Author: Marc N. Katz

Posted on

Should You Attend A Caribbean Medical School?

The most frequently asked question that I receive from students from around the world is ‘should I apply to a Caribbean medical school?’. There are plenty of blog posts on the internet that provide advise without objective evidence. So before I give you my unfiltered opinion I want to first present the cold hard facts surrounding the topic as well as some information that is not common knowledge to many pre-med students, most individuals outside of medicine, and future Caribbean graduates. My hope is to arm you with data so that you can make an informed decision about applying to Caribbean medical schools and how best to prepare yourself for success when attending a Caribbean medical school. Before jumping into the benefits and drawbacks of these programs let’s first take a step back and look at the journey of becoming a doctor in the United States.

Part I: Becoming a doctor in the United States

‘What do you call someone who graduates at the bottom of their class in medical school? Unemployed.‘

In order to apply to medical school in the United States you are required, at a minimum, to have completed your pre-med requisite courses which include one year of biology, one year of physics, one year of english, and two years of chemistry (usually general and organic chemistry). Many medical schools are also now requiring molecular genetics and biochemistry. For school specific requirements you can check out the Medical School Admission Requirement website. On top of your pre-med course requirements most American medical schools require a stellar MCAT score, extracurricular activities inside and outside of the medical field, and shadowing experiences of some sort. For the sake of brevity this blog post will not cover the lengthy topic of how to get into medical school.

There are two types of medical schools in the United States- allopathic and osteopathic. Students who graduate from allopathic medical schools earn an ‘M.D.’ which stands for ‘medical doctor‘ and students who graduate from osteopathic medical schools are a ‘D.O.‘ which stands for ‘doctor of osteopathic medicine’. There are differences between the two in certain aspects of their training and the standardized tests they have to take but in clinical practice they are quite synonymous and are otherwise both ‘doctors’ in every modern sense of the word.

In general, medical school in the United States is four years. This includes both MD and DO programs. However to make matters slightly more complicated there are also many medical schools that offer dual MD/PhD programs (generally speaking these are 7 year programs) as well some schools that offer or even require an additional year of research. Other medical schools also offer dual degrees. Some schools offer an MBA or MPH alongside their medical degree. So generally speaking medical school is a four year process but clearly there are exceptions to the rule if you choose to pursue a different path.

After graduating from medical school you are now a doctor, in name at least. In the United States you cannot practice medicine independently without completing residency training. This is worth repeating. In the United States you cannot practice medicine independently without completing residency training. This is the crux of issue regarding Caribbean medical schools. Acceptance into medical school ≠ a job. Acceptance into medical school guarantees you two fancy letters at the end of your name but without landing a residency position you will never practice medicine as a physician. In the remainder of this post I will explain that, based on prior residency match data and from personal experience, by attending a Caribbean medical school you put yourself at a distinct and intrinsic disadvantage in your ability to obtain a residency position in the United States compared with graduates from stateside MD and DO medical schools.

Part II: The Match

‘Like speed-dating but worse’

If we are going to understand why Caribbean medical graduates are at a disadvantage historically compared to American medical graduates we have to first understand the National Resident Matching Program (NRMP), or ‘the match’. 

Near the end of the third year of medical school students begin applying for residency. The program known as ERAS, or the electronic residency application system, is the online application students use to apply. It is a common application that almost every residency program uses and makes applying for residency simpler. After uploading your application and appropriate paperwork all you have to do, generally speaking, is click which school you want to apply to.

After the application deadline passes residency programs begin downloading applications. Many programs have hard cut offs. For instance, some programs require you to have a step score above a certain value and if your score is not up to par then your application simply won’t be looked at. Next the residency program picks who to send interview invitations to. Interview season generally lasts 3-4 months from October to January but varies from specialty to specialty. After interview season concludes both students and programs must submit ‘rank lists’. Rank lists are exactly what they sound like. Applicants rank which programs, from the ones they interviewed with, that they want to go to with their most highly sought after program at number 1 and then rank each subsequent program down the line. Programs do the same with applicants. Eventually a computer system attempts to ‘match’ students and programs together to make the best possible fit based on each respective applicant and programs choices. The following video is the best one that I could find that explains this quite complex process as succinctly as possible.

On the Monday of ‘match week’ applicants find out if they have matched or not. They find out where they matched on Friday. The reason for this is that if a student does not match they can participate in the SOAP, or supplemental offer and acceptance program. This is a second chance to try and match into a residency position that went unfilled. More information on the SOAP can be seen at The NRMP website.

This is why medical students ‘match’ into residency spots. It isn’t as simple as a job application. And Caribbean medical students match into residency at a far lower rate compared to their stateside colleagues.

Chapter 3: Raw Data

‘Without data you’re just another person with an opinion’

So now that we kind of understand what it means to ‘match’ into residency let’s finally take a look at the raw data from the 2018 main residency match. The NRMP data is widely available and I encourage you to take a look yourself here. The data describes Caribbean graduates with the term ‘international medical graduates’ or an ‘IMG’. These are further split into two categories: US citizen IMG and non-US citizen IMG. So if you are a US citizen and went to a Caribbean medical school then you are considered a US IMG.

In 2018 there were 37,103 active applicants and 30,232 first year and 2,935 second year residency positions. The following are the match rates for each type of applicant:

  • US allopathic graduates (MD’s): 94.3%
  • US osteopathic graduates (DO’s): 81.7%
  • US IMG: 57.1% 
  • Non-US IMG: 56.1%

If you only remember one thing from this post then this should be it. Only 57.1% of US IMG’s, or people like me who are US citizen Caribbean medical graduates, match into residency positions versus 94.3% of US allopathic grads and 81.7% of US osteopathic grads. This is terrifying! Imaging going through four years of medical school, accumulate a crushing amount of debt, only to end up without a job or the ability to practice as a physician (check out prior interview posts with individuals who went through that exact experience).

An interesting graph from the NRMP data shows that not every specialty ranks equally.

This graphic shows that the specialty in which the highest percentage of US IMG’s were able to match into was pediatrics at 69.8% of applicants matching while psychiatry on the other hand was the most difficult specialty for US IMG’s to match into at 30%.

So why do Caribbean graduates have a greater difficulty matching? Let’s take a look at NRMP data from a survey of program directors. This survey is also widely available and I encourage you to analyze it yourself here. The survey was sent to 209 program directors (PD’s) and 78 responded, or 37.3%.

The data shows each individual factor that program directors find important when they choose applicants to interview and rank for residency. As you can see below the USMLE step 1 score, based on this data, is by far the most important factor for choosing applicants to interview.

So a strong STEP 1 or COMLEX 1 score gets your foot in the door but it does not necessarily get you the job. Now let’s use the data from pediatric program directors (PD’s) for the next few graphs. This next graph shows the most important factors that pediatric PD’s felt were the most important factors when ranking applicants.

This graph clearly shows that the more important component of how medical students are ranked on a program’s rank order list is how an applicant interacts with residents and faculty on interview day. Again, a strong USMLE step 1 score seems to be of critical importance in helping get an applicant’s foot in the door but how they interacted on interview day earns medical students the opportunity to walk through it. Of note, each specialty seems to vary slightly in what they rank as most to least important but grossly these trends seem consistent across the board.

The issue however is that getting a stellar USMLE step 1 score isn’t the only obstacle when it comes to matching into residency for Caribbean medical students. At the end of the day all medical students learn the same science but not all medical students have access to the same residency programs.

The same survey of pediatric PD’s (and the same specialty that in 2018 had the highest successful match rate from US IMG’s) shows that some program’s won’t even consider an applicant if they graduated from a Caribbean medical school. The graph below shows that out of the PD’s who responded to the survey only 67% of them typically even interview US IMG’s.

Broken down even more we see that an even smaller percentage of programs will ‘often’ interview and rank candidates from Caribbean medical schools. This is another huge point that you should take away from this blog post.

Again, the match rate for US IMG’s in 2018 was 57.1% versus 94.3% and 81.7% match rate for allopathic and osteopathic grads respectively. I believe that part of that intrinsic disadvantage is that some residency programs simply won’t touch Caribbean medical school graduates. You simply can’t get a job if they won’t interview you for it.

Another unfortunate aspect of being a Caribbean graduate is that it seems to impact the fellowship match too, although to a lesser degree compared to the residency match. If we take a look at the results of the 2019 fellowship match data we can see a clear trend that does not favor Caribbean graduates. The following are the match rates for fellowships in 2019:

  • US allopathic graduates (MD’s): 89.4%
  • US osteopathic graduates (DO’s): 78.9%
  • US IMG: 68.5% 
  • Non-US IMG: 71.4%

For the sake of brevity I won’t delve too much into this data because the fellowship match is a little bit more complicated and not so clear cut. I’m not certain as to why Caribbean medical graduates have a tougher time matching into fellowships but I am certain that some fellowship programs won’t touch a Caribbean graduate just like how some residency programs don’t.

Chapter 4: Informed Consent

‘Without consent surgery would be considered assault’

In medicine before we perform any test or procedure we are required to get informed consent from our patient. Informed consent is the concept of understanding all of the possible consequences with full knowledge of the possible risks and benefits of said procedure. I think the same should be true about applying to Caribbean medical schools and after getting through all of that data I think we’re closer to fully understanding the implications of attending a Caribbean medical school.

Don’t get me wrong, I’m not trying to scare you away from applying. I graduated from a Caribbean medical school, matched into an internal medicine residency program, and successfully matched into a cardiovascular disease fellowship. There are plenty of success stories that originate in the Caribbean and I’ve interviewed nearly a dozen of my colleagues who matched into competitive specialties like emergency medicine and surgery. But Caribbean medical schools aren’t for everyone and you should understand that before you sign up or apply.

Chapter 5: The Caribbean Stigma

‘Some stereotypes originate in truth but are exaggerated by myth’

There is a common misconception in the pre-med community about the ‘Caribbean stigma’. This myth that there would be a doctor or nurse in the hospital you are rotating in that would choose not to work with you because of where you went to medical school. Or that Caribbean medical students are not as qualified as their stateside counterparts. Unfortunately the stigma is steeped in truth.

Caribbean medical students go to the Caribbean because they could not get into a US MD or DO program. That’s why I went to Ross University. I applied to 36 medical schools and Ross University was the only one that accepted me. Caribbean medical schools typically have lower standards and thus not every medical student makes it to graduation. I could not find the statistics on the attrition rate from stateside or Caribbean medical schools but I can speak from experience.

Out of the 440 students who started with me in my first semester of medical school only 76% advanced to their second semester. Although this is only one anecdotal piece of evidence and shouldn’t be used to grossly generalize against all Caribbean schools it does in fact happen. Furthermore, the fact that some Caribbean medical schools are for profit organizations is worrying to me and further underlines the fact that they accept too many students who otherwise wouldn’t be accepted into stateside medical schools. Not to mention that medical school in the Caribbean is just as expensive as medical school in the US. So if you are unable to secure a residency position you will be left with massive loans and a hard road ahead to paying them off.

So although the ‘Caribbean stigma’ exists when applying to and while attending medical school once you make to the hospital nobody cares where you went to med school. In the hospital I’ve met incredibly passionate, intelligent, and competent medical students, residents, fellows, and attending physicians from both Caribbean and allopathic and osteopathic medical schools. I’ve also met terribly incompetent individuals from Caribbean, allopathic, osteopathic medical schools too. Just because you attended a certain medical school doesn’t make you a better or worse doctor. Sure, it certainly impacts your ability to match into residency but there isn’t a single nurse, physician assistant, or doctor out there who will treat you any better or worse just because of what med school you went to.

Chapter 6: The Life of a Caribbean Medical Student

‘It doesn’t really matter where go to medical school because it’s always 72 and fluorescent in the library’

I won’t delve into the specifics of each individual Caribbean medical school and this list is not exhaustive but each of these schools share many similarities with the majority of Caribbean medical schools. In general when you go to a Caribbean med school only the first two years are spent ‘on the island’, or in the actual Caribbean. These first two years are spent in the traditional classroom where we are taught the same basic sciences that allopathic and osteopathic med students learn in preparation for USMLE step 1. It’s really not that bad. I enjoyed my time on the island. I remember being stressed out before my first major exam so I took a stroll on the beach to relax. After leaving the island most medical students rotate in hospitals across the US that each respective medical school has affiliations with. I rotated in hospitals in New York and Florida.

Chapter 7: The End Game

Measure twice, cut once

Your first choice should be to get into a US allopathic or osteopathic program. People who are not accepted at first often work on improving their weak spots in their resumé or work while they study to retake the MCAT. Often students will work a few years, do research,  get various master’s degrees, or do a post-baccalaureate degree. Others, like me, don’t want to wait and choose to attend a Caribbean medical school instead. 

This is a viable option for certain students but it might not be the right fit for everyone. Some residency specialties, like neurosurgery, orthopedic surgery, ophthalmology, otolaryngology, plastic surgery, urology, and dermatology, are some of the most competitive medical specialties that exist. Even US graduates often have difficultly earning these residency positions (my osteopathic colleague took three attempts to match into derm and he was a PhD too!). By attending a Caribbean medical school you are again giving yourself another uphill battle to fight. So if your heart is truly set on one of these specialties understand that although it is not impossible to match as a US IMG it will make it increasingly more difficult to do so. That being said, if you know you want to go into primary care fields like internal medicine, family medicine, or pediatrics then a Caribbean medical school might be the right fit for you. Again many residency, and fellowship, programs simply won’t look at you because you are a US IMG. So you might not be able to go to an ivy league internal medicine residency or fellowship program but you certainly can still become a doctor.

The ironic part of all of this is that in order to be a good doctor at the end of the day it really doesn’t matter where you went to medical school or what you got on your USMLE step 1 (as this blog post points out). In residency nobody care what your test scores were and when you are an attending your patients won’t care that you went to an ivy league school if you aren’t compassionate, kind, caring, or intelligent. And yet if you don’t do well on your exams, especially coming from the Caribbean, you hurt your chances of ever being able to treat future patients. Whether you like it or not this is the current status quo. So if you go to the Caribbean be ready to work hard, crush your step exams, and get great letters of recommendation.

I hope this post helped uncover some of the hidden curriculum of medical school and residency and didn’t scare you away from applying to Caribbean medical schools. Ross University was the only medical school I was accepted to and they gave me the opportunity to pursue my dream of becoming a physician. It’s up to you to make the best decision for your future career and then make the most of that opportunity. Hopefully now you can do so with confidence and informed consent.

You can also check out my YouTube video on the topic below:

Drop me any follow up questions that you may have below and be sure to subscribe so you don’t miss my next post!

Subscribe! 
Posted on

When the doctor becomes the patient

An interview with an emergency medicine resident who shares her experience after undergoing a heart transplant

Today I had the opportunity to interview Alin (pronounced uh-leen). Up until a few months ago she was your typical emergency medicine resident in her final year of residency and had been accepted to a critical care fellowship in New York. Then she was diagnosed with viral myocarditis with a suspected underlying inherited dilated cardiomyopathy and has since undergone a successful heart transplant all before the age of 31, a birthday she recently celebrated. Since her heart transplant she has become an active advocate for organ transplantation.

Before we begin I want to express my humble admiration for you. You were intubated in the medical intensive care unit, underwent multiple heart catheterizations, were on life sustaining pressors, and ultimately underwent a successful heart transplant. You started to share details about your journey on Instagram and ultimately a blog and throughout this process you’ve maintained a powerfully positive mindset. You are inspirational Alin. How did you stay so positive throughout all of this?

I’ve always been a pretty positive person. In my opinion, there was no other way to handle this whole situation. My mindset was EVERYTHING. It was the only thing I was able to control during my hospitalization. Of course, there were worse days than others. But this was normal, and this was part of the process. There were a lot of good things that came out of this as well—because we found out that this was due to a genetic dilated cardiomyopathy, a lot of my family members are now getting checked out for abnormalities. In addition, I knew that I’d be able to do something with my experiences—become a better patient advocate, and use my unique “from-doctor-to-patient” perspectives to increase awareness on heart failure, cardiomyopathy, and the importance of organ donation. All of these things kept me going.

How did this all start? How did you go from a relatively healthy young woman to almost dying in such a short amount of time?

I had a “cold” for about a month (cough, runny nose, fatigue), but started getting short of breath during mid-December. This is what scared me, because I had no history of any asthma or heart issues in the past. I found myself taking breaks from walking around the city, and I even became short of breath while I was talking at one point. I knew I needed to get checked out. I was hospitalized for a viral pneumonia, but we soon found out that this was all acute heart failure from a genetic cause (likely exacerbated by a pneumonia or myocarditis, as per the official documentation).

Do you have any family history of heart disease?

My dad has dilated cardiomyopathy. He is and always has been very healthy otherwise (exercises daily, has never consumed alcohol/caffeine, has never been a tobacco user). It was incidentally found during a primary care visit when he was 44 years old. His cardiologists had always attributed it to a viral myocarditis, because he didn’t know his family history too well. When I was hospitalized, we found out that his father died of sudden cardiac death in his early 40s, but no autopsy was ever done. The puzzle pieces came together.

So this dilated cardiomyopathy must have been brewing under the surface for a while, no?

I had an ejection fraction of 5-10%, with severely damaged, thin walls. The care team estimated that this was all chronic in nature—at least 6 months to 1 year. I just had no symptoms because I was healthy otherwise. In Emergency Medicine, we always say to look out for the “young patient with one very abnormal vital sign” because they’re the ones who are probably going to crash quickest. That was me.

Did your doctors discover a specific virus that they believe caused this?

No. My viral panels were essentially negative, but there are a few tests still pending (some take months to result).

So you get admitted to the hospital. That night you went downhill fast and suddenly you are intubated and in the medical intensive care unit (MICU). What did it feel like to be intubated?

I apparently I called out for my own intubation like a good ER doctor would! I don’t remember much. I just remember feeling really sweaty one second. A “Rapid Response” was called because I was crashing. And then I woke up 24 hours later with a tube in my mouth. The tube itself was very uncomfortable, and I think I was trying to self-extubate at some point. I will tell you—it felt terrible to be intubated, but it felt GREAT to be extubated. 

I saw some pictures you posted that had some scrawled messages on post-it notes from when you were intubated attempting to communicate. In my experience communicating with someone who is intubated is one of the most frustrating and heart breaking experiences in the MICU (and I’m not the one intubated). After the experience of being intubated what did you learn that will change what you do in the hospital with intubated patients?

I was restrained and trying to suction myself. I was so frustrated because I had so many questions but I couldn’t talk and kept gagging on my secretions. I remembered this scene in “Extremis” (a great, short documentary on Intensive Care Units available on Netflix) where the doctor was trying to communicate with an intubated patient via paper/pen. I tried to do the same. I will forever keep these with me for my intubated patients.

I saw that you were allowed to leave the house for the first time and have yourself a nice fifteen-minute stroll with your camera. What did it feel like to have the energy to do that?

I’ve been working a lot with my wonderful physical therapist, who comes over a few times per week. She is worried that I’m going to “do too much,” so she is very good with setting time limits for me and cautiously walking with me everywhere. I do get lightheaded when I exert myself too much, and I always have to have my pulse oximeter on while I walk or exercise during these few months. BUT …. it was SO NICE to be outside! Even if it was just for a few minutes.

What is something you learned about heart transplantation that you otherwise wouldn’t have known if it weren’t for this experience?

The Heart Transplant Allocation System—the whole system changed just a few months ago. It’s all a very confusing process, but it is supposed to work out well for our patients. You can check out their site here: https://optn.transplant.hrsa.gov/learn/professional-education/adult-heart-allocation/.

What did it feel like to undergo heart transplant surgery? Is your chest still tender?

The sternotomy pain is one-of-a-kind. I am still on “sternal precautions” because it takes about 1-3 months for everything to fully heal, according to my surgeon. I take pain medications, do daily stretches and light work-outs, and collaborate with my home physical therapist a few times per week to help with the discomfort. All is slowly improving!

How many pills do you take everyday?

36 pills per day, as of right now. Ha! It will slowly decrease to just a few pills per day.

What happened to your old heart?

I gave it to the hospital (an academic center) for research purposes. I believe in the importance of medical research and wouldn’t want to do anything else with it.

Do you still plan on pursuing a critical care fellowship?

Absolutely. I want to use my experiences to better the care of my own critically ill patients, both in the ER during resuscitations and in the ICU for continued, meticulous management.

How has this changed you as a person and as a doctor?

My whole experience has changed me in several ways. I have always been a big proponent of “living life to the fullest,” but this has just confirmed how important this is (albeit cheesy, I know). I want to use my experience to become a better person, a better doctor, and eventually use it all to help advocate for organ donation and improving heart health.

Who or what helped you get through all of this?

The real MVP? My support system. There wasn’t a day I was alone in the hospital. Friends, family, co-residents, attendings were there so often that the nurses had to put a limit on my visitors. They helped me get through so much, whether it was by making me laugh, coloring with me, watching TV shows with me. However, with that being said, I think it was also important for me to be alone to process the situation well. I did a lot of writing and met with therapists weekly for my own sanity.

Anything else you care to share?

For all the residents interested in critical care: chest tubes are definitely the most painful procedure ever. Arterial lines don’t hurt as much as I thought they would.

Thank you so much Alin for letting me have some of your time. And for anyone who wants to follow her progress or donate to a good cause please check out her blog, https://www.achangeofhe.art, where you can also find her social media links. As always, don’t forget to subscribe below so you don’t miss out of my next blog post!
Subscribe! 
Posted on

How To Match Into a Hematology & Oncology Fellowship

Joel Alcid is a third year internal medicine resident finishing up his final year of residency at Hahnemann University Hospital/Drexel University College of Medicine. Next year he will be starting his fellowship training in hematology and oncology. I sat down with him to learn more about how he earned this monumental achievement and tips for medical students and residents who are interested in pursuing a heme/onc fellowship too

Thanks for letting me pick your brain Joel. Can you tell my followers a little bit about yourself?

Thank you for this opportunity. I am happy to share my thoughts and provide some guidance for those who are interested in pursuing a career in hematology/oncology. But first here are some fun facts about me

  • I am Filipino-American
  • Born and raised in North Jersey
  • Attended the University of Hartford and majored in respiratory therapy (yes, I originally thought of pulmonary/critical care prior to med school)
  • Attended the American University of Antigua for medical school
  • I’m a huge boxing fan, my favorite boxer is of course…Manny Pacquiao
  • I currently train at James Shuler’s Gym in West PhillyI recently got married in August of this year in Riviera Maya, Mexico

Did you always know you wanted to pursue hematology and oncology (heme/onc) fellowship? What about it attracted you?Yes. I knew since my third year of medical school that I wanted to pursue a career in hematology/oncology. I was always interested in the variety of pathology within the field, especially the cancer aspect. During my fourth year of medical school I was fortunate enough to do a one-on-one sub-internship rotation with an attending in his private practice. I had the chance to gain firsthand experience of what a career in heme/onc would be like. The diversity and complexity of the cases I was seeing on a daily basis attracted me to this specialty. From a patient with recurrent invasive ductal carcinoma who had developed metastasis to bone to a patient with a skin lesion that was diagnosed as mantle cell lymphoma.

Another aspect of the field that I developed immense respect towards during my rotation was the chance to support patients through their emotional struggles. Close patient contact and forming relationships with the patients is an important aspect of medicine in which I really enjoy and I feel the doctor-patient relationship seems especially important when the battle against cancer is shared over many years and often through multiple phases of progression and response. It’s definitely an exciting time to go into heme/onc as there are many new up and coming treatments along with endless ongoing clinical trials.

Do a lot of subspecialties in heme/onc exist? Are they traditionally additional years of dedicated fellowship training?

Great question. Those who are pursuing a career in academics tend to specialize in one area of hematology or oncology such as only treating breast or lung cancer for example. Most academic centers have faculty members for each type of cancer. Just like internal medicine, it is difficult to “know everything” and I think that’s why some are heading into the direction of just focusing on one type of cancer. A sub-specialist in an academic setting will generally spend most of their time geared towards research, clinical trials, teaching and maybe 1 or 2 days of clinic. How it typically works is you would either tailor your practice towards your specific interest or look for an opening in your area of interest which will usually be in an academic center.

For those who want to pursue a career in bone marrow transplant, additional fellowship training is required. Bone marrow transplant is an advanced fellowship which is an additional year after completing the initial 3 years of heme/onc. There are some non ACGME accredited 1 year fellowships available at top cancer centers like MD Anderson for leukemia, lymphoma, and myeloma.

Do you plan on pursuing a subspecialty?

Although I have an interest in solid tumors I will not be pursuing any subspecialty. The variety of pathology is what attracted me to this field so I would like to be a “generalist” and treat all types of cancer. If I only focused on breast or lung for example I would definitely miss seeing patients with myeloma, pancreatic, prostate, or even gynecologic cancers. My career goal is to go into private group practice and treat a variety of malignancies.

Every specialty is becoming more and more competitive to match into. Can you share with us some data on what your fellowship application looked like?

I definitely agree that most specialties continue to become more competitive each year. Here are some data for hem/onc from the 2018 NRMP fellowship match data

  • 553 spots with 760 total applicants
  • 73 % matched, 27% went unmatched
    • US allopathic grads: 327 matched, 62 unmatched
    • US IMG’s (like Caribbean med grads): 36 matched, 48 unmatched
    • Non US IMGs: 142 matched, 95 unmatched
    • Osteopathic: 34 matched, 15 unmatched

Below are the details on the statistics from the NRMP match data. You can see the average USMLE step scores for matched and unmatched applicants from US medical schools, IMG’s, international medical graduates, and osteopathic graduates. For instance, the average USMLE step 1 score of US, IMG, and international matched grads respectively were 239, 237, and 242.

What research did you work on during residency? Was that below, above, or an average amount of research for someone applying to heme/onc?

Research is a major component of the fellowship application (especially compared to residency). Research can be any abstracts, poster presentations, publications, or quality improvement projects. Anytime I would see a patient with a rare malignancy I would look it up to see if there have been any case reports published and if only a few have been reported, then I would use that opportunity to write up my own case report. I was taking care of a patient with a primary DLBCL (diffuse large B-cell lymphoma) of the cervix and primary pulmonary angiosarcoma (both extremely rare) and took the opportunity to write them up. They were both accepted for publication in an online oncology journal and have been presented as poster presentations at several meetings. I also worked on a case series with a gynecologic oncologist comparing patients with low grade serous ovarian cancer that was also published in an online oncology journal.

As far as poster presentations, I was able to present some of my abstracts at several meetings including the Lymphoma and Myeloma International meeting in NYC, the American College of Physicians Southeastern PA chapter meeting, the Drexel Discovery Research Day and our departments own internal medicine annual research day. I also presented an overview of the treatment guidelines for autoimmune hemolytic anemia at the Drexel Hematology journal club.

Here are some data regarding research from the 2018 NRMP fellowship match. For US allopathic grads, the average research (abstracts, presentations and publications) was 9.1 for matched and 8 for unmatched. US IMGs had 12.5 for matched and 4.5 for unmatched. Non US IMG had 16.5 matched and 9.6 unmatched. Based on this data, the more research you have, the safer you are to match. Bottom line..find time for research!!

Did you complete any quality improvement projects?

I worked on a quality improvement project with 3 other residents who were also going into heme/onc. We decided to evaluate blood transfusion utilization and cost analysis at Hahnemann University Hospital. We conducted a retrospective chart review of packed red blood cell transfusions administered at Hahnemann University Hospital during the month of May 2017. Data collected included pre-transfusion hemoglobin level, quantity of units transfused, post-transfusion hemoglobin level, the patient’s primary service, and level of care. One hundred and fifty-three charts were reviewed across all specialties and units. Twenty-one               percent of blood transfusions in this period, representing 41 units of packed RBC, were determined to be inappropriately administered. Based on the figures from the ASH 2008 study, the estimated patient costs of these inappropriately administered units may be as high as $140,753. Our conclusion was that the number of blood transfusions administered during the period under review that did not follow the AABB guidelines was substantial. Stricter adherence to established evidence-based guidelines for red blood cell transfusions could represent a significant cost-saving measure.

What advice do you have for medical students interested in pursuing heme/onc?

For medical students who know they want to pursue hem/onc…more power to you! To make yourself a competitive applicant for residency, you must do well on USMLE step 1 and step 2 CK. Lower than average scores can hurt you in the long run and yes they still matter for fellowship. I would recommend setting up 1 or 2 heme/onc electives during your 4th year so you can get an idea of what it’s like to be an oncologist. Try to rotate at the outpatient clinic, as heme/onc is primarily an outpatient specialty. An inpatient or consult elective would be a misrepresentation of what the specialty is truly like.

When rotating on a hem/onc elective try to attend all of the conferences such as tumor boards and ask if you can even present a case. Feel free to ask the fellows and attendings questions on what their daily routine is like. Remember, to become a hematologist/oncologist, you must first get accepted into an internal medicine residency. So work hard and ace those boards!

What advice do you have for residents who are interested in pursuing heme/onc?

For residents interested in pursuing heme/onc, I would make sure the attendings and fellows know you’re interested from the beginning. Try to do as many rotations as you can whether it be the inpatient service, consults or outpatient clinic. The more they see you around, the more they will see that you are truly interested. I know not all residency programs will have an in-house fellowship or not have any available heme/onc rotations so I recommend scheduling an away rotation at program that has a heme/onc fellowship. This can be an “audition rotation” and might be beneficial in the long run (letters, connections, etc). 

Also try to join any heme/onc interest groups and if there are none then perhaps create one! This will definitely look good on the CV.

As mentioned above, research is a vital component of the fellowship application. Try to get started early (as early as first half of intern year). Some projects will take time and you want to make sure you have enough to put on your CV come application time (towards the end of PGY-2). Ask around if any ongoing projects are available for you to join. Senior residents and fellows are good resources to ask.

Ask for letters in advance (anywhere from January-April) depending on the size of the residency program. Internal medicine program directors have to write a letter for every resident applying for fellowship so make sure to notify them early so they have ample amount of time.

How many programs did you apply to, interview at, and rank?

Hem/onc gets more competitive every year. I thought I had a decent application (also reviewed by current fellows and attendings) but I was surprised with the response I received from programs. I applied broadly to around 80 programs and only received 6 interview invites. I ranked all 6 programs and I’m thankful that I matched. I heard the safe number of interviews to have to increase your chance of matching is around 6-10 but that is variable. Some have matched with fewer and some didn’t match with 10 or even more.

I will training at East Carolina University/Vidant Medical Center in Greenville, NC. I am definitely excited for this opportunity but will miss my family and friends in Philadelphia/New Jersey.

If you had to be a component of plasma what would you be?

Hmm…I would probably be the globulins..since they are important for immune system and help protect against bacteria and viruses. I can put the boxing training to use!

If any of my readers have a follow up question where can they find you?

My instagram is @joelal_md and my email is joelalcidmd@gmail.com . Please feel free to contact me with any questions

Posted on

How To Match Into Dermatology: an interview with a dermatology resident

Dermatology is one of the most competitive specialties in medicine. Today I sat down with Benny Wu who is a current dermatologyy resident at Broward Health Medical Center. He shared his journey to dermatology and some advice on how to match into derm.

 

Thanks for letting me pick your brain, Benny. Can you tell my readers a little bit about yourself?

It is an honor for me to share my path to Dermatology residency with your readers and followers. I am currently a PGY-2 Dermatology Resident at Broward Health Medical Center in sunny Fort Lauderdale, Florida. Before medical school, I was a figure skater for thirteen years – competed on the national and international level. In 2005, I chose to end my competitive skating career due to recurring injuries and realized it was ‘time’ to move forward with life by pursuing my second passion: medicine and science. Unfortunately, during college, I did not juggle my college coursework and figure skating very well. I had an embarrassingly low G.P.A. from the University of California, Irvine and did terribly on my MCAT. The next pivotal moment that had a direct impact on my medical career came in 2007. A medical school formerly known as the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine, now called Rowan University School of Osteopathic Medicine (RowanSOM), offered a Master’s in Biomedical Sciences degree for students who performed poorly during college but remained interested in attending medical school. RowanSOM advised me that my chances of being accepted into their medical school would be greatly increased if I performed exceptionally well in the Master’s program and if I improved my MCAT score. I performed extremely well in the Master’s program and brought my MCAT score way up (I distinctly remembered in 2005, my Physical Science score was 5/15, but in 2008 my Physical Science score went up to 10/15). Luckily, I was accepted into RowanSOM’s D.O. program in 2008. During the Master’s program and pre-clinical years I fell in love with immunology and became invested in how the body worked from the cellular and molecular level. Because of my fascination with immunology and medical research RowanSOM invited me to complete the D.O./Ph.D. combined program in 2011. Outside of medicine, I enjoy staying physically active (running and cycling) and cooking. One of my therapeutic outlets is cooking with fresh ingredients accompanied by a glass (or several glasses) of wine!

 

What motivated you to pursue dermatology?

Answering the following two questions can best explain my motivation for pursuing Dermatology

(1) What interests me in Dermatology – Dermatology requires a STRONG background and fund of knowledge in Internal Medicine and its subspecialties (Infectious Disease, Rheumatology, Nephrology, Pulmonology). Response to treatment is readily appreciated and is not heavily dependent on laboratory findings. One example I share with medical students is this – imagine being able to make a clinical diagnosis and assess response to treatment independent of lab findings – of course, more often than not, a confirmatory diagnosis will require a skin biopsy (side note: there are lots of procedures in Dermatology, too!). On the other hand, as much as we would like to refute this way of thinking, the importance of outward appearance in our society, and how it impacts one’s sense of self-worth, cannot be ignored or disregarded – just ask any severe nodulocystic acne patient how he feels after a full course of Accutane – it really is life-changing!

(2) What problems do I think Dermatology faces – I emphasize the difficulties because issues in any specialty can serve as motivating factors for medical students and young attendings. In Dermatology, the pathophysiology of many skin conditions remain unclear or unknown – there is a lot of opportunities for both basic science and clinical research in Dermatology. However, the more pressing concern is the dwindling interest in complex medical Dermatology – this may be due to decreased reimbursements from insurance carriers – but I see this unique problem as an opportunity for Dermatologists-in-training to start new Dermatology fellowship programs, such as Dermatology Hospitalists. For example, severe pemphigus patients admitted for rituximab infusion – this is classically a Dermatology-driven problem that can be managed by the primary Dermatology service.

 

Something that impressed me about you is that how persistent you were in pursuing your desired specialty. You didn’t match into dermatology…twice. But you persisted and landed a residency position in your dream job. What did the experiences of not matching into dermatology teach you?

Not matching into Dermatology taught me the importance of focusing on my modifiable weaknesses.

After failing to match again during my intern year at Drexel, I had to ask myself two questions: (i) is Dermatology the only specialty for me? (ii) if so, what can I do to maximize my chances the third time around?

Facts are facts. I am a D.O. with average USMLE scores for Dermatology (these are not modifiable). However, my lack of publication and research experience in Dermatology was modifiable. Thus, I made a promise to myself that I would give myself one last chance – reapply to Dermatology – but this time as a Northwestern Dermatology Clinical Research Fellow.

Also, I learned how much ‘grit’ I have. Dr. Angela Duckworth’s book, “Grit: the power of passion and perseverance” discussed the importance of being ‘gritty’ especially when dealing with failures or disappointments. If you have not read this book, I urge every one of your followers to read it, especially before the interview season begins – I believe in the two equations outlined by Dr. Duckworth: talent x effort = skill; skill x effort = achievement; TALENT counts ONCE while EFFORT counts TWICE.

 

Why do you think you didn’t match multiple times?

I failed to match numerous times because of the following reasons:

  1. Did not initially consider D.O. Dermatology programs
  2. Did not apply broadly (limited myself geographically).
  3. My degree, D.O. – Dermatology is a competitive specialty even for U.S. M.D. graduates.
  4. Average to below-average USMLE Step 1 score (238) for matched applicants – as a D.O., a spectacular Step 1 score (>250) would have helped – but not a guarantee by any means.
  5. CV did not differ much between the first and second time applying.

What did you do differently the second time to improve your chances of matching? Why do you think you failed to match a second time?

I did not do anything differently the second time around – as you know, we were co-interns at the time and had limited time to add significant publications or research experiences to my CV. The only addition to my CV in the 2017 cycle was one publication – a review article on drug-induced pyoderma gangrenosum.

 

So you finished your required preliminary year in internal medicine and you are offered the opportunity to stay and complete a categorical three-year residency in internal medicine. Why didn’t you stay?

Do you want a fluffy answer or the real answer? ☺ I did not stay because Dermatology remained one of the few medical specialties that I could see myself doing long-term. However, I loved infectious disease as well. Like I said before, there was one modifiable ‘weakness’ in my application – Dermatology research experience. Near the end of intern year, I was offered a Dermatology Clinical Research Fellow position at Northwestern University, Feinberg School of Medicine. Privately, I told myself that if I did not match the third time around, I would complete Categorical-Medicine residency and possibly pursue Infectious Disease.

 

What did you do professionally after your preliminary year to improve your application while you re-applied for the third time?

Right after the Medicine-Preliminary year, I moved to Chicago and completed a Dermatology Clinical Research Fellowship at Northwestern University. Simultaneously, I entered the 2018 ERAS and NRMP and applied with new recommendation letter writers (2 from Northwestern Dermatology Faculty, 1 from University of Pennsylvania Dermatology Faculty, 1 from Drexel/Hahnemann University Hospital Medicine Residency PD) and 1 new publication (ichthyosis, X-linked) with the Northwestern Dermatology Chair, Dr. Amy Paller (https://www.ncbi.nlm.nih.gov/pubmed/28846233).

 

Thankfully you matched. What do you think you would have done if you didn’t match for a third time?

If I did not match, after three attempts, I would have done the following in sequential order:

  1. Try to secure an unfilled position through the SOAP.
  2. Apply to the few programs that secured extra funding for more spots or received ACGME-approval to increase program size after the NRMP Match quota deadline. Because Dermatology is a relatively small community, one advantage of doing a research fellowship at a major academic institution, such as Northwestern, is that PDs will advertise open positions on a listserv available to only Association of Professors of Dermatology Members (Dermatology PDs). Northwestern forwarded open positions to their research fellows since 2 out of 5 research fellows did not match.
  3. If number 1 and 2 don’t work in my favor, then I would seek out available PGY-2 Medicine Categorical positions, with the hope of specializing in Infectious Disease later down the road.

How many dermatology programs did you apply to each year? How many did you rank?

– In 2016, I applied to ~50 Dermatology Programs and 18 Medicine-Preliminary Programs. Ranked 5 Dermatology Programs (NRMP).

– In 2017, I applied to ~90 Dermatology Programs (including both Advanced ‘A’ and Physician-only ‘R’ positions). Ranked 2 Dermatology Programs (NRMP).

– In 2018, I applied to 95 Dermatology Programs (15 AOA-accredited “D.O.” programs and 80 Dermatology Programs – including both ‘A’ and ‘R’ positions). Ranked 2 AOA-accredited Dermatology Programs (NMS Match). Ranked 6 Dermatology Programs (NRMP)

 

What advice do you have for medical students who want to pursue dermatology?

– Read, read, and read more: highly recommend Lookingbill and Marks Dermatology textbook – this is a basic Dermatology textbook – very user-friendly.

– Approach to reading primary research articles: learn how to interpret and formulate questions as you read research articles – (i) is the study design robust – assess strengths and weaknesses (ii) any bias (iii) does it directly address the hypothesis – keep in mind that negative papers can still be valuable (iv) author financial relationship disclosure – is there a conflict of interest? Learning these skills early on will help you tremendously at audition rotations – this will quickly set you apart from other applicants – always remain inquisitive.

– Align yourself with a Dermatology mentor as soon as possible: if your school does not have a home Dermatology Department then search for a local Dermatology Society (for example, Chicago Dermatological Society [CDS] and PhillyDerm in Philadelphia, PA).

– No need to submit to only Dermatology journals: if you see a compelling case in your non-Dermatology clerkships that is Dermatology-relevant (for example, VZV reactivation in an immunocompromised patient) submit the case as a Continuing Medical Education (CME) quiz to a Family Medicine or Internal Medicine journal.

– Ask yourself these question: “is Dermatology the only specialty I see myself doing?” Remember, Dermatology has significant overlap with Rheumatology, Infectious Disease, and Family Medicine/Primary Care. By not limiting your publications to Dermatology journals, should you decide to apply to Family Medicine or Internal Medicine down the road, it will appear less likely that you ‘settled’ for another specialty.

 

What are important aspects of a residency application for dermatology? Is it heavily research oriented?

– Research is critical (except for a few Dermatology programs, most are academically-driven and require residents to publish annually). Many of the applicants I met on the interview trail took a year off to do research. However, a dedicated research year is not critical – instead, focus on getting 2-3 FIRST author PMID (PubMed Indexed) publications by the time ERAS is ‘due’ (typically ~ September 15)

– First authorship holds much more weight – keep in mind papers can come in a variety of flavors: case-reports, case-series, CME quizzes, and review articles.

– By taking command of your publications, this will serve you well during the interview – you may be interviewing with a faculty member who is an ‘expert’ in the topic of your research or publication(s).

 

Any residency interview tips specific to dermatology that you wish someone told you before you hit the interview trail?

(i) Please do not discount the value and importance of PCs! I believe that Kaiser-Los Angeles Dermatology granted me an interview because I was professional and courteous when communicating with the PC.

(ii) Compile a list of programs that you would like to receive an interview – construct a personalized letter of interest to each program – outline the reasons why that program is attractive (besides being Dermatology!) – email the letter to the PC in late September so it can be added to your file for review.

(iii) Pay attention to your speaking volume and level of engagement during the pre-interview dinner and interview day – I lived by this saying ‘loose lips sink ships.’

(iv) If you are placed on the wait-list, email the PC and ask when the interview(s) are held? – Three weeks before the interview date(s), send the PC an email reminding him/her of your interest and provide application updates, if applicable.

(v) Avoid emailing or calling the PC with general questions about the program – study and thoroughly comb through the program websites.

(vi) Only reserve emails when you have SIGNIFICANT application updates – for example, I was asked to give an oral presentation at the 2018 American Academy of Dermatology (AAD) Annual Meeting [https://www.aad.org/scientificsessions/am2018/SessionDetails.aspx?id=11492] after I certified my ERAS – after updating my programs of interest, I received an interview invite from one program several hours later.

(vii) After the interview, prepare handwritten thank you cards for the PD and PC – note: in 2018, several programs explicitly stated NO thank you cards.

(viii) Prepare written templates for the following scenarios: (a) requesting letter of recommendations (b) accepting interview invites (because rarely do Dermatology applicants reject interview invitations) (c) letter of interest – tailored to specific programs (d) post-interview thank you card (e) top choice/you are my number one letter. I have templates (Dermatology-specific) for all these scenarios – please contact me directly if you wish to see my templates.

(ix) Avoid post-interview communication with the PD, PC, and residents – unless it is for SIGNIFICANT application updates – also, no harm in sending your number one a letter of intent several weeks before the rank list is due – note: in 2018, several programs explicitly said no post-interview communications.

 

Here are some facts for you and my followers. In 2016, based on NRMP match rate data, dermatology was the 5th most difficult specialty to match into behind only neurosurgery, orthopedic surgery, plastic surgery, and vascular surgery. Likewise in 2016, dermatology was among the six specialties with the highest average USMLE step 1 score for applicants who matched into their preferred specialty along with neurosurgery, orthopedic surgery, otolaryngology, plastic surgery, and radiation oncology. That average USMLE step 1 score was 250. Although I believe that high board scores shouldn’t be the only important aspect of a medical student’s residency application, it is hard to argue with objective data in that if you want to match into a highly competitive residency like dermatology you need to ace your boards. What advice do you have for medical students who want to pursue dermatology but don’t have those ultra-competitive board scores?

I scored a 238 on my USMLE Step 1 (please keep in mind that I took my Step 1 in 2011 – the passing score changed several years later). Regardless, 238 is not a strong score for Dermatology. If you scored <240 on USMLE Step 1, focus on the modifiable aspects of your application – (i) research – aim for 3 to 4 first author publications (ii) mentorship – seek out mentors as soon as possible so you have time to develop a relationship with them – this will lead to STRONG letters of recommendation (iii) research year – consider a research year (between MS III/IV) – I highly recommend the Northwestern Dermatology Pre-Doctoral Fellowship (iv) I cannot stress this enough – if you want to pursue Dermatology, remain focused on the modifiable aspects of your CV!

 

How did you find and develop a relationship with a mentor in dermatology?

My Ph.D. was on neutrophil biology in sepsis. Naturally, I asked myself the question “which skin conditions are driven by neutrophil dysfunction?” I found out that several neutrophil-mediated skin diseases fall under the spectrum of diseases commonly known as ‘neutrophilic dermatoses (ND).” As a fourth-year medical student, I reached out to Drs. Misha Rosenbach and Robert Micheletti from the University of Pennsylvania Dermatology (they are both Dermatology Hospitalists and have research interests in ND) – I contacted them and expressed my interest in Dermatology and ‘expertise’ in neutrophil biology. At that time, they happened to be in the process of spearheading a retrospective chart review of patients admitted with Sweet’s syndrome! Long story short, I completed two months of research with them, and they became my mentors through this process. Although I was not a University of Pennsylvania medical student, Dr. Micheletti supported my Dermatology Residency Application all three times – Dr. Micheletti emailed me on Match Monday, one hour after NRMP released the much anticipated “Did I Match?” email, and asked how I am doing and if I matched. Mentors do not have to be from your home institution. The mentor-mentee relationship takes work – take these relationships seriously but also show your ‘humanistic side’ or ‘brand of personality’ when appropriate. Remember, there are MANY ways to find and develop a relationship with a mentor – this is just one example of how I did it.

 

What is the biggest misconception about the field of dermatology?

The biggest misconception about Dermatology is that it is an ‘isolated’ specialty – like I mentioned before, Dermatology overlaps with many, if not all, of the Internal Medicine subspecialties – think: systemic lupus erythematosus (Rheumatology), HIV-associated dermatoses (Infectious Disease), systemic sclerosis (Rheumatology, Nephrology, Gastrointestinal, Pulmonology). There is significant overlap between all of the previously mentioned specialties – we see more multidisciplinary clinics, such as Rheumatology-Dermatology, for connective tissue disease patients with skin manifestations. Again, you do not need to limit your manuscript submissions to Dermatology journals – many internal diseases present on the skin – for instance, a CME quiz or review paper on atypical presentations of sarcoidosis can be submitted to a Pulmonology journal.

 

What are the strangest, most bizarre, or most unique questions you’ve been asked after people find out that you’re going into dermatology?

What people commonly say when they find out I am a Dermatology Resident is “oh, that is why you have such nice skin.” The most common question is “what should I do about X, Y, and Z (insert common COSMETIC complaints here) – because of this, I tell new people I meet that I am a Medicine Resident ☺. Also, my phone will occasionally receive pictures of rashes and bumps from my friends – I usually respond with “not interested” haha, just kidding! All jokes aside, I enjoy the question “why Dermatology?” – this question reminds me of the reasons why I chose to pursue Dermatology – and I take this opportunity to educate the public that Dermatologists are not merely ‘pimple-poppers, cyst-removers, and soft tissue injectors.’

 

Okay, so now the question that I’m sure you must be asked non-stop: what’s your skincare regimen?

Well, I do have pretty fabulous skin… ☺ haha. Disclaimer: ‘healthy’ skin is heavily driven by his/her genetic makeup – but evidence-based medicine suggests that sun protection and intact skin barrier are critical for optimal skin health. And of course you should not use this as medical advice. If you have skin questions or concerns you should always seek out an expert consultation with a dermatologist. This is my skin care routine:

 

Morning

In the shower: limit shower time to <10 min and use lukewarm, NOT HOT, water.

(a) Panoxyl 10% benzoyl peroxide (BPO) face and body wash – apply wash to my face only – prevents acne breakouts – has antibacterial and anti-inflammatory properties (BPO will whiten colored clothing so make sure you thoroughly rinse off the BPO, especially if you use colored towels).

(b) Cetaphil Gentle Cleansing Bar Soap.

 

Post-shower

If you are prone to eczema or dry skin – use towel to damp dry – followed by emollient (cream-based, not lotion) application – emollient will ‘lock-in’ moisture.

– Cetaphil Men’s Daily Facial Moisturizer SPF 15 – quick word about SPF – unless you have a genetic skin disease (i.e. Gorlin’s syndrome) – no need for SPF>30 – SPF and percentage of UV blocked employs a base-10 logarithmic scale – this means that an SPF of 10 blocks out 90% of UV, SPF 15 blocks out 93.3% of UV and so forth – the percentage of UV blockage basically levels off above SPF 30 – save your money and spend it on an excellent emollient, instead – see below.

– Cetaphil or CeraVe Moisturizing Cream (from tub NOT pump or squeeze bottle) – I use this to prevent moisture loss and to maintain an intact skin barrier – this is especially important for long hours in the hospital (definitely experienced this as a Preliminary-Medicine intern) – apply liberally to arms and legs.

 

Evening

Same as morning routine (BPO face wash) with the addition of topical retinoids – retinoids such as adapalene 0.1 or 0.3%. Retinoids are indicated for acne and pre-cancerous skin lesions, but they have also demonstrated repeatedly in several controlled studies to improve fine wrinkling, increase dermal collagen synthesis, and lighten uneven pigmentation – because of these reasons, I use adapalene 0.3% nightly – if your insurance does not cover retinoids (tretinoin, adapalene) it can be purchased over-the-counter under the brand name Differin (adapalene).

 

Things to avoid

Alcohol-based products (dries skin) and anything scented.

 

Benny Wu was born in Taipei, Taiwan and immigrated to the United States (Cupertino, California) when he was 10 years-old. Before medical school, he was a figure skater for thirteen years – competing on the national and international level. He graduated from the University of California at Irvine (Irvine, California) the same year he decided to end his competitive skating career. Before attending Rowan University School of Osteopathic Medicine, Bennybecame interested in medical research while he earned a Master’s of Biomedical Sciences from the University of Medicine and Dentistry of New Jersey. This led him to enroll in the combined D.O./Ph.D. program at Rowan University in 2009. Upon graduation from Rowan University in 2016, Bennycompleted an intense but rewarding Medicine-Preliminary internship year at Drexel/Hahnemann University Hospital in the ‘City of Brotherly Love’ (Philadelphia, PA). After his internship year, Benny fully immersed him in Dermatology clinical research by completing a Dermatology Clinical Research Fellowship at Northwestern University, Feinberg School of Medicine. Besides immunodermatology and translational research, he is passionate about mentoring medical students serious about pursuing Dermatology. Outside of Dermatology, Benny enjoys cycling, completing workouts that incorporate stability, endurance, strength, and athletic power, cooking, baking, and traveling. His next dream vacation spot is South Africa (cage dive with Great Whites). To learn more about Benny including his winding path to a dermatology residency you can follow him on Instagram at dermination_sk8r.

 

Interested in other specialty specific resident interviews? Check out these resident interviews and subscribe so you don’t miss out on the next blog post!

https://mykittykatz.com/what-happens-when-you-dont-match-into-residency-twice/

 

Subscribe! 
Posted on

How To Survive 28-Hour Residency Call Shifts

In my internal medicine residency program we work 28-hour shifts while rotating through the medical and cardiac ICU every 4 days. You show up at 7am and work your usual shift and then cover all of the patients in the intensive care unit when everyone else goes home. You see new evaluations on the floors and in the emergency department and help run any codes that happen throughout the hospital. The following morning you get to leave at 11am if all the work is done and do it all over again 3 days later.

Thankfully the CCU and MICU rotations usually are only 3 week stretches at a time but it is still mentally and physically exhausting. Here are my tips to getting you and your patients through your overnight shifts alive.

 

 

Sleep (duh)

Never stand when you can sit, never sit when you can lay down, and never lay down when you can sleep. At some point you will be able to find some down time so take advantage of it when you can. I’ve found that if I can get 4 hours of sleep overnight I can somewhat function well enough the next day. 3 hours and everything takes me a little bit longer than usual. Anything less than that and I’m a zombie. Bonus points to whoever can manage to have a nap during the day before your evening call shift starts.

 

 

Pack an overnight bag

I have the same routine during every overnight shift. I claim my favorite call room with the best AC, steal an extra pillow from an unused call room, and snag two towels from the linen cart. Usually sometime around midnight or whenever there is a lull in the action I wash my face, brush my teeth, and throw on some new socks and underwear. If nothing else it makes me feel a little more refreshed and clean after being in the hospital for close to 18 hours. Of course, this plan goes sideways if I forget to bring my overnight bag. My overnight supplies consists of the following:

  • Toothbrush and toothpaste
  • Face wash
  • Contacts/glasses
  • Fresh socks
  • Fresh underwear
  • Advil

 

 

Meal Prep

My usual goal is to bring at least one full meal with me for my overnight shift. Sometimes that consists of a Trader Joe’s burrito or home made mac ‘n cheese while other times its simply some yogurt and a coffee K-cup. It takes minimal effort but makes a big difference when you’re tired and hungry. This way you can just be tired! Not to mention that ordering take out gets old and expensive pretty quickly.

 

 

Go home and sleep afterwards..but set an alarm

The best overnight shifts, and rarest, are ones where you get enough sleep during the night that you can just go home, take a quick nap, and have the rest of your day off to enjoy. Typically what happens is I get home by 11:15am, eat something small, and pass out. When I first started working overnight shifts as a junior resident (PGY-2) I would sleep as much as I wanted. The problem I encountered is that I would wake up at 7pm and not be able to fall back asleep until 3am. Which would be fine if I didn’t have to be back in the ICU by 7am the next morning. To avoid this sleep schedule nightmare I always set an alarm for somewhere around 3-4pm. This way I would get enough sleep to be able to function for the rest of the afternoon and also still be tired enough to have an early night. Or catch happy hour depending on the day.

 

How do you survive your 28-hour overnight shifts? Don’t forget to subscribe so you don’t miss my next blog post!

[button link=”https://wp.me/P31Asd-mT” icon=”envelope-o”]Subscribe![/button]

Posted on

What Happens When You Don’t Match Into Residency…Twice

Two years ago I interviewed a fellow Caribbean medical graduate. I interviewed him because of his failure. Specifically his failure to match into residency. I wanted to shed light on what the medical education community seems to shun and ignore- what happens after you fail to match into residency. Last year we were both hopeful that we would be able to share a comforting update on his path toward residency. His story was seemingly not yet ready to be told because for the second year in a row he heartbreakingly failed to match into a residency position. However, as the old adage goes, third times the charm.

 

 

It’s been two years since I interviewed you the first time. Back then you were recoiling from not matching into residency. Then you went through the match for a second time. What did you do during that first year after not matching your first time?

Hi Marc, it’s been quite some time and I’m happy to be back talking with you and answering your questions. After the first time of not matching, I began the process of getting my MBA in Health Services Management, studied for Step 3, and worked part-time for Ross University as a standardized patient. I also shadowed one of the pediatricians I worked with to keep my clinical skills fresh as she saw both adults and children.

 

 

How did you deal with the emotions of not matching for a second time?

To be quite honest, at first, I didn’t deal with the emotions. I was rather numb for a while and chose to ignore the feelings. But I started to really develop that anger more than I felt the depression stage of grief (Kubler-Ross knew what she was talking about). I had a hard time accepting the fact I did not match, considering what a program director told me, in which they implied that I was going to match at that program. I felt betrayed and became distrustful in the whole process.

 

 

What strategies did you change the second time around? Different specialties? How many interviews did you get the second time? Why don’t you think you matched the second time? 

I applied strictly to Family Medicine, which I definitely felt comfortable doing and I had wanted to really do it after attending the AAFP National Conference in July 2016. I met a lot of people and had some meaningful conversations with program directors. However, with all that said, I only had two interviews. It wasn’t that I was a repeat applicant that held me back, but it was the fact that I was never able to obtain a letter of recommendation from a board-certified Family Medicine physician. I do not believe that it was my interviews that did me in, but simply the numbers were against me.

 

 

So it’s your second match day and you find out you didn’t match, again. Take me through that week for you. 

It was a dark week. No…a dark couple of weeks. I was teaching our Ambulatory Care Competencies elective, which prepare MS-IV’s for Step 2 CS. We had finished around 10:45 AM and as I was walking to my car, I get the e-mail AGAIN that states “You did not match.” Again, there was no “oh hey girl” or “what’s going on” or anything like that. Just a simple “You did not match.” I immediately drove back to our school’s campus and got to work on SOAP. I actually had a phone interview at a university-based internal medicine program for a categorical position, which did not happen the year before. I spoke with three people and I naively felt very optimistic, thinking I was going to get the position. Well, the rounds of offers went by and there was nothing. It was very difficult to show up to work on Tuesday being surrounded by people who were celebrating having matched. In no way, shape, or form was I jealous or bitter. I knew that all of our journeys were our own and our applications were all different. However, it was just a little tough to be happy around them because I wanted to know what that feeling was like, so I took a break from social media. When I did that, the outpouring of support via text and email came from my former classmates and colleagues. So many people voluntarily reached out to me offering positive thoughts and were willing to put in good words for me for the next process. These people knew my work ethic and personality and were willing to put their reputation on the line by recommending me. That was a huge motivation for me to keep going and to get back on the horse again.

 

 

What did you do for the year after your second time not matching? Where did you work? 

I managed to get a full-time position with Ross University teaching for their Internal Medicine Foundations clerkship. However, I wasn’t even on their radar! According to the requirements, I was too far removed from graduation to be hired but they took me on the team on a per diem basis, if you will. I was working 40 hours a week, but just for the six-week clerkship. Unfortunately for one of the hires, he was unable to take the position and I had proven myself worthy of the position. They liked my teaching and mentoring style so much that they ended up offering me a full-time job and eventually, I became the Chief Clinical Teaching Fellow. I went from not even being considered for the team to becoming the team captain, which gave me the confidence going forward in the application process and it was something that I spoke about in my interviews.

 

 

Fast forward to your third time going through the match. You finally get a categorical position in internal medicine. What do you think was different this time around?

Well, my MBA was finished (and I graduated with highest honors) and my Step 3 score was in. I had taken Step 3 in January 2017, hoping to have it in time for the rank order list that was due in February 2017. Of course, I was part of the group of exams that wouldn’t get their score until May. May 2017 rolled around, and I passed so this showed that I am in good standing to eventually pass the boards, whether I ended up in Internal Medicine or Family Medicine. I also finally got that FM board-certified LOR for my application, which was a bonus since the writer is also a program director. Also, I was working on getting published in a medical textbook.

I knew that it was going to be very difficult to get residency interviews on my own, so I had to reach out to as many people as I could that were in residency programs. I asked people to talk about my character and work ethic. I looked at as many Family Medicine programs as I could and saw what scores they were looking for and narrowed Internal Medicine programs to the east coast and Chicago. Overall, I applied to 260+ programs. To my surprise, within the first week, I had my first interview offer and within four weeks of applying, I had four interviews lined up. I also constantly checked for new programs that were opening up and applied to those, which gave me some additional interviews. Overall, I had 3 IM interviews and 5 FM interviews (one of them was an interview I had last year, for which I was really grateful). Some of the interviews were from the help of people in the program, but that’s the main help I received. It helped me get my foot in the door, but I had to impress in the interviews. I did not take that help for granted and realized that I was not only representing me, but I was also representing them.

 

 

Do you know a lot of other students who didn’t match? What about people like you who didn’t match multiple times? What do people do who don’t match for a third time? What would you have done?

I have heard of a handful of students who matched after a third or fourth attempt. After I matched, I posted my story on Facebook and I got a huge number of messages with people asking for ideas on how to help them match and the best I could do was help brainstorm. Everyone’s application is different and since I don’t know what’s on their application or record, I could only speak on what I ended up doing.

To be quite honest, I don’t know what I would have done if I hadn’t matched a third time. I have been living in Florida already for my rotations and one thing that I was considering was applying for my ACN (Area of Critical Need) license. Since I had passed all the Step exams, I would’ve been able to practice medicine under the license of another primary care physician.

 

What general advise do you have for pre-med students researching Caribbean medical schools with regard to match rates? Did your medical school have resources available to you after you didn’t match?

Match rates are definitely useful, but you have to take them with a grain of salt, as you do with the match residency placements. Sure, Ross has matched at Yale and Duke, but you have to realize they are a rarity and have worked with the right people to earn that opportunity. However, use that as motivation to push yourself further to get that opportunity. Also, be aware of the school’s data. Take a look at what year the data came from because it may be slightly outdated. Take a look at where the graduates are able to practice. Even if you transfer into a “Big Four” (I guess Big Five school with AUA) medical school for your rotations, where you did your basic sciences will limit where you can obtain licensure so keep that in mind before you go to a cheaper Caribbean medical school. The extra cost is completely worth it.

 

 

What advise do you have for medical students who don’t match? What about if they don’t match twice?

Excellent question, Marc. Simply do not give up. It’s not a matter of if you will match, but rather WHEN you will match. Do not be afraid to reach out to colleagues who are in residency programs. I was hesitant at first because I wanted to earn it on my own merit, but if other industries interview people based on reference from those within the company, why can’t we do it in medicine? I know many people who got residencies because their parents knew people. My parents are not physicians. No one in my family is a physician. However, my friends from medical school could vouch for me, which in my opinion, carries more weight as there is no obligation to push for me.

Also, take Step 3!!!! You might as well get it out of the way, especially if you have lower scores like me, a failed attempt, or need a visa for residency. It can definitely open doors because every single interview mentioned that they were glad I had Step 3 done. One PD told me that it was a deciding factor in my application. In the words of Larry the Cable Guy, GIT ‘ER DONE.

To see our original interview after Steven’s first failed match check it out here- what happens when you don’t match.

Thank you again Steven for being so open and honest about your success and failures. I wish you only the best during residency and beyond.

 

[button link=”http://wp.me/P31Asd-mT” icon=”envelope-o”]Subscribe![/button]

Posted on

How To Study For USMLE Step 1

I’ve been getting a lot of messages on Instagram about how to study for USMLE step 1 so figured I would put all of my answers into one concise blog post. First off, take my advice with a grain of salt. Actually, you take anyone’s advice on how to succeed in medical school with a grain of salt. What worked for me might not work for you. That being said, I hit my goal of getting a +240 score on USMLE step 1 and this is how I did it.

 

 

Step studying starts day 1 of medical school

I struggled a lot my first semester of medical school because I had to learn how to learn. Everything you see from day one of medical school can show up on your USMLE’s. So my biggest advice on how to study for step 1 or step 2 CK is to learn everything right the first time around. Remember that at the end of the day you aren’t studying to pass your classes. You’re studying for your step exams.

 

 

Start using question banks early

I’ve previously written about how to study in medical school, my favorite resources in medical school and my favorite resources for USMLE Step 2 CK. A recurring theme is question banks. Again I will reiterate 2 things: (1) that question banks are meant to challenge you to apply your knowledge and find gaps in your knowledge to then go back and study and (2) UWorld is the gold standard. Save UWorld for when you are truly in your two months of intense step 1 studying. But when you are in medical school I encourage you to use other question banks like Kaplan. I used Kaplan as a second year medical student while I tutored gross anatomy to supplement my knowledge base and show me the scope and depth that I truly needed to know for the test. Incorporate question banks as early as possible.

 

 

Use your resources consistently

Just like question banks the rest of your study resources are important tools for success. The more you use them the more valuable they become. For instance, if you plan on using Picmonic you should start using it early in medical school. It loses its value if you only start using it in the months leading up to USMLE step 1. Similarly, don’t stop using whatever resources you found valuable during medical school. If you used Pathoma then keep using it. If you used FirstAid then keep using it! And if you found that you didn’t like certain resources then don’t use them!

 

 

My background

If you don’t already know, I went to Ross University School of Medicine. Back when I started at this Caribbean medical school it was strictly an accelerated program. We did the first two years of medical school in 18 months (they now have a ‘slow’ track too). This gave me 2 full months of strict step 1 studying before I started third year clinical rotations. On top of those two months, we finished our last semester of 2nd year a month early to allow us to study for a comprehensive exam that we had to pass in order to leave the island. So I was refreshing my knowledge for one month before I started my non-stop, pedal to the metal step 1 studying.

 

 

My resources

I used everything that helped me succeed in medical school. That included the following:

 

 

Overall and daily schedule

I had 2 months of strict step 1 studying time. I used Doctors in Training (DIT) which acted as the backbone of my study curriculum. DIT created an awesome two month calendar for me. Inside that timeline I put one true weekend off for a snowboarding trip. Other than that I isolated myself and didn’t really go out much.

My daily schedule consisted of the following:

  • 730am – 745am: review Picmonic
  • 745am – 8am: review notes from yesterday
  • 8am- 9am: 1 full UWorld question set
  • 9am- 12pm: reviewing UWorld
  • 12pm-1pm: lunch break
  • 1pm – 5pm: 4 hours of DIT videos
  • 5pm – 8pm: exercise, dinner, relax
  • 8pm – 10pm: relax and passively review topics

I hope this helps! If you have any more specific questions drop them below. As always don’t forget to subscribe so you don’t miss my next post!

[button link=”http://wp.me/P31Asd-mT” icon=”envelope-o” color=”orange”]Subscribe![/button]

Posted on

Is Anyone Here A Doctor?!

I grabbed a few beach pillows, put on my old worn out blue beach button down, poured myself a glass of whiskey, and walked down to the beach from our villa to watch the sunset. My four friends and I were ten days deep into a two week vacation. We had already toured Seoul, South Korea for 3 days, Tokyo, Japan for 4 days, and Hong Kong for 3 days so I welcomed the two days of rest and relaxation that accompanied the beach resort of Vinpearl in Nha Trang, Vietnam.

I remember laying down perched up on a pillow or two to support my head. The fine white sand of Nha Trang starting to stick to my almost empty but still cold glass of whiskey. I was in my own little world. The sun was just about to slip behind Vietnam’s mountain range in the distance when I heard a commotion coming from our villa. I sipped the final remnants of Johnyny Walker from my glass when my friend Demitri approached me with a worried look on his face. He knelt down onto one knee next to me and said, ‘I just puked blood’.

I immediately gathered my pillows, stood up, and lead Demitri to our beachfront villa. I brushed the sand off my shirt and pants and switched to doctor mode. Demitri was tremulous and hunched over due to his abdominal pain and his physical symptoms were matched with the anxiety of being potentially sick in a foreign country.

Back at our villa I could see that my three other friends were almost as anxious as Demitri. ‘I got this guys’, I assured them, ‘can you grab us some bottled water please?’.

While one of our friends was fetching water the other two explained that they were hanging out when Demitri felt nauseas and began to vomit. After retching a third time Demitri saw blood. They didn’t know what to do so they did the only logical thing- they went and got the doctor off the beach.

With water bottle in hand, Demitri explained that he was feeling lightheaded. I laid him down on the beach chair and and lowered its head flat. The differentials ran through my head quickly with infectious etiologies being the highest. Unlikely arrythmogenic in nature given lack of gross physical exam findings with no past medical history in an otherwise relatively young and healthy adult man in his late 20’s. His lightheadedness likely due to orthostatic hypotension likely complicating his underlying issue given that he was vomiting and had decreased oral intake over the last 12-hours.

I tweezed out that he had no other associated symptoms including fever, chills, diarrhea, black, dark, or bloody stools, and he had no major past medical history. No meds or allergies. His physical exam was benign except for six firm abdominal masses which we deduced was his rock hard abs. He was in great shape with a regular heart rate and strong peripheral pulses. He was an otherwise healthy guy until today.

In the end, it was a scant amount of blood in the bowl but it always looks worse than it is. Like adding a drop of red food dye to a bowl of water. He had something to eat earlier that day that disagreed with him and likely caused some gastritis. Highly unlikely for this to be a manifestation of a Mallory-Weis tear or something potentially life threatening.

8mg of ondansetron, or Zofran, which I keep with me when I travel helped his nausea and stomach pain and his vomiting did not return. He began to feel better within a few hours and a lack of diarrhea pushed me to hold off on giving him antibiotics, 1g of Azithromycin that I bring with me on tropical vacations in case of traveler’s diarrhea.

As a medical professional the experience made me realize a few things. First, that as physicians one of our most valuable skills is our ability to triage. To be able to tell someone, ‘you are sick and need to go to the hospital immediately’ versus ‘take two and call me in the morning’. To be able to separate the inconvenient medical issues from the potentially life threatening.

Second, that half our job as doctors is medicine but the other half is humanism. Sure, nobody will care about how good your bedside manner is if you aren’t a smart doctor and are unable to do the medical part of your job. You know, diagnose and treat and all that jazz. But what separates the good from the best is the ability to connect with someone rapidly, show them you are listening, and to quell their fears and anxieties that accompany being sick.

Lastly that as a medical professional, be it a nurse, PA, or physician, you never know when you will be the only medically trained individual in an emergency situation, be it on an airplane, on the street, or a beach in Vietnam. You will be the person that civilians will look to for help. So regardless of what level of training you are at, be it fellowship, residency, or medical school, use everyday as an opportunity to learn and absorb everything you can. It might just help you save someone’s life one day.

 

—

Have you ever had to answer the call ‘is anyone here a doctor’? Want to share your story? E-mail me your story at KittyKatzMD@gmail.com for a chance to be featured as a guest author!

Posted on

How To Prepare for Intern Year of Residency

One of the most frequently asked questions that I receive from medical students is about how to prepare for their first year of resident. It parallels one of the most common fears among medical students in that they will not be adequately prepared for day one of residency. It’s a valid concern because you will never truly be ready for intern year but if you’ve made it this far in your training then you are likely ready enough. Almost everything you learn intern year isn’t taught in medical school because you have to do actively do it to learn it. At least that’s what I thought until I came across OnlineMedEd.. It’s the only resource I’ve found that actually prepares medical students reasonably well for intern year. Again, nothing is going to make you fully prepared but this is as close as you’re gonna get.

 

I started using OnlineMedEd during third year of medical school

OnlineMedEd is an amazing resource with videos that help explain complicated topics that overlap real world experience with the textbook. They do an amazing job of translating all of that USMLE step 1 material into actual practical knowledge so you can look sharp on all of your third year rotations. I would watch a few before each rotation started and it showed. Dustin and the OnlineMedEd team also drill home all of the important facts that are frequently tested on step 2 CK. Sure, nothing will ever replace UWorld but OnlineMedEd gives it a run for it’s money. Start using OME early and often.

 

A curriculum for fourth year medical students

Your fourth year of medical school is a magical time especially after interview season is over and your rank list is finalized. You’re basically just waiting to graduate and planning your vacation to South East Asia. It is all to easy to fall into a trap of laziness and forget that you are going to be a full fledged doctor in 6 short months (well technically you’ll be an intern but a doctor nonetheless). If you dedicate yourself to the structure of OnlineMedEd during your fourth year you will have a dedicated curriculum that keeps you fresh and sharp on the wards. Sure, you’re still gonna forget a lot before intern year starts but at least OnlineMedEd will get you into some good habits.

 

It prepares you for intern year

My advise to all of my fourth year medical student is always the same- go home because life is too short to be spent in the hospital watching me type notes and at least one of us should see the sun today. I also tell them that the best way to be a good intern is to develop good habits while you are still in medical school. The dirty truth about residency is that you don’t need to be all that intelligent to be a good intern. You simply need to be efficient, thorough, and work hard. The sooner you develop habits that enable you to work smarter, and not harder, the better off you will be. OnlineMedEd has developed a fantastic Intern Boot Camp that helps you do exactly that. If I could do my fourth year all over again I would use the Intern Boot Camp and test out what does and does not work for me while I was still on the wards in the hospital. That way when I show up day one of residency I at least had a system that I knew worked for me. It’s like when I had to learn how to actually study in medical school- I wish I didn’t have to go through the process of figuring out what works best for me. I wish I knew how to study more efficiently back in undergrad. Likewise, take the time to learn the ropes of what it takes to be an intern while you are still a medical student.

 

Start studying for step 3

Ugh I know. Sorry for bringing up the USMLE’s again but you have to get it over with eventually. I’ve written extensively about when you should take USMLE Step 3 as well as how to study for USMLE step 3. If you use OnlineMedEd during your fourth year of medical school you will get a head start on it. You don’t need to use OnlineMedEd as your primary study aid but it will certainly help cement concepts in your head and make it easier for you once you start your dedicated step 3 study period as you transition from medical student to resident.

 

They also have great study products

Last thing I’ll mention are their study aides. The Intern Guide Book and the Quick Tables Book are great study tools for medical students. They succinctly provide you with a ton of well organized material. You have to fill in the blanks and annotate it just like any guide book. But if you are going to use OnlineMedEd then these books are essential as they go hand in hand with some of the videos. Just like any resource, the more you use it the more results you get from it!

 

So if you are interested in using OnlineMedEd check them out here: OnlineMedEd.

 

*Full disclosure: sponsored content. That being said, I only support brands that I believe in.*

Posted on

Why Are You In Medicine?

I was recently interviewed on a podcast (Surviving Medicine) and was asked the simple question, ‘why are you in medicine?’. In retrospect, that’s the exact question I silently ask myself in frustration and exhaustion a little bit too often while I’m in the hospital. In those moments I recognize that I feel burnt out. In those moments if someone told me that I had to repeat intern year in order to finish residency I would probably quit medicine altogether.

So much of our job as medical students, residents, fellows, and attending physicians are out of our control. Even when we are able to treat our patients appropriately we are faced with the simple fact that many of our patients might simply not follow our recommendations. But you know what? That’s okay. We can’t control everything and acknowledging that is the first step. What we can control is how those external forces make us feel. You are in control of your own emotions and your personal sense of job satisfaction.

Residency trains physicians in how to treat patients and develop into well-rounded doctors. Sometimes however we lose focus on why we went into medicine in the first place. The truth of the matter is that the day to day struggles and frustrations weigh heavily on our professional and personal lives during training and those stressors likely won’t abate upon graduation to the next level of professional development. The stressors of medical school compared to residency are different but the same. The stressors of residency to fellowship or our first job as an attending physician are different but the same. Residents today more than ever need to train themselves in how to perceive job satisfaction in order to find personal enjoyment in their day to day life as a physician and in doing so help combat professional burnout. We must not lose sight of the forest for the trees.

Thinking back to the original question I was asked on the podcast, “why are you in medicine?”, I tried thinking of my favorite aspects of my job. Things like teaching my medical students and interns, presenting interesting cases at conference, learning how to manage and treat the basics of internal medicine, and the time I spend with my patients.

As any patient could tell you doctors don’t spend much time with their patients. Unfortunately it’s one more aspect that I feel is out of my control. I wish I could spend more time at bedside with my patients and it’s one of the most frustrating aspects of medicine today. However the simple fact of the matter is that our day is packed to the brim and we can only spend so much time at bedside. But those small moments of my day are my favorite. That inseparable bond between patient and physician. Being able to tell a patient and their family in their time of need that I hear them and I’m listening and that we will figure this out together. To explain a diagnosis and why they haven’t felt well over the past few weeks. Or to console a grieving family when my sympathy is all I can offer them.

Today I reminded myself why I went into medicine and it was invigorating. I even went back and read my personal statements from medical school and residency because I wanted to remember the version of me that applied with eyes wide open. I’m not that same person but the passion that drove me to apply to medical school in the first place is the same passion that pushes me each and every day in the hospital. It’s the same passion that motivates me to do my personal best for each and every one of my patients day in and day out. It’s the same passion that helped me remember why I love my job.

I leave you with the same question that helped center me, “why are you in medicine?“.

This blog post was originally featured on KevinMD, social media’s leading physician voice.