University of Miami Jackson Memorial

[umgrad123]

I graduated a couple of years ago from this program and since it is such a large program in a desirable location I wanted to post a little bit about the program. Partially to vent, partially to educate.

There are pros and cons of any program and this certainly applies to UM but I feel that I would be remiss if I didnt warn people about a malignant program like the University of Miami. I am attempting to post anonymously due to concern over the repurcussions I might suffer if the powers that be at UM got wind of someone posting something negative about their program.

I will first go into the pros of the program. It is a huge program so you get all kinds of exposure, especially to trauma and diverse general surgery cases. The OB experience is the best rotation in the program. Dr. Ranasinghe really puts together a great educational experiences, cares about your learning through both didactics and experience. She is very dedicated to resident education and making sure you learn and pass your boards. The VA is also a fairly good place to learn as it is lead by Dr. Martinez Ruiz who is dedicated to resident education and teaching housestaff how to become professional, educated and dedicated physicians. The last and best positive is that you will more than likely match into your fellowship of choice. There are plenty of opportunities available at UM to further your training and the attendings have a large network they can call on to help you match.

Now for the bad. The heads of the department run the department like businessman, not educators. Dr. Lubarsky is an MBA who rarely goes in the OR and his policies dont really care about resident well being and education. He fired multiple residents throughout my time there including one who was a single mom without a second thought. I imagine there is a 10% attrition rate from each class, which is very high, especially for a program with a five year accreditation. He had meetings to admonish residents for filling out surveys that werent the way he wanted them filled out. The better attendings that didnt really follow Dr. Lubarskys style were either fired, left or sent to the VA to work for Dr. Martinez and Dr. Matidial. The ones who preferred to act like businessmen (which is basically an oxymoron in academic medicine) got promoted and moved up the food chain. These are the politics cons.

Experience wise, the regional experience is poor at best for such a large hospital system. We would get about one and a half months total of blocks. The pain department is basically fellow run and all of the procedures are done by the fellows. You spend almost 50% of residency in trauma which is fine but it is not exactly useful in the real world when it comes to experience needed. I felt more like an overblown CRNA and with all of the new residency programs popping up in Florida I would highly recommend heading somewhere else for residency like Kendall Regional, Cleveland Clinic, and Mount Sinai. All of which are run by the expats of UM who are good people running a good program where I imagine your education will be placed first. If you have any questions email me.

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[dchz]

Wow, I really appreciate this thread. I really applaud your attempt to not be too bashful. One of the few threads that have a good amount of information instead of ad hominem "venting".

My program is very similar in set up: VA attendings are the best teachers because they signed up for that job to teach the next generation. But the nonVA side is more focused on cookie-cutter anes. Academics is a safe haven for some bad anes out there. My chairman has a similar MO - very hands off, but I don't feel like that made the residency experience bad for me; he kept the department very stable and retained some pretty good junior faculty. I also tend to stay out of politics, but the CRNAs we have are not that bad. They take up a lot of scuts so we can be freed to do some good cases during their shift.

In an attempt to prevent this thread from ending up like this one, give us some objective measures:

What are the average ITE percentiles?

You say blocks are a weakness, how many blocks did you get in residency?

You did not mention peds experience, what is it like there?

When you say malignant, how many hours did you work on average: CA-1, CA-2, CA-3?

10% attrition rate is 3 (2.8) fired PER CLASS, that is a RIDICULOUSLY high number of residents fired per year. Although the blame of residents being fired often falls on the resident, what light could you shine on this that can convince me that they didn't just happen to get some bad apples?

Are there times where the CRNA would be asked to central lines when there is a resident readily available? Do CRNAs ever take your blocks? Are there CRNAs doing CT cases?

 

[Twiggidy]

I graduated a couple of years ago from this program and since it is such a large program in a desirable location I wanted to post a little bit about the program. Partially to vent, partially to educate.

There are pros and cons of any program and this certainly applies to UM but I feel that I would be remiss if I didnt warn people about a malignant program like the University of Miami. I am attempting to post anonymously due to concern over the repurcussions I might suffer if the powers that be at UM got wind of someone posting something negative about their program.

I will first go into the pros of the program. It is a huge program so you get all kinds of exposure, especially to trauma and diverse general surgery cases. The OB experience is the best rotation in the program. Dr. Ranasinghe really puts together a great educational experiences, cares about your learning through both didactics and experience. She is very dedicated to resident education and making sure you learn and pass your boards. The VA is also a fairly good place to learn as it is lead by Dr. Martinez Ruiz who is dedicated to resident education and teaching housestaff how to become professional, educated and dedicated physicians. The last and best positive is that you will more than likely match into your fellowship of choice. There are plenty of opportunities available at UM to further your training and the attendings have a large network they can call on to help you match.

Now for the bad. The heads of the department run the department like businessman, not educators. Dr. Lubarsky is an MBA who rarely goes in the OR and his policies dont really care about resident well being and education. He fired multiple residents throughout my time there including one who was a single mom without a second thought. I imagine there is a 10% attrition rate from each class, which is very high, especially for a program with a five year accreditation. He had meetings to admonish residents for filling out surveys that werent the way he wanted them filled out. The better attendings that didnt really follow Dr. Lubarskys style were either fired, left or sent to the VA to work for Dr. Martinez and Dr. Matidial. The ones who preferred to act like businessmen (which is basically an oxymoron in academic medicine) got promoted and moved up the food chain. These are the politics cons.

Experience wise, the regional experience is poor at best for such a large hospital system. We would get about one and a half months total of blocks. The pain department is basically fellow run and all of the procedures are done by the fellows. You spend almost 50% of residency in trauma which is fine but it is not exactly useful in the real world when it comes to experience needed. I felt more like an overblown CRNA and with all of the new residency programs popping up in Florida I would highly recommend heading somewhere else for residency like Kendall Regional, Cleveland Clinic, and Mount Sinai. All of which are run by the expats of UM who are good people running a good program where I imagine your education will be placed first. If you have any questions email me.

Sadly, probably not unique to UM

 

[nimbus]

Lubarsky does have a reputation for being a business man. Hopefully he is passing on some of his insights on the business of anesthesia to the residents. If he has the will, he could be a great resource for the residents in the program.

 

[umgrad123]

Wow, I really appreciate this thread. I really applaud your attempt to not be too bashful. One of the few threads that have a good amount of information instead of ad hominem "venting".

My program is very similar in set up: VA attendings are the best teachers because they signed up for that job to teach the next generation. But the nonVA side is more focused on cookie-cutter anes. Academics is a safe haven for some bad anes out there. My chairman has a similar MO - very hands off, but I don't feel like that made the residency experience bad for me; he kept the department very stable and retained some pretty good junior faculty. I also tend to stay out of politics, but the CRNAs we have are not that bad. They take up a lot of scuts so we can be freed to do some good cases during their shift.

In an attempt to prevent this thread from ending up like this one, give us some objective measures:

What are the average ITE percentiles?

You say blocks are a weakness, how many blocks did you get in residency?

You did not mention peds experience, what is it like there?

When you say malignant, how many hours did you work on average: CA-1, CA-2, CA-3?

10% attrition rate is 3 (2.8) fired PER CLASS, that is a RIDICULOUSLY high number of residents fired per year. Although the blame of residents being fired often falls on the resident, what light could you shine on this that can convince me that they didn't just happen to get some bad apples?

Are there times where the CRNA would be asked to central lines when there is a resident readily available? Do CRNAs ever take your blocks? Are there CRNAs doing CT cases?

I cant say for sure what the ITE pass rate is but that is one of the primary reasons residents are fired. I saw my colleagues get stigmatized after not being in the top 80th percenile once then they would be fired immediately after a second score in the bottom 20th. The single mom whose husband left her to raise the baby alone stood out in my mind because he basically threw her out with no help finding work after.

You get one to two months of regional experiene where you would do two blocks per day split between residents and fellows which was not enough in my opinion.

Peds is an ok experience. There are multiple sites which all offer different experiences. Primarily work with CRNA and AA students and function as a cog in the wheel. Very little teaching at Miami Childrens which is where most residents go. Its run by a PP group whose goals are to move patients. You dont even leave the OR to bring patients to PACU so they just keep the flow going. It is what it is.

Hours worked are probably average. Call is primaril Q4 and depending on rotation you work 50-80 hours per week. Its really the attitude of attendings towards residents that creates the malignant atmosphere which i believe is directly due to lubarskys managerial style.

Side note there is only one day throughout my four years I remember learning business of anesthesia and it wasnt taught by Lubarsky.

The interactions with the CRNA and AA students are everywhere. You get first dibs primarily but an aggressive student can get their way if youre more passive. It isnt necessarily hostile but all the CRNAs are getting their "doctorates" now so who knows what that will bring.

There are just so many other programs popping up that I would go to a different program if I had the choice. Lubarsky doesnt hold a monopoly on South Florida anymore so maybe he will change the program but I seriously doubt it.

 

[AdmiralChz]

Interesting post, I don't doubt your experience. I know several recent UM grads as I trained in the southeast myself. It's one of the larger programs out there at around 30 a class, definitely hard to emphasize education/lectures with so many residents. Such a large program certainly isn't for everyone, especially if you want more hands-on education in the OR. But my friends have had largely positive things to say, and they are excellent, very much above-average anesthesiologists which reflects the strong training. UM also sends graduates routinely to excellent fellowships, if one is so inclined.

But thank you, OP, for your candor. I hope you shared your concerns with your program during your exit interview and on the ACGME surveys as that is where real change happens in a large program.

with all of the new residency programs popping up in Florida I would highly recommend heading somewhere else for residency like Kendall Regional, Cleveland Clinic, and Mount Sinai. All of which are run by the expats of UM who are good people running a good program where I imagine your education will be placed first.

I don't agree with this statement, at all. UM is an old program with a proven track record, all of these listed (I've never even heard of Kendall) are brand new/tiny and may have not even graduated their first classes yet. It is unknown how these graduates will perform compared to their peers. Many PP groups (such as the one I'm joining) places a large amount of stock in where you trained and graduates from these programs would have difficulty breaking in being so unknown. Some fellowships operate this way as well. I mean no offense to current residents at those programs - they are just brand new!

If you are still looking for solid, academic-based anesthesiology education you are better off looking elsewhere in the Southeast. More traditional programs like UAB, UF, Emory and maybe MCG are better if one is competitive enough for UM. Mayo in Jax also has a solid, small program that would be an option. Kendall, CC and Sinai are among those community-based programs I would recommend to lesser-competitive applicants to be honest. These programs should not be confused with similarly-named Cleveland or NYC.

I saw my colleagues get stigmatized after not being in the top 80th percenile once then they would be fired immediately after a second score in the bottom 20th.

These are two different things in this sentence. My program had a similar process for low performers in the ITE - you were placed under remediation, and a second repeat poor performance might result in dire consequences. UM is so large and has an excellent alumni network, I am sure they work with dismissed residents to find them a landing place at another program or (more likely) a different specialty in the South Florida area.

 

[dchz]

I cant say for sure what the ITE pass rate is but that is one of the primary reasons residents are fired. I saw my colleagues get stigmatized after not being in the top 80th percenile once then they would be fired immediately after a second score in the bottom 20th. The single mom whose husband left her to raise the baby alone stood out in my mind because he basically threw her out with no help finding work after.

You get one to two months of regional experiene where you would do two blocks per day split between residents and fellows which was not enough in my opinion.

Peds is an ok experience. There are multiple sites which all offer different experiences. Primarily work with CRNA and AA students and function as a cog in the wheel. Very little teaching at Miami Childrens which is where most residents go. Its run by a PP group whose goals are to move patients. You dont even leave the OR to bring patients to PACU so they just keep the flow going. It is what it is.

Hours worked are probably average. Call is primaril Q4 and depending on rotation you work 50-80 hours per week. Its really the attitude of attendings towards residents that creates the malignant atmosphere which i believe is directly due to lubarskys managerial style.

Side note there is only one day throughout my four years I remember learning business of anesthesia and it wasnt taught by Lubarsky.

The interactions with the CRNA and AA students are everywhere. You get first dibs primarily but an aggressive student can get their way if youre more passive. It isnt necessarily hostile but all the CRNAs are getting their "doctorates" now so who knows what that will bring.

There are just so many other programs popping up that I would go to a different program if I had the choice. Lubarsky doesnt hold a monopoly on South Florida anymore so maybe he will change the program but I seriously doubt it.

Very interesting perspectives. I love that Admiral came in to give some regional perspective. I'm very far removed from this as i'm not in the east coast. so i'm going to keep on pressing with the tough points:

The problem with percentiles is that by definition, 20% of the people in residency are going to be in the bottom 20%tile. Does that mean they don't deserve to be given a second chance, specially given life altering experiences like a becoming a single mother during residency or overworked to the brink?? I could definitely see both sides of the argument. How i think my PD would handle it: give the resident some time off and tell him/her to keep her head up. It looks like this wasn't the attitude of the program which is a red flag to me: we are expected to be professionals, but we are also humans. Striking the right balance can be hard. It feels like from your perspective they didn't do that well.

I had some attendings say very over the line things to me. That made me feel like ****. I took it as an experience to learn how to deal with unreasonable people in real life when you graduate. But in your case, being treated like cog in the machine rather than a human doctor that is trying to care for patients is a problem but unfortunately it's a growing trend as we as doctors can't get our **** together with ourselves... Thanks for sharing that with us.

Next thing is the fact that you have to fight CRNA and other students for cases. That is a HUGE red flag to me.

But the problem with threads like this is there is only 1 person's side of a story. Too bad we can't get someone from the other perspective to share their version.

 

[Ronin786]

Peds is an ok experience. There are multiple sites which all offer different experiences. Primarily work with CRNA and AA students and function as a cog in the wheel. Very little teaching at Miami Childrens which is where most residents go. Its run by a PP group whose goals are to move patients. You dont even leave the OR to bring patients to PACU so they just keep the flow going. It is what it is.

Huge red flag to me. There is zero reason any ACGME-accredited program should place their residents with CRNAs in any capacity other than supervising. Anytime I meet with med students I tell them that's what they should be looking for in a program. CRNAs should have no say in what cases you do, should never have any access to cases that you should be in and you should never be competing with them for blocks. In my opinion, any program with an affiliation with a SRNA program should not be ranked. No matter the guarantees they offer.

 

[Twiggidy]

Huge red flag to me. There is zero reason any ACGME-accredited program should place their residents with CRNAs in any capacity other than supervising. Anytime I meet with med students I tell them that's what they should be looking for in a program. CRNAs should have no say in what cases you do, should never have any access to cases that you should be in and you should never be competing with them for blocks. In my opinion, any program with an affiliation with a SRNA program should not be ranked. No matter the guarantees they offer.

Truth

 

[Katheudontas parateroumen]

Huge red flag to me. There is zero reason any ACGME-accredited program should place their residents with CRNAs in any capacity other than supervising. Anytime I meet with med students I tell them that's what they should be looking for in a program. CRNAs should have no say in what cases you do, should never have any access to cases that you should be in and you should never be competing with them for blocks. In my opinion, any program with an affiliation with a SRNA program should not be ranked. No matter the guarantees they offer.

True, I would prefer if a residency had nothing to do with CRNAs. But it is a fact of life for all fields of medicine. That there will be midlevels, they are here to stay. Not ranking programs with SRNAs would preclude you from Yale, Michigan, Mayo Clinic, Columbia, Duke, UNC, Wake Forrest, CCF, OHSU, UPenn, Pitt, Baylor, UT Houston. To name a few, however, these are consensus great places to train. The only states that don't have CRNA schools are Alaska, Delaware, Hawaii, Idaho, Indiana, Montana, Nevada, New Hampshire, New Mexico, Oklahoma, Vermont, and Wyoming.

 

[dchz]

True, I would prefer if a residency had nothing to do with CRNAs. But it is a fact of life for all fields of medicine. That there will be midlevels, they are here to stay. Not ranking programs with SRNAs would preclude you from Yale, Michigan, Mayo Clinic, Columbia, Duke, UNC, Wake Forrest, CCF, OHSU, UPenn, Pitt, Baylor, UT Houston. To name a few, however, these are consensus great places to train.

I agree it's too extreme to not rank those places at all, but if you're an incoming resident and you have to put up with stuff like this, you'd want to know? I know i would, and that's why i appreciate this thread.

Attending from Baylor told me they had to extubate with an attending in the room until the last day of CA-3 year.

If one of the "top tier" places has CRNAs doing lines over residents, wouldn't you want to know so you can weigh it in your decision? Its definitely hard to avoid CRNAs, but you'd definitely be good to avoid places that value CRNA(or even SRNA) over residents. Thats why i love threads like this because it's very good information for the next generation of trainees.

 

[Katheudontas parateroumen]

I agree it's too extreme to not rank those places at all, but if you're an incoming resident and you have to put up with stuff like this, you'd want to know? I know i would, and that's why i appreciate this thread.

Attending from Baylor told me they had to extubate with an attending in the room until the last day of CA-3 year.

If one of the "top tier" places has CRNAs doing lines over residents, wouldn't you want to know so you can weigh it in your decision? Its definitely hard to avoid CRNAs, but you'd definitely be good to avoid places that value CRNA(or even SRNA) over residents. Thats why i love threads like this because it's very good information for the next generation of trainees.

Yeah, for sure. Important questions to ask for all future applicants. And although SDN is bagged on a lot, if you read between the lines, there is a ton of good information on here. I tell applicants to look on SDN with an open mind. Btw, I am going to Baylor and I know that they have a giant CRNA program however, knowing residents on the inside and speaking with them eased my trepidation of CRNA/SRNAs. So future applicants, please do ask how CRNA/SRNAs function at the institution. I have friend at University Miami too. My advice to applicants is not be afraid to just cold email residents or residents at the interview at the program you're interested in too. That's what I did and helped out a lot to get inside scoops. The vast majority of us residents are happy to help

 

[AnotherUMResident]

I'm a current resident at UM/JMH. There are a few assertions made in this thread that need to be cleared up. I am overall happy with the training I've received here. The program may not be as good as other similar sized programs in the Southeast, but we're highly regarded on fellowship interviews, we've consistently matched residents in top programs in Chronic pain, ACTA, and Critical Care, and as far as I know, people don't have problems finding jobs when they leave.

There are obvious deficits that are well known and openly discussed with medical students when they interview here. We don't get as much regional experience as we would like. Our program is trying to ameliorate this by opening up spots at new sites. Overall though, I think we get adequate experience in the common blocks we'll see after graduation.

We are probably a larger program than we should be. There's currently 28 residents per class and in some areas, like regional and Cardiothoracic, we get just enough cases to meet the minimum numbers. That being said, since I am only a resident, I don't know what this means for us when we get to private practice. As some posters have said, graduates from our program seem to perform at an above average level.

As far as CRNAs, AAs, SRNA-DNP-MBA-Chiropractors go, they are here to get us out of the OR on a regular basis at a reasonable hour (75% of the time you're out of the or at 3pm. Also, q 4 call means coming in between 2-4pm and leaving at 7 the next day). As far as I have seen and heard, we do not compete with them for cases. The daily assignments are made by residents and attendings. If you see a cool case on the schedule for the next day, you almost certainly get it, unless your a brand new CA1 that wants to do a transhiatal esophagectomy on a 98 year old. Some rotations have SRNAs, like trauma, and I hate that we train people with a governing body as lecherous as the AANA, but when they're here, you get a break from the 6th lap chole of the day, and someone else gets to go home early.

The two biggest benefits of the program are the diversity of cases done on sick as **** patients and the reliable relief from the OR. We do every transplant imaginable (the liver service is incredibly busy), we have more patients on VA/VV ECMO than you can shake a stick at, people get LVADs left and right, and as mentioned, we have an insanely busy high-risk OB service. Also, there's a 100+ bed NICU, and a busy Pedi-CT surgeon. Residents complain when they're in the OR after 5 because we're relieved so reliably between 2-4, depending on the rotation.

I'd argue that Dr. Lubarsky is a pretty strong asset. He's well known throughout the country and doesn't hesitate to pick up the phone for any resident that asks. He's also the chair of the department, not the program director. Dr Banks, the current PD, is an awesome human being that goes to bat for the residents everyday. Rotations are constantly optimized based on resident feedback, and he writes some of the best letters of rec for residents when it comes time for fellowship.

UM/JMH isn't perfect, but it's pretty solid. We cross paths with residents from Mount Sinai and Kendall. To suggest that medical students would be better served going to any of these programs instead of UM/JMH is a joke. Maybe Emory and UAB are better programs. I don't know. But I think we're pretty well trained here, and there are certainly much worse places to go.

 

[dchz]

I'm a current resident at UM/JMH.

UM/JMH isn't perfect, but it's pretty solid. We cross paths with residents from Mount Sinai and Kendall. To suggest that medical students would be better served going to any of these programs instead of UM/JMH is a joke. Maybe Emory and UAB are better programs. I don't know. But I think we're pretty well trained here, and there are certainly much worse places to go.

welcome! about time the other side showed up, LVAD and ECMO seems like a plus, but if you average that out per resident, how many is that?

Before this turns into a he said she said, let's start with some objectives measures (i think you can stay very anonymous given the size of the program).

What year are you in training?

What are the average ITE percentiles?

How many blocks did you get in residency?

How many pedi cases did you end up with after you're done?

How many hours did you work on average: CA-1, CA-2, CA-3?

How many residents have been fired or contract not renewed in the last 5 years?

Are there times where the CRNA would be asked to central lines when there is a resident readily available? Do CRNAs ever take your blocks? Are there CRNAs doing CT cases?

 

[AnotherUMResident]

welcome! about time the other side showed up, LVAD and ECMO seems like a plus, but if you average that out per resident, how many is that?

Before this turns into a he said she said, let's start with some objectives measures (i think you can stay very anonymous given the size of the program).

What year are you in training?

What are the average ITE percentiles?

How many blocks did you get in residency?

How many pedi cases did you end up with after you're done?

How many hours did you work on average: CA-1, CA-2, CA-3?

How many residents have been fired or contract not renewed in the last 5 years?

Are there times where the CRNA would be asked to central lines when there is a resident readily available? Do CRNAs ever take your blocks? Are there CRNAs doing CT cases?

When you rotate through the CSICU, you'll see at any one time 2-5 patients on ECMO, and at least 4-5 LVADS. Not to mention the BnB cardiac plus heart and lung transplants.
In the OR most residents probably see at least 2-4 LVADs in one month of Jackson Hearts.
CA2
I'm not sure about the average ITE percentiles. Two residents in my class got >90th percentile on ITE and 3 > 90th percentile on Basic.
I did between 40-50 blocks on my one month of regional so far.
Haven't done Pedi yet, but I know that residents who rotate at Miami Children's get above the minimum number in one month.
CA1- 50-60 (80 if in trauma ICU); CA2- 55-65 so far; CA3- close to CA1 hours (word on the street). Plenty of people regularly moonlight on top of these hours.
Of the classes that I have worked with, I'm only aware of one resident being fired. At least one left from the current CA3 class, but that was to switch fields. There may be more, but I don't want to say without being certain.
I am not aware of CRNAs doing lines when residents are available (I have at least not experienced this). CRNA do not do PNBs, they may do the spinals if covering a joint room, SRNAs are tossed the occasional CSE on OB, and they are no where near adult CT cases. I think they may help out with the Pedi CT cases, but this is only when a resident is not doing that rotation.

 

[dchz]

Well what you're saying is a very stark contrast to the OP, but we appreciate the other side of the story and will probably guess the truth is somehwere in between.

Of the classes that I have worked with, I'm only aware of one resident being fired. At least one left from the current CA3 class, but that was to switch fields. There may be more, but I don't want to say without being certain.

One of the big flags is not finishing residency. I lean towards the camp that the fault usually falls on the resident rather than the program, however, having a high attrition rate is a big deal. Let me ask this question another way, how many people did not finish the anes residency in the last 5 years? if you don't know i'm sure a quick ask around will get you a lot of results in a program so big, everyone knows when a resident doesn't finish.
(that number should include field switches, as this is often a way to not ruin the doctor's entire medical education).

Lastly, i find the CRNA situation odd. I hope you can enlighten me. Our CRNAs take shifts and work very desirable hours (7-3). They are hospital employees and they are the ones that get their room relieved before the residents. Are you saying at your residency CRNAs relieve you guys at 2-4 PM?? that would mean the CRNAs are working worse hours than the residents. I find that VERY hard to believe.

 

[AnotherUMResident]

Well what you're saying is a very stark contrast to the OP, but we appreciate the other side of the story and will probably guess the truth is somehwere in between.



One of the big flags is not finishing residency. I lean towards the camp that the fault usually falls on the resident rather than the program, however, having a high attrition rate is a big deal. Let me ask this question another way, how many people did not finish the anes residency in the last 5 years? if you don't know i'm sure a quick ask around will get you a lot of results in a program so big, everyone knows when a resident doesn't finish.
(that number should include field switches, as this is often a way to not ruin the doctor's entire medical education).

Lastly, i find the CRNA situation odd. I hope you can enlighten me. Our CRNAs take shifts and work very desirable hours (7-3). They are hospital employees and they are the ones that get their room relieved before the residents. Are you saying at your residency CRNAs relieve you guys at 2-4 PM?? that would mean the CRNAs are working worse hours than the residents. I find that VERY hard to believe.

I will ask around about attrition. I know I have heard stories, but I'd rather quote as close to fact as possible. Regardless, a 10% rate is absurd.

The CRNAs at both Jackson and UMH work staggered shifts. Some 7-3, 7-7, 9-9, 3-11. They are hospital employees at Jackson, I'm not certain about UMH. There was a problem last year with residents at Jackson not getting out reliably at 3pm, and it was promptly fixed. At the next grand rounds, Lubarsky made a point of emphasizing that resident education was the #1 priority of the department, and the main reason why we had so many CRNAs.
The only time I've heard of a resident relieving a CRNA when they weren't moonlighting, was when they were the in-house call resident and the case was going later than 11 pm. The only rotation that you're not reliably relieved by nurses is hearts, where you work till the room is done, or the call heart resident gets you out. (But even then, if for some reason you're not in a pump case, you're relieved by a CRNA at 3pm).
Sure, sometimes you're stuck in rooms late at UMH on Neuro, but only 2 residents in 28 are on that rotation, and it's not all the time (it really depends on how many residents are moonlighting that day). On trauma, you're out of the room at 2 half the time, and by 5 at the latest the other half. The 3rd day you're on call from 2pm-7am, and the fourth day is post call. And trauma makes up ~1/2 of CA1 year.

Overall, I would say that the residents are not at all harmed by the presence of CRNAs at this program. If anything, they enhance the learning experience by getting you relived reliably at a decent hour, both on days when we have lecture and when we don't.

 

[umgrad123]

Everyones entitled to their opinion. I stand by my statements including the attrition rate. I can think of at least 7 off the top of my head that were out due to test scores, mental illness and drugs. Ask about Dr Pierre Dr Nedeff and Dr Gologorsky. I heard Dr Mijares passed away which is an incredible loss as he was a great man and educator in how to practice anethesia in the real world. These were the "good guys" that Lubarsky, Candiotti and Varon seemed to run out of the program. Maybe Dr Banks has changed as PD but Dr Lewis was much more pro resident than Banks was at the time. I dont want to get into ad hominem attacks on the attendings but UMH is just not a very good hospital and a poor educational hospital. The surgeons dont respect the anesthesiologists but they werent in the room much at UMH. Contrasted to Sinai where the attendings were respected and offered a better, more realistic PP experience.
There are certainly some great things at Jackson and I was proud of the program as a CA1 and got upset about negative comments but my view changed over time.

 

[d9sccr]

welcome! about time the other side showed up, LVAD and ECMO seems like a plus, but if you average that out per resident, how many is that?

Before this turns into a he said she said, let's start with some objectives measures (i think you can stay very anonymous given the size of the program).

What year are you in training?

What are the average ITE percentiles?

How many blocks did you get in residency?

How many pedi cases did you end up with after you're done?

How many hours did you work on average: CA-1, CA-2, CA-3?

How many residents have been fired or contract not renewed in the last 5 years?

Are there times where the CRNA would be asked to central lines when there is a resident readily available? Do CRNAs ever take your blocks? Are there CRNAs doing CT cases?

I'm another current resident at JMH/UMH.

Year
Currently, I'm a CA-3 and plan on going into private practice. Almost half my class is doing fellowships this year in pain, pedi, or ICU. Since I've been here, those pursuing fellowship have matched well. To my knowledge, we've placed residents at MGH, BWH, Hopkins, Wash U, Stanford, Cedars Sinai, MD Anderson, Colombia, etc, etc.

ITE
I have no clue what our average ITE percentiles are. Is this something most residents know? I do know my scores and can tell you that my scaled score has been good enough to pass the written boards (historically of course given the recent changes to our exam structure) since I've been a CA-1.

Blocks
As @AnotherUMResident alluded to, this has been really the biggest weakness of our program. We have two new sites that opened in large part due to residents asking for more exposure. The new sites accommodate 70-100 blocks/month/site. I don't know how many blocks I'll finish residency with but I'm guessing around 200 total as I already have logged >120 in my one month of regional plus various other block opportunities.

Pedi
Pedi is whatever you want to make of it. We currently have 3 pedi sites, Bascom Palmer (ambulatory pedi) being omitted so far. Miami Children's is by far the weakest site. I wouldn't say we train "along with SRNAs or AAs" or anything like that but the staff isn't terrible concerned with teaching. As a CA1 I did major spine and abdominal cases here during my first ever pedi month but primarily learned via independent reading. Pedi at JMH is WAY different. Most of the attendings here make an effort to teach and some of the best teaching faculty in the department reside here. Dr. Rodriguez and Dr. Orihuela come to mind as everything you could want in an anesthesia attending. We do some of our sickest pedi patients at Jackson and I personally loved this rotation so much I almost went into pedi. Bascom Palmer is more ambulatory pedi with a heavy emphasis on ENT which ,as I understand, is more indicative of private practice. I met my pedi numbers long ago.

Hours
CA-1: 50-60hrs/week outside ICU rotations
CA-2: 60-65hrs/week outside cardiac and ICU
CA-3: 50-60hrs/week

Cardiac can be long hours depending on how busy the surgeons are but I imagine that's pretty much the case everywhere. If you're case goes past 11pm or you get called back in the middle of the night for a transplant, you have post-call the next day.


Lost Residents
I can only speak to what I know about:

- 2 classes before me: Lost 1 person to drugs
- 1 class before me: Lost 1 person to drugs
- My class had 2 residents switch into a different specialties, 1 of our "matched" class never showed up (I don't know the back story), and 1 resident left to follow her fiancée to for fellowship and incidentally is coming back here for own fellowship
- Current CA-2 class intact
- Current CA-1 class intact

That makes 6/140 residents (conservative estimate given some of those classes were bigger) not making it through the program and NONE due to any board score dilemma as was previously suggested.

CRNAs
I don't even know where to begin with this this. To the best of my knowledge CRNAs don't do lines. There are 1-2 CRNAs that take liver call so presumably they could do those lines but I don't know if they do. There certainly aren't a ton of residents around at that point in time. CRNAs never take lines, airways, procedures away from residents. Beyond that, CRNAs never take cases away from residents. The main OR schedule is made by the PACU resident the day prior. The PACU resident and board runner (also a physician not a CRNA) determine which cases residents should do. Everything else is left over to the CRNAs. If there's a case you want to do as a resident and ask to do, you're probably going to be in that room unless a more senior resident is required or MAYBE requested it. CRNAs don't do CT cases anywhere to my knowledge. CRNAs do the ortho hand room (after a resident had blocked the case), GYN rooms as needed, Neuro as needed, ENT as needed, and vascular as needed. They are quite literally the stop gap. And yes, CRNAs do relieve us. As previously mentioned, they work in staggered shifts and as such are used as lunch relief and case relief. It's uncommon to have residents in the room much longer 330 and often we're relived by CRNAs by 3 pm. The only time we relieve CRNAs are when cases are still running past 11pm (usually an acoustic neuroma resection or late kidney transplant add on).



Personally, I don't get the attack on the program. With all the references to "other Miami programs" it seems more like someone is actively recruiting for their program vs has an axe to grind for whatever reason. Given the timing (middle of residency interviews), I'd elect the former. I have no desire to bash other programs. We do work alongside residents from programs from every other Miami anesthesiology residency I know with certainty which one provides the better clinical experience. Beyond that, we rank pretty high as a department in published research and even offer a research track if you're so inclined.

To all the applicants reading this: Visit the programs yourself and see which residents seem happy and where you'll fit in. I know we don't lack for work-life balance as several of my classmate moonlight for 10-20 hrs/week. I don't think we lack in clinical training given the acuity of our population. Our program strengths lie in OB, trauma, and cardiac. Feel free to ask any questions and I'll gladly answer them to the best of my ability.

 

[sheeed]

Have some good friends at UM/JM. They love it there. Agree with the fellowship matches. They seem to match pretty well for pain.

Id gladly take Q4 call if i got to come in between 2-4 pm lol. 12 pm for us isnt terrible though.

 

[dchz]

I think this is a pretty good contribution from both sides. Thanks for all the residents that contributed.

As an outsider looking in, the program seems like a very solid program given the objective measures.