Anesthesiology - competitiveness?

[gnocchi]

Hi everyone,

 

I’m interested in anesthesiology and wondering how competitive it is to match. It looks like middle of the road based on another post but I’m not sure what that means in terms of research experience needed to be competitive

 

There don’t seem to be a lot of research opportunities in anesthesia at my university. If I did research on something tangentially related, is it irrelevant or does it still help? If I did a shadowing/exposure program instead of research, is that sufficient? 

[premed72]

Bumping. I would also like to know this!

[McMasterMD]

Traditionally, anesthesiology is not too competitive to get into. It is one of those specialties that people tend to discover in their clerkship, so the field welcomes applicants who decided on pursuing it fairly late in medical school. 

Regardless, you'll have to demonstrate interest in the specialty through research, extra-curriculars, networking (you would need 3 strong letters) and electives. 

1. I'd say if you submit and present 1-2 anesthesia-related abstracts and have some tangential research project in the works, that would be enough. A first author pub would be a +++, but not required. Also, it doesn't have to be in anesthesia, it can be in internal medicine or surgery...as long as you can relate it to anesthesia in your personal statement & interviews.

2. Try to get involved in some anesthesia-related med-ed projects or extra-curriculars, e.g. help build an anesthesia educational module for pre-clerks, host anesthesiologists for talks on "why anesthesia" or "basics of anesthesia", organize a workshop on intubations, IVs etc. Be creative. Join the anesthesia interest group.

3. Building connections is the next most important thing. Pick 3 faculty members and build strong relationships with them through multiple observerships (and don't just observe, but help as much as possible) and research projects (if available). 

4. Max out your electives in the field

[robclem21]

In part, I agree with above in the sense that you obviously need to demonstrate interest in the field. However, from I think most of the things listed here (which are standard/typical for applying to any specialty to CaRMS) may not be as important/relevant for anesthesia. Anesthesia on the surface is not too competitive, but it can be a challenge to match where you want to be as some programs are in high demand compared to others.

As far as research or extra-curriculars go, I don't think its the productivity that anyone particularly cares about so much that you have made some effort to show dedication to the field. As far as connections go, this can be challenging because unlike most other specialties, you don't build a longitudinal relationship with anybody through your rotations. Over the course of your rotation you may only have 5-6 days in the OR, and will likely be with a different staff person/resident every shift (kind of like Emerg). This can make it difficult to build connections with people who would go to bat for you. This can be overcome a bit by getting more involved in the department and by doing electives. Past strong reference letters though, there are usually more than 1-2 spots in each program so you don't typically need someone to go to bat strongly for you.

What I will say is a key element missing from a large portion of applications is people showing a true understanding of the specialty. This is usually what makes it difficult to match and gets peoples applications dismissed. Number 4 above is really important because you need to know what you are getting into. Most people apply thinking that anesthesia is purely intubating, and doing IVs, and doing spinals, and really don't show any appreciation for the breadth of the specialty, or what goes into an anesthetic plan, or how stressful/demanding call can be, or that you will not finish every day with an elective list at 3pm. You need to spend enough time in anesthesia to know and understand this, and demonstrate it with your application. If you can do that then you will have a decent shot.

Lastly, be personable. Anesthesia (while it seems counter intuitive) tries to select for people who have good social skills. Not only because anesthesiologists are seeing patients at a vulnerable time before their surgery, but because staff and residents have to spend 10-24 hours a day together 1 on 1 in the OR. Nothing is worse than being stuck with someone who is annoying for a whole day. Be nice and friendly and normal.

Hope that helps.

[premed72]

Thank you both for the information and advice! Really appreciate it. 

[Redpill]

Anesthesia seemed exceptionally competitive this year. Might be an outlier. But I believe 40 people were going for it at UBC, which has ~20 spots

[rgu12]

Competitive this year due to the perception of jobs CURRENTLY available across Canada. In 5-10 years? Who the heck knows, could get saturated pretty fast with residency graduates. Plus have to worry about CRNAs likely coming to Canada.

[robclem21]

6 hours ago, rgu12 said:

Competitive this year due to the perception of jobs CURRENTLY available across Canada. In 5-10 years? Who the heck knows, could get saturated pretty fast with residency graduates. Plus have to worry about CRNAs likely coming to Canada.

I think it is likely that the job market will remain favourable for some time in anesthesiology. It is a rapidly aging workforce with much more turnover to continue into the next 5-10 years when the current group of medical student students are graduating. When you think of the number of anesthesiology graduates compared to surgical graduates (including OB), there is also going to be increased demand for services on top of the current workforce demands.

Also, 95% of anesthesiologists are not concerned about CRNA. The CAS has spoken strongly about the need for FRCPC anesthesiology and since when does the Canadian government move quickly with any transition in the provision of care. CRNA will still need anesthesia supervision and the option to relocate always exists. You don't have established practice or patient roster in anesthesia so its simple to pack up shop and move.

[Pakoon]

4 hours ago, robclem21 said:

I think it is likely that the job market will remain favourable for some time in anesthesiology. It is a rapidly aging workforce with much more turnover to continue into the next 5-10 years when the current group of medical student students are graduating. When you think of the number of anesthesiology graduates compared to surgical graduates (including OB), there is also going to be increased demand for services on top of the current workforce demands.

Also, 95% of anesthesiologists are not concerned about CRNA. The CAS has spoken strongly about the need for FRCPC anesthesiology and since when does the Canadian government move quickly with any transition in the provision of care. CRNA will still need anesthesia supervision and the option to relocate always exists. You don't have established practice or patient roster in anesthesia so its simple to pack up shop and move.

They will need supervision until they don't.

[rgu12]

I think the only saving grace with the CRNA argument is whether Canadian governments are willing to compensate them at a similar level they're compensated for in the US (quite a lot, equivalent to over >$200k/year I believe).

Edit: CRNA training is also like 5 years, which is much more training over FPAs.

Medicine is doomed! AI and other allied health professionals taking over! (Hope not, haha).

[BCelectrophile]

@robclem21 @Pakoonthe current proposal by the BC ministry of Health is to introduce CRNAs as independent anesthesia providers. However I am still not very worried as I believe it will take many many years before they gain any kind of foothold (look at other midlevels eg. PAs/NPs/midwives, they have been around for quite some time and have their own issues however the vast majority of medical care in Canada (>95%) is still delivered by physicians). 
 

their argument re. helping the rural anesthesia shortage is almost moot because rural communities often don’t have the caseload to support a full-time anesthesiologist, hence why we have FPAs who can work in many roles such as clinic and ER.

I also think the physician community in Canada is much more cautious of midlevel encroachment due to watching the issue in the states and also because there is no real way to use midlevels to increase profit in private practice as is the case in USA. 
 

That said, I am also going into gas and we need to stay vigilant as we become the next generation of physicians. Refuse to train midlevels and refuse to cover for their mistakes. Advocate to patients and other physicians about the dangers of poor anesthesia care when provided by an undertrained midlevel to their patients, as well as the liability risks to surgeons when they are the only physician in the room. Support your AA and FPA colleagues to ensure safe physician-led anesthesia care for Canadians.

[BCelectrophile]

On 5/14/2022 at 8:34 PM, rgu12 said:

I think the only saving grace with the CRNA argument is whether Canadian governments are willing to compensate them at a similar level they're compensated for in the US (quite a lot, equivalent to over >$200k/year I believe).

Edit: CRNA training is also like 5 years, which is much more training over FPAs.

Medicine is doomed! AI and other allied health professionals taking over! (Hope not, haha).

I believe American CRNA programs are only 2 years (3 years if DNP which only means added non-clinical fluff). Also the 4 years of medical school, 2+ years of family medicine residency and staff experience (many FPAs work as rural staff covering EM/OB/inpatients before returning to a rigorous FPA residency) puts Family Practice Anesthesiologists miles ahead of any nurse anesthetist in terms of any and all clinical skills and knowledge. Nursing is not medicine.
 

Please show support for our FPA colleagues to ensure safe physician-led care for all Canadians.

[Edict]

The whole concept that CRNAs can independently provide anesthetic care as safely as physicians is really a slap in the face to all the safety improvements we have made over the years in the OR. Imagine painstakingly implementing things like the safety checklist and simply have the anesthetist being vastly undertrained for the job. The amount of training CRNAs and NPs receive compared to physicians is vastly different. 

The benefit of the public system in Canada is that it remains evidence based and cautious. The US is really the wild wild west and the profit motive and lack of regulation is a huge reason why things have turned out the way they have in the US.