My question is, when applying to various anesthesiology residencies, what things should I be looking at closely in making a decision in regard to where to train. The only things that immediately come to mind are location and hours.
Any other issues that are of utmost importance that I may not recognize as a new applicant?
Any things you wish you had looked at more closely before choosing your program? Any advice is greatly appreciated
Kudos on having the inclination to ask people that have been there what is
actually important when applying to a residency. It's always interesting each year to hear applicants ask questions about things that seem important at the time, but turn out being less-so in reality..
Fortunately for all the applicants out there, there are a ton of great anesthesia programs to train at, and most have a LOT of spots. The ACGME and ABA have made it so that there are oftentimes more similarities in programs (in regards to the actual training) than differences. That being said, there are few things that I would personally recommend in a program:
1) Location, location, location. As any good realtor will tell you, this is of paramount importance. The good news is that one person's ideal location will be another's worst nightmare. Do you need to live close to family to help with your kids? Do you want to try living in a big city? Do you want to surf/ski/hike on your days off? In each case there will be a location that is a better fit for you than others. At the end of the day (IMHO) this is usually the single biggest
actual difference between programs. Don't go to one of the 40+ "Top 10" programs if it's in a place you would
never want to live. In fact,
if you have the choice, don't waste your time (or theirs) interviewing somewhere where you'd never actually consider living. For me, I wanted to live on the West Coast in the Bay Area. I live in a smaller apartment but can drive 20 minutes to the beach or 45 minutes to wine country. That means something to me. I had friends in medical school who had 2 kids and wanted someplace where they could have a whole house with a backyard for the dog. They are in MN and loving it, and they made a good choice for their situation.
2) Do you feel like you "fit" with the program? I know this is cliche (and often hard to actually judge), but you want to ideally feel comfortable with the people you are training with (and those training you). This is something you won't be able to tell before an interview, and can even be difficult to ascertain on the interview day, but at least think about it while you're checking out a program. Do the residents seem like people you would be friends with? Is the culture one where people do their work and go home, or do people hang out socially outside of work? Is there a rigorous academic undertone or are things more clinically oriented and relaxed (or somewhere in between)? I remember while interviewing that there were several places where I really liked the residents, and other places where I felt like an outsider. My reactions were quite strong in both instances and not very subtle. You will hopefully find several programs that feel like a good fit.
3) What are the grads doing? Do the grads have a tough time finding jobs in the location of their choice? Do grads get their top choices of fellowships? How many stay on as faculty? Is there a network of alums to help with job-placement after graduation? Honestly, I think most programs do reasonably well in this regard, but it's certainly something to ask.
4) How many/what types of hospital(s) will I work at? Depending on where you train, you will work in as few as one hospital or as many as 6+. Each situation has its ups and downs. The downside of working at multiple locations is having to negotiate the learning curve for each site, learn a new system (sometimes electronic), and become known to the people working there (not just your anesthesia attendings, but surgeons, nurses, etc.). Once you accomplish this, however, the benefits become apparent. By working at multiple sites you are able to enhance your 'bag of tricks' (beacase you learn from so many different people), you become adaptable to new places and situations, and you realize that there are
many acceptable ways of performing a task.
So here are some things that (again, in my opinion) applicants tend to worry about that end up
not being that important in the end.
1) Can I moonlight? Turns out that you are generally pretty busy just doing residency and will oftentimes want to just relax if you have extra time. It's pretty different being in anesthesia where you can sometimes work long hours than, say, Internal Medicine where you might have a monthlong rotation of 9-5 clinic and may want to pick up a night or weekend shift in Urgent Care. Is it nice to have the opportunity to make extra money from time to time? Of course. Should it be a deciding factor when deciding on where to go? I would argue that it is not.
2) What do the call-rooms/ORs look like? As above, these things are nice to have, but are not make-or-break for a residency program.
3) How many hours do residents work on average? This one is tricky - the question should be asked, but you should find out more beyond just number of hours worked. The number of hours residents work on average can bear little reflection on the quality of the training or the satisfaction of the residents. I know at our program we generally hover around the 55/week mark (with a few notable rotations pulling that average higher and the median number of hours per week being lower). You want to have enough clinical experience while you're in training with someone looking over your shoulder so that you can emerge in 3 years competent to do a real job in the real world. On the other hand, you also don't want to be gratuitiously busy constantly, with little educational value. This is where it pays to ask residents
what they're doing with their hours and not how many hours they work. Remember:
you will not be doing any favors for yourself or your future patients if you select a residency program where you don't have to work very hard. I mean, I get it: who wouldn't rather have more weekends off, be relieved at 2pm every day, and be more rested? We all would. I'd just like to think that the more I am working, seeing actual patients/cases/complications while I'm in training that I am learning and better preparing for being on my own. One concern I've heard from one of my favorite attendings multiple times is that "with the new duty hours continually getting more restrictive, we are in danger of making the residency experience easier than the real thing". Think about it - you don't want to be done with residency training only to find out that the real world is actually tougher than the artificial bubble you trained in for 3 years.
This list is certainly not all-inclusive but are just some of my thoughts while sitting here on OB call on a slow Sunday.
Cheers.
Scotch
