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Anaesthesia!


Guest TimmyMax

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  • 4 months later...
There are currently 10 IMG Anesthesiology positions per year in the CaRMS match.

 

Thank you for the reply. I did look it up on CaRMS. I'm just wondering how competitive is applying to this field for an IMG? If you're an IMG, do programs prefer that you have previous post-grad experience or some other extra-ordinary clinical exp that a lowly 4th yr med student would, most likely, not have?

 

Anybody know if there are any IMGs matched into anesthesiology recently?

 

Thanks!

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Thank you for the reply. I did look it up on CaRMS. I'm just wondering how competitive is applying to this field for an IMG? If you're an IMG, do programs prefer that you have previous post-grad experience or some other extra-ordinary clinical exp that a lowly 4th yr med student would, most likely, not have?

 

Anybody know if there are any IMGs matched into anesthesiology recently?

 

Thanks!

I know a few alumni from my school who matched into gas. There's usually a couple every year from my school who take a few of the spots. I don't know how hard it is, but you can look at the number of people who apply vs. match into the anesthesia spots on the CaRMS site. The frustrating part is that in the applicant pool you have a large volume of weak applicants who had no chance, and you have no idea how many people were in that pool that were actually viable candidates to get a "real" statistic.

 

Edit: The weak applicants I'm referring to are mostly the old IMGs who have been out of practice so long that they have significantly lost their medical skills/knowledge, and also fresh grads who just came from really bad schools, and lastly students who were just intrinsically bad.

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  • 3 weeks later...
  • 2 weeks later...

Hmm... unfortunately I have also heard that there seems to be a shortage of jobs. Is this really the case or is it particular to location? I would think that if the population is getting older and needing more surgeries, there would be an equal demand for anesthetists. Anyway, does anyone know what the job situation is like in the rest of Canada, or what the more competitive residency locations are?

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i don't think there are a shortage of jobs across the country. its just in specific locations. Its tight in all of the lower mainland. One I spoke to said he had to do locums for 5 years before getting a staff position. its easy to find a job if you are willing to travel anywhere in the country, but when you think about family and lifestyle it may not be worth it.

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  • 3 months later...

Holy crap, this thread is still alive nearly 5 years to the day after I started it?!? Wow, I'm old! :P

 

Anyway, I was just in the neighbourhood researching something else when I felt compelled to log back onto this site...and here I am!

 

Okay, here's the deal with me- I'm now a PGY-5 anaesthesia resident (still!) here in London and just a month out from my Royal College exams, so I'm not going to have a lot of time, but I pledge to check this thread semi-regularly and answer questions as best I can.

 

For those of you wondering, the Royal College examination in Anaesthesia consists of a written and an oral. The written is sat over 2 days, this year it will be 5-6 April 2011. The first day is 150 MCQs, 1 mark apiece. Supposedly 50% are "new" questions and 50% will be "bank" questions (ie: recycled from previous years). The second day is 20-30 SAQs, which I thought worked out to 150 marks, but that might not be the case. There will be multiple marks per question. Who really knows what the total will be? Fortunately, the written is sat in your centre of training.

 

The oral will take place the week of 7-10 June 2011 in Ottawa. It will consist of 8 oral examination questions, each marked by two examiners. Each question will be 15 minutes long. You need to pass on 9 of 16 scorecards to pass the oral, so I'm told. AFAIK, a "pass" is 70%.

 

Your final score will be 50/50 written and oral. The mark from one can save the other- ie: if you come in just under the water line on one and you've aced the other, then you will pass overall. People who score in the "borderline fail" range get their FITERS (Final In-Training Evaluation Record Sheet) opened and reviewed by the marks panel to see if you're a good person or not. You can be bumped up to a "pass" overall if you have a good FITER and you fall into this category. Hopefully I won't.

 

Anyway, that's the news on the Royal College exams for all of you anesthesia wannabes out there. It will consume your entire existance from about mid-PGY-4 until the end of your residency. Why am I posting here, you ask? Because reading about chronic pain pathways when you're post-call blows, that's why. And the Leafs are getting killed...again.

 

So yeah, I'm back and I might be able to answer your questions about anesthesia. Sorry about my long absence, but that is what residency will do to you. Take care and here's hoping to hear from you again soon!

 

And yes, anaesthesia still rules!

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Hey Cdn,

 

Let's see if I can answer some of your questions...

 

WRT Job market...still looking for a job myself. Not too worried about it because if my primary lead ends up falling through, there are ample locum opportunities out there to be had, and it would be kinda fun to travel around a bit (and make a few bucks while I'm at it!) and see what else is out there. Most times, locums will lead to an eventual job offer if you're a decent person, so it's a nice foot in the door. Plus, you get to see and work in places that you might not have otherwise had on your radar- you never know what you might find out there!

 

In terms of jobbing (is that a word?) in Canada, the main question to ask yourself is academic versus community. If you're looking to work in an academic centre, then it is quite likely that you will need a fellowship- at least that is the case at UWO and a lot of places elsewhere (in my case, I knew that I didn't want to wind up in an academic centre, so I couldn't be ar$ed). Fellowships make your much more marketable in the eyes of the ivory towers and thus increase your chances of landing that dream job at an ivory towered institution of your desiring.

 

As for those of us thinking about community practice, some do take the fellowship route as well- it will make you more marketable to not only academia! Communities always seem to be on the lookout for a guy holding a fellowship- fellowships in pain and paeds seem to always be in demand!

 

On the other hand, one must consider the scope of practice that is waiting for them at their preferred destination, as their skills might leave them for lack of a better word a little "overqualified"- example: doing a fellowship in paeds anaesthesia to eventually work in a community centre that either doesn't do paeds or does nothing more than "bread and butter" community paeds (ie: paeds ENT and dental only, no "complicated" paeds (ie: neonates)).

 

As for pain fellowships, I know that UWO has sent two in the last two years down to the USA to do pain fellowships. One has returned already and is in fact doing pain while the other will be back next year (I think!). While yes, it is outpatient work and potentially chill hours, the whole issue of funding is a major mountain to overcome. I seriously doubt that in Canada it is as lucrative as it is in the USA- the pain types at UWO don't seem to be driving around in souped-up BMWs (but maybe they're just modest- who knows?), but then again, they're not driving around in beat-up 2002 Saturns with 245,000 kms on them either!

 

Getting back to the idea of funding, the reality is that there is simply more of it in the USA, and if you're hoping to come back with your American pain fellowship and set about doing the exciting, wicked, exotic blocks you learned down there (with your own personal C-arm and other cool toys at your immediate disposal), you might be in for a rude awakening. Hardcore interventional pain (the highly lucrative stuff that they have in the USA) seems to be in its infancy here, and if you were the only guy on your staff wanting to do this kind of thing, then you might be in tough convincing the hospital acquisitions board why you need a C-arm, radiocontrast and funky block kits with which to go about it. That said, it can be done, especially if there is already a chronic/interventional pain group in place where you want to end up (definitely power in numbers), but if you're going to be the only guy, it might not be exactly what you had in mind. Nonetheless, it's a great field!

 

Hope this helps!

T-Max

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Is there any concern about anesthesiologists losing work to advanced practice nurses like the CRNA situation in the US? I don't think it's going to be a problem, but then I look at idiotic decisions by the government like allowing naturopaths the ability to prescribe medications and order labwork, and I get a bit worried.

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Hey leviathan,

 

It's not something that I am worried about personally- just like the fastball is the best pitch in baseball, nothing is better than a 5-year trained anaesthesiologist.

 

That said, I will ask one of the staff tomorrow about the "official" stance on the CRNA issue, since he is a pretty big wheel in the OMA and everything.

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Okay folks, here we go...

 

The short answer to your question, leviathan is no, there is NOT a concern about anesthesiologists losing work to advanced practice nurses like the CRNA situation in the US. After speaking with my OMA source earlier this week, there is basically no concern about this becoming reality in the future any time soon.

 

The story goes that a few years ago, when there was a full-on physician shortage (no longer the case in anaesthesia, sadly), the nursing associations pressured for expanded roles to fill this gap, mainly in the form of nurse practitioners and what have you. For the most part, they were quite successful in many different medical fields.

 

One area in which they were notably unsuccessful was in anaesthesia, where the member associations defended the realm of intraoperative anaesthesia provision vigorously and successfully. Though there were concessions given, mostly in the form of preoperative and postoperative care, intraoperative anaesthesia care remains the exclusive territory of anaesthesiologists and GP-anaesthesioologists (and basically no one else). This stance has been in place for a long time now and there are currently no plans to relinquish this stance anytime in the foreseeable future in this country.

 

As I said before, nurses do have advanced practical roles to play in terms of preoperative assessments (they can take your pre-op histories for you and see patients in pre-admission clinics) and postoperative care (in terms of PACU and pain service), but the intraoperative care is one area they are not allowed to participate in. This is in stark contrast to the US, where CRNAs have quite a strong foothold and are aggressively pushing for expanded role definitions, including provision of neuraxial anaesthesia, among other areas.

 

The other thing that he told me was that CRNAs were initially brought on as a way to increase access to anaesthesia services and cut costs. The irony is that, as a unionized body, the CRNAs have managed to negotiate steadily escalating salaries for themselves. He said that some CRNAs in the USA were making upwards of 250k/year! All this in addition to being unionized, having full benefits, fixed work hours and protected breaks. Sounds like I'm in the wrong field! ;)

 

Hope this helps clarify the issue!

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Hi all,

 

Great to have this thread back up and running, and welcome back Timmy- its always nice to have insightful answers to all of these questions.

 

I have 2 quick questions.

 

1)

What are the most sought after anesthesia programs in the country (the 5-year programs)? I understand that this is largely subjective as many residents will tell you that the program they are in is one of the best but try to be as objective as possible :P I recently spoke to a resident who told me that the programs in Ottawa and Winnipeg are considered very good

 

2)

If you are considering anesthesia, is it wise to do all of your 4th year electives in anesthesia? I recently talked to two 4th years (who matched to anesthesia) who did almost all of their electives in anesthesia, and by that i mean they did all but 1 in anesthesia (the other being internal med). Is this a wise thing to do? Or is it better to do 2-3 anesthesia electives to show your interest in the specialty and then do 2-3 related electives such as ICU, resp, CCU?

 

Thanks for the insight!

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Hey there,

 

I'll give my thoughts as a current anesthesia resident. You're right, and I'm sure anyone who replies would give the typical spiel: all programs in Canada will train you well...you need to decide what strengths you are looking for in a program...etc.

 

That being said, here is a bunch of biased, anecdotal heresay to get the ball rolling :)

 

Dalhousie: known as a good program overall, esp known for airway

Ottawa: recognized as one of the top programs

Toronto: known for having strong research support

Western: kind of hampered by rumours of irate surgeons and late-running ORs (sorry TimmyMax but just the word on the street!)

McGill: residents complain about poor teaching and more attitude than you would expect from old school surgeons/french patients, lowest pay in the country but cheap cost of living

UBC: known as a good program, typically highly desirable at least partly b/c of location in Vancouver, expensive living

Winnipeg: known as excellent program with unfortunate location, excellent simulation facilities

Calgary: awesome program director, small program with a good feel, good pay

Alberta: hampered by issues of accreditation/probation recently I believe, revolving door for program directors last I heard, good pay

 

Cheers,

UBCmed09

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Hey all,

 

Here are my two-cents, as someone who finished the CaRMS tour this year. Most of the things that UBCmed09 are still current, but there have been some changes, as far as I can tell. I've copied UBCmed09's comments and added my own opinions about them in brackets.

 

Dalhousie: known as a good program overall, esp known for airway

(Still true! Smaller program that portrays a sense of being a supportive community. Very satisfied residents overall. Some rumours of high Royal College fail rate last year)

 

Ottawa: recognized as one of the top programs

(Certainly still the case from an academic standpoint, but there has been a change in program directors (PDs). The outgoing one was loved by all the residents dearly and described by more than one resident as "angelic". The new PD refused to chat/meet with students who traveled across the country for an elective (wonder how you'll be treated as a resident). Needless to say, the staff anesthesiologists' opinions of this PD were less than complimentary. Overall, an impression of them being a cocky program)

 

Toronto: known for having strong research support

(Great teaching and excellent research support! A PD that was extremely approachable and caring, despite running the biggest program in the country. Difficulty in getting to know all your staff since there are over 250)

 

Western: kind of hampered by rumours of irate surgeons and late-running ORs (sorry TimmyMax but just the word on the street!)

(True about late-running ORs, which run 8:00 to 18:00. Depends on your learning style though, because this can be advantageous for some. Staff who weren't necessarily overly enthusiastic to provide intra-operative teaching)

 

McGill: residents complain about poor teaching and more attitude than you would expect from old school surgeons/french patients, lowest pay in the country but cheap cost of living

(No comments, since didn't do an elective, or interview there. Just keep in mind that old school surgeons are found at every academic center)

 

UBC: known as a good program, typically highly desirable at least partly b/c of location in Vancouver, expensive living

(Was on academic probation last year. During our interview day, they were forthcoming with this and explained what steps they had taken to deal with this. The city trumps the program in my opinion)

 

Winnipeg: known as excellent program with unfortunate location, excellent simulation facilities

(Strongly agree with this statement. Anesthesiology program has superb leadership and a great deal of influence/power with how health services are delivered. Top academic program in my opinion)

 

Calgary: awesome program director, small program with a good feel, good pay

(Good PD, limited research capacity, limited intra-op teaching, not-so positive experiences from many elective students. Highest pay in country, but not cheap to live in Calgary)

 

Alberta: hampered by issues of accreditation/probation recently I believe, revolving door for program directors last I heard, good pay

(No comment, since didn't interview there)

 

Here are some bits of info from other programs:

 

Saskatoon: extremely welcoming, caring and tight-knit group. Supportive PD. Not-so-great location

 

McMaster: many staff and residents spoke highly of PD. Young, enthusiastic group of staff to provide great teaching. City of Hamilton isn't the greatest.

 

Queen's: Same situation as McMaster. This program won the PAIRO Residency Program Excellence Award: http://www.queensu.ca/news/articles/anesthesiology-wins-provincial-honours

 

Memorial: Got national publicity with this headline: “Harassment imperils N.L. anesthesia training” (http://www.cbc.ca/news/canada/newfoundland-labrador/story/2010/11/09/nl-anesthesia-program-1109.html)

 

Hope this helps!

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Thanks very much for the great responses. Seems like each program has its own unique characteristics.

 

I was wondering if someone can shed some light on the issue of a bigger vs smaller program. Do residents in such a large program such as Toronto get lost in hustle and bustle of large busy hospitals compared to a smaller program such as Queens for example?

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Hey man,

 

Legitimate question. I don't have much insight on this one other than to say that this is something I wondered about myself back in the day.

 

I will base my answer to this question on the fact that 3 years ago, our program (UWO) traded by far our worst resident to UT for another far more capable resident. Whether or not this bad resident (ask anyone who has worked with this person from either program!) passes their Royal College will answer this age-old question. Stay tuned!

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Hey timmy

 

Thanks for the info, that is really reassuring. I'm not 100% sure what I want to do yet, but one of the factors I'm looking at is what kind of job future does X specialty have with all of the nurse encroachment going on, and governments looking to save a few bucks at the expense of patient safety.

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Hey leviathan,

 

Yeah man, I wouldn't worry too much about nurse anesthetists encroaching on your job prospects, at least not for the foreseeable future! It's kinda like the fact that the street outside of my house is not too busy, traffic-wise. I'm sure that 9 times out of 10, I could shut my eyes and run across said road and not get hit by a car. But does that make running across the road with my eyes shut a good idea? I guess only time will tell!

 

Otherwise, I feel the need to qualify my previous answer about the "slip through the cracks" phenomenon at UT. The short answer is no, you will not "slip through the cracks". Most residents that match there will be, by definition, good or average, and since the UT pass rate on the Royal College is no worse than anywhere else (for CMGs, of course), then I would say that "slipping through the cracks" there is not a major concern. Unless, of course, you ARE a bad resident to begin with, hence my answer. But who knows, maybe the time at UT has taught said resident a thing or two about anaesthesia. We shall see, won't we?

 

Take care! Royal College written is exactly one week from today!

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  • 2 months later...

Hey,

 

So my very general question is....do anesthesiologists tend to be those who really love pharmacology? It seems to be such a drug oriented specialty. And to be honest I don`t love pharmacology. And I can't stomach most pain research I have read about.

 

Wow, I'm sorry it has taken me so long to answer this question! I must have missed it before I went into hibernation to try and pass my Royal College exams in anaesthesia!

 

Okay, in answer to your question, I would not consider myself nor my colleagues as people who really LOVE pharmacology. Most of us fall asleep at the back of the room during the clinical pharmacology lectures, where the formulae are derived and stuff like everyone else does. Those who truly love pharmacology can pursue the area of clinical pharmacology, which is a great field, but it just isn't for me (nor the vast majority of my colleagues!).

 

That said, I do enjoy clinical pharmacology. Not enough to pursue subspecialty training in the field mind you, but with anaesthesia, we are using clinical pharmacology every day. I personally like the qualitative side of pharmacology and physiology, and I love the fact that we get to use drugs every day to evoke specific responses from our patients in response to various stimuli. I also love the fact that if something goes awry intraoperatively, we can rely on our knowledge of pharmacology and technical skill set to quickly and accurately diagnose, manage and resolve the problem (usually without anyone from the remainder of the OR team noticing)!

 

As for not being able to stomach chronic pain research- you are not alone! I don't mind managing acute pain and running an acute pain service (the rounding kinda bites, but that's besides the point), but yeah, when it comes to chronic pain, I agree with you 100%. Don't get me wrong, it is a great field and does a great service to a great number of patients, but in all honesty, it just isn't for me. There are a select few in any given anaesthesia group with an interest in chronic pain (a great way to get a job pretty much wherever you want, BTW!), and all the more power to that group! They usually run chronic pain clinics, do wicked-cool blocks and interventional procedures, and do a great deal of good in the world. The reality is, that just like OB/GYNs with an interest in urodynamics, etc., there are people within a field with their own areas of interest and chronic pain is no exception.

 

I guess what I'm trying to say is that if you aren't interested in chronic pain, then don't let that dissuade you from doing anaesthesia! Yeah, it's kind of a pain (literally!) to study and unfortunately, there always seem to be a number of MCQs and SAQs (and even the odd oral exam question!) dedicated to the domain of chronic pain, so you will never get away from it in anaesthesia. That said, all you will need is to have some appreciation of it, just like you would for some basic CNS, Endocrine, Immunology, GI, and Heme knowledge if you are to go into the field.

 

Thanks a lot for your question and hope this is helpful!

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Wow, that question was like asked 5 years ago and I'm sure was addressed waaay back then! I didn't realize- sorry guys!

 

In unrelated news, I just wanted to share with everyone that I was fortunate enough to pass my Royal College FRCP examination, so now I am a full-fledged anaesthesia consultant! :) How the time flies!

 

Anyway, I will remain available to answer your questions regarding this area for the next few weeks, since everyone keeps telling me how much more free time I will have now that I don't have to spend all of it studying! For the most part, that seems to be true, which will give me more time to check this thread in particular!

 

So take care and here's looking forward to reading and answering your posts!

 

T-Max

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