Temple, Anesth

Temple, Advanced, 8 positions

I love Philadelphia. It is a beautiful, beautiful city. There is a lot of pathology to be seen at Temple.

My interview experience was strange. PD walked into the room and spoke extemporaneously about the program rotation by rotation, took 90 mins. He seemed approachable but did not ask us to introduce ourselves/did not foster a discussion of any sort. He left immediately after the talk and the interviews started after.

Dr B: Seemed friendly, asked me why anesthesia, how electives, where electives.
PD: Before I even sat down, had asked me to describe the qualities that would make me a good anesthesiologist. Talked about my future goals.
Dr F: The nicest, it felt like he really wanted to get to know me, and we talked about his vision for the residency program.

Residents: They were in and out fast. Tour was short and quick. We went inside the OR but only at my insistence. ORs seem good, spacious. No EMR yet, getting it next year

PROS
H1B possible
PHILADELPHIA
Level 1 trauma and burns
Transplants including liver
Most rotations at Temple: 32-33months at Temple
Great patient pop: Underserved, inner city as well as very advanced referral cases
32 full time faculty, 50% trained at Temple, the rest trained outside.
9w orientation starts with CA1. Classroom orientation, sim center, assigned faculty member for structured learning.
CA1: 75% finish a CT rotation
Critical Care month in CA1:staffed by 2 surgery, 1 anesth, 1 E med resident with equal responsibility. Call every 4th day on critcal care month.
Neuro ICU in CA2: Anesth is the only resident working there, day rotation, no call.
Peds at CHOP: fantastic, 8 weeks, all teams start and finish on the same day, didactics for 8 weeks, well structured and the same no matter when you do it during the year.
CA3: 5.5months of selectives: Rank order wishlist and he tries to accommodate everyone's top priorities. Popular: Neuro, Cardiac, Thoracic, Peds at CHOP-peds cardiac anesthesia. St Chris rotation where you can manage OR board.


Didactics: Not great, but getting better. 6:15 to 7am resident conferece on Wed. Followed by grand rounds/m&m/case conf 7-8am.
Tuesdays: CA 1 and CA2/3 have separate lectures, protected time.
Mock orals happen 3-4/year for CA3, and 2-3/year for CA2.

Support of national meetings if presenting. Will only sponsor for ONE DAY that you're presenting at. IF you want to stay longer, pay for it yourself.

Iphones for intra hosp communication

Free parking
$500 book allowance/year

CONS
No Peds here: All peds at CHOP or St Christophers, Mandatory 3m peds rotation there. No other peds at Temple, no peds trauma to temple. Basically don't see any peds cases at all while at Temple.

No transition to private practice rotation

Barely any international elective opportunities: these have to be set up at residents initiative, not easy to get done

Research: weak, not mandatory, no dedicated research time during CA1 CA2. Can take a few elective research months in CA3 (between 3 to 5 m) to finish/publish papers.
Sim Center access only 3 to 4 times/year.

CALL: 24 hours, till 7 am. 6 calls/month throughout residency, no changes. In CA3, you can arrive at 11am. Call team: 2 attendings (1 OB), plus 5 anesth providers (resident/CRNA)

CA3: No 'running the board' rotation. Can maybe work 1 week with schedule runner, thats it.

Realisitically, will only use Sim lab 2-3 times/year

I asked Residents: 'Getting work done vs Resident education' They said, its 50-50.

Surgeons not pleasant to work with, not sure how much the Anesth attendings stand up for the Anesth residents inside the OR.

Didactics are not structured enough in my opinion.

CALL is so frequent. Work hours: Get in at 6am, usually stay till 6pm.

NO EMR yet, but will have by 2015. ?take it for granted?

CURRENT RANKING:

0. Uni of Iowa Anes, Iowa City, H1B, categorical

1. Metrohealth Anes, Cleveland. H1B possible, Advanced, requires prelim

1.5 LSUHSC Anes, Shreveport, J1 only, categorical

1.7 Temple Uni Anes, Philadelphia, H1B, Advanced, requires prelim

2. Henry Ford Anes, Detroit, H1B possible, categorical

2.5. UF-Jacksonville Anes, Jax, J1 only, Advanced with linked Surgery prelim

3. New York Methodist Anes Brooklyn, out of match, H1b only if already sponsored, req prelim

4. Metrowest TY, Framingham, only J/ Griffin Hosp, Derby Int Med, H1B possible

4.5 Providence Hospital, Southfield, Gen Surgery, H1B possible

4.7 Abington Memorial, Abington, Gen Surg, J only but H possible (?) This is good if I have anes in place already. Rethink other wise.

5. UIC MGH Surgery, Chicago, only J

5.5. Hurley Med Ctr, Flint TY. H1B possible

6. St Agnes, Baltimore Int Med, H1B possible

7. Uni at Buffalo Sisters of Charity, Buffalo Int Med, J1 only

9.Bronx-Lebanon, NYC, Surgery H1B possible

Abington Memorial, Philly (I LOVE PHILLY!!)

Surgery, 4 prelim positions, J1 only (exceptions MAY be possible)

Interviews:

Dr W: Asked about clinical rotations, asked me to reiterate my interest in Anesth. Asked me why surgery over Int Med/TY. I talked to him about learning to optimize surgical patients, being part of the OR team. Talked about 'what do you do outside of the hospital', I mentioned reading and naturally he didn't seem too happy. He asked about physical pursuits and I told him about running and working out and waterpolo team in college. Said 'I want my residents to be happy outside of the hospital, happy residents are those that have a life'
'You wont get weeks and weeks off to interview next year. Our responsibility extends only over this prelim year, we do not invest our time finding you a job after. You cannot take too much time off, because you are not a child anymore, you need to grow up and step up to the responsibilities as a surgical intern' Ugh...

Dr M (PD): Excellent credentials, he said. Talked about my experience as a visiting student, I emphasized the hands-on nature of the rotations, that I didn't do any more after graduating because it would have only been an 'observership'. I talked about my excellent interview at LSU, he asked if they require a prelim from outside (I said yes. Oh no. Lie). He asked me to rate my clinical skills on a scale of 1 to 10. I laughed, then I said, 'My skills are good, I have no problem communicating with patients, getting a history or doing a physical exam. I have never had any problems with patient interactions' He replied saying, I believe that, I can see that from the way you present yourself. Just from talking to you for five minutes, even though I have never worked with you, I can see that your clinical skills are probably good. I said thank you. (It is hard to market myself this way, I feel like I am objectifying myself, creating a 'brand' and selling it mindlessly. I am still extremely awkward about it when an interviewer compliments me on my self-motivation/grades/communication/whatever) I just say 'thank you, I appreciate it.'
I sold myself pretty hard to him.
I asked about maybe completing some sort of research in my prelim year, he said, 'I will be the last person to stop you from doing that. However with your 80 hour work week and adjustment issues etc, I'd be happier if you would take some time off to just relax and be happy. I want residents to be happy. If however you are motivated to do something I wont stop you.'
Also 'yes you will have time off to interview next year if you need it. We want you to be successful, we will support you'

Dr N: Talked to her about the ICU experience. Talked about why surgery prelim for anesthesia. Talked about living in the area, talked about needing a car. Talked about an elective month in anesth during my prelim year, she says they try their best to be flexible but are not always able to accommodate. Talked about 'surgical experience in India'. I told her about internship year in India. She asked 'do you know how to scrub/have you scrubbed in'. I was amused. 'Yes I have scrubbed, assisted, done a simple case under supervision. Have closed skin several times. Done a lot of procedures: pleural taps/ascitic taps/lumbar punctures etc. Not sure if that is relevant to surgery....she interrupted and said, 'Well procedures are procedures, either you can do them or you can't.'
She rushed me out pretty quick saying 'I'm sorry, I have other people to see'

PC talked to me, separate short interview about visas. Really appreciated this one.
She said J1s only, I showed her the info packet that she gave to us where it said clearly H1 is available. She apologized for the misinformation and said thank you for bringing that to her notice.

I told her I was taking step 3 soon, and she wrote it down, I asked why it mattered, she said 'well it's always good to know'
I asked if there were any exceptions to the J rule, she said 'Yes'
I said 'are you getting my hopes up?'
She said, 'just keep us posted on your scores' Cryptic. But I appreciated that she told me that it MIGHT be negotiable.

Call:
-4w night float: 1 SR+2JR+2 Interns to cover. No transplant/cardiac emergencies, mostly vascular/general/emergency
-No home call
-12 hour calls on both weekend days to maximize availability of golden weekends
-Sometimes Sat overnight call
-Every 5 wks, 3 weekends working, 2 weekends golden




PROS:
-H1 MAYBE
-PHILLY! I love Philadelphia. I really liked Abington too. Safe neighborhood, rich.
-Residents are happy
-Full support for presenting at conferences
-Private practice but lots of autonomy
-Busy ER: 100,000 visits/yr
-Lots of geriatrics
-Lots of faculty are products of Abington Memorial's surgery residency and so they are personally invested in the quality of education here
-Protected didactic time about 1 hour in the mornings twice a week
-Lots of procedures. Interns avg 120 log-able cases/year
-Chief's clinic: resident run clinic, faculty supervised. Lots of autonomy. Underserved patient population.
-Students from Temple, Drexel and PCOM

CONS
-Week long blocks for vacation
-Not sure how much time off I'd get to interview again next year. Chiefs said usually 7 days given for interviews. This does not seem like enough time. Chiefs make the schedule and they seem supportive, but not incredibly supportive.
-No dedicated research time
-Hard hard work
-Level 2 trauma, mostly blunt, nothing penetrating
-No anesth rotation in PGY1
-No dedicated ICU rotation, just enough to get the required experience on the transcript. Interns part of the Trauma service, which includes rounding in the ICU every morning for a month and managing incoming trauma's the rest of the time. Not sure if I'll get enough?
-No electives in PGY1
-No outside rotations possible at bigger hospitals in Philly
-Not much scope to interview/do meaningful research in one year.

CURRENT RANKING:

0. Uni of Iowa Anes, Iowa City, H1B, categorical

1. Metrohealth Anes, Cleveland. H1B possible, requires prelim

1.5 LSUHSC Anes, Shreveport, J1 only, categorical

2. Henry Ford Anes, Detroit, H1B possible, categorical

2.5. UF-Jacksonville Anes, Jax, J1 only, Advanced with linked Surgery prelim

3. New York Methodist Anes Brooklyn, out of match, H1b only if already sponsored, req prelim

4. Metrowest TY, Framingham, only J/ Griffin Hosp, Derby Int Med, H1B possible

4.5 Providence Hospital, Southfield, Gen Surgery, H1B possible

4.7 Abington Memorial, Abington, Gen Surg, J only but H possible (?) This is good if I have anes in place already. Rethink other wise.

5. UIC MGH Surgery, Chicago, only J

5.5. Hurley Med Ctr, Flint TY. H1B possible

6. St Agnes, Baltimore Int Med, H1B possible

7. Uni at Buffalo Sisters of Charity, Buffalo Int Med, J1 only

9.Bronx-Lebanon, NYC, Surgery H1B possible

Providence, Southfield MI

SELECTION:
900 apps, 6 selection members, 125 selected for interview.
75-80 are invited to interview.
Each candidate has 3 interviews with faculty.
Graded on spreadsheet= democratic
Then rank order list

Pros:
-H1B possible. Step 3 required at time of Match for H1B. Some Step 3 score better than not having a score at the time of ROL deadline. No cap on number of H1s, ie, every resident that wants to start on H1B will be able to as long as they fulfill requirement.
PC says I should give in a Step 3 score as soon as I can, an 'okay' score won't push me down the list, but a great score my push me up.

-Call: Night float for all interns. Sundays always off, unless on call. If Sunday call then Saturday off and Mon post call day. Usually weekend call = 3/month. Have to come in on Sat morn to round with team on 'off' weekends, gone by 10 am.

- Small class: PGY1= 6 prelims +3 cats

- Protected Didactics: No cases on Wed, only have to take care of floor. about 4-5 hours of didactics. Lectures, skills lab, journal club/M&M etc

-Research: staff gives resident first author status. Residents get 2-3 publications in intern year, if interested. Animal lab, tissue culture lab, PCR. Staff is present: statisticians, research coordinators.

-Vacation: Taken in 2 week block (for international travel) and 1 week + Conference time later in the year. If days off needed to interview, then the Chiefs usually take care of it. Some 'interview' days off are allowed.

-Private

- In OR from Day 1.

-Radio rotation in prelim year.
-No fellows, very good technical and hands on skill development
-All experience is private practice experience
-Unmatched prelims: may or may not be absorbed here.
-Residents seemed happy. Chiefs are approachable, they make the schedule, try to accomodate everything every one needs
-Enough ICU experience to feel confident.

Cons
-Surgery
-Southfield, Detroit
-Not sure about support available for pursuing anesthesia if I dont match
-No elective in prelim year
-No anesthesia month
-Private patients mostly. Lots of experience with private attendings.
-ICU run by pulmonary critical care trained intensivists.
-EMR for labs but hand write notes
-Level 2 trauma (not level1) All trauma here is MVA/blunt trauma/hit on the head cases.
-'What is the worst part?' - we are frustrated working with some attendings who wont give us the autonomy we know we are capable of. Some attendings give us more independance than others.

CURRENT RANKING:

0. Uni of Iowa Anes, Iowa City, H1B, categorical

1. Metrohealth Anes, Cleveland. H1B possible, requires prelim

1.5 LSUHSC Anes, Shreveport, J1 only, categorical

2. Henry Ford Anes, Detroit, H1B possible, categorical

2.5. UF-Jacksonville Anes, Jax, J1 only, Advanced with linked Surgery prelim

3. New York Methodist Anes Brooklyn, out of match, H1b only if already sponsored, req prelim

4. Metrowest TY, Framingham, only J/ Griffin Hosp, Derby Int Med, H1B possible

4.5 Providence Hospital, Flint, Gen Surgery, H1B possible

5. UIC MGH Surgery, Chicago, only J

6. St Agnes, Baltimore Int Med, H1B possible

7. Uni at Buffalo Sisters of Charity, Buffalo Int Med, J1 only

8. Hurley Med Ctr, Flint TY. H1B possible

9.Bronx-Lebanon, NYC, Surgery H1B possible

EDIT: I am considering ranking Hurley higher because I see AP chilling. However, he has connections/family there so he is happier. But seems like a relaxed TY

To Step 3 or not to Step 3

Things become clearer every day. Now that I’m done with October, November and December; I feel relatively relaxed about January. January requires a lot of planning, and probably more flights than I’ve used within the last three months.

January involves travelling to more esoteric locations such as Johnstown, PA; Youngstown, OH and Pittsfield, MA. In addition, I absolutely MUST take step 3 before Jan 15^th. This will probably involve cancelling one, maybe two interviews. Am I being too confident, overconfident perhaps? I know people that are struggling with a lack of interviews, but after doing 7 Anesth, 2 TY, 3 Int Med and 3 Gen Surg (Southfield coming up!) interviews so far I feel like it’s a waste of time (and money!) to invest in any more out-of-the-way locations.

Step 3, on the other hand, will give me the boost I need for my H1B programs: Griffin, Metrohealth, Iowa. All of these are places that I prefer over LSU. I deserve to give Step 3 a shot.

Worst case scenario:

-I fail Step 3, no one finds out, I match into whatever place and start on a J.

Slightly better but still less than ideal:

-I take Step 3, barely pass, I tell no one, match into whatever program and start on an H (Except LSU, where Step 3 doesn’t play any role because they’ll only give me a J)

OR

-I take Step 3, barely pass, I tell everyone. Then I risk being moved lower/higher on the rank list based on their philosophy. Still, potentially might give me an edge over the other international applicants. Hopefully match somewhere. If Iowa hates me (bye bye H!), hopefully LSU(only J) will still have me.

Good but not the best:

-I get a decent score (220 – 230), I tell everyone. Match wherever, except LSU. And start on H1.

Best case scenario:

-I score in the 240s. Tell everyone, EVERYONE, without being coy. Match to an H1 program.

So given that I have about a month’s worth of time in my hands, COULD I POTENTIALLY kill Step3?

Also, is it worth the cost? The cost = Cancelling the following interviews:

-         Howard Uni, DC : Int Med

-         Conemaugh Memorial Med Ctr: Int Med, H1 possible

-         Berkshire Med Ctr: Surgery, have emailed about type of visa

-         Charleston Area Medical Center: Int Med, Sana so cannot postpone, J1 only

-         WRHE/NEOMED Youngstown, OH: Int Med, have emailed and asked about type of visa

Perhaps I should check the visa details for these 4 programs and then figure it out.

I need sound advice from a resident doing Anesthesia on a J visa. I need to talk to someone candidly about this. Ask them what is terrible about a J visa.

OR

I don’t have to compare visa types at all, given that the J programs I have interviewed at don’t want me to give them a Step 3 score: And they are likely to rank me independent of Step 3. So my chances of making it into a J program DO NOT CHANGE HENCEFORTH, with or without Step 3.

ALSO: Taking step 3 is not ‘optional’ at this point. I AM GOING TO TAKE THE TEST in the next 30 days. We’ll decide what to do after I have a score. Therefore it is redundant to ‘talk to someone about the pros and cons of J’.

Getting on a J is easy once I have an H. The inverse is not true. Also, after I match, I can decide to use a J instead of an H.

Basically, taking Step 3 keeps more options open for me, when compared to not taking Step 3.

The cost is giving up on being placed on 4 program’s prelim rank lists.

Thanks for clearing my head, dragonsgate. You always help.  

Iowa, memories

I regret not writing about Iowa, I forget the details.

Interview with Chief Resident: he told me that Ive done well for myself to come this far, that I should be proud of myself.

Pros:
-H1B
-2m intro to anesth in PGY1: 1m didactics, 1m 'two headed intern' rotation. Two interns in the OR, 1 attending
-No call first few months CA1
-Night float system for all days
-Incredible Sim lab, frequent frequent simulations. Residents create sim modules for anesth practice
-lots of protected didactics
-full support when presenting a paper outside
-lots of in house research
-Iowa city
-residents are so nice... bend over backwards to support each other
-residency sponsored 'party fund': Drinking.bowling
-The only fellowships they dont have is OB and Peds.
-During lunch a PGY1 walked up to me and said 'I know you like to read, I saw that in your profile, did you know about the Iowa Writers Workshop?' Then we talked about Abraham Verghese. I was so touched/impressed by the sincerity of his interaction with me. I was taken aback that he actually bothered to read my profile. He had the most empathetic, soulful eyes ever. His eyes. Oh my god, I'd want my doctor to have those eyes. So understanding, gentle and full of pain. Like he had experienced a lot of pain in his life and all he wanted to do now was to find other people in pain and then take the pain away. It was incredible.

He walked away, said: I have to go back to my room now.
He came back 2 minutes later, said: If you ever want to come back for a second look, don't get a hotel. My wife and I would be happy to have you stay for a few nights. When I was interviewing, I remember that the chief resident offered me the same thing. I understand how tough interview season is, please don't hesitate to get in touch with me.
He wrote his email address for me and left again. I loved it. I LOVED IT. This is the kind of environment I want to train in.

-3 hours from Chicago
-At the moment, this is the best interview I've had, reputation wise.
-They gave us all an Iowa Anesth mug filled with chocolate at the end of the day.
-International electives!


Cons
-Current PGY1 year seems all married
-Not many indians
-Iowa city

I believe a part of me was influenced by the attention I got from AP the night before when we talked about the program. Out of all the places I'm interviewing at, this is the only place that he seemed to have heard of. Granted, this is probably because he focused on the Mid West only.

-'Iowa is great! Good research, great didactics. Its not far from Chicago. I know people that interviewed there, they liked it'  and 'U Iowa is a well respected institution'
Now when someone from Northwestern says a certain program is great, and that they have friends (presumably from Northwestern too) that interviewed there, it automatically raises the bar in my head. So now I'm thinking, Iowa has to be awesome if northwestern is interviewing there.

Iowa told me in the interview that they do not normally invite too many foreign students to interview. So I guess they think I deserve it if they invited me.

LSU HSC

Group interaction in the beginning was odd. Dr Herron was curt, so was Dr Fox. When I mentioned that I rotated with them earlier, they seemed a little more open. Perhaps this was because they did not want to appear as though they were singling me out from amongst the rest of the applicants? Who knows. Things changed immediately during my individual interviews.

Dr F: Supposed to be a 15 min interview. Shows me the keychain I'd given him last year. Says 'look I still have it'. Asked me how the dinner was the night before, how the day was going.
Spends next 7 minutes telling me how:
-The staff and residents here are pulling for you
-Across the Board, people are vouching for you
-You have impressed everyone here during your rotation
-I have not a single bad thing to say about you or your applications
-Do you have questions?
I had none. I told him I understood the program. I know it well.
-Well ok then. I have nothing more to say. Excuse me while I run downstairs and pick something up from my wife.
Walking out the door: Nothing but good, nothing but good. Nice seeing you again, goodbye

Dr H:
-I would be comforted and reassured by having you in my residency. I would pick you in a heartbeat. I was impressed by your work during the rotation. Your clinical skills, your patient interaction and they way you carry yourself is impressive. I look forward to having you here next year.

Dr Y: talked about the neuro case we did together. And travelling.

Dr D: He said the staff really wanted me on the team. Then we talked about his plans to go into private practice.

the coordinator said 'everyone already loves you'

I met Dr Vee and Dr Pee and they were both so have to meet me! They all said I have a sure shot of getting into LSU. All of them were so loving and so supportive. They asked me the other places im interviewing at, they were pleased at the number of interviews I had.

Dr P: Ran into her at the gym on the tour. She got off the cross-trainer and talked to me. Said 'you did good'. When I thanked her she said 'you deserve this'

Dr S: wanted to chat with him, I had a chance to duck into his office between interviews but he seemed busy. 'I don't recognize you all dressed up in that suit'. After the interview/lunch etc, I tried to talk with him but he wasn't in the office. I left with everyone, texted him on the way down: Hi, I wish we'd had more time to catch up, but I guess you're in the OR. He replied: I'll be in my office in two minutes. Wait for me there.

I told the shuttle to leave without me (awkward!). Walked back to anesthesia.

Sat down with Dr Saus. He whispered to me: We had a discussion earlier before interviews started. They already love you. I can't tell you this but you're in the top 10.
I was shocked.

Top ten!

We talked about what I'd done in the past few months and what my plans are in India before I start residency. I told him I wanted to work in the ER for a bit just to keep in touch clinically. He was impressed, said it would be great experience for me.

I told him all the other places I interviewed at and he made a list on a piece of paper. I could tell that he wanted to support me the whole way.

I tried to find the right words to thank him, but everything seemed so inadequate. I told him how he was my strongest advocate, a great teacher, and my most cherished mentor. He replied saying 'I was impressed. You demonstrated that you were interested and learned quickly, then performed well. It was a pleasure to work for you'

I told him how it was so nice of him to give me all the chances to prove myself. He let me intubate several times, he taught me how to start art lines, and let me do them on my own on 3 occasions. He taught me the single handed surgical crossed knot (reefing) using IV tubing (my idea, which he really liked). He let me play with the TEE after a heart case was induced and while the surgeons were getting ready to start.

If he hadn't given me multiple opportunities to try things, I would have never been able to shine.

He told me again that 'he hopes to see me here soon' and that 'If you're ever in the area I should like you to come home and meet my wife and dogs'

He hugged me on the way out. Left in a hurry, paged to the OR.

SIGH....

After I left, I chilled at the Hilton bar for a few hours, just reveling in this feeling of being desired.
I texted the residents I hadnt met during that day and they all replied saying 'we KNEW you were coming today but I am post call/I am at the VA/I am sick' and 'i'm sure you did great, I hope you match here. Good luck'

God I felt so loved.

PROS:
-I'm already part of the family
-Research is being revamped. Chairman is well connected. 13 presentations at ASA, and growing every year. Book chapters all the time, case reports all the time.
-New machines coming in
-Starting a sponsored MBA position
-Chairman very forward looking, talks of training in perioperative management
-Didactics now include enrollment in the START program online
-Trying to set up liver transplant away elective
-Ditto for a private practice away rotation.


CONS:
-NO H1B
-Shreveport
-Used to be on probation (7 years ago), currently have a warning status. PD explained, they have asked for a report that we are writing and processing. Annual inspections force them to stay on their toes.
I am reasonably certain that with the current leadership, this program is going to get better and better.

CURRENT RANKING:

0. Uni of Iowa Anes, Iowa City, H1B, categorical

1. Metrohealth Anes, Cleveland. H1B possible, requires prelim

1.5 LSUHSC Anes, Shreveport, J1 only, categorical

2. Henry Ford Anes, Detroit, H1B possible, categorical

2.5. UF-Jacksonville Anes, Jax, J1 only, Advanced with linked Surgery prelim

3. New York Methodist Anes Brooklyn, out of match, H1b only if already sponsored, req prelim

4. Metrowest TY, Framingham, only J/ Griffin Hosp, Derby Int Med, H1B possible

5. UIC MGH Surgery, Chicago, only J

6. St Agnes, Baltimore Int Med, H1B possible

7. Uni at Buffalo Sisters of Charity, Buffalo Int Med, J1 only

8. Hurley Med Ctr, Flint TY. H1B possible

9.Bronx-Lebanon, NYC, Surgery H1B possible

iowa IOWA IOWA!!!

This is it, boys and girls.

THIS IS IT.

Enough said.

Florida

UF- Jacksonville, Anesthesia: 4 spots, advanced. But link their surgery prelim.

PROS
Small program
Residents happy, supportive
Education focused. They don't need residents for manpower.
Call is once/week, maybe 3 times/month. No call first 6m. 24 hour call on T/F/S/S for trauma exp.
Level 1 trauma, high risk obs
Transplants at Mayo, CCU rotation at UF Gainesville, Peds rotation at Proton(bread and butter,one of 6 in the country) and at Wolfson (big peds cases)
CHAIR is very resident-oriented, strong contacts, will get a job anywhere
Aspire to be the 'best small program' by next year
Lots of nurturing, good city, happy residents.
STRONG scheduled didactics. Seperate CA1 lectures. Largest SIM center across the street. CSESAR, Regional and USG workshops.
Cases: inner city hospital, large variety of cases, uninsured, no work up etc. Similar to case diversity in NYC.
CA3: 2m rotation 'transition to practice': Running the OR, Lectures and practice on how to schedule and run the OR
EPIC EMR
Residents lounge: gym, free food
Food: 1200/year, they don't run out, use to buy food for patients
2 bedroom apartment $850/month



CONS
Only J1 available, H1B visa not clear
Program director has changed twice, and is changing again. LOOK IT UP
No in house transplant

Interviews: Behavioral. lots of challenging questions. I feel I like them more than they like me.

CURRENT RANKING:

1. Metrohealth Anes, Cleveland. H1B possible, requires prelim

2. Henry Ford Anes, Detroit, H1B possible, categorical

2.5. UF-Jacksonville Anes, Jax, J1 only, Advanced with linked Surgery prelim

3. New York Methodist Anes Brooklyn, out of match, H1b only if already sponsored, req prelim

4. Metrowest TY, Framingham, only J/ Griffin Hosp, Derby Int Med, H1B possible

5. UIC MGH Surgery, Chicago, only J

6. St Agnes, Baltimore Int Med, H1B possible

7. Uni at Buffalo Sisters of Charity, Buffalo Int Med, J1 only

8. Hurley Med Ctr, Flint TY. H1B possible

9.Bronx-Lebanon, NYC, Surgery H1B possible

Flint, MI

HURLEY MED CENTER: 8TY, might decrease to 6 because they are trying to expand their IM program.

Weird fact: They made us try on Lab coats.

Pros
-H1B possible, they need Step3 at the time of match/visa app. The PC said Step 3 scores do not matter when it comes to being ranked.
-Level 1 trauma, Level 2 peds ICU, Level 3 NICU. VERY SICK KIDS HERE.
-No research requirements/Just present one poster or paper
-1 noon conf presentation/year is mandatory.
-Attendings/Residents easy to work with
-Patient pop: mostly uninsured. 'Hurley is the Cook County of Michigan'. Most patients are teaching patients. No heavy involvement in private patients.
-ED rotation: Adult (level 1 trauma) and Peds. Can play around with FAST. First responders. Central lines, several. Intubations.
-Resident autonomy +++. Once they trust you, you can drive the plan.
-Great Lib: nice interiors, great selection, available online, open 24/7 but librarians only around certain hours. Can come in and read anytime. Comfy chairs to take a nap.
-4 blocks electives: Anes, Surg, CCU, Cardio, Nephro, Radio, Pulm Med. MOST SPECIALTIES are run by private attendings who like to teach. But no central referral service. So working with private attendings on Cardio month. High level of autonomy for same reasons.
-ED 19 shifts/month, 10 hour shifts
- Housing on campus: $300/month for upto 9 months. Personal room and bathroom, shared kitchen
-Can do ICU elective: On electives, weekends off and not on call schedule.
-Intern cap in general ~5 patients
-Night float: total of about 4-5 weeks in the year, not all at once
-Cost of living: 1BHK 600-900$/month. 2 bed 2 bath in Burton 1000$/month
-BACKDOOR: They like to take TY's into Int Med residency. HOWEVER TY is not the same as Med PGY1. Hence have to repeat PGY1.
-Dental work: covered once per calender year. Start the year and get it done in Aug. Then get it done again in Jan/Feb


Cons
-Living in Flint: Closest fun place is Ann Arbor/Lansing/Troy. Have to drive. Lonely. Residents live in Grand Blank
-No support after TY, no one here is into Anesthesia. Anesthesia at this hospital is done by a private group of physicians. CRNA training program exists, Anesth elective available in TY but no support if no Anesth residency lined up after
-Didactics based on the specialty you are rotating through in that month. Therefore, no structure. No idea which set of lectures you will have at which rotation.
-1/3 TY class do not match further. Support? On avg, most 'find something eventually'
-No away electives.
-4 blocks electives, vacation must be taken ALL AT ONCE and in an elective block.
-Call can be once every 3 days. Till 10pm.
-'What's missing?' 'No subspecialties like cardio'
-NEED A CAR
-IPD peds and IP ICU can be tough. Cap at 4-6. NO ICU DIDACTICS AT ALL. ICU team= 1 attending/senior resident+2 seniors+2 interns. 12 hours overnight call.

TY Schedule
EM 1 block
CCU 1 block
Int Med 2 blocks
Ped OPD 1 block
Ped IPD 1 block
OBGYN 1 block
Geriatrics 1 block
Electives 4 blocks

INTERVIEWS: They really wanted to feel us out. Very probing, tried to be tough on us.

PD: Case 75 yo male, pre anesthetic check up, Said im a strong candidate,  but might have visa issues. 'You have done your homework, you have come well prepared'

Acad Officer: Behavioral. Hardest decision I made. Something weird about america. What makes your personality unique. What would you change about yourself. How would you spend a billion dollars. Said I was 'detailed'.

Chief Res: Asked how I spend free time. Asked won't anesthesia be repetitive. Asked about time management skills.

Dr HG: Why anes, what rotations have you got in mind. questions on geriatrics (highlight this). 'You have done your homework, you have a clear plan, that is good.' SHOWED HIM THE MAG.

IMPRESSION: they liked me more than I liked them. I'm happy not studying at Flint. There's no advantage to coming here, ESPECIALLY if I don't match to anesthesia.

CURRENT RANKING:

1. Metrohealth Anes, Cleveland. H1B possible, requires prelim

2. Henry Ford Anes, Detroit, H1B possible, categorical

3. New York Methodist Anes Brooklyn, out of match, H1b only if already sponsored, req prelim

4. Metrowest TY, Framingham, only J/ Griffin Hosp, Derby Int Med, H1B possible

5. UIC MGH Surgery, Chicago, only J

6. St Agnes, Baltimore Int Med, H1B possible

7. Uni at Buffalo Sisters of Charity, Buffalo Int Med, J1 only

8. Hurley Med Ctr, Flint TY. H1B possible

9.Bronx-Lebanon, NYC, Surgery H1B possible

Case and Henry Ford

CASE WESTERN/Metrohealth

I was skeptical: this is Cleveland.

Interviewed with 7 others. I was the only one that needed a visa. 3 current surgery residents were interviewing for anesthesia. There were 3 Caribbean students, US citizens. I was the only foreigner.

There were only 4 candidates at dinner, with around 6-8 residents. Candid residents. Very friendly. Talked openly.

·         PROS:

o   H1 B possible

o   Residents are happy, very confident, camaraderie+, they hang out downtown a lot. Mix of married and single residents.

o   TRAUMA experience so intense. Level 1 trauma. Important Burns center in Cleveland. TRAUMA ANESTHESIA!! NICU level 3 (highest level). High risk OB.

o   County hospital, so mix of LES and HES patients.

o   Newly renovated ORs (2004), new anesthesia machines. Apollo drager. >20 ORs

o   28 attendings~21 residents.

o   CWRU students rotate, also students from other schools.

o   GYM in the hospital, 45$/month. Access to Veale recreation center, also access to all of CASE resources: Lib/Labs etc

o   Insurance with no extra charge for vision/dental plans

o   FINANCIALLY STABLE, and expanding.

o   Great Sim lab: Dummies. Plus might get a new USG training module.

o   Great didactics: 4/ week. Lectures staggered based on year. CA1 have separate basic lectures. CA2 and 3 have advanced lectures.

o   No fellows, so lots of autonomy, CCF fellows come to metrohealth and are overwhelmed by trauma. Not so for residents here. However no sink or swim attitude. ‘Residents work as fellows’

o   Fellowship placements are high: including Johns Hopkins, UPMC, Uni of Iowa.

o   All surgical specialties are equally representated. Lots of regional done here

o   CA1 49,000 CA2 50,000 CA3 53,000.

o   No SRNA training here
21 attendings ~7 residents/class

o   In house moonlighting allowed on the Lifeflight plan

o   Outside moonlighting is also permitted

o   Lots of really sick patients, and so lots of confidence

o   CA3: 6m elective time. Can do research, but they are not very interested in research electives. They don’t care about not doing research but if you do research then they support you fully. One faculty is into research. Research is clinical oriented, not basic science! GREAT

o   CA1 1500$/year for books/tablet. CA2 and 3 2000$/year

o   Meal cards 90$/month.

o   Vacation time can be scheduled in one day increments, no need to take 2 or 4 weeks ‘blocks’ off

o   If presenting at a conference: Days off NOT taken from vacation, financial support for travel and hotel.

o   Board Exam: paid based on ITE results. 30 percentile get 50% off, 40 percentile get 75%off, 50 percentile get 100% cost waived

o   Board pass rate is much higher than national avg.

o   Anesth run ICU rotation in CA2 at VA hospital

o   Supportive, stable leadership. Residents run the residency. Feedback is taken and worked upon.

o   They mix up cases throughout training, so for eg: Even though on neuro cases, might be OB call. So constantly ‘in touch’ with clinical cases.

·         CONS

o   Bottom heavy program: CA1 intense work. Get in at 5:30am, get out at 6:30pm. Call can be upto 8/month. 24 hour calls.

o   CA1 get 7-8 calls/month, CA2 5-7/month, CA3 3-5/month

o   Cleveland

o   No prelim year linked here.

o   CA1 gets out at 6pm, CA2 at 5pm, CA3 at 4pm

INTERVIEWS

Dr T: Went over my entire app with me. Asked about how I figured out the electives on my own, scheduled them etc. He seemed to like that I had planned everything out. Said I was better than the other international applicants. ‘You are self driven and self motivated and that will get you far’. I showed him the magazine. Asked how I would deal with the pressures of residency.

Dr B: Asked me why I picked anesthesia, asked what I like to read. How often I exercise. Talked about the Hunger games and The Game of Thrones. Books are always better than the movies. What am I looking for in a residency program. Talked about my experience at Case Medical Center ER.

Dr K: ‘Do you have any questions for me’. I asked what kind of prelim they prefer. She said anything, IM is more appropriate. Try to get 2m ICU, 1m ER. Strong Renal, Cardio, Radio, Pulmonology ICU rotations. Asked me about a challenge I had to overcome, What accomplishment I am most proud of. Showed her the Magazine. Asked me to email her later when I have questions.

Dr S, Chairman: Spoke to all of us. He is Indian. Told us that they love the residents, but work is hard. I believe him.

This program is awesome because of the strong focus on trauma and how it will turn me into a rock star anesthesiologist that can deal with ANYTHING.

HAVE TO EMAIL mbecker@metrohealth.org TO ASK WHEN SHE WANTS STEP 3 SCORES FOR h1B VISA PROCESSING.

DETROIT: Henry Ford Hospital, Anes, 12 categorical spots (but only 8 for MD, rest DO)

Cons:

·         Detroit

·         No structured didactics: ‘learn by yourself/read by yourself’

o   ‘scheduled lectures often cancelled’

o   CA1 separate lectures: trying to start but not really happening yet

o   SIM lab: CA1 only thrice a year. CA2/3 : one to two times a year.

o   I really would prefer dedicated didactics.

o   Learning on the job is the norm here. With so many of their residents already having post grad training in Anesthesia, I wonder how I would cope.

·         Only 4m electives in CA3

·         Bottom heavy program, like Metrohealth

·         Community program

·         Peds is low: They have designated peds rotation months at Childrens hospital.  Call during that time is Peds call.  The rest of the time, won’t be dealing with pediatric patients at all. No call,  no general peds cases at Henry Ford.

·         CA1 only neuro  and OB (apart from Gen)

·         CA3 only 4m electives

·         I got a nicer, more laidback vibe from Metrohealth. Metrohealth felt like a more American/white program compared to Detroit.

·         Lots of IMGs at Detroit. All Indians here have previous post grad training in home country.

·         Sladen library: ‘terrible place’ 17^th floor, only 9 to 5 timings. BUT everything available remotely with a username and password.

·         Call rooms: basic, bunk beds. Anes resident hangout areas are small, cramped.

·         SIM Center exposure: ‘In CA-1 maybe 3 times/year’

·         3 weeks vacation/year, they like you to take it in 1 week blocks. ‘Sometimes you can get 2 weeks at a time.’ Sick days are taken out of this 3 week vacation.

·         35 attendings~36 residents

·         ITE yearly. Mock oral boards in CA1,2,3. Individually, I will only get a chance to practice about once/year.

·          

Pros:

·         H1B possible

·         Transplants, start by beginning of CA2, Livers+, Intra op MRI.

·         Residents seem happy, lots of clinical experience. Residents say it is a welcoming program.

·         High risk OB, Level 1 trauma

·         No problem meeting numbers. They do more ASA3 cases than avg: This means the residents are constantly dealing with sicker, higher acuity patients. ASA 1 is lower.

·         More regional anesthesia: also implies sicker patients that can’t handle GA.

·         No 24 hour call

·         Intern year includes interesting things: Int Med, Nephro, ENT, Cardio, Pulm, EM, Critical care, Pain med, Transfusion med, Preop clinic, Anesthesia in final month

·         Good orientation, lots of autonomy

·         Fellowship in Cardiothoracic anesth, Pain medicine.

·         Moonlighting possible after cardiac month in CA 2

·         EPIC

·         LOTS of ICU experience. Lots of rooms, patient pathology is incredible. Lots of experience.

·         Resident housing. ~800$/month. Directly behind henry ford hospital. Basement of hospital almost connected to the housing facility. BUT it only accommodates aout 20% of physicians. Usually in short supply. Might need to make transition arrangements for June, July.

·         PGY1 48G, PGY2 49G, PGY3 52G, PGY4 54G

·         Professional devp fund for step 3, iPad, Books, journals, abstract fees. Professional society dues. $300 for PGY 1,2. $1250 for PGY3,4.

·         Iphones for hospital communication: email/text/calls

·         Grads are comfortable going into pvt practice/fellowships. Some ate Henry Ford Hospital faculty.

·         High pass rate for ABA.

·         Good eval process: electronic evals, intra day debriefing. Feedback is given early so time to improve during the same rotation.

·         No SRNAs

·         Many opportunities to teach.

·         No major changes expected, apart from better CA1 didactics for the Basic exam

·         Non clinical responsibilities: presentations at grand rounds, presenting a paper/poster. Need not be published. No one pushes for publication.

·         Sim lab exists

·         Diverse residents, lots of Indians, I will feel ‘at home’

INTERVIEWS: ‘Behavioral’

Dr GA: Challenging patient, How did you organize elective rotations, medical education. Situation where you had to speak up. ‘I have a good understsanding of your work ethic’

Dr WA: speed vs accuracy and why. Deficit in medical training. Working smart and working hard.

Dr AS: Chief resident. Talked about Indian jokes, Dealing with conflict in the workplace. Getting along. Why anesthesia. Said he likes me.

Dr DG: Talked about the comparison between Henry Ford and Hopkins. Mistakes made at the workplace. Talked about what I want from a residency program. I expressed a strong interest in Henry Ford. Said I would fit in well, that he likes me.

CURRENT RANKING:

1. Metrohealth Anes, Cleveland. H1B possible, requires prelim

2. Henry Ford Anes, Detroit, H1B possible, categorical

3. New York Methodist Anes Brooklyn, out of match, H1b only if already sponsored, req prelim

4. Metrowest TY, Framingham, only J/ Griffin Hosp, Derby Int Med, H1B possible

5. UIC MGH Surgery, Chicago, only J

6. St Agnes, Baltimore Int Med, H1B possible

7. Uni at Buffalo Sisters of Charity, Buffalo Int Med, J1 only

8.Bronx-Lebanon, NYC, Surgery H1B possible