up.
 

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LRingers said:
Well, it's been pretty slim pickings so far. The series of emails stating "all of our positions are filled" are somewhat discouraging. I'm beginning to think that I may HAVE to enter the 2006 match for a PGY 2 spot. Or maybe lucking up if all positions don't fill in the 2005 Match. It seems like it was alot easier for UTSouthwestern and qlobb to make the switch over into a PGY2 spot. I am starting out late in the year so maybe I'll have better luck beginning my pursuit for a PGY 2 position at the start of the next resident year. Though, I am keeping my fingers and toes crossed on something for 2005 to open up.
It's timing. Don't give up. Nothing says you can't start applying for fall '06 right now and have a leg up on the competition. If something comes up for fall '05, great. If not, you have greatly increased your chances for fall '06. Also, sending in your application puts your info in front of the PD's eyes and if a spot for fall '05 does suddenly open up, your file with the attached "if I can come in for fall '05, I would be available" suddenly becomes a lot more attractive.
 

MD Dreams

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qlobb, thanks for the input. I too have always loved surgery but am starting to reconsider. It's good to know that there are others out there like myself and to hear their input. Thank you.
 

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LR I know its tough out there

I have a good friend who didnt match last year (too picky and only ranked 5/10). He did prelim medicine this year. He has had THE hardest time trying to get a PGY-2 spot somewhere and latley... anywhere. From what he tells me the programs are packed...even the so called "low tier" ones. I know the program at the med school we graduated from was one that did not fill last year...but by Match Day ALL extra spots had been signed in the scramble. Keep at it but I would gear up for next years match as well.

-Will
 

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"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."

I'm also switching and I'm having a tough time finding a CA-1 position for 2005. In your advice to LR you mentioned applying through next years match for "fall '06 positions." I thought next years match was for programs starting in 2007 -- b/c 4th year MS still have to do their internship. How many programs (generally speaking) offer CA-1 positions for the year immediately following the match? And BTW don't gas programs start in July? What's this about the 'fall?'
 

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refreshingred said:
I'm also switching and I'm having a tough time finding a CA-1 position for 2005. In your advice to LR you mentioned applying through next years match for "fall '06 positions." I thought next years match was for programs starting in 2007 -- b/c 4th year MS still have to do their internship. How many programs (generally speaking) offer CA-1 positions for the year immediately following the match? And BTW don't gas programs start in July? What's this about the 'fall?'
Many programs allow or ask you to go through the match even for positions that will start in less than 12 months. You usually end up signing outside the match, but the application goes through the match. Others will have you fill out an application and mail it in. Some give you the option to do it either way.

When I was transferring, I also applied for fall '03 as well as fall '02 CA-1 positions through the match, as well as applying outside the match to programs that did not want me to go through the match to apply for fall '02 CA-1 positions.

July, fall, summer, whatever you want to call it. I am not talking about an off cycle start, although that is something I forgot to mention to LR as something he/she could mention in the application as being willing to do. That sometimes allows a program to circumvent their yearly cap of residents.

I am not sure of the total number of spots, but our program holds 3 positions out of the match to fill with transfer candidates and we have already given out one of those positions for fall '06. It varies between programs and can be increased if a resident leaves for whatever reason but I would suspect that most programs have at least one spot available outside the match for one reason or other.
 

timtye78

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Looking forward to working with you as well!
See you soon!
Tim



qlobb said:
I am one of the surgery interns TimTye78 spoke of. (Lookin' foward to working with you this summer Tim!) To those of you considering the switch I have this to say: I had my sights set on a career in surgery since high school. I spent all of my summers in college shadowing surgeons and spent most of my free time in med school hanging around the OR. I loved surgery, still do... but there were some things about the field which I did not realize I would dread until I got hip deep into my intern year--> clinic, bogus consults either to the ER or by another resident (IM, FM, Ob/gyn) who were more than capable of managing the situation themself without needing a surgery resident to lance a superficial abscess at 3:00a.m, drug seekers, cranky ancillary personel who forget to draw labs/hang a drip, or refused to give a hand during rounds (... I could go on and on). I began to look around (both figuratively and literally) for another area of medicine in which I would work more with pharmacology/physiology, work with my hands, and not deal with tasks that I felt were being sloughed off onto my colleagues and myself by other specialties. My program director was very supportive of my request to do a rotation in anesthesiology-->BAM! Not only was I loving every minute of working in the OR all day, but I was doing all kinds of things I found fascinating (TEE, RSI to name a couple). Now, I realize I won't be cracking chests and transplanting organs, but I found myself more than satisfied at the end of the day. I continue to spend time with the anesthesiologists on my days off since my rotation ended 4 months ago and cannot get enough. It's like real-time medicine! You manage acute problems rapidly with either your hands or with pharmacology and get immediate results. Not like placing someone on a diuretic and hopeing to see a decline in their BP the next AM on rounds. Regarding the switch, at my interviews the attending anesthesiology were very inviting and understanding of my desire to switch. They seemed to expressed the delight in having a surgery resident join their program since we have considerable experience on the other side of the drape in addition to ample knowledge in the management of surgical condition pre and post operatively. I wish anyone who desires to change the best of luck. I recommend it even if you have to repeat your intern year. after all we're are talking about an extremely rewarding career in which you'll spend decades.