What are the 'best' Anesthesia Programs?

[Bertelman]

I think he did an away rotation at CCF as a med student...

Must have highlighted that on his CV.

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[Stank811]

But wait- YOU didn't go to CCF, did you Lane? How could that be? Is there someone else other than amyl scoring 500k a year?

I know of multiple places that have similar offers

 

[Mman]

The real question is the following: if you, or if, God forbid, your neonate kid/sick grandmother, were undergoing a major surgical procedure, which model do you consider to be "safest"? I think we all know the answer. There is nothing "proven" in the ACT model. I chose to reply to your response becasue you specifically chose the word "proven." Lets face it, when the **** hits the fan (and this can happen even with healthy patients), the "proven" safety--and this is my strong opinion-- is in having a well trained anesthesiologist who will get things immediately diagnosed and under control. This, unfortunately and as you well know, cannot be at all possible when you are supervising. So, in pure essence, you are risking patients lives and your license when you are supervising. You are simply placing your hopes on having a complication that you can tend to fast enough, such that the patient will eventually survive because of your delayed intervention. Simply put, it is easiest to put out a fire once you are close to it and before it becomes a huge, engulfing flame.... The ASA supports this "most common" model because they have no choice: there are not enough anesthesiologists to care for all americans and the lobby of the CRNAs is like a cancer that keeps recurring. These words, by the way, are coming from a guy who both supervized and worked solo. But I personally like hearing these words from a former CRNA turned MD: "I didn't know what I didn't know and that was the problem..".

There was a large retrospective study from North Carolina comparing (I believe) 30 day surgical mortality rates with type of anesthesia care model. ACT fared quite well. It actually came in slightly better than MD only, but that wasn't statistically significant. CRNA not supervised by anesthesiologist was the worst as I recall.

So yes, with millions of patients cared for it is proven to be safe. And yes, I'd let any of my loved ones be cared for by our group in our ACT model for any type of surgery. We do it all. Obviously nobody is supervising 3 other rooms when doing a pedi heart. That would be stupid. Our supervision ratio is adjusted to the acuity of the patients.

 

[IN2B8R]

There was a large retrospective study from North Carolina comparing (I believe) 30 day surgical mortality rates with type of anesthesia care model. ACT fared quite well. It actually came in slightly better than MD only, but that wasn't statistically significant. CRNA not supervised by anesthesiologist was the worst as I recall.

So yes, with millions of patients cared for it is proven to be safe. And yes, I'd let any of my loved ones be cared for by our group in our ACT model for any type of surgery. We do it all. Obviously nobody is supervising 3 other rooms when doing a pedi heart. That would be stupid. Our supervision ratio is adjusted to the acuity of the patients.

Friend, do tell me that you are not going to pin this discussion on a "large retrospective" study. The safest place for a patient is in the hands of a well trained anesthesiologist. That is a blanket statement that requires no studies for back up. A 4:1 staffing model is the norm in busy PP settings. "Aquity adjustment" is not always possible. Something, usually, in such a busy setting goes a miss. No matter what you do, you will always have to put out a fire--one that you hope you can arrive to early enough.... I have supervised before, I know what it is like. I am not against it. I just wanted to clearify what is safest. Putting your loved ones in the hands of your ACT model is one thing. Putting them in the hands of different ACT models is, likely, very different: the diploma mills are producing worse and worse chair sitters. They are arrogant, for "they know not what they do not know." There is stuff out there that is outright shocking.... Suffice it to say that I would never agree to put the lives of those whom I love in the hands of the lesser trained/arrogant. At the end of the day, experience has taught me what is best for my patients, family, and ultimately myself!

 

[BLADEMDA]

Friend, do tell me that you are not going to pin this discussion on a "large retrospective" study. The safest place for a patient is in the hands of a well trained anesthesiologist. That is a blanket statement that requires no studies for back up. A 4:1 staffing model is the norm in busy PP settings. "Aquity adjustment" is not always possible. Something, usually, in such a busy setting goes a miss. No matter what you do, you will always have to put out a fire--one that you hope you can arrive to early enough.... I have supervised before, I know what it is like. I am not against it. I just wanted to clearify what is safest. Putting your loved ones in the hands of your ACT model is one thing. Putting them in the hands of different ACT models is, likely, very different: the diploma mills are producing worse and worse chair sitters. They are arrogant, for "they know not what they do not know." There is stuff out there that is outright shocking.... Suffice it to say that I would never agree to put the lives of those whom I love in the hands of the lesser trained/arrogant. At the end of the day, experience has taught me what is best for my patients, family, and ultimately myself!

Honest. Brutal. Truthful.

 

[Mman]

Friend, do tell me that you are not going to pin this discussion on a "large retrospective" study. The safest place for a patient is in the hands of a well trained anesthesiologist. That is a blanket statement that requires no studies for back up. A 4:1 staffing model is the norm in busy PP settings. "Aquity adjustment" is not always possible. Something, usually, in such a busy setting goes a miss. No matter what you do, you will always have to put out a fire--one that you hope you can arrive to early enough.... I have supervised before, I know what it is like. I am not against it. I just wanted to clearify what is safest. Putting your loved ones in the hands of your ACT model is one thing. Putting them in the hands of different ACT models is, likely, very different: the diploma mills are producing worse and worse chair sitters. They are arrogant, for "they know not what they do not know." There is stuff out there that is outright shocking.... Suffice it to say that I would never agree to put the lives of those whom I love in the hands of the lesser trained/arrogant. At the end of the day, experience has taught me what is best for my patients, family, and ultimately myself!

Can I assume you wouldn't let your loved ones be taken care of at an academic hospital with an anesthesia residency program? I mean what if they put the first year resident in August in their room and the attending was spending 90% of their time in another room tending to various issues? I mean if you argue that you need a board certified anesthesiologist at all times in the room, well that isn't what happens at big fancy medical schools.

Look, I can't speak to the quality of care at every medical institution in the country. I can say that the ACT model when staffed with good anesthesiologists and good anesthetists works wonderfully. I don't need a retrospective study to know that. We could do a prospective study. You'd need an N approaching 10 to 20 million patients to even come close to finding a difference in safety between MD only and ACT model.

And to say that we shouldn't base our practice on science, but should go with what we "know" to be true is just insane. That's the antithesis of modern evidence based medicine.

 

[IN2B8R]

Can I assume you wouldn't let your loved ones be taken care of at an academic hospital with an anesthesia residency program? I mean what if they put the first year resident in August in their room and the attending was spending 90% of their time in another room tending to various issues? I mean if you argue that you need a board certified anesthesiologist at all times in the room, well that isn't what happens at big fancy medical schools.

Look, I can't speak to the quality of care at every medical institution in the country. I can say that the ACT model when staffed with good anesthesiologists and good anesthetists works wonderfully. I don't need a retrospective study to know that. We could do a prospective study. You'd need an N approaching 10 to 20 million patients to even come close to finding a difference in safety between MD only and ACT model.

And to say that we shouldn't base our practice on science, but should go with what we "know" to be true is just insane. That's the antithesis of modern evidence based medicine.

Academic residency programs are different than busy PP gigs, as you may well know. In academia, the redundancy and "presence of mind" of all the providers is there. Furthermore, you invariably adjust providers to patient acquity in academia. In the busy PP setting, that "presence of mind" and redundancy is often lacking. Adjustments to patient acquity is often lacking. You often heavily rely on the person baby sitting the chair and you know the "good ones from the bad ones." That leaves plenty of room for hairy situations, especially when you have more than one sick patient, which is happening with more and more frequency in PP. One more important point that seems missing in your reply: an anesthesia resident, even the brand new minted "August resident" is an extension of you. That resident realizes that his/her arse is on the line and they do not dare screw things up because they realize how badly it can fire back at them. They will call you into the room as instructed and report to you as instructed. I know this first hand, as I too have taught residents. PP CRNAs on the other hand are a different animal: they think that they know enough to handle major problems and, often, never call you into the room until they have either exhausted the patient or all of their knowledge, which, in either scenario, leads to patient suffering in the end.... Fortunately, underlying this entire discussion, is the fact that anesthesia complications are exceedingly rare--not zero, just rare--events. To come up with a study supporting what is the safest staffing model, one indeed needs to come up with a huge N to compute a meaningful difference. But I would say that a simpler, more elegantly designed study does exist, one that is manifest in OR private practice anesthesia everyday: look at all ASA-4 cases and examine all complications--all complications, including long term morbidity and mortality--then examine the staffing model that took care of such patients. You see, I am very pro EBM, I never said that I was not in favor of studies. But practice and experience has taught me what to actually look for in studies, not just promote/do a study simply to achieve an end (which is what AANA and its supporters are doing). What I am not at all in support of are public, unsupported statements, namely that there exists such a study that claims that the ACT model is "slightly better" than the MD-only model and that the ACT model is "proven" to be safe. At the end of the day, as the saying goes, the "onus is on the claimant": if the ACT model is "proven" safe and there exists "EBM" out there that supports this model as, potentially, "safer" than an MD-only model, then I would like to see such "evidence." If your intent was to say that the ACT model is safe enough given our circumstances, then we both are on the same page... But I would never extend that beyond what it is, by saying that it is possibly the safest out there!

 

[pretenda]

My goal is private practice gas/pain. I chose the "best residency" based on the exposure I was going to get. I figured that I can read as much as I want and find as many online lectures as I want at any residency program but I couldnt be exposed to a multivisc transplant, Whipples, heart transplants, hemicorpectomies, etc at any residency program. I made sure it wasn't totally malignant but I also didn't want to take the most cush residency either. I wanted to make sure Id see everything so nothing would throw me off when its my arse on the line.

Find the one that works for you and will give you the best exposure so you can function in the real world on the first day especially if private practice is your ultimate goal.

If you want to go into academics...go to one of the places already mentioned in this thread.

 

[Anesthetist2016]

Where does the ivy league fall into program rankings? Do these names not necessarily carry the same weight for residency programs?

 

[El Dooderino]

Where does the ivy league fall into program rankings? Do these names not necessarily carry the same weight for residency programs?

The ivy league, being an undergraduate sports conference, has a huge effect on anesthesia programs. I've always said Princeton has one of the best anesthesia programs in the country, you'll never meet a grad out of there who doesn't have a great job

 

[lane]

Where does the ivy league fall into program rankings? Do these names not necessarily carry the same weight for residency programs?

about as much weight as the PAC-12, if you're looking to group programs by their football conferences

 

[copes]

How much does the name factor really come into play when looking for jobs or applying for fellowship? Obviously there are differences between a candidate coming from a school considered to be in the top tier and a school at the bottom of the barrel, but what about situations where its not so drastic? Is taking a step off of the "top tier" level really sacrificing potential future options?

I have talked to some residents from top programs who didn't seem to be the happiest, but claimed it was worth it for the training and the name. At the same time, I've talked to residents from programs outside of the top tier (but still good schools) who seemed very happy with residency and claimed they would still be able to get jobs/fellowships where they wanted.

I'm just confused as to the magnitude of the name factor and if it is the end-all, be-all when considering ranking or if it really is not a huge thing.

I also have the same question. Could a resident/fellow/attending give some insight?

 

[michigangirl]

I also have the same question. Could a resident/fellow/attending give some insight?

The problem with this question is-- name is neither the end-all be all nor "not a huge thing"-- it all depends. It depends on what you want to do, where you want to go....Being at a "big name" can never really hurt-- but in some circumstances it may not help that much compared to another program. Often private practice jobs are won with word of mouth, references, this guy knows that guy and thinks your awesome, etc.-- there are networks everywhere. If you want to be an academic, then a big academic name definitely works to your advantage if you have letters from folks who have been successful in academics and are known in the field and among their peers. But this doesn't mean you have to go "top tier" to get a great job that you'll love. So it's not all or nothing. it's helpful, but if it's not for you, you have plenty of options.

 

[positraction]

You'll never meet a grad from Princeton's anesthesia program...

 

[deleted126335]

The ivy league, being an undergraduate sports conference, has a huge effect on anesthesia programs. I've always said Princeton has one of the best anesthesia programs in the country, you'll never meet a grad out of there who doesn't have a great job

People don't seek out ivy league schools for the quality of their sports teams.

 

[El Dooderino]

People don't seek out ivy league schools for the quality of their sports teams.

Thanks! This post was both necessary and useful

 

[deleted126335]

About as useful as yours.

 

[copes]

The problem with this question is-- name is neither the end-all be all nor "not a huge thing"-- it all depends. It depends on what you want to do, where you want to go....Being at a "big name" can never really hurt-- but in some circumstances it may not help that much compared to another program. Often private practice jobs are won with word of mouth, references, this guy knows that guy and thinks your awesome, etc.-- there are networks everywhere. If you want to be an academic, then a big academic name definitely works to your advantage if you have letters from folks who have been successful in academics and are known in the field and among their peers. But this doesn't mean you have to go "top tier" to get a great job that you'll love. So it's not all or nothing. it's helpful, but if it's not for you, you have plenty of options.

Thanks!