UCSF vs USC vs UTSW anesthesiology residencies

[gaslearnt]

I have been blessed with multiple anesthesiology interviews at some great programs. I am having trouble with my rank list and am wondering if you would be able to share your opinions. I have family in Southern California and my ideal location for training would be close to them. After residency training I could see myself moving to Texas to start my career.

I have heard the advice to complete your residency training in the location you want to end up. But I have also heard that private practices do not care where you did your residency training. Would it be foolish to rank USC above UCSF and UT Southwestern if I wanted to end up in Dallas after training? If I don't end up in Dallas, I could see myself in SoCal - which leads to my next question: how competitive is the SoCal PP job market? I have heard that top SoCal PP jobs go to UCSF, Stanford, UCLA, and UCSD grads. Would doing my training at USC put me at a disadvantage to UCSF grads if I were to stay in SoCal?

Appreciate your input!

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[ucladoc2b]

In this market, not really. The connections will help with some groups. But almost everywhere is short.

That being said, if you want to live in CA and practice there, doing a residency in CA is the right move.

 

[Pharmado]

These are all good thoughts. I can’t speak to the PP jobs in CA, but at least for Texas you don’t really need to do residency in the area to find a job. It is helpful because you build contacts, but not necessary. I suspect that in the current job market that’s true most places. 4 years from now that may have changed, but I suspect we are 5-10 years from the balancing point where supply of anesthesiologists and CRNAs balance with demand. If your family is in CA I suggest focusing there because having a support system is very important in residency and you can’t be certain what life will hold by the time residency is ending. Personally, I’d look at which of my top programs have the best work-life balance and fewest external challenges (high COL, poor housing situations, far from family etc) and rank them based on how happy I think I’ll be during residency. The jobs will come. Focus on your own mental and personal well being for the next 4 years.

 

[kidthor]

What you’re calling USC is really the Los Angeles General residency program. USC is becoming less and less involved in that program from what I hear.

A lot of people hate on SF as a city but UCSF for anesthesiology residency is exceptional. Everyone I’ve worked with from there is excellent and they all liked their time there.

 

[dumbmedstudent]

There was a thread a while back with a lot of negative comments about USC. You should try see if you can search for it.

 

[triggermaster]

What you’re calling USC is really the Los Angeles General residency program. USC is becoming less and less involved in that program from what I hear.

A lot of people hate on SF as a city but UCSF for anesthesiology residency is exceptional. Everyone I’ve worked with from there is excellent and they all liked their time there.

The biggest douche I ever worked with was from there. YMMV.

 

[UscGhost]

Go where you feel is the best fit. Find somewhere that gives you a lot of autonomy, good location, good work/life balance.

Connections are important. So mainly wherever you feel comfortable. USC grads everywhere in OC and LA. Probably more common than UCSF or Stanford given the geography.

USC training is fantastic and the residents are great. Some may struggle if they are weaker overall and require more handholding from attendings or if they want to do research. USC rewards those seaking autonomy.

 

[UscGhost]

The biggest douche I ever worked with was from there. YMMV.

You can probably get exposed to 40 different attending during residency at USC. Not surprised that you wouldn't like all of them.

The value comes in being exposed to a variety of methods and ideas.

 

[triggermaster]

You can probably get exposed to 40 different attending during residency at USC. Not surprised that you wouldn't like all of them.

The value comes in being exposed to a variety of methods and ideas.

I meant the biggest douche ever was a UCSF grad. Sorry I was unclear.

 

[UscGhost]

I meant the biggest douche ever was a UCSF grad. Sorry I was unclear.

Ahh gotcha.

Yea it can be tough. I haven't heard any complaints from recent USC grads about their training or experience. And I enjoyed my time there.

So check them all out and go with your gut feeling

 

[Test Boy]

I meant the biggest douche ever was a UCSF grad. Sorry I was unclear.

Lol, It was obvious you meant UCSF = dbag, and not USC.

 

[ans2021]

UTSW was one of two programs I didn't rank. 99% of the people who interviewed same day as all felt the same.

 

[gaslearnt]

UTSW was one of two programs I didn't rank. 99% of the people who interviewed same day as all felt the same.

Why didn't you rank them? And how many years ago was this?

 

[dabears505]

Ucsf and don't think about it any more

 

[ucsfgaspain]

Haven't been on forum in a long time. Obvious where I trained. Having the pedigree can't hurt but it isn't the end all/be all. I trained there over 2 decades ago and the only thing I can say is that it prepared me well for being comfortable being uncomfortable. This has been an extremely valuable. The pedigree is helpful as a cognitive aid for groups that chances are you are not an idiot. But ultimately, it is all about you. I'm switching employment and the UC name distinguishes you but isn't a game changer.

I live in the sf bay area. the tales of the doom of SF are overembellished. Like any big city, there are crappy areas but except for SOMA everywhere else hasn't changed for the worse. You are young (I assume) so going to SF as a young person is pretty sweet especially if you are an outdoorsy person. UC's secret sauce is the varied practice locations. You get the large academic death star with Parnassus and the wild west of SFGH. Zion and Mission bay are somewhere in the middle. Hope this helps.

 

[GassYous]

Haven't been on forum in a long time. Obvious where I trained. Having the pedigree can't hurt but it isn't the end all/be all. I trained there over 2 decades ago and the only thing I can say is that it prepared me well for being comfortable being uncomfortable. This has been an extremely valuable. The pedigree is helpful as a cognitive aid for groups that chances are you are not an idiot. But ultimately, it is all about you. I'm switching employment and the UC name distinguishes you but isn't a game changer.

I live in the sf bay area. the tales of the doom of SF are overembellished. Like any big city, there are crappy areas but except for SOMA everywhere else hasn't changed for the worse. You are young (I assume) so going to SF as a young person is pretty sweet especially if you are an outdoorsy person. UC's secret sauce is the varied practice locations. You get the large academic death star with Parnassus and the wild west of SFGH. Zion and Mission bay are somewhere in the middle. Hope this helps.

Why are you switching after so long

 

[Urzuz]

Haven't been on forum in a long time. Obvious where I trained. Having the pedigree can't hurt but it isn't the end all/be all. I trained there over 2 decades ago and the only thing I can say is that it prepared me well for being comfortable being uncomfortable. This has been an extremely valuable. The pedigree is helpful as a cognitive aid for groups that chances are you are not an idiot. But ultimately, it is all about you. I'm switching employment and the UC name distinguishes you but isn't a game changer.

I live in the sf bay area. the tales of the doom of SF are overembellished. Like any big city, there are crappy areas but except for SOMA everywhere else hasn't changed for the worse. You are young (I assume) so going to SF as a young person is pretty sweet especially if you are an outdoorsy person. UC's secret sauce is the varied practice locations. You get the large academic death star with Parnassus and the wild west of SFGH. Zion and Mission bay are somewhere in the middle. Hope this helps.

Agree with everything you said except for the tales of doom of SF being over-embellished. SF has progressively gotten more ****ty over the last 10 years. Homelessness and crime are out of control in the city and they really need to be reigned in somehow. It doesn’t help that rent prices are also completely obscene.

Also, FWIW, though the anesthesia department is still very strong, a lot of the pioneers of anesthesiology that were around when you trained that gave UCSF the name that is still carries today are now gone and not practicing anymore.

 

[ucsfgaspain]

Why are you switching after so long

Different priorities in life now. I'm an old fart, lucky to be FI, and am optimizing for life outside of work.

 

[ucsfgaspain]

Agree with everything you said except for the tales of doom of SF being over-embellished. SF has progressively gotten more ****ty over the last 10 years. Homelessness and crime are out of control in the city and they really need to be reigned in somehow. It doesn’t help that rent prices are also completely obscene.

Also, FWIW, though the anesthesia department is still very strong, a lot of the pioneers of anesthesiology that were around when you trained that gave UCSF the name that is still carries today are now gone and not practicing anymore.

I think I may have a different perspective than you as I was at UCSF med school during the AIDS crisis, residency/fellowship during the dot com boom and bust # 1. Peeps' memories are always short and the City has always had boom bust cycles. Yes **** on the street and sidewalks is a different tinge to the tenderloin, but the tenderloin was always rough. I remember driving through the tenderloin in the early 2000's post call from the general and seeing some "interesting" things. The mission wasn't gentrified and u were taking your chances walking through at night. But in that chaos, we got to run the SFGH ourselves. Not sure if you guys still have passed on MASTERBLASTER from our time.

The pioneers of anesthesia of course have aged out. But honestly, except for george gregory, jim caldwell, yung sohn, and mark rosen, it was a learn by doing program. You had to seek out your own knowledge sources. But like I say, the greatest thing about the program was that you got comfortable being uncomfortable.

The whole cost thing is obscene but that's because you aren't tech. Medicine is plebeian class. Doesn't change when you are an attending. The only smart thing I did was marry tech

 

[UscGhost]

Go where there is a county hospital. You are much more likely to be more involved in the care of your patients vs a private hospital. In a private setting, the attendings tend to be more hands on (and you are hands off)

A balance is fine but that experience is invaluable.

Ask the current residents about autonomy, lifestyle, comfort level as a Ca3.

The rest is geography and personal choice

 

[Urzuz]

Not sure if you guys still have passed on MASTERBLASTER from our time.

You know it! There was no other way to induce a patient at 2am at the general. You ain’t got no time for fun and games. Actually come to think of it, that’s all that sfgh nights was…! Good times

 

[ans2021]

Why didn't you rank them? And how many years ago was this?

I interviewed in 2016. Chair tried to convince everyone of why UTSW was superior to to all other programs, including MGH, UCSF, Stanford, etc. Didn't talk about the good things of UTSW, just the bad of the other programs. Like UH, they spent a good 30 mins talking about how not work horse program they are. Then I interviewed with 6/7 people. One of the interviewers asked for me to share an experience that demonstrates x. I told a true story and the interviewer scoffed and said well that's just not a true story. On my last interview after 30 mins talking, and after asking a few questions, he asked if I had any other questions. I replied that I really appreciated the day and that I didn't have any further questions. He told me that was a dumb response. How dare I not have more than the questions I had already asked. It was by far the longest day for interviews than any other program. Pretty much everyone on the bus with me back to the hotel said they had a similar interview experience. They even told stories of hearing attendings in the OR telling really unacceptable things about their residents, that even if true, didn't need to be said to the surgeons and nurses and everyone that could hear. Residents struggled to make it to the dinner and overall seemed to try and put on a good face but weren't happy.

 

[DoctwoB]

Not anesthesia but can speak to the regional effect. Anesthesia at my hospital (bay area) is probably 90% UCSF or Stanford trained.

A lot of that is self selection, people that want to be in the area, spouses in tech, etc. But a lot of it is just the network effect. You will always hire the guy (or gal) that your buddy you trained with or the attending you respect vouches for over a complete unknown, even if coming from a good program. Even the best program will have their stars and their duds and everyone looks good on paper, so having insight into the person is huge.

 

[GassYous]

Not anesthesia but can speak to the regional effect. Anesthesia at my hospital (bay area) is probably 90% UCSF or Stanford trained.

A lot of that is self selection, people that want to be in the area, spouses in tech, etc. But a lot of it is just the network effect. You will always hire the guy (or gal) that your buddy you trained with or the attending you respect vouches for over a complete unknown, even if coming from a good program. Even the best program will have their stars and their duds and everyone looks good on paper, so having insight into the person is huge.

And the people who already live there are the only ones who aren't shell shocked by the price of everything

 

[NitroS]

I would choose a program where you would wanna work/settle down eventually. In anesthesia, word of mouth is everything. PP groups don’t really care where you trained, it’s mostly about your personality and how well you can fit in with the group. If you have someone that can vouch for you, you’ll get in over any Ivy League programs

 

[DesiredMemberName?]

I would choose a program where you would wanna work/settle down eventually. In anesthesia, word of mouth is everything. PP groups don’t really care where you trained, it’s mostly about your personality and how well you can fit in with the group. If you have someone that can vouch for you, you’ll get in over any Ivy League programs

I think this is generally true for most residencies (as long as it’s not some bottom of the barrel, sketch program created/run by an insurance company), but it is not always the case for fellowship training.

For example, if you’re going to do big boy hearts at a legit center, the surgeons may expect that you trained at a legit program doing a high volume of complex cases. If you can’t hang right out of the gate, it may be painful for everyone involved.

 

[kidthor]

For example, if you’re going to do big boy hearts at a legit center, the surgeons may expect that you trained at a legit program doing a high volume of complex cases. If you can’t hang right out of the gate, it may be painful for everyone involved.

Ehhh will they really? I suspect the surgeons have no idea nor do they care where most anesthesiologists trained. They barely know anyone’s name.

Granted, cardiac is a smaller world - but I’d still be surprised if most cardiac surgeons have any idea where most cardiac anesthesiologists trained…

 

[Bertelman]

Each time I interview a candidate, my surgeons are asking where they trained.

Last one I hired, my surgeon knew a surgeon there. I can’t say he reached out to get an opinion, but that’s because the timing of the hire prevented it. Easily could have made that call, and he may for all I know.

 

[nimbus]

Ehhh will they really? I suspect the surgeons have no idea nor do they care where most anesthesiologists trained. They barely know anyone’s name.

Granted, cardiac is a smaller world - but I’d still be surprised if most cardiac surgeons have any idea where most cardiac anesthesiologists trained…

They care about the quality of the anesthesiologist but they don’t care at all about where they trained or even if they are fellowship trained.

 

[DesiredMemberName?]

They care about the quality of the anesthesiologist but they don’t care at all about where they trained or even if they are fellowship trained.

I suspect this may be more likely to be true at a community hearts practice that mostly does chip shot cabgs and valves. It definitely doesn’t jibe with my direct experience.

Obviously, I can’t speak for every hospital but our CV surgeons (and interventional cardiologists) want to know where our new hires trained and will protest if it’s not a “legit program.”

At the end of the day, if someone is good, they will eventually be accepted, but it’s harder to be good from day one in a complex practice if your program exposed you to minimal complexity. It’s also easier to succeed if the surgeons respect your training.

 

[DesiredMemberName?]

Ehhh will they really? I suspect the surgeons have no idea nor do they care where most anesthesiologists trained. They barely know anyone’s name.

Granted, cardiac is a smaller world - but I’d still be surprised if most cardiac surgeons have any idea where most cardiac anesthesiologists trained…

They really have in my experience. They know where all our people trained, and they know which programs are good and which are not.

Once someone demonstrates that they are skilled, it doesn’t really matter where they trained, but when someone is first coming out it can make a big difference. Those coming from better programs are more likely to hit the ground running and more likely to be given the benefit of the doubt by the surgeons.

What I’m saying is I would recommend anyone considering a cv fellowship to go to a strong program if they want a smoother transition into practice unless they’re going to a simple community type practice. In that case maybe you don’t even need a fellowship if you did enough hearts as a resident.

 

[nimbus]

They really have in my experience. They know where all our people trained, and they know which programs are good and which are not.

Once someone demonstrates that they are skilled, it doesn’t really matter where they trained, but when someone is first coming out it can make a big difference. Those coming from better programs are more likely to hit the ground running and more likely to be given the benefit of the doubt by the surgeons.

What I’m saying is I would recommend anyone considering a cv fellowship to go to a strong program if they want a smoother transition into practice unless they’re going to a simple community type practice. In that case maybe you don’t even need a fellowship if you did enough hearts as a resident.

Which programs are not good? How do the surgeons know which ones are not good?

 

[DesiredMemberName?]

I’m not going to publicly trash any programs. I’m sure you or anyone else in the know could separate the best vs the rest in your region at least.

Many of the case volume numbers are publicly available, and the surgeons know who is operating where and what kind of cases/volume they are doing. Some programs have fellows getting bare minimum of transplant, MCS, major aortic cases, etc.

 

[nimbus]

I’m not going to publicly trash any programs. I’m sure you or anyone else in the know could separate the best vs the rest in your region at least.

Many of the case volume numbers are publicly available, and the surgeons know who is operating where and what kind of cases/volume they are doing. Some programs have fellows getting bare minimum of transplant, MCS, major aortic cases, etc.

So I assume all your surgeons and cardiologists likewise only trained at “top tier” places.

 

[DesiredMemberName?]

Ha! Of course not, but they’ve mostly been practicing for decades. They don’t tend to be so concerned if we are bringing on an experienced anesthesiologist who has been working in a high acuity environment. It’s more of a concern for those fresh out of training.

Look, I’m not saying it’s reasonable to be hyper focused on pedigree. There are plenty of trash anesthesiologists with great credentials who nobody wants as a partner. I still think training program quality (e.g. 2-3 transplants vs 20-30) does matter, at least for new grads. I was responding to a poster who said PP groups don’t care about where you trained. I can assure you that our group does care.

 

[dumbmedstudent]

Lol, you guys are giving too much credit to surgeons.

In there mind a good anesthesiologist= never cancels a case + fast even if sloppy + does whatever they say

 

[coffeebythelake]

does whatever they say

That's why some surgeons like to work with crnas. They get to order them around and get no push back

 

[Bertelman]

Lol, you guys are giving too much credit to surgeons.

In there mind a good anesthesiologist= never cancels a case + fast even if sloppy + does whatever they say

You’re not describing cardiac surgery. Canceling a case isn’t something you typically do. Why would I cancel? Critical AS? 99% LAD and 100% RCA? That’s a normal day in my room.

Fast? Yes. Sloppy? That kills people. Cardiac programs don’t like that.

 

[Gern Blansten]

Surgeons don’t get to weigh in at all on who we hire unless it is for the Chair position, and even then, they just get to participate. They are not deciding. Cardiac surgeons get to meet a candidate if they are being considered for chief of cardiac. Even then, they can share their opinion but that is all it is.
Otherwise, surgeons only know who we hired after we have made the decision.
Also, the so-called “legit programs” put out their share of duds who can’t cut it. There are lots of great anesthesiologists who trained at programs that are far less well known than the big name programs.

 

[DesiredMemberName?]

Surgeons don’t get to weigh in at all on who we hire unless it is for the Chair position, and even then, they just get to participate. They are not deciding. Cardiac surgeons get to meet a candidate if they are being considered for chief of cardiac. Even then, they can share their opinion but that is all it is.
Otherwise, surgeons only know who we hired after we have made the decision.
Also, the so-called “legit programs” put out their share of duds who can’t cut it. There are lots of great anesthesiologists who trained at programs that are far less well known than the big name programs.

I don’t really disagree with any of this. Our surgeons don’t get a vote on who we hire, but if they doubt the new hire’s credentials it can be an uphill battle for that person when they’re starting out. Fair or not, that’s how it is. I’ve seen it.

Aside from big name or reputation, I do think it can be easier starting off for those who train at a program that provides plenty of experience managing complex cases. Not all programs are equal in this regard.

I just don’t think that “PP groups don’t care where you trained” is good advice, and I am trying to provide an alternative perspective.

 

[gaslearnt]

I don’t really disagree with any of this. Our surgeons don’t get a vote on who we hire, but if they doubt the new hire’s credentials it can be an uphill battle for that person when they’re starting out. Fair or not, that’s how it is. I’ve seen it.

Aside from big name or reputation, I do think it can be easier starting off for those who train at a program that provides plenty of experience managing complex cases. Not all programs are equal in this regard.

I just don’t think that “PP groups don’t care where you trained” is good advice, and I am trying to provide an alternative perspective.

I appreciate your alternative perspective. I understand you don't want to name and shame, but I'm curious what "tier" of program would lead to doubt in the new hires training. Are all university based residency programs viewed more or less the same?

 

[Bertelman]

Surgeons don’t get to weigh in at all on who we hire unless it is for the Chair position, and even then, they just get to participate. They are not deciding.

I would echo this as well. My previous post may have been misleading. But if I’m interviewing someone, I at least mention their training to tte surgeon.

I go through due diligence reaching out to people I know in the community to get insight into candidates. If I can use cutbacks thtoygh my surgeons to get additional insights, I will.

 

[nimbus]

10 years ago, we only hired people who trained at “top programs” because we were a desirable group in a desirable location. More recently we have had to hire people from what would be considered solid middle of the road programs. They are indistinguishable. We’ve had duds from top programs and stars from less than top programs. But in general almost everybody is excellent. As a corollary to this, we had close to zero DOs 10-15 yrs ago. Now we have a lot and many are outstanding.

Our busiest cardiac hospital has a heart failure program and a very active structural program. They do over 2000 pump cases/year. The cardiac folks there run the gamut from experienced people with no fellowship to grads of middle of the road fellowships to tippy top fellowship grads and they can all hang.

 

[GassYous]

10 years ago, we only hired people who trained at “top programs” because we were a desirable group in a desirable location. More recently we have had to hire people from what would be considered solid middle of the road programs. They are indistinguishable. We’ve had duds from top programs and stars from less than top programs. But in general almost everybody is excellent. As a corollary to this, we had close to zero DOs 10-15 yrs ago. Now we have a lot and many are outstanding.

What about thirty years ago

 

[mdo1738]

Texas>>>>>>>>>>>California, the end

 

[UscGhost]

Texas>>>>>>>>>>>California, the end

Hmm not sure.

It's November in California and the weather is fantastic.

Location location location.

 

[ToKingdomCome]

Go to UCSF one of the most storied anesthesia residencies lol

 

[Luv2N2B8]

Do you really want to live in Trump’s dingus for four years? Or worse, LA? Easy decision.

 

[DocMcCoy]

For 90% of the groups in Texas, the only requirement is you have a pulse.