By Boris Heifets, MD, PhD (Stanford University)
You’re finishing med school. You did a PhD, or spent serious time doing research. You are shocked how much you love anesthesiology (not quite what you expected a few years ago). Somewhat less shocking: you alone, among your peers, are going down this road instead of a research-track residency in medicine/peds/path. Can you really combine a career in science and anesthesiology? How do you even know which residencies to apply to? You need some help with this.
Congratulations on navigating to the eSAS site! It’s true; you are looking for advice from a stranger on the Internet about one of the key decisions of your professional life. Well, I’m happy to help. Chances are we have something in common: I did an MD/PhD (neuroscience), was dead set on a career in neurology until Day 1 of my anesthesia rotation. In 2008, at my small east coast med school, I knew exactly one person who had become what I hoped to be, a clinically trained anesthesiologist with a 75%+ commitment to basic science. The advice he gave me was gold, and I wish there was a centralized source for the kind of things he told me about. Like the eSAS website, for example. Anyway, with plenty of help and luck, I found the residency for me (Stanford), and am still in the process of establishing an independent lab. Hopefully the following will help you do the same.
Your biggest challenge will be figuring out what questions to ask.
To quote one of my favorite martial poets:
Because as we know, there are known knowns;
There are things we know we know.
We also know there are known unknowns;
That is to say we know
There are some things
We do not know.
There are also unknown unknowns –
The ones we don’t know we don’t know.
It is the latter category that tend to be the difficult ones
Where should I apply?
What kind of program has a solid research track? One easy, if simplistic, way to gauge the strength of a department’s research is by its NIH funding. Here’s a ranking of anesthesiology departments from 2014. Harvard hospitals are not included, nonetheless it’s clear that NIH dollars are concentrated in a dozen-or-so departments. (Future blog post idea: how much room does academic anesthesiology have to grow? Hint: take a look at the “GRAND TOTAL” entry for Internal Medicine compared to Anesthesiology).
The number of anesthesiology residency programs with bona fide research tracks is, as you may have guessed, finite. We’ve done our best to compile a (growing) list here (it may still be under construction, but be sure to check back). You will have your own preferences based on geography, cost of living, significant others’ input… but I recommend applying broadly. When I applied for residency in 2008-09, I think we could fit the nation’s research-track candidates in an elevator. The number and caliber of applicants has risen substantially since then.
What makes a good fit?
Most programs on our list have some form of supplemental application for prospective residents interested in a career involving research. I strongly suggest you send this in before your interview. It’s your chance to introduce yourself as a researcher, and can get you thinking about what you’re looking for in a program.
Without a doubt, the top criteria you need to assess are:
- The program’s track record
- Your prospective peer community
Track Record. Can a program’s research track launch the career you envision? A record of producing independent, successful clinician scientists is the best metric I know to predict a program’s ability to help you become an independent, successful clinician scientist. Some research tracks have been around long enough that their websites actually have a list of all their graduates. Many research tracks have a strong history of graduating clinician scientists, but have only become “formal” entities in the past 5-10 years. Learn what you can from a departmental website’s research pages, do some pubmed searches. This question is a good one to bring to interviews, and may put you in direct contact with those who are on the path you envision for yourself.
Mentorship. If you’ve done a PhD, you already know that mentorship may be the single biggest determinant of your success. Identifying a mentor for your budding career as an anesthesiologist and scientist is more challenging during residency.
Look outside the anesthesia department for a scientific mentor. I love the breadth of anesthesiology, but it’s impossible for a single department to corner the market on science in every topic touched by our field (neuroscience, immunology, cardiovascular medicine, vascular biology, informatics….to name a very few). Program directors and chairs (the ones I’ve talked to) want you to go to the best lab in your interest area, get the best training available, and hopefully bring that knowledge back to our specialty.
If you’re trying to combine two different careers in one, why not have two (or more) mentors? You should. In addition to the potential scientific mentors you’ve identified, try to identify senior faculty within the anesthesia department who can help you navigate your department’s resources. Oftentimes, this person may be in charge of the research track, or is doing research in an area similar to yours. A mentoring team is a great idea – so great, in fact, that the NIH program officers I’ve spoken to strongly recommend having a team in place for K08 and K99R00 applications.
Peer community. Have you ever gotten a blank stare when you’ve started describing your research to a colleague? Residency is demanding, and staying focused on your research career is much easier when you have like-minded company. Find out how many residents (or recent graduates) are in the research track. Do they have structured meeting times? Do they have enough clout to pre-set their research months? How many months during residency have they taken to do research? Do they do Sunday brunch? They needn’t be in the same field – you will almost certainly face similar issues with finding labs, balancing your work/life (more aptly work/work/life), and applying for grants and fellowships.
These pointers should give you a start in looking for your ideal residency program, and figuring out what to ask when you get there. Got more questions? Please email me or any of the eSAS board.