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