Anesthesiology Residency Questions

[ElmerFudd]

I see. Post-match. Didn't deal with it, nor did my program while I was there.

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[Chip N Sawbones]

SOAP?

Are you really going to lecture me on the importance of Step I scores when you don't even know what the SOAP is? I know perfectly well that I'm going to have a tough time finding a residency with my Step I score. I took that test two years ago, and there's nothing I can do now to change it. When I finally got to do my anesthesiology rotation last month all the residents seemed pretty happy with me, mainly because I'd arrive early and set up their rooms for them before I'd even met them. My hope is that when my program, or one of the ones I'm doing away rotations at, is ranking applicants and chucking beer cans at the screen when they see one they don't like, one of the guys I've worked with will point out that at least I was a good worker and they should pull my application out of the trash even if I did have problems with Step I. I'll let you know next March how things worked out for me.

 

[TempleChairman]

"Evolving" - what a great word!

Surgeons (grudgingly) acknowledge us as gatekeepers who allow or block procedures, but by no means do they routinely value our input. To them, we are a tool for them to get their surgeries done and they are often uninterested in our input unless it really matters (and even then, sometimes they're not interested). Don't tell me that you've never performed a procedure under general anesthesia rather than regional, or given a unit of blood you didn't think was necessary, simply because the surgeon requested it! This is the way of private practice, which is where most of us end up working. In the end, it's the surgeon's patient, they think they know more than we do on pretty much everything, and they have the final say. We simply comply (as long as it's not harmful) and document "at surgeon's request" on our records.

While it's true that we can be "logistic experts" who can tackle "operational issues", I'd hate to think that I went through all this training for non-clinical purposes.

You have wandered into a subject that is of enormous interest to me, and which I could spend hours discussing. However, I am currently attempting to depart for a lengthy trip so I will attempt to be brief.

I completely acknowledge your experiences as described above. I also recognize the experience of "working for the man" in the form of AMCs as referenced by BLADEMDA. Despite being an academic Chair, I can assure you that my perspective is much broader - I have spent half of my career in private practice, have been a full equity partner in two different private practice groups, and tend to look at healthcare a bit differently than most physicians (either academic or private practice).

The US healthcare system is on the edge of a paradigm shift. The major payors, lead by CMS, are charging towards full-risk reimbursement schemes where health care systems assume financial accountability for the overall cost-effectiveness of the services they provide. The largest initiative to date is commencing this fall (October 2017) in over 1100 hospitals across the country. I don't have time to describe the details tonight but I would recommend anyone who is interested research the CMS Episode Payment Models initiative. In a nut shell, this payment methodology puts hospitals and physicians into a single bucket and penalizes healthcare systems when their average cost of total care per admission exceeds regional benchmarks (or rewards them when averages costs are lower). The only way to win under this sort of system is if hospitals leverage the expertise of their physicians to identify low-value aspects of care which can be eliminated, and improve the efficiency of the high-impact aspects of care that work (ie: "take responsibility for managing the system").

Under this model, the historical pattern of valuing those physicians who "bring the most admissions" is a failure. Hospitals can not afford to have sloppy inefficient care driven by the whims of individual physicians, nor a high volume of "hail-mary" surgical procedures predictably associated with complicated and prolonged post-operative hospital stays. The attraction of AMCs will also rapidly fade. When an institution is financially at risk for the integrated and efficient functioning of their system of specialists it does not make organizational sense to have these individuals loyal to outside contractors and their potentially competing interests.

At Temple our care is increasingly driven by protocols and pathways achieved by consensus with all the relevant specialists at the table (not by accident, anesthesiologists are often disproportionately represented at these meetings). Individual patients with specific issues do require somewhat frequent deviation from these established protocols, but these exceptions are only undertaken with one or two external clinicians weighing in to confirm that this is in the patients best interest - sometimes surgeons, sometimes anesthesiologists, sometimes both.

Temple has long survived in a resource sparse environment (ie: lousy payors) so we are probably earlier to this evolution than most. However, there is no doubt that this is the direction in which US healthcare is headed and the systems of integrated decision making that we are working to refine are also well ingrained in those systems around the country already adapting well to the shifting reimbursement environment.

As for the idea that an anesthesiologist's education and training are wasted on logistical or operational issues, I think you are missing the point entirely. As our systems of care become more complex and more tightly coupled the logistical and operational decisions to which I am referring are rapidly becoming medical decisions. Leaving these issues to the business majors or nurses who stepped away from clinical practice 15 years ago is a sure recipe for disaster. Experienced practicing physicians must come to the table and lend their expertise to these planning and management processes. Jack Welch (GE) was an engineer, and Bill Gates (Microsoft) studied computer science at Harvard (but dropped out - point conceded). It is now past time for physicians to start behaving like the highly educated and motivated professionals that they are and begin managing the systems upon which they depend, rather than just individual patients.

 

[ElmerFudd]

You have wandered into a subject that is of enormous interest to me, and which I could spend hours discussing. However, I am currently attempting to depart for a lengthy trip so I will attempt to be brief.

I completely acknowledge your experiences as described above. I also recognize the experience of "working for the man" in the form of AMCs as referenced by BLADEMDA. Despite being an academic Chair, I can assure you that my perspective is much broader - I have spent half of my career in private practice, have been a full equity partner in two different private practice groups, and tend to look at healthcare a bit differently than most physicians (either academic or private practice).

The US healthcare system is on the edge of a paradigm shift. The major payors, lead by CMS, are charging towards full-risk reimbursement schemes where health care systems assume financial accountability for the overall cost-effectiveness of the services they provide. The largest initiative to date is commencing this fall (October 2017) in over 1100 hospitals across the country. I don't have time to describe the details tonight but I would recommend anyone who is interested research the CMS Episode Payment Models initiative. In a nut shell, this payment methodology puts hospitals and physicians into a single bucket and penalizes healthcare systems when their average cost of total care per admission exceeds regional benchmarks (or rewards them when averages costs are lower). The only way to win under this sort of system is if hospitals leverage the expertise of their physicians to identify low-value aspects of care which can be eliminated, and improve the efficiency of the high-impact aspects of care that work (ie: "take responsibility for managing the system").

Under this model, the historical pattern of valuing those physicians who "bring the most admissions" is a failure. Hospitals can not afford to have sloppy inefficient care driven by the whims of individual physicians, nor a high volume of "hail-mary" surgical procedures predictably associated with complicated and prolonged post-operative hospital stays. The attraction of AMCs will also rapidly fade. When an institution is financially at risk for the integrated and efficient functioning of their system of specialists it does not make organizational sense to have these individuals loyal to outside contractors and their potentially competing interests.

At Temple our care is increasingly driven by protocols and pathways achieved by consensus with all the relevant specialists at the table (not by accident, anesthesiologists are often disproportionately represented at these meetings). Individual patients with specific issues do require somewhat frequent deviation from these established protocols, but these exceptions are only undertaken with one or two external clinicians weighing in to confirm that this is in the patients best interest - sometimes surgeons, sometimes anesthesiologists, sometimes both.

Temple has long survived in a resource sparse environment (ie: lousy payors) so we are probably earlier to this evolution than most. However, there is no doubt that this is the direction in which US healthcare is headed and the systems of integrated decision making that we are working to refine are also well ingrained in those systems around the country already adapting well to the shifting reimbursement environment.

As for the idea that an anesthesiologist's education and training are wasted on logistical or operational issues, I think you are missing the point entirely. As our systems of care become more complex and more tightly coupled the logistical and operational decisions to which I am referring are rapidly becoming medical decisions. Leaving these issues to the business majors or nurses who stepped away from clinical practice 15 years ago is a sure recipe for disaster. Experienced practicing physicians must come to the table and lend their expertise to these planning and management processes. Jack Welch (GE) was an engineer, and Bill Gates (Microsoft) studied computer science at Harvard (but dropped out - point conceded). It is now past time for physicians to start behaving like the highly educated and motivated professionals that they are and begin managing the systems upon which they depend, rather than just individual patients.

Excellent answer, sir.

You'd be surprised to know that, where I work (a large, non-academic community hospital), there are indeed protocols that are followed for certain procedures. Such protocols have yet to become more broadly applied, but I suspect they will be in good time. I do wonder, however, how 'evidence-based' they are and, more importantly, how much room they will leave for physicians to use their clinical judgment in "forming an anesthesia plan". Yes, as physicians we are certainly qualified to optimize care and control costs in the manner you described, but you must remember that most of us out in practice are indians like me, and not chiefs like yourself. Our clinical judgment isn't sought in the formation of these protocols, some of which quite frankly I don't think make much sense.

But you're right. Even I can see that health care is going in this direction, for better or for worse.

 

[ElmerFudd]

Are you really going to lecture me on the importance of Step I scores when you don't even know what the SOAP is? I know perfectly well that I'm going to have a tough time finding a residency with my Step I score. I took that test two years ago, and there's nothing I can do now to change it. When I finally got to do my anesthesiology rotation last month all the residents seemed pretty happy with me, mainly because I'd arrive early and set up their rooms for them before I'd even met them. My hope is that when my program, or one of the ones I'm doing away rotations at, is ranking applicants and chucking beer cans at the screen when they see one they don't like, one of the guys I've worked with will point out that at least I was a good worker and they should pull my application out of the trash even if I did have problems with Step I. I'll let you know next March how things worked out for me.

Well, I really do wish you luck. Have you taken your Step 2 yet?

 

[BLADEMDA]

Excellent answer, sir.

You'd be surprised to know that, where I work (a large, non-academic community hospital), there are indeed protocols that are followed for certain procedures. Such protocols have yet to become more broadly applied, but I suspect they will be in good time. I do wonder, however, how 'evidence-based' they are and, more importantly, how much room they will leave for physicians to use their clinical judgment in "forming an anesthesia plan". Yes, as physicians we are certainly qualified to optimize care and control costs in the manner you described, but you must remember that most of us out in practice are indians like me, and not chiefs like yourself. Our clinical judgment isn't sought in the formation of these protocols, some of which quite frankly I don't think make much sense.

But you're right. Even I can see that health care is going in this direction, for better or for worse.

One of the big concerns with "protocols" is that a CRNA can legally administer anesthesia. Outside of the heart room and the icu why should a hospital system pay a physician to do a nurse's job? Instead, the hospital CEO hires a few Anesthesiologists to oversee the protocols and supervise the DNP Crnas who are the actual providers. The paradigm shift in anesthesia and change in reimbursement means CEOs are going to look even harder to save money. This may mean the newly minted Anesthssiologist may not have the skill set (no fellowship) or experience ( vs senior level Anesthesiologists) to compete in the market place. Another casualty of this paradigm shift is the supervisory ratio which will no longer be limited to 4:1
Instead, the hospital employed Anesthesiologist will be encouraged by the CEO to go to the independent CRNA model or the collaborative model model. Neither is beneficial to the medical specialty

 

[ElmerFudd]

One of the big concerns with "protocols" is that a CRNA can legally administer anesthesia. Outside of the heart room and the icu why should a hospital system pay a physician to do a nurse's job? Instead, the hospital CEO hires a few Anesthesiologists to oversee the protocols and supervise the DNP Crnas who are the actual providers. The paradigm shift in anesthesia and change in reimbursement means CEOs are going to look even harder to save money. This may mean the newly minted Anesthssiologist may not have the skill set (no fellowship) or experience ( vs senior level Anesthesiologists) to compete in the market place. Another casualty of this paradigm shift is the supervisory ratio which will no longer be limited to 4:1
Instead, the hospital employed Anesthesiologist will be encouraged by the CEO to go to the independent CRNA model or the collaborative model model. Neither is beneficial to the medical specialty

In my job, I typically cover four CRNAs and that is very, very challenging - even when dealing with bread and butter cases that they can't screw up. I don't think I could handle seeing patients in pre-op for five or six operating rooms and staying on schedule.

 

[Drangue]

Thank you so much. If anyone has any further tips, tricks or advice for the upcoming match it would be greatly appreciated.

One question I have is how are interviews like at some programs if you are aware? One example, Radiology, I have friends who matched into this and they mentioned it was the most laid back interview out of the other programs they applied to.

What do the interviewers at Anesthesiology Programs look for, ask about, talk about?

 

[deleted171991]

What do the interviewers at Anesthesiology Programs look for, ask about, talk about?

Good-looking applicants.

 

[TempleChairman]

Thank you so much. If anyone has any further tips, tricks or advice for the upcoming match it would be greatly appreciated.

One question I have is how are interviews like at some programs if you are aware? One example, Radiology, I have friends who matched into this and they mentioned it was the most laid back interview out of the other programs they applied to.

What do the interviewers at Anesthesiology Programs look for, ask about, talk about?

Drangue,

Unfortunately I don't think there is a succinct and meaningful answer to this question. The interview process varies quite widely between institutions and is driven largely by local cultures and personalities. That being said, perhaps the most important aspect of the interview from a candidate's perspective is the ability to gauge each institution's culture and personalities.

Is the day disorganized, does it lack any obvious structure? Or is it informative and designed around an obvious objective? Are the individuals who interview you engaged with a purpose, or simply going through the motions? Is the atmosphere very formal, or more relaxed? Do the individuals you meet address you by name and guide you through the process, or is the interview day an exercise in mass production? Are the people you meet smiling and relaxed, or more serious and restrained?

There is no right or wrong answer to any of the questions posed above. But it is somewhat important to find a match between your personality and the organization where you will be spending several (very, very long) years working night and day elbow to elbow with your peers and instructors under often challenging circumstances.

My best advice for your interviews is to show up, conduct yourself in a professional but friendly fashion, be yourself (to the extent that "being yourself" is compatible with the prior piece of advice), and keep your eyes and ears open.

 

[anbuitachi]

Good-looking applicants.

The people in my class are very good looking i must say

 

[TempleChairman]

Good-looking applicants.

FFP,

The vast potential for humor here notwithstanding, I will not touch this with a 20 foot pole.

On the other hand, it is very reasonable advice to suggest that: if you are a male applicant you invest $20 in a tie; if you are an applicant of either gender you take the 5 minutes required to iron your shirt / blouse the night before. Despite aspiring to a profession that spends 90% of their working hours in the institutional version of pajamas, it is a sign of respect and good judgement to show up to your interview somewhat resembling your mother or father's mental image of a doctor.

 

[anbuitachi]

FFP,

The vast potential for humor here notwithstanding, I will not touch this with a 20 foot pole.

On the other hand, it is very reasonable advice to suggest that: if you are a male applicant you invest $20 in a tie; if you are an applicant of either gender you take the 5 minutes required to iron your shirt / blouse the night before. Despite aspiring to a profession that spends 90% of their working hours in the institutional version of pajamas, it is a sign of respect and good judgement to show up to your interview somewhat resembling your mother or father's mental image of a doctor.

20$ on a tie?? thats pretty expensive. my residency interview tie were all 5 bux each haha

 

[pgg]

20$ on a tie?? thats pretty expensive. my residency interview tie were all 5 bux each haha

Why buy more than one?

 

[Drangue]

Temple Chairman,

We might have covered this topic earlier in the thread or maybe in another but I'll ask it anyway. I am about to begin my first anesthesiology elective and one of the questions I was curious about was the negative aspects of the specialty. I want to get a sense of full understanding of the specialty in its entirety. My friends like to say that there are no negatives in their specialty, but I know saying this would demonstrate a lack of insight.

I am not too concerned about the trivial things; being treated poorly by surgeons, how cold the room is, the amount of time it takes for the surgeon to close, or the uncomfortable chairs you have to sit in.

 

[TempleChairman]

Drangue,

I believe that you are correct and that this question has at least been touched on earlier in the thread. But, I will attempt to provide further insight anyways.

I am actually quite happy when I find a chair and have a few peaceful moments to sit down, uncomfortable or not! The surgeons and anesthesiologists at Temple have a very good working relationship as they have in most of the institutions in which I have worked - I would suggest this is mostly a historical stereotype (although there will always be a few jerks everywhere you go). The rooms are too cold but most institutions now provide for some form of extra layer (warm-up jacket) that can be worn in the ORs.

The worst part of anesthesiology, in the opinion of most who practice this specialty I think, is the time commitment. Our department maintains at least two faculty anesthesiologists in the building 24 hours per day 365 days per year just to provide OR and OB coverage. If you add our critical care service there are often three faculty members in the hospital in the middle of the night every night. Then layer in the on-call obligations for liver transplants, heart or lung transplants, back-up call to cover trauma or emergency services and faculty members invest a significant proportion of their lives on-call - either in the hospital or from home - when they are not on vacation. This means that for most there are many school plays, kids hockey games, birthdays, anniversaries, etc, etc that get missed. This past weekend I spent all night on Friday night in a lung transplant, slept most of the day Saturday, spent all night Sunday night in a double lung transplant and by Monday morning could barely find my house.

This is not to say that anesthesiologists are unique in this aspect. There are other specialties that carry heavy on-call burdens as well, but also many that don't. Two of my best friends are community pediatricians. For their particular practice, on-call means having to step away from the dinner party to provide some brief advice via cell phone.

This is the factor that I most often caution potential applicants to consider carefully when deciding on a career in anesthesiology. I believe the true gravity of what you are committing to is often not adequately grasped by individuals not yet in the specialty.

 

[GasMan315]

Temple Chairman,

I recently began a fellowship and now that the written boards are over (hopefully), I have begun the job search process. What advice do you have for new graduates with this process? How would you advise us to find jobs and what ways do you find the most successful when you are contacted? Gaswork seems popular with some, but most of these jobs seem to be large AMCs. There seems to be no perfect way of graduates finding positions, unless they stay with their residency program.

I am focusing on one specific city, but am having some difficulties finding contact information of the chair or anyone for that matter at one of the academic institutions in this city. Additionally, I am not sure where to start with the private groups in the area. Some have suggested calling the ORs and asking for the MDA in charge, but I know our charge Drs would not be too happy to receive this phone call when coordinating the OR.

Thanks

 

[TempleChairman]

Temple Chairman,

I recently began a fellowship and now that the written boards are over (hopefully), I have begun the job search process. What advice do you have for new graduates with this process? How would you advise us to find jobs and what ways do you find the most successful when you are contacted? Gaswork seems popular with some, but most of these jobs seem to be large AMCs. There seems to be no perfect way of graduates finding positions, unless they stay with their residency program.

I am focusing on one specific city, but am having some difficulties finding contact information of the chair or anyone for that matter at one of the academic institutions in this city. Additionally, I am not sure where to start with the private groups in the area. Some have suggested calling the ORs and asking for the MDA in charge, but I know our charge Drs would not be too happy to receive this phone call when coordinating the OR.

Thanks

GasMan315,

I think that your gut instinct is correct - cold calling the MDA running the schedule for the day is unlikely to produce a positive response. First of all, they will be busy with multiple other issues and will commonly not have time to talk. Secondly, in many or most cases they may not be involved in resource planning or recruitment and may not be able to tell you whether the group has uncommitted positions.

I can tell you what I have seen to be the most common and effective pathways to anesthesiology positions over the past 20 years.

By far most matches between candidates and open positions seem to occur via word of mouth. An individual working within an institution or group knows someone who is considering moving to the area or changing positions and they make this known to those responsible for planning and hiring. Sometimes the referring individual is even a surgeon, nurse or administrator. The fact that someone with ties to the institution knows the candidate and thinks they are a quality individual tends to open many doors. Often the positions on offer have not ever been advertised externally. Many times a candidate comes to light in advance of an anticipated and planned retirement or relocation and the group will bring on a promising recruit before the date of the actual "need" in order to get the people they want. This underscores the importance of working your network. Look for individuals with whom you trained during your residency, or even medical school, who are now working in the region you want to relocate to and start to pick their brains. What have they heard about the local practices? Which institutions seem the best to work for? Who do they know in the different groups around town, even just socially, that they could provide you with an introduction to? As mentioned above, these bridging individuals need not be anesthesiologists. Anyone can begin to provide the first critical introductions you will need.

The less common route is responding to advertised positions. I would estimate the split to be ~85% word of mouth versus ~15% advertisements with regard to filling anesthesiology positions overall. Vacancies most often are advertised when (1) a group is experiencing a period of rapid growth of services, (2) a specific uncommon skill-set is required (subspecialty fellowship or board certification required), or (3) they are difficult to fill. The last scenario is most often the result of a less popular location (smaller, more rural, or isolated institutions) or difficulties in the group or hospital - takeovers, salary cuts, unpopular new management, etc (advertised positions at the large AMCs often fall into either #1 above or this group). Each of these factors should be considered carefully to determine which is the likely reason the job is being advertised. An advertised position is not a bad position as long as you understand all of the conditions and decide that the positives outweigh the negatives.

Hope this helps. Please let me know if any of the thoughts above need clarification.

 

[deleted126335]

GasMan315,

I think that your gut instinct is correct - cold calling the MDA running the schedule for the day is unlikely to produce a positive response. First of all, they will be busy with multiple other issues and will commonly not have time to talk. Secondly, in many or most cases they may not be involved in resource planning or recruitment and may not be able to tell you whether the group has uncommitted positions.

I can tell you what I have seen to be the most common and effective pathways to anesthesiology positions over the past 20 years.

By far most matches between candidates and open positions seem to occur via word of mouth. An individual working within an institution or group knows someone who is considering moving to the area or changing positions and they make this known to those responsible for planning and hiring. Sometimes the referring individual is even a surgeon, nurse or administrator. The fact that someone with ties to the institution knows the candidate and thinks they are a quality individual tends to open many doors. Often the positions on offer have not ever been advertised externally. Many times a candidate comes to light in advance of an anticipated and planned retirement or relocation and the group will bring on a promising recruit before the date of the actual "need" in order to get the people they want. This underscores the importance of working your network. Look for individuals with whom you trained during your residency, or even medical school, who are now working in the region you want to relocate to and start to pick their brains. What have they heard about the local practices? Which institutions seem the best to work for? Who do they know in the different groups around town, even just socially, that they could provide you with an introduction to? As mentioned above, these bridging individuals need not be anesthesiologists. Anyone can begin to provide the first critical introductions you will need.

The less common route is responding to advertised positions. I would estimate the split to be ~85% word of mouth versus ~15% advertisements with regard to filling anesthesiology positions overall. Vacancies most often are advertised when (1) a group is experiencing a period of rapid growth of services, (2) a specific uncommon skill-set is required (subspecialty fellowship or board certification required), or (3) they are difficult to fill. The last scenario is most often the result of a less popular location (smaller, more rural, or isolated institutions) or difficulties in the group or hospital - takeovers, salary cuts, unpopular new management, etc (advertised positions at the large AMCs often fall into either #1 above or this group). Each of these factors should be considered carefully to determine which is the likely reason the job is being advertised. An advertised position is not a bad position as long as you understand all of the conditions and decide that the positives outweigh the negatives.

Hope this helps. Please let me know if any of the thoughts above need clarification.

Temple Chairman,

The term "MDA" is something that many of us consider to be a pejorative and a construct of the AANA whose use of the term is part of their "blur the differences" agenda. Use of the term by any anesthesiologist is distressing. Far more so when used by the chairman of a respected anesthesia department.

 

[TempleChairman]

Temple Chairman,

The term "MDA" is something that many of us consider to be a pejorative and a construct of the AANA whose use of the term is part of their "blur the differences" agenda. Use of the term by any anesthesiologist is distressing. Far more so when used by the chairman of a respected anesthesia department.

Dr. Doze,

Thanks for the feedback, certainly no offense was meant. I was simply employing the language of the question posed and obviously did not appreciate the distress this might cause for some. I have never been one to pay much attention to titles or labels so was genuinely unaware of the baggage attached to this abbreviation by some readers.

 

[Psai]

Dr. Doze,

Thanks for the feedback, certainly no offense was meant. I was simply employing the language of the question posed and obviously did not appreciate the distress this might cause for some. I have never been one to pay much attention to titles or labels so was genuinely unaware of the baggage attached to this abbreviation by some readers.

There's nothing wrong with it except that crnas use it to try to pretend as though they are equivalent to physicians. Language matters as I'm sure you know very well which is why they have their "doctorates" and "board certification" even though everyone knows that nursing trophies are a joke.

 

[deleted126335]

There's nothing wrong with it except that crnas use it to try to pretend as though they are equivalent to physicians. Language matters as I'm sure you know very well which is why they have their "doctorates" and "board certification" even though everyone knows that nursing trophies are a joke.

Other than that, how was the play Mrs. Lincoln?

 

[Drangue]

Temple Chairman,

The term "MDA" is something that many of us consider to be a pejorative and a construct of the AANA whose use of the term is part of their "blur the differences" agenda. Use of the term by any anesthesiologist is distressing. Far more so when used by the chairman of a respected anesthesia department.

I'm doing my anesthesiology elective right now as a 4th year and this is pretty much what my attending said to me the other day about this. It's a bummer because the hospital i'm rotating at just installed brand new white boards for the OR rooms and they all have a specific spot to put the name of the "MDA/CRNA:________"

"Blur the differences" really is the best way to put it.

 

[deleted171991]

I'm doing my anesthesiology elective right now as a 4th year and this is pretty much what my attending said to me the other day about this. It's a bummer because the hospital i'm rotating at just installed brand new white boards for the OR rooms and they all have a specific spot to put the name of the "MDA/CRNA:________"

"Blur the differences" really is the best way to put it.

Don't worry, you'll still have a great future in anesthesiology anesthesia.

 

[Drangue]

Don't worry, you'll still have a great future in anesthesiology anesthesia.

Oh, I was just pointing out that he wasn't alone and there are other physicians who shared similar thoughts.

 

[jayhawk103]

What are the chances of me getting into anesthesiology as a DO with a 222 on step 1 and 597 on comlex?

 

[bashwell]

What are the chances of me getting into anesthesiology as a DO with a 222 on step 1 and 597 on comlex?

NRMP for DOs (2016):

There's no NRMP for DOs and Step 1 as far as I know, but you can compare yourself to US MDs applying to anethesia using NRMP for US Allopathic Seniors (2016):

 

[TempleChairman]

What are the chances of me getting into anesthesiology as a DO with a 222 on step 1 and 597 on comlex?

Bashwell, thanks for posting the graphics - very illuminating for the candidates I think.

Jayhawk103, I think the graphics above should provide some reassurance. A very common question either on this thread or to my SDN account via private message is to ask, based upon a few basic data points from a candidate's CV, for an opinion regarding their ability to match into anesthesiology. This is, to be honest, not a very helpful exercise for the candidate I believe. Acceptance into a specific program or any program depends on a large number of subtle factors. Asking for a probability based on your degree and standardized test score is analogous to a newborn US male being reassured that his life expectancy is 76.3 years. He, as an individual, is going to be 100% alive or 100% dead at the age of 25 based significantly on his gender, genetic background, race, socioeconomic status, etc, and the fact that 50% of his cohort will be alive by the age of 76 is not really helpful information.

That being said, it should be obvious from the NRMP data above that the vast majority of US medical school graduates who pursue a position in an anesthesiology residency find one. If I have a single piece of wisdom to offer at this point which might increase your chances of matching into the program of your choice, it is to focus on those things currently under your control (your mental, emotional, and ethical approach to entering the profession of medicine) and ignore the things that are not (your past choice of medical school, prior exam scores, etc). Hope this helps.

 

[jayhawk103]

Bashwell, thanks for posting the graphics - very illuminating for the candidates I think.

Jayhawk103, I think the graphics above should provide some reassurance. A very common question either on this thread or to my SDN account via private message is to ask, based upon a few basic data points from a candidate's CV, for an opinion regarding their ability to match into anesthesiology. This is, to be honest, not a very helpful exercise for the candidate I believe. Acceptance into a specific program or any program depends on a large number of subtle factors. Asking for a probability based on your degree and standardized test score is analogous to a newborn US male being reassured that his life expectancy is 76.3 years. He, as an individual, is going to be 100% alive or 100% dead at the age of 25 based significantly on his gender, genetic background, race, socioeconomic status, etc, and the fact that 50% of his cohort will be alive by the age of 76 is not really helpful information.

That being said, it should be obvious from the NRMP data above that the vast majority of US medical school graduates who pursue a position in an anesthesiology residency find one. If I have a single piece of wisdom to offer at this point which might increase your chances of matching into the program of your choice, it is to focus on those things currently under your control (your mental, emotional, and ethical approach to entering the profession of medicine) and ignore the things that are not (your past choice of medical school, prior exam scores, etc). Hope this helps.

Ok thanks I just wanted to know if I would be competitive at all with those scores and getting interviews, I know there is much more to the process then a standardized exam

 

[zero0]

NRMP for DOs (2016):

There's no NRMP for DOs and Step 1 as far as I know, but you can compare yourself to US MDs applying to anethesia using NRMP for US Allopathic Seniors (2016):

So basically take USMLE, pass, don't commit any felonies, or at least don't get caught, and you'll match anesthesiology. Well, that's a relief. Slightly ominous, but a relief nonetheless.

 

[bashwell]

So basically take USMLE, pass, don't commit any felonies, or at least don't get caught, and you'll match anesthesiology. Well, that's a relief. Slightly ominous, but a relief nonetheless.

Yup, looks like it. Especially if you're a US MD. In fact, all 5 US MDs who applied with a <190 still matched!

Also, if you look at the NRMP Main Math Results and Data (2017) for anesthesiology PGY1 positions, only 66.8% were filled by "US Seniors" (for anesthesiology PGY2 only 51.9% were filled by "US Seniors").

The only other specialties that had lower percentages than anesthesiology in percentage of US Seniors matching are:
IM (44.9%)
Neurology (50.6%)
Pathology (35.9%)
PM&R (62.2%)
Psychiatry (61.7%)
Radiology-diagnostic (60.3%)

(I'm not counting specialties like IM-genetics, child neurology, combined programs, prelim years, etc).

Surprisingly, pediatrics (categorical) had a slightly higher percentage of US Seniors matching than anesthesiology (67.5% vs 66.8%).

For better or for worse, it looks like anesthesia is not a competitive specialty for US MDs (except probably at the brand name programs, like every other specialty).

 

[jayhawk103]

Bashwell, thanks for posting the graphics - very illuminating for the candidates I think.

Jayhawk103, I think the graphics above should provide some reassurance. A very common question either on this thread or to my SDN account via private message is to ask, based upon a few basic data points from a candidate's CV, for an opinion regarding their ability to match into anesthesiology. This is, to be honest, not a very helpful exercise for the candidate I believe. Acceptance into a specific program or any program depends on a large number of subtle factors. Asking for a probability based on your degree and standardized test score is analogous to a newborn US male being reassured that his life expectancy is 76.3 years. He, as an individual, is going to be 100% alive or 100% dead at the age of 25 based significantly on his gender, genetic background, race, socioeconomic status, etc, and the fact that 50% of his cohort will be alive by the age of 76 is not really helpful information.

That being said, it should be obvious from the NRMP data above that the vast majority of US medical school graduates who pursue a position in an anesthesiology residency find one. If I have a single piece of wisdom to offer at this point which might increase your chances of matching into the program of your choice, it is to focus on those things currently under your control (your mental, emotional, and ethical approach to entering the profession of medicine) and ignore the things that are not (your past choice of medical school, prior exam scores, etc). Hope this helps.

 

[jayhawk103]

Well I am not an MD so what are some of the more DO friendly anesthesiology programs?

 

[surfguy84]

Drangue,

I believe that you are correct and that this question has at least been touched on earlier in the thread. But, I will attempt to provide further insight anyways.

I am actually quite happy when I find a chair and have a few peaceful moments to sit down, uncomfortable or not! The surgeons and anesthesiologists at Temple have a very good working relationship as they have in most of the institutions in which I have worked - I would suggest this is mostly a historical stereotype (although there will always be a few jerks everywhere you go). The rooms are too cold but most institutions now provide for some form of extra layer (warm-up jacket) that can be worn in the ORs.

The worst part of anesthesiology, in the opinion of most who practice this specialty I think, is the time commitment. Our department maintains at least two faculty anesthesiologists in the building 24 hours per day 365 days per year just to provide OR and OB coverage. If you add our critical care service there are often three faculty members in the hospital in the middle of the night every night. Then layer in the on-call obligations for liver transplants, heart or lung transplants, back-up call to cover trauma or emergency services and faculty members invest a significant proportion of their lives on-call - either in the hospital or from home - when they are not on vacation. This means that for most there are many school plays, kids hockey games, birthdays, anniversaries, etc, etc that get missed. This past weekend I spent all night on Friday night in a lung transplant, slept most of the day Saturday, spent all night Sunday night in a double lung transplant and by Monday morning could barely find my house.

This is not to say that anesthesiologists are unique in this aspect. There are other specialties that carry heavy on-call burdens as well, but also many that don't. Two of my best friends are community pediatricians. For their particular practice, on-call means having to step away from the dinner party to provide some brief advice via cell phone.

This is the factor that I most often caution potential applicants to consider carefully when deciding on a career in anesthesiology. I believe the true gravity of what you are committing to is often not adequately grasped by individuals not yet in the specialty.

Temple Chairman, thank you for your candid insight. In regards to the heavy call, are you referring to simply academic anesthesia? In speaking to a couple community docs, they speak glowingly about their schedules and how lifestyle friendly their field is. Is their situation simply unique?

 

[AdmiralChz]

Temple Chairman, thank you for your candid insight. In regards to the heavy call, are you referring to simply academic anesthesia? In speaking to a couple community docs, they speak glowingly about their schedules and how lifestyle friendly their field is. Is their situation simply unique?

You can't make such huge assumptions about academics or private practice like this, for any specialty or job in general. Some will work a lot and have poor reimbursement, some will work little and make relatively more. This is true for every job out there, that's why it's important to weigh the pros/cons and investigate these details with groups before you sign a contract.

 

[nimbus]

Temple Chairman, thank you for your candid insight. In regards to the heavy call, are you referring to simply academic anesthesia? In speaking to a couple community docs, they speak glowingly about their schedules and how lifestyle friendly their field is. Is their situation simply unique?

I'd say on average the call burden is lower in academics compared to PP. But it is very institution specific.

 

[surfguy84]

You can't make such huge assumptions about academics or private practice like this, for any specialty or job in general. Some will work a lot and have poor reimbursement, some will work little and make relatively more. This is true for every job out there, that's why it's important to weigh the pros/cons and investigate these details with groups before you sign a contract.

So essentially, if someone wanted to find a job with less call, that would be possible.

 

[nimbus]

So essentially, if someone wanted to find a job with less call, that would be possible.

Yes. Absolutely. But most of the time you will take a disproportionate hit in income. You will be on mommy track.

 

[Higherprimate]

Well I am not an MD so what are some of the more DO friendly anesthesiology programs?

Many of them. I've researched this extensively and since I think we both go to the same school we can get together sometime and I can go over what programs I have found that are really DO friendly and those that are less DO friendly. Hope your rotations are going well.

 

[dsdoc15]

@TempleChairman,

Thanks for taking time out of your busy schedule to address so many questions. I've greatly appreciated your insight covering many topics.

I have a question about applicants/applications. I am applying for Anesthesia physician-only "R" positions this fall. I am a military candidate who may be selected to have a civilian anesthesia training position funded by the military (maintain my military salary while training and unable to receive compensation from the civilian training institution) for the 2018 match. I graduated from a M.D. program, completed internship, and am currently serving as a general medical officer. I would like to restart training as CA-1 as opposed to redoing an internship thus leaving the 50ish "R" positions that start July 2018. Please correct me if I am wrong but I'll assume the previous qualities you've addressed in this forum regarding applicants hold true for all anesthesia applicants and not just medical school seniors. Regarding my specific scenario, does the fact that my position would not require funding from the training program make me a more desirable applicant? i.e. if you had two similar applicants who you've identified as likely to succeed in your program would your program be inclined to take the applicant funded by the military? Do you have any specific guidance for applicants applying for "R" positions that you look for or like to see that is different from applicants applying for your advanced positions?

I have heard on several occasions that a funded military position makes an applicant highly competitive (assuming all other qualities - board scores, mspe, LOR, etc, are competitive). This may be a no brainer but I am curious if this is a reality or just a poorly understood myth.

Thanks in advance for your response.

 

[TempleChairman]

@TempleChairman,

Thanks for taking time out of your busy schedule to address so many questions. I've greatly appreciated your insight covering many topics.

I have a question about applicants/applications. I am applying for Anesthesia physician-only "R" positions this fall. I am a military candidate who may be selected to have a civilian anesthesia training position funded by the military (maintain my military salary while training and unable to receive compensation from the civilian training institution) for the 2018 match. I graduated from a M.D. program, completed internship, and am currently serving as a general medical officer. I would like to restart training as CA-1 as opposed to redoing an internship thus leaving the 50ish "R" positions that start July 2018. Please correct me if I am wrong but I'll assume the previous qualities you've addressed in this forum regarding applicants hold true for all anesthesia applicants and not just medical school seniors. Regarding my specific scenario, does the fact that my position would not require funding from the training program make me a more desirable applicant? i.e. if you had two similar applicants who you've identified as likely to succeed in your program would your program be inclined to take the applicant funded by the military? Do you have any specific guidance for applicants applying for "R" positions that you look for or like to see that is different from applicants applying for your advanced positions?

I have heard on several occasions that a funded military position makes an applicant highly competitive (assuming all other qualities - board scores, mspe, LOR, etc, are competitive). This may be a no brainer but I am curious if this is a reality or just a poorly understood myth.

Thanks in advance for your response.

Hi dsdoc15 - my apologies for the lack of response. It seems that SDN intermittently stops sending email notifications to me when questions are posted to this thread. The days are busy enough that I don't log in here unless I know there is something new to address. If this question is still an ongoing concern please let me know.