Author: Marc N. Katz

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What To Do Before Starting Med School & Residency

What to do before starting medical school is one of the most commonly asked questions I hear from students about to begin their first semester of medical school. It’s the same question that I wrangled with after graduating medical school before starting my internal medicine residency. Here are my top three things to do with your last remaining days of freedom before starting medical school or residency.

 

 

Travel

Before starting residency I explored Thailand for two weeks and my only regret is that I didn’t stay longer. Traveling is a source of sustenance for the soul that can never truly be satiated. Traveling pushes you out of your comfort zone and forces you to grow as a person. You learn a lot about yourself when you remove your familiarities and submerge yourself in another culture and society. Who knows what a few weeks in another country will do for you. Go get lost so you can find yourself.

 

 

Nothing

As a resident we average one day off per week each month. That means we get, at minimum, four days off per month and sometimes that’s exactly what you get. So during residency, when you finally have free time on your hands you are often forced to be productive despite your zeal to just stay in bed and sleep all day. You have groceries to buy, laundry to fold, and an apartment to clean. Not to mention that research project you’re working on because you want to go into a competitive specialty. The work never stops. And after medical school you think your days of studying are over but  step 3 and your specialty specific board exams always loom in the background. So if you want to sit and do nothing before you start medical school or residency then go sit and do nothing. You earned it and you don’t have to explain yourself to anyone.

 

 

Work

Med school is expensive and residency doesn’t pay too well so it certainly won’t hurt if you can muster up some extra cash while you can. I worked as the most overqualified AP bio tutor prior to starting residency. A friend of mine worked at our medical school as a standardized patient. A colleague of mine worked as a scribe in the emergency department. There are opportunities out there if you seek them out. Ultimately everyone’s financial and social situations are unique and you may not have the luxury to choose to work or not, let alone go on a vacation. For instance, the extra money I earned prior to residency helped me pay for my vacation while my friend who was a standardized patient used his money that he earned to pay for step 3 while my colleague used his extra money to pay for his kid’s braces. So work if you can but don’t overdo it. You don’t want to squander these last few weeks of sanity and freedom if you can afford to.

 

 

Take USMLE Step 3

Okay this is residency specific and should only be performed if you have so much extra time on your hands that you can do the aforementioned (1) Travel, (2) Nothing, and (3) Work and then still have more free time before starting residency. I would not advise anyone to take step 3 in lieu of traveling or doing absolutely nothing. Step 3 isn’t a particularly difficult test in my opinion. However, it is difficult to find the time and energy to study for it during residency. So do yourself a favor and if you have the time and money to take step 3 then register for the test, finish UWorld, and take it already (more detailed post on how to prepare for step 3 and when to take it is in the works).

 

 

What did you do the summer before medical school or residency?

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The life of a family medicine intern who failed step one

Thanks for taking the time to let me interview you…again. I introduced my readers to you a few months ago in an interview about the residency application and interview process. Specifically about how it’s still possible to match after failing step one. Fast-forward to today and we’re both about six months into intern year. So what is it like to be an intern?

My pleasure! I’m so glad to share more with your readers. Being an intern is great. It’s not as scary as people make it out to be. I’m learning so much working on different services and with different attendings.

 


 

What has been the most rewarding part of being a family medicine intern?

As cliché as this may sound, the best part is feeling that I’ve helped someone. Knowing that I’ve touched a patient and made their day a little better makes me smile – whether it is addressing depression that has been overlooked and neglected for decades or reassuring an anxious first time mom-to-be that her pregnancy is safe and viable.

 

 

What has been the most frustrating part of residency?

Lack of flexibility with my schedule can get frustrating… More frequent than not, I cannot commit to social events, like dinner with friends on a Friday night or holiday parties. Luckily everyone around me is understanding of my rigid schedule and they’re cool with me scheduling get together on average 3-5 weeks in advance.

 

 

What has been your most challenging aspect of residency?

One of the internal questions I wrestle with daily is “am I good enough?” Am I learning enough? Am I giving my best to my patients? After years of schooling and studying, it’s easy to take time to relax and fall into a lull of complacency. Integrating study time into a full time residency is my challenge.

 

 

What was your biggest fear going into intern year? Have they come to fruition? How have you dealt with those issues?

I think my biggest fear was that I would be a completely incompetent physician and my residency would regret hiring me. I’m glad to say, that hasn’t come up yet. Every new intern comes in with fears, it is normal and to be expected. People are aware that you’re climbing a steep learning curve. Self-reflection was my preferred way to deal with my fears. I even visited a psychologist for a session just to talk out loud about this new chapter in my life (settling in a new place, moving in with my boyfriend, having real responsibilities at work, no longer being a student, “officially” moving from Canada, etc…)

 

 

What are you hours like? What’s a typical day for a family medicine intern?

There are usually two types of “typical” days: at the hospital or at the clinic. Hospital days are almost always longer than clinic days. A day in the hospital can range from 8-13 hours, whereas in the clinic or with private physicians I can clock in 7-10 hours. It’s hard to describe a regular day for me because it varies depending on which rotation I’m on. I could be working a 10h shift in the emergency department, helping manage a service at the Children’s hospital, seeing patients at my clinic, or working on a consult service at my hospital.

 

 

What do you do outside of the hospital to keep your sanity?

When I’m outside of the hospital I try and disconnect. I have always been a big proponent of separating work life and home life. My parents rarely talked about work when they were at home. I intend on following suit. I relish in wandering the aisles of the grocery store, strolling through the mall, calling my friends with no purpose other than to catch up, and planning how I will spend my next vacation.

 

 

How often do you exercise? More or less compared to before residency started?

I’m embarrassed to admit that I exercise MUCH less than before residency. At this point, I barely exercise once a month. Shameful, yes I know. I ended up canceling my gym membership because I simply was not going. I wish I had established a more diligent work out habit before starting residency but now I value sleep more.

 

 

How often are you able to see your family or significant other?

My family lives 9+ hours away so I see them max once a year. I haven’t been great at calling my mom very often but I try and touch base with home once a week or once every other week. My boyfriend and I moved in together before the start of residency. We’ve been good at making a point to have one activity a week – going out to dinner, opening a bottle of wine at home, going for a long walk near the woods. As with any relationship, you have to make it a priority and dedicate time and energy.

 

 

How are you handling the debt?

Money management is always a work in progress. Budgeting and number crunching was essential to me. I found it insightful to hash out on paper how much I got per paycheck then subtracting my fixed and variable expenses. It helped me see where my money was going and I would be more mindful of my spending as to not go into credit card debt.

 

 

When do you plan on taking step 3?

I have my Step 3 scheduled in April 2017. I’m nervous as with any exam but my goal being to pass regardless of the score is somewhat comforting.

 

 

What’s it like having the responsibility of teaching medical students?

I haven’t fully grasped yet this responsibility. I’m trying to keep my own head afloat! Since I don’t feel at this time that my medical knowledge is all that phenomenal, I make a point to teach my students about the art of medicine. I like to show them my approach to difficult subjects, how I weave humor into interviews, and my use of analogies to simplify medicine to patients.

 

 

In retrospect, with the knowledge that you have now, are there any questions you would recommend to medical students to ask during their interviews?

I would encourage medical students to ask programs what kind of support they have in place to help residents through the years. Do they have board review courses? How do they handle resident burn out? What support will they offer if you score below average on the yearly in service exam? While some students may fear that asking these questions show weakness on their part, I think it is important to know what is available to you in your new work place.

 

 

Speaking of medical students, do you strongly feel that there is anything you wish you did differently while you were in medical school that would have better prepared you for residency?

I don’t think there is anything that I would do differently per se. As a student, I took full advantage of the various opportunities offered to enrich my learning by attending conferences, going to drug rep talks, and striking up conversations with other physicians. I would encourage students to do the same. You never know what you will learn and you never know whom you might meet.

 

 

For the current medical students reading this, what general advice do you have regarding residency?

For medical students approaching residency, I urge you to enjoy the process. Although residency and the match are riddled with stress, anxiety, and uncertainty, have faith and trust the process. Everything happens for a reason and you will end up where you are meant to be. I know it is easier said that done to relinquish control but things will happen the way they were intended to. You will get out of residency what you put in. Your attitude and outlook are the biggest factors in your satisfaction with residency.

 

 

 

Thank you so much Emily for taking the time for this interview. I know there are plenty of other students out there who have come short on big exams like the USMLE’s or COMLEX and it’s encouraging to see someone else who still managed to match and continues to succeed in residency.

 

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Intern Interview Spotlight Update- The Life of a Pediatrics Intern

Prior to starting intern year I interviewed Zack Manier about the residency application and interview process. Today he is six months into his intern year, the first year of his pediatrics residency at The Children’s Hospital at St. Peter’s University Hospital in New Brunswick, NJ. I sat down with Dr. Manier to find out what it’s like to be a freshly minted medical doctor.

Thanks for taking the time to let me interview you again. I introduced my readers to you a few months ago before we both started residency in an interview about the residency application and interview process. Fast-forward to today and we’re a little more than six months into intern year. What’s it like being a doctor?

Ummmmm…so many feels. Important, accomplished, nerve-wracking, busy, overwhelmed, stimulated, stressed, anxious, lost, rewarding, powerful, prolific…shall I go on?

 

That sounds like the all too familiar. So what’s the most rewarding part of being a pediatrician?

Honestly, the gratitude from the parents. Hearing parents (and even adolescent patients) compliment me or compliment me to an attending saying things like “best doctor we’ve had” (yes, that’s happened…I’m not just bragging) is so amazing. It makes all the times I feel completely stupid and useless worth it. Also, definitely having parents ask to specifically have me as their child’s doctor and come to my Thursday afternoon office hour. Clearly my competence (or confidence) is showing, and that is just as rewarding.

 

 

To contrast that story what has been the most frustrating part of residency?

Continuing to be at the bottom of the totem pole. “Yay, I’m a doctor now and no longer a student! I’ve moved up in the ranks!” Wrong. You’re back on the bottom. You’re just the intern. And yes, interns still do [female dog] work. Definitely not as much as when I was a student, but it happens. Oh, and overnight nursery pages. It’s frustrating, but hey…that’s the way the cookie crumbles, right? Now I want a cookie…

 

 

Ah, answering pages. Grey’s Anatomy made it always seem like every page was life and death. Turns out its more often that the patient is having too few or too many bowel movements. So what about residency do you find most challenging?

Trying to be confident with my decisions and not just looking to my senior for everything I’m unsure of (even though they are the best and are always happy to help). I’m not a student anymore. I’m not supposed to just ask my senior to do everything. I have to do it. It’s on me now. I make the phone calls. I order the medications. I call the attendings in the middle of the night. I tell the parents that Child Protective Services is taking their child away. I decide a baby’s respiratory status is improved enough to discontinue oxygen. And if that baby decompensates? It’s on me now. That’s something that you have to realize from day one…you’re a doctor now. This is the start of the rest of your career.

 

 

Our jobs can indeed be quite humbling and terrifying at times. Can you speak on what your biggest fear going into intern year was? 

 Probably what I just discussed above…that even though, yes, you have your seniors…you have to make your own decisions and become a self-sufficient physician. It was hard a first, but I quickly realized I didn’t have a choice. I couldn’t be passive (not that I am that type of person anyway). You have to. That made that fear dissolve within the first two months.

Also, one fear that I’m sure everyone shares…feeling incompetent. You’re going to enter feeling like you know nothing, especially when you’re put on the spot. I imagine that’s what tabula rasa feels like. But magically, somehow…from somewhere…the answers pop out. Your hand starts writing the corrects words. You’re entering medications like you’ve been doing this for years, and you start to realize you know more than you think. The knowledge is there…you just have to apply it.

Thankfully, my co-interns were/are all in the same boat. Having them around and spending time outside of the hospital with them to talk and vent (and drink) have helped to depress those fears.

 

 

Ah your co-interns. As corny as it sounds, I’ve found that they truly are the best part of any residency program. You spend so much time with them in the hospital that it’s nice to enjoy their company too. Speaking of hours, what are yours like? What’s a typical day for a pediatric intern?

This is obviously institution-dependent, but I guess I’ll give you a little snapshot into mine…

It all depends on the rotation. ER is just 18 shifts/month, and we basically make our own schedule— clutch. Lighter rotations like nursery and neurodevelopment as well as outpatient electives are typical M-F 8-5, with weekend floor calls here and there. Floor sucks. Floor sucks everywhere. Sign-out is at 6:30am, and intern sign-out to the oncoming evening intern is at 7:00pm. Yes, that’s 12+ hours a day, usually 6 days/week. Morning report every morning from 8-9am, noon conferences daily from 12-1pm, grand rounds from 9:30am-10:30am every Thursday, and my office hours (or continuity clinic) Thursday afternoons.

Oh, and nights…nights are great. We specifically do 3 sets of 2 weeks of nights as interns, which are 7pm-9am Sunday-Thursday. Which means weekends off (for the most part). Lovely.

My institution is (amazingly) different in a way…interns get every Friday night off. Every one. For the entire year. All eight of us. Those nights…we drink and complain. I also usually get at least one entire weekend off per month, and use that time to get the hell out of New Brunswick for sanity purposes.

 

 

Speaking of sanity, what do you do outside of the hospital to keep it? 

I guess I covered a lot of that above. But yes…relax, drink, travel…in that order. I need it. We all do. Get close with your interns. Go out when you can. If not to drink then for dinner. Vent. Complain without your seniors around. Even if you think you’re in the most amazing place at the start (which I did), you will start to realize the flaws as you become familiar with the inner-workings and the politics. Every institution has them. And you need close people to talk about it with. That’s what we do. I can’t stress enough how important it is to be close with your co-interns, or as in my case, even your second (and sometimes third) years. Also, I get away when you can. I have friends and family all over, and getting out of the little hospital bubble with all your (likely) hospital friends is necessary to stay sane. Plus, I’m in the cold…I hate the cold. Winter sucks. I go to Miami every chance I get.

 

 

That’s great advice. How about exercising? How often do you find yourself exercising compared to before residency started?

This will be a short one. I don’t. I exercise the same amount as before, because I didn’t. Should I? Definitely. Quite honestly though, my feet hurt (I hate dress shoes). And after the day is over, I want to be horizontal. In my bed. Am I complaining? Yes. Do I plan to change this soon? Yes! You can’t be a doctor (especially a pediatrician) promoting health and wellness when you don’t do it yourself.

 

 

How often are you able to see your family or significant other?

This is something I struggle with daily. My family is in one city, my SO is in another, and I’m in a third. So when I get the chance, where do I go? To see my SO. It’s a hard decision, but I’m used to being away from my family…I went to college out of state, medical school internationally, and I haven’t lived at “home” in almost 10 years. It’s difficult being apart from my SO, and we need frequent visits to maintain our relationship, just like all long-distance relationships. Thankfully, we see each other at least monthly (whether I go there or he comes here), and Facetime is a live-saver. Since I moved to NJ in June, I haven’t been back home. My family did come visit for Thanksgiving, and I’m currently writing this on the plane home for Christmas. Holidays and occasions…that’s been pretty typical for seeing my family over the past years.

 

 

How are you handling the debt?

Debt? What’s that? Oh, right…I mean, the cronies automatically take money from my account monthly, and I don’t think about it. And that’s all I have to say about that.

 

 

When do you plan on taking step 3? 

Bleh. Adult medicine. I don’t want to study it. It’s like, I want to take it and get it over with so I never have to study adult medicine again, but at the same time…I don’t want to start studying adults again. But alas, I must. I’m either taking it mid-February or end of April, as those are the times that work with my lighter rotations. I’m getting UWorld for Christmas (yay, adulting), so I’m about to start on that. Mainly, I don’t want to spend the $900 or whatever is it to take the exam. I’d rather spend it on drinks. Medicine is a damn money pit, ya know?

 

 

What’s it like having the responsibility of teaching medical students?

I love it. It’s great. I’ve tutored in the past and was a head anatomy TA in medical school, so it’s something I enjoy. It’s also nice to have attendings tell me that medical students compliment me and enjoy working with me. They don’t think I’m dumb! However, it is sometimes hard to give them full attention as the intern…especially on floor when it’s super busy and I have one million things to do. That’s what the seniors and attendings are for.

Also, pro-tip: get the medical students to follow your patients. That’s what I do. Why? Because on floor rounds, the student presents and gets pimped, not me.

 

 

In retrospect, with the knowledge that you have now, are there any questions you would recommend to medical students to ask during their interviews? 

Other than all of the medical knowledge, you mean? I don’t think there is anything that I now wish I had asked…I pretty much knew what I was getting into, and I feel like it’s on par with my expectations. The most important thing is to ask the resident’s if they’re happy. We won’t lie. We really do tell it like it is. And definitely ask how they feel they attendings are and what their relationships are with the attendings. It will make a world of difference. I’m fortunate enough to have amazing attending physicians. It’s something I have been bragging about to all the interviewees this season. Like, you know how in medical school or residency even there are those physicians that people are “scared” to work with or grumble about being placed with? Yeah, we don’t have any. None. I would say 90-95% of ours are absolutely amazing, and the rest are good but ever-so-slightly more intimidating. That might be the best part of my residency. Definitely ask about that.

 

 

Speaking of medical students, do you strongly feel that there is anything you wish you did differently while you were in medical school that would have better prepared you for residency?

My one and only regret is not taking USMLE Step 3 prior to residency. I was going to, but I ended up drinking and traveling instead. (A common thread here, clearly) So, if you have time, seriously consider taking it. It will save you a load of stress and annoyance later, when that is the last thing you have on your mind or want to deal with. Otherwise, just be proactive. Act like a resident on rotations, not a student or a shadow. Ask to do procedures, to see extra patients, to write notes, to have your H&Ps checked and reflected on, to stay later, to make phone calls. These are all things you have to do as a resident, and the sooner you start, the better. These are all things I did, and not only did it get my outstanding grades and letters of recommendation, but it also significantly prepared me for residency. If you have all of these things (mostly) down before starting, you can focus on expanding your knowledge and being the best provider for your patients you can be.

 

 

For the current medical students reading this, what general advice do you have regarding residency?

First and foremost, the last line I just said. Be the best provider you can be FOR YOUR PATIENTS. That’s what it’s really about, and why (most) of us all are in this profession. It’s for the patients. Check your egos at the door. This isn’t about you, it’s about them. The rest…the knowledge, the fearlessness, the confidence, the competence…that will come with time. But your patients always come first, no matter what.

 

 

Zack, thank you so much for taking the time to let me interview you. I appreciate your words of wisdom and motivation.

Check back next week for my next intern interview update. And as always subscribe so you don’t miss out!

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The Life of a Pediatrics Intern

I sat down with a first year resident in pediatrics to find out what her life is like as a pediatrician in training. Here’s what she had to say.

 

 

I’m getting flashbacks of interview season but can you tell my readers a little bit about yourself?

Hello readers! I’m Sarah with an h, currently working as a 1st year pediatric resident at Cooper University Hospital in South Jersey. I’m a born and raised Jersey girl from a middle class family right outside of Philadelphia. I grew up playing soccer which I played at Widener University, a small private college in Chester, PA. The only medical blood in my family is my mother who is a NICU nurse. My original major at Widener was nursing, but halfway through my sophomore year I realized there was SO MUCH to learn and I wanted to continue my education past my four undergrad years. I switched to pre-med and it was at that point that my advisor told me about Caribbean medical schools, which accept applicants year round and geared more to the less traditional student like myself. I attended Ross University in Dominica, West Indies where I had the most amazing experiences and made lifelong friends. While I feel I did not get as many residency interviews as I would have liked because I went to a foreign medical school, through hard work, perseverance and constant contact with the programs I was interested in I wound up matching to my top ranked residency at Cooper back home in South Jersey.

 

 

So we’re about a quarter of the way through intern year and you’ve been a doctor for about four months. How’s it feel?

I feel like I’m finally settling into my role as a decision maker. The first couple months it was difficult transitioning from a closely monitored medical student to a doctor being pressed for urgent decisions and orders to be placed. I had to fight the urge to call a senior resident when being faced with medical decisions for several weeks before I felt comfortable in my new role. Even decisions I KNEW were correct, I suddenly became much less sure of when I was the one writing the order or telling the nurse which dose of medication to give. You are immediately thrown into the role as a team leader, which is daunting but extremely rewarding. I’m now at a place where I feel much more comfortable with my knowledge base, but know I have a long road to go.

 

 

What has been the most rewarding part of being a pediatrician?

Hands down seeing my patients’ laugh, smile or feel better. People always ask me what I love about my job, and it’s 100% the kids. The connections I make with children and their families make a 14 hour day all worth it. It can be one thank you, or one hug, or a colored picture and suddenly my hectic day where I haven’t sat down is put into perspective. It is so rewarding to be a part of the connections between the patients, to see the sigh of relief when they realize they’re not alone, and to be a part of an amazing team of medical personnel from social workers to physical therapists to nurses. Sometimes it’s surreal to think about what a critical role you play on that team. I am so grateful for the opportunity I’ve been given to positively impact children and there isn’t a day that goes by, even if it’s just for a brief moment, that I don’t remember that.

 

 

What has been the most frustrating part of residency?

I think a lot of frustration during residency comes from having a life and schedule that is no longer your own. Just know that for however long your residency is, mine being 3 years, you are more or less signing over your freedom. It sounds harsh, but when you look at it that way it makes you appreciate the time you do have off!

I went into residency with that outlook, and I found myself far less frustrated with the long hours.

The thing I would say I struggle with the most is disagreeing on medical care with other residents, more importantly my senior residents. Residency is a hierarchy, post graduate year 1 (PGY-1), PGY-2, PGY-3, and then fellows and then of course your attending. Medicine is also not black and white. Yes we have guidelines and peer reviewed articles, but in all honesty until I became a resident I didn’t realize how much of medicine was up to your own discretion.

Turns out, my treatment plan isn’t always the same as my senior residents. I think it’s important for interns to be prepared for differences of opinion and to know there is no one right answer in medicine. Like a bad USMLE question, it’s your job to choose the MOST correct answer, grapple with the opinions of other people around you, but ultimately do what is best for your patient. This is not as clear cut as you’d think, so pick and choose your battles and surround yourself with a strong support system.

 

 

What are you hours like? What’s a typical day for a pediatrics intern?

The hours vary depending on what rotation you’re on. There are more intense rotations which require 80+ hours and some less intense rotations where you work 40 hours a week or less. I feel that most programs do a good job of interspersing the two types of rotations so you have some time to breath in the middle of your tougher one.

For me, being on the “floors” or a pediatric hospitalist is the rotation that requires the most time and not only mental but emotional energy. Days start at 6am when you rush to get all of the vitals, history, updates and see all of your patients before rounds. The day ends at 7pm, but you usually have 2-3 hours of notes after that (14-15 hour days if anyone was keeping count). And you also have to remember you’re taking about two to three 12-hour weekend shifts per month.

But keep your head up! I’m in outpatient Behavior and Development now and I’m working a regular 9-5 (and some days less!).

 

 

What do you do outside of the hospital to keep your sanity?

Anything BUT medicine! I love doing guided meditation, which you can find on YouTube. I find the less time I feel like I have, the more that means I need to meditate. I hang out with my friends, I read non-medical books, I go to music shows, I go out to eat, drink and be merry. I travel on my vacation weeks. It’s so important to remember to do the things you love to do. So have a good idea of what makes you happy (outside of medicine) before you start residency and never lose sight of that.

 

 

What has been your most challenging aspect of residency?

Time management has probably been the most difficult for me. Not just in the hospital, but managing being a good resident, friend, sister, aunt and daughter. And going grocery shopping, keeping my apartment clean and bills paid. And on top of that studying enough to keep up with your own specialty, what you’re interested in, and preparing for the USMLE. It always feels like you should be doing more. Deep breaths throughout the day help.

 

 

The average medical school graduate finishes their schooling with roughly $160,000 of debt. How do you plan on paying it off?

The government really helps us out. They have amazing repayment plans you can enroll in now, which you can talk to your loan provider about. I’m currently enrolled in the Public Service Loan Forgiveness plan with an income-driven repayment plan. What that basically means is that if I work for a non-profit hospital and pay 10% of my income for the next 10 years, all of my loans are forgiven. It’s something to think about when ranking residencies, because this plan only applies to non-profit organizations. There are a lot of other plans available so definitely something to talk to your financial aid counselor or loan provider about!

 

 

You grew up playing soccer. In fact, that’s where we met! So you’ve always been an active person  How much are you exercising these days compared to before residency started?

Significantly LESS. Like I say, if exercising is one of your passions, you really have to set aside protected time for it. I try to just work exercise into my daily routine. I set a goal of 15 sets of stairs a day when I’m on floors. 100 squats any time before I take a shower. Stretching anytime you have the space to bend. Drink TOO much water. Take deep breaths throughout the day. Even if you don’t feel like you can be your most fit self, you can always lean in the direction of health.

 

 

Do you strongly feel that there is anything you wish you did differently while you were in medical school that would have better prepared you for residency?

Honestly, no. I wish I could have done more elective rotations in the hospitals where I wanted to match, but for insurance reasons Ross University students couldn’t rotate in the states of NJ and PA. But it’s absolutely something you SHOULD do if possible. And if you have the opportunity to rotate in a hospital where you’d like to match, to try to be in the hospital on the floors because some of the subspecialties are pretty far removed from the doctors and residents who make up the bulk of the program.

Take your role seriously, because the type of student you are is the type of doctor you will eventually become. And every skill you’ve learned will help contribute to making you the best doctor you can possibly be, regardless of what rotation you’re on.

But most importantly I enjoyed myself. That’s something I tell all my medical students now, just take time to really enjoy your role and learning experience because it’s a big change once you enter residency.

 

 

What was your biggest fear going into intern year? Have they come to fruition? How have you dealt with those issues?

The biggest fear was that I’d be a bad doctor. I’m sure people want to know more specifics, but really just that I would not be able to help my patients, or know what to do, or what to say, or that I wouldn’t be as good as the other interns. Luckily, these have NOT come to fruition! Turns out, you know a lot more than you think you know. And a lot of what patients’ need to hear is that they’re going to be ok and you’re here for them no matter what. And the other residents aren’t my competition, they’re my biggest allies. I go to work every day knowing that I am here to do the best I can for my patients. With that motivation, a good team, and a lot of hard work, you have all you need to succeed. Never forget WHY you’re doing this.

 

 

What’s it like having the responsibility of teaching medical students?

As an intern, you feel so overwhelmed by your work and getting used to everything yourself, you almost feel like you don’t know enough or have enough time to really make any difference in their education. But I found that just carving out a little time to explain how I’m approaching certain patients or problems, or how I like to write notes can help contribute to how they will eventually practice. And every single one has been SO grateful for the time. If they ask me a question I don’t know, I say let’s look it up together. I try to incorporate them into the team, ask them something I don’t know that they might, or ask them to look certain things up so we can learn together. It’s so rewarding when you see a student you taught succeed on rounds or pick up new interviewing techniques they saw you do.

 

 

When do you plan on taking step 3?

I plan on taking Step 3 mid-April, which is a little more than half way through my intern year. I tried to coordinate taking the test with a month I was on a lighter rotation. I know people who took it before residency started which I commend. I knew I wanted that time to celebrate, travel, and enjoy myself so it was not an option for me. I feel like it takes a good 6 months to settle into your new role as a resident, so I would recommend sometime before or after that period.

 

 

For current medical students, what advice do you have for residency interviews?

Just be personable. I think the questions are just a formality. I really feel interviewers are just trying to see if you can hold a conversation and will fit well with the other residents. I would ask questions about the interviewer, “Where are you from? What do you like to do in the area? What brought you to this place/position?” Start a conversation. Be a real human. Actually get to know the person.

 

 

For the current medical students reading this, what general advice do you have regarding residency?

Take DEEP breaths as often as you remember and DRINK plenty of water !!!

 

Thank you so much for taking the time for this interview Sarah!

 

And keep on the look out for a follow up interview with a family medicine resident who failed step one.

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The Most Frequently Asked Questions on Residency Interviews…by Medical Students

It’s my first interview season as a resident and I am loving the free lunches. Uh, I mean…meeting all of the applicants. It’s kind of strange being on the other side of things because I remember asking the exact same annoying inquisitive questions that all of you are asking. However, I’m realizing most of my answers are not specific to my program and I end up giving general residency advice like how to survive your intern year and how to create your residency rank list. Here’s what I tell the prospective fourth years:

 

 

What’s your favorite part of your residency program

My co-residents. It’s annoyingly corny but true. This is a highly sensitive test for weeding out unhappy residency programs. Residency sucks but you should at least be able to get along with the people you are stuck in residency with because the only thing worse than going through residency is going through residency alone.

 

 

If you could change one thing about your program what would it be?

Daily free lunches, a personal assistant, and a raise would be nice. Otherwise, well…every residency program has there bugs but the tell of a good program is that the administration will listen to their residents and make appropriate changes. A better question to ask is ‘what are the most recent changes that were made to your program based on complaints or concerns raised by residents’. Ask that. You’ll look like, really smart.

 

 

Why did you choose this program?

It was a gut feeling. Every program I interviewed at had essentially the same things. Maybe some had more or less research, was in a bigger or smaller city, had a bigger or smaller residency class size, or had varying degrees of fellowship opportunities. But you will likely be a successful doctor wherever you end up. The question you have to ask yourself is ‘will I be happy in this city at this hospital if I match here’. And the answer to that question depends a lot on you (and your family’s) priorities.

 

 

What stood out about your top choice residency programs compared to the rest on your list?

The program director’s leadership and enthusiasm when meeting us (despite likely giving the same speech and presentation hundreds of times before), the impressive amount of teaching that occurs during morning report (yes, it’s like this every morning), and my interactions with the other applicants and residents . Again, these residents and fellow applicants are the people you’re going to be stuck with for the next three years. If you can’t enjoy an afternoon with these people then that residency program likely isn’t a great fit for you. My favorite interview days were ones with the best lunches. And also when I got along well with the other residents and applicants. But also lunch.

 

 

So lunch is really important to you, huh?

It’s all about the little things. When a program would take us to their cafeteria for lunch it made me feel like they weren’t even trying to impress us. Sure, maybe they have an amazing cafeteria and all of the residents eat there everyday. Except it ends up coming across like a cheap date who forgot their wallet at home. It would never be a reason to rank a program higher or lower but it consistently served as a surrogate marker for other things that may be awry. Like someone who wears ankle socks with dress pants. Judged.

 

 

So you get along well with your residency class?

I enjoy hanging out and working with most of my co-interns and residents. You find your people early on and you go through hell with one another. Working on the same floor together for a month builds some pretty strong bonds. Especially if chased with tequila. Just recognize you aren’t going to get along with everybody and that’s okay. Hopefully the bell-curve is skewed towards positivity and most attendings, fellows, and residents there aren’t jerks. Again, big red flag if lots of people within the residency program don’t like one another.

 

 

Are you involved in any research at the moment?

I’m currently four months into residency. I finally have my feet underneath me and I can navigate the hospital system pretty well. Don’t get me wrong, I’m still a bumbling intern but I am more efficient bumbling intern compared to July 1st. I now feel comfortable pursuing research projects and am currently getting involved in a QI project. However, I’m waiting to take step 3 before I jump into some bench research going on in my hospital. Just beware, the only thing worse than not performing any research is getting involved in research and dropping out because you weren’t available or weren’t interested. It’s unprofessional, word will spread, and people will be less willing to offer you future research opportunities.

 

 

When are you taking step 3?

ASAP! More specifically the middle of December. Many of my friends in OB/GYN and pediatrics have already taken and passed step 3. Internal medicine constitutes a large proportion of the exam so there isn’t a huge rush for IM residents to take step 3 because you’re going to learn the majority of what’s on the exam during your training anyway. However, non-medicine residents are often advised to take the exam as soon as possible so they can get it out of the way. Personally, I’m taking a middle ground approach and will be taking it six months into my residency. It really depends on your schedule. Mine is lighter early on so I have time to finish UWorld (yes, it is the only resource I am using. Will confirm that it was a good decision once I pass). Getting step 3 out of the way also let’s you finally focus on the more important things in residency. Like research and not killing your patients.

 

 

Should I take step 3 before starting residency?

Only if you have an insane amount of time prior to residency. Otherwise, go enjoy your life and follow up on my next blog post about what to do the summer before residency! You can also check out my two blog posts on this exact subject:

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Spotlight Interview: DO graduate earns OB/GYN residency

Tell us a little about yourself. What are your career goals in medicine? Who are you outside of medicine?

I’m Maureen. I’m 27 and originally from California. The first question people ask me when they learn that is “why did you leave beautiful sunny California to come to gross Philadelphia?” but I actually really love it here. I guess you could say I’m more of an east coast, fast paced type of person…probably part of why I love OB/GYN. I hope to be an adolescent gynecologist but I’m sure I will change my mind in the next four years. Outside of medicine, I love to cook, travel, and hang out with my friends with a glass of cab.

 

 

What should fourth year medical students do the summer before medical school? What did you do?

Before medical school, I took a vacation. I stopped working about two months before med school started to travel with friends and reset my mind. I also had to move from San Diego to Philadelphia, so I road tripped across the country with my dad. I wouldn’t suggest anything else. Relax. Don’t study. Spend time with family and friends. Work on your friendships because free time will be compromised.

 

 

Where did you go to medical school?

I went to PCOM—the Harvard of DO schools! I only applied to DO school. I had a 33 MCAT, but my GPA was only a 3.2. I knew I wasn’t competitive for MD schools in locations I wanted to live (California, Philadelphia, NYC). PCOM was the first school I interviewed at, in the beginning of October. I got my acceptance October 31st. I went to one other interview and cancelled the rest. I knew PCOM was the right place for me.

 

 

What advice would you give to pre-med applicants about applying to medical school?

I would tell pre-med students to do well on their MCAT and to not neglect their GPA. Scores get you in the door—a theme that will ring true again for residency. Nothing else will guarantee interviews like solid numbers.

 

 

So for those of us who don’t know, what’s the difference between a DO and an MD medical school?

At DO schools you learn osteopathic manipulative medicine (OMM). It means 1-2 extra lecture hours a week along with one 90-minute lab session to practice the techniques. It means taking a different board examination. Otherwise, I don’t think there are any differences—but I am a little biased.

 

 

Do you plan on continuing to use OMM in practice?

Unfortunately it’s not realistic to use OMM in residency. You just don’t have time. If I end up in private practice then I will 100% use OMM. It really does help patients with musculoskeletal issues. If you learn to bill correctly, it can also be extremely lucrative. I spent two months of my fourth year working in my school’s OMM department so I was able to see what consistent treatment can do for a patient with low back pain or carpal tunnel. I probably have a bigger appreciation for OMM than most other current DO students.

 

 

Let’s fast forward to fourth year of medical school. How many OBGYN programs did you apply to? Any backup specialties?

I applied to 59 programs. Philadelphia, New Jersey, and NYC. I didn’t apply to any backup specialties. I got around 20ish interviews and stopped counting. I really wanted to be in either Center City, Philadelphia or NYC, so I cancelled most of my NJ interviews when I had a few in Philadelphia. I went on 9 interviews—much less than the average candidate. I would say most people did 15-20 at least. I also took a big risk and only ranked 6 programs. I honestly just had a hard time picturing myself being happy at any program outside of my top 4. It was a hard decision but I risked it. Luckily, I got my first choice and it’s been 6 weeks and I haven’t cried yet. Complete success.

 

 

Do you think you had an advantage or disadvantage applying to residency as a DO?

Definite disadvantage in a few areas. First, certain schools do not accept you. Waste of money to apply. Second, some sites, especially those tied to Caribbean schools, do not allow you to rotate there. Which takes away the chance to do sub-internships there which are important for almost every specialty. I definitely got asked awkwardly on interviews “What is a DO?” and it sucked.

 

 

Every potential applicant is probably dying to know, so what were your step scores? Did anything on your resume separate you from the crowd?

  • COMLEX level 1: 629
  • COMLEX level 2: 627
  • USMLE step 1: 233
  • USMLE step 2: 251

Those scores definitely helped me land interviews at solid allopathic university programs like Drexel, Temple, SUNY- Downstate who have a paucity of DO’s in their resident pools. I was often the only DO or one of a handful on interview day. I also did research between first and second year of med school and got a paper published in Menopause. I think my research my scores are 100% what got me interviews. I also was president of PCOM’s OB/GYN club, served as a class representative in our student government, and taught gymnastics during first and second year.

 

 

What advice do you have for someone who wants to apply to OBGYN but didn’t score that well on step 1 and/or step 2?

Apply early and broadly for sub-I’s and show up and work your ass off. That’s the single best, and in some cases only, thing you can do to get an interview.

 

 

What were OBGYN interviews like? Any advice on how to succeed on interview day?

Lots of women, ha. I actually made some great friends on the interview trail. It was really comforting. Know your application, know your research, know where you want to be in five years. Have questions ready—my favorite was “how do you hope to see the program improve in the next 5 years?” Know where the program director trained. Otherwise, just be friendly. Talk to the residents about their personal lives. Ask if they residents hang out together—if the answer is anything other than “oh yeah! We’re all friends!” you know that program probably isn’t very social. Really try to see how you fit with the residents. That’s the most important thing. Who do you want to be stuck on 15-hour nights, 6 nights a week with?

 

 

What should current applicants look out for in an OB/GYN program? (besides free food on interview day)

They should look how they fit in with the residents. Go to the pre interview dinners and talk to them about how they feel about the program. Interviews will get very cumbersome by the end so you will cancel a few. Rationalize it in that you’re opening the door for someone else who might really want that spot. Figure out your non-negotiables and make your rank list from there.

 

 

Any other advice that you’d want to give fourth year medical students currently applying for the match?

Breathe!

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Gift Ideas for Someone in Medicine

With the holiday season approaching I wanted to update this blog post with my newest favorite gift ideas for someone in medicine. These are some of my favorite gift ideas for anyone with a loved one going into dentistry, medical school, residency, fellowship training, nursing school, PA school and everything else in between.

 

Professional lapel pins- perfect for any specialty

 

 

 

 

Dr. VOROBEV

This is probably one of my favorite Etsy stores I’ve found. They’ve got everything. From podiatry, surgery, orthopedics, pharmacy, and more. Whatever specialty your loved one goes into you can definitely find something for them. These are some of my favorites:

 

 

 

 

 

Stethoscope Heart necklace

Cardiology: Anatomical Heart Pendant

Rod of Asclepius

Orthopedic surgery: Tree of Andry
Pharmacist: Bowl of Hygieia
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Spotlight interview: from the Caribbean to a categorical surgery residency

Today I had the good fortune to interview a close friend who matched into one of the toughest specialties in the medical field. Not only did she match into general surgery but she also earned a categorical position. Here’s her advice on how she did it.

 

 

Tell us a little bit about yourself. Who are you professionally? Who are you outside of the hospital?

 

I go by Laura Edwards, or just Laura. I am a native South Floridian but I was raised by a strong mid-western mother. I come from an extremely diverse place, which was paired with values that cherish a nonjudgmental attitude and service for others.

I carry those values with me into practice. I use these with patients and colleagues just the same. I am a team player, whatever that means today or tomorrow. I feel comfortable to take the lead or to coordinate behind the scenes.

Outside of the hospital, I am a laid back lady. I binge-watch amazing TV shows, I meet friends for a brewsky, I read fiction, and I have dog. And yes, I study too.

 

 

What specialties did you apply to? How did you come to choose it/them?

I applied to general surgery positions (categorical and preliminary) only. Not applying for other specialties was a serious decision that was made with much thought and care. Many people encouraged me to have a back-up plan. I had to ask myself all the ‘What if’s?’; “what if I get a preliminary spot the first year, and then AGAIN the second year?’, “How will I significantly improve my application before the next cycle?”, “What will I do if I don’t become a surgeon?”, “How will I cope with that?” etc. I calculated the risks as best I could. Yet, in the end I listened to my gut, which told me that I was going to be a surgeon.

 

  

For those who don’t know, what is the difference between a categorical and a preliminary surgical residency?

In the world of general surgery, a preliminary position is a 1-year contract whereas a categorical position is a 5-year contract (or the amount of years required to finish the program). A preliminary position is for a Post Graduate Year (PGY) -1, -2 or even -3 resident. Going into a preliminary position will require the resident to apply for another position the following year, which means entering ERAS again, i.e. residency starts in July and you start your new application in September, only 2 months later. And as many of us know, the more times one enters ERAS the poorer the outcomes can become with each cycle.

When preliminary positions are offered to general surgery candidates it likely means there is something about your application isn’t absolutely perfect. This can be a variety of things: your medical school, your evaluations, your grades or scores, something said on your interview day, etc. It is my understanding that preliminary positions are usually given as a trial year. The program is confident enough to train you for one year but not enough to commit to 5 years.

Therefore, categorical positions i.e. full-contract positions are the goal. When a categorical position is offered, the program director is saying “We see you as a real potential surgeon. We believe with our training and your foundation you could complete our residency program successfully.”

 

 

How many programs did you end up applying to? 

I applied to approximately 230 categorical positions and 150 preliminary positions. As a international medical graduate, I was very unsure of how my application would fare. Fortunately, my family supported my efforts during this time. We all believed the more applications sent the more opportunities I would find. Every penny is worth it.

 

 

How many interviews did you go on for each?

I went on 6-7 categorical interviews and 5 preliminary interviews.

 

 

Any crazy stories from the interview trail?

No crazy stories really. But always be friendly with the other applicants; they might become your co-resident or you will see them again at another interview.

 

 

What did you find to be the most frustrating part of the interview process?

 

There were two things that left me frustrated again and again. The first was waiting.

Waiting for interview invitation emails to come in is the most gut-wrenching part. I found myself going through highs of triumph and hope and lows of defeat and fear. It is an extremely unpredictable and emotionally taxing time. I highly suggest taking up some activity that will strongly distract your mind.

Once on the interviews, the second thing I found most frustrating was that many interviewers were unaware of how the Caribbean schools are structured. I found that my interviewers assumed that I completed all my rotations on the island. I found myself explaining the general flow of my medical education. Once I was able to explain that I had done 2 years of clinical rotations at various hospitals in the US, they were much more open to me as a candidate.

I guess, you would think that all interviewers at least glance through your transcript or would see that your letters were from American institutions, but unfortunately this was not always my experience. My advice concerning this is just to assume your interviewer has no idea where you completed the 3rd and 4th years. Use this as an opportunity to talk up your experience.

 

 

Do you feel that coming from a Caribbean medical school hindered your chances to match in one of the most competitive residency specialties?

Yes, without a doubt. The US applicants I interviewed alongside were overall more relaxed with the whole process. They spoke of turning down interviews and gave off the vibe of “It will all be okay; I’ll end up somewhere [as a categorical surgical resident].”

But let’s step back a bit.

I decided to go for surgery very early on in medical school. Therefore, everything I did was geared towards this goal. I joined the surgery interest group, attended knot-tying sessions and studied as hard as I could without going crazy for Step 1. I spent my entire third year lining up sub-internships (aka audition rotations) at hospitals outside of my medical school’s network. I pursued research within the surgical department from the 2nd week of my third year. I nurtured and maintained a MEANINGFUL relationship with my research mentor (and still do to this day). Everyday I woke up; I made sure I did something to become closer to my goal. I thought about it multiple times a day. I made a phone call to a surgery department while walking in between patients, sent a quick email to a coordinator. My efforts were relentless.

I’m sure some US graduates work this hard to attain their goal but I did not get the feeling from fellow applicants that they had the same level of intensity. I truly believe that my edge/aggressive attitude was what got me to where I am today.

In my mind, there is only one chance to gain that cherished categorical surgery spot, so hold nothing back and have no regrets.

 

 

What do you think were your greatest strengths about your application? What set you apart from the other applicants?

 

My step scores got my application through the filters. Then, my letters of recommendation only confirmed what others saw in me. And lastly, probably what set me apart was the friendly and confident-yet-humble manor I held during interviews.

I also have a MA degree in Marriage and Family Therapy. This was the unique twist I had in my application. This gave my application depth and made my reasons for applying to surgery even more sincere and pragmatic. In reality, I use counseling skills in every relationship I have and more importantly at work and with my patients.

For my program in particular, what set me apart in their eyes was my work and patient care they saw during my sub-internship. I went out of my way to make sure the program director knew my name. I always asked my attendings how I could be better. I made sure my chiefs knew I was reading and following up on previous concepts I was unsure of. I was so intent on being impressive that it actually worked and they vouched for me following my interview.

 

 

In contrast, what were your greatest weaknesses about your application?

Of course, the fact that I was an international graduate and had average step scores were things that I had to compensate for, but at the same time, these are things you cannot change.

The one weakness I could have prevented was a particularly bad evaluation from a particularly important person. The clerkship director for my 3rd year surgery rotation knew my interest in surgery and therefore held me to those standards. Instead of striving for excellence, I became overwhelmed and eventually gave up on trying to impress her. That led to poor decisions that only worsened the situation. I knew her evaluation of me would not be stellar but I did not think she would be so damming either.

The lesson to learn from this is to never let anyone get so down on you that you start to believe them. You are your best advocate and champion. Never let that go.

 

 

How did you do on the USMLE’s? 

I studied hard for Step 1 and received a 233.

I took a risk and scheduled my first sub-internship during the month I was also studying for Step 2 CK. I ended up splitting my time 90% rotation and 10% on CK. So inevitably, I got a 233, the same score as Step 1. This was devastating because all institutions look for an increase in score. A stagnant or decrease in score is can be seen as a red flag. Interviewers asked about my CK score on two occasions. Once I explained that I was also doing my first sub-internship rotation they all understood and did not ask any further questions.

However, the risk I took was worth it because that first sub-internship is where I matched that following March. Hennepin County Medical Center saw me as a person, as a blooming surgeon and not as a number. I hope you all find this too when searching for your residency spot.

 

 

What advice would you give to other international medical graduates who want to pursue a categorical residency position?

 

First of all, thank you Marc for interviewing me. The process of getting this all down on paper has been a good exercise. It has helped me to realize new foundational truths that will help others and me along the way. My main pieces of advice for those pursuing a categorical surgical position are as follows:

  • Be your own champion, always
  • Be relentless in your efforts to stand out
  • Do away rotations at non-affiliated hospitals
  • If you don’t have the scores (~230 or above), be realistic about your chances

 

 

Thank you Laura for taking the time to let me interview you. Your tenacity is inspiring.

Be sure to subscribe below and like me on Facebook so you don’t miss you next week’s interview!

 

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The Worst Part About Being an Internal Medicine Intern

The only thing I love more than complaining about being a doctor is actually being a doctor. Intern year sucks. There’s no way around it. I wake up at 5:15am to get to the floor at 6:00am and I rarely leave at 5:00pm when my shift is scheduled to end assuming I’m not on call till 9:00pm.

I often feel my stomach growl at 9:00am and wonder why the hell I’m hungry again. Didn’t I just have breakfast? OH WAIT. I ate breakfast 4 hours ago. By noon I’ve already been at work for 6 hours.

It’s stressful. I’m constantly in situations that I don’t quite know how to handle. For instance, when my patient’s nurse walks over and tells me that my patient’s family wants to speak with the doctor. The first time it happened I kind of looked back blankly at the nurse, shrugged my shoulders and said ‘okay?’. I looked over to my senior resident inquisitively and she gave me a bleak stare back and simply said, ‘she means you…doctor’. It’s fucking terrifying.

Don’t get me wrong. I love my job. I love being better tomorrow than I was today. Sure, I would generally prefer not to look like an idiot in front of my attendings but it’s kind of inevitable. And if my pride and ego are the only things that are hurt in the process then I’m happy to learn something new. Not to mention I look dashing in that long white coat.

But the worst part of intern year so far? It isn’t the lack of sleep, or getting yelled at by a cardio fellow, or looking stupid in front of my entire team. It’s been watching my patient slowly die and not being able to do anything about it. I feel helpless. I can’t even imagine what’s going through my patient’s head.

There are literal teams of physicians working to keep my patient alive. Cardiology, cardiothoracic surgery, plastic surgery, radiology, interventional radiology, nephrology, infectious disease, gastroenterology, hematology & oncology, physical therapy, nutritionists, and the entire nursing staff (oh thank the lord for the nursing staff). And all of the ancillary staff that help us do our jobs.

When this man dies the entire hospital is going to be present for the morbidity & mortality conference. Except the one department that should have been involved from the beginning- palliative care.

Getting a palliative care consult doesn’t mean giving up on our patient. It means making the patient’s quality of life a priority.

I won’t begin to pretend to know what’s best for my patient or how to get my patient well enough to get him out of the hospital but what’s the point if we don’t make his quality of life, and his family’s quality of life, a priority. 

——–

This post was originally featured on KevinMD.com

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What happens when you don’t match

What happens to medical students who don’t match? Here’s what one unmatched psychiatry applicant had to say.

 

Thanks for letting me interview you Steven. You have a pretty unique story that my readers would love to hear about but before we delve in can you tell us a little bit about yourself? Who are you professionally? Did you go straight from undergrad to Ross? Who are you outside of the hospital?

My pleasure, Marc. I appreciate the opportunity to share my story as I feel people can learn from any experience in this process, both good and bad. I graduated from NYU in 2010 with a Bachelor of Arts in Mathematics. After graduation, I had about six months before starting with Ross University’s MERP (Medical Education Review Program) and I knew I needed to make money. So I took a job that any medical school bound person takes – working in the jewelry and diamond industry. I did mostly bookkeeping but I also prepared orders for a wholesale company that dealt with Macy’s, JcPenney, Sears, HSN, QVC, etc. It taught me a lot about dealing with large staffs and it was a nice break away from the science and math world I had spent so much time with in undergrad.

Professionally, I’m the one making jokes in the office but I focus on the patient when I’m in the room. I like to be a reason people enjoy coming to work, because they know it’ll be fun and productive. On the same token, I’m also someone who isn’t afraid to call someone out for their BS because I expect someone to do the same to me if I ever act out of line. I also am one of the first people to teach someone how things run in the office, how to order labs, do procedures, etc. Not only do people feel comfortable if it’s a peer teaching them but it helps me better my skills as well.

 

 

What specialties did you apply for? How many programs in each specialty? What was your reasoning for that number of programs?

I applied to psychiatry, internal medicine, and internal medicine-psychiatry combined. For psychiatry, I applied to 76 programs. For internal medicine, I applied to 10. And for IM-psych, I applied to all 9 programs in the country. My step scores weren’t that competitive and there are only 196 psychiatry programs in the country. I went through each program on FREIDA and checked to see if I matched their step requirements. If I did, I tried to see who the residents were. If there were zero or one Caribbean grad in all the PGY positions, then I didn’t apply as I felt that that one particular Caribbean grad may have had a connection there or had stellar scores. Plus, why would I spend money on programs that were going to outright reject me?

For IM, I applied to where I had rotated and since I could apply up to 10 for one fee, I applied to some hospitals in the NY/NJ area (which is where I’m from). And for IM-psych programs, there were only 9 so it made the most sense to apply to all of them.

 

 

How many interviews did you end up receiving? How did you feel your chances were at matching?

Formally, I received three interviews, but in total, I ranked four positions. I received 2 for psychiatry and I was taken off the waitlist for 1 IM-psych program. All of them were university-based programs. At the IM-psych program, I had mentioned that I had also applied for a psychiatry categorical position at the same place and I wanted to know if I had to come back for another interview, which I was totally willing to do. Ten minutes after that mini-interview, I had an impromptu meeting with the program director of psychiatry and she told me that she will see what the other four interviewers had to say about me from that day and she would let me know if I needed to come back or not. Two weeks later, I’m notified that she had enough to consider me for a position. Throughout the next two months prior to match day, I had received several emails about how the psychiatry program is expanding and there’s new facilities and all these wonderful things. I didn’t think I was a shoo-in but I felt that maybe I had a great shot.

 

 

So, it’s Monday, March 14th. The day applicants find out if they matched. You open the e-mail and find out that you did not obtain a residency. What’s going through your head?

Before that day, I told myself whatever happens, happens. I actually slept well the night before! I was driving in Fort Lauderdale and taking care of some errands and I happened to look at my phone. For five seconds, I was completely numb. And then it hit me. My biggest fear came true. All that work, all that money, all the stress, and for what? Nothing.

*cue Kim Kardashian ugly crying*

I can honestly say that it is one of the most devastating experiences and I would not even wish it upon an enemy. The e-mail just says “you did not match”. Not even a “good morning” or “hey girl!” Just one line that says you’re not good enough to continue in your career. After quickly doing my errands and a few snot-filled tissues later, I sped home passing several cops on the way and began on SOAP.

Most of us aren’t familiar with the SOAP, or the Supplemental Offer & Acceptance Program. Can you walk us through your experience with it? (Here’s a link to the SOAP schedule for my readers)

SOAP is a chance for unmatched applicants to apply to unfilled spots in all fields of medicine. However, this means that you will have to come up with new personal statements in the matter of hours, which is exactly what I had to do for family medicine. As Markus said in a previous posting, the website was down and no one could send in applications (because like LOL, heaven forbid the ERAS website works when it needs to).

I spoke with a friend who match into IM the year before through SOAP and she guided me through the process while she was at work. She told me to apply to the IM prelim, IM categorical, and family med programs that had the MOST open spots. I had only 45 spots to pick from and I used 5 of them on psychiatry programs that were unfilled. Then I went through family medicine and internal medicine. In retrospect, I could’ve used those 5 on family medicine or IM spots but what’s done is done.

 

 

So on Monday you found out that you didn’t match. Then during the week you went through the SOAP.  Friday comes along and you find out that you didn’t SOAP into a residency. How did that feel?

By that point, I had already gone through the five stages of grief. Denial set in when I was in the car. Then anger when I was cursing at anyone on the road that was slowing me down from getting home (which is what I do on a regular basis and I’ve been trying to work on but YOU try driving on I-95 in Fort Lauderdale and Miami and tell me you don’t have road rage, but I digress…). Bargaining was SOAP. Depression set in when the 5th round of SOAP happened and I hadn’t received any offers. It continued for a week when all I saw on Facebook were my friends posting that they matched at their number one or number two choices. It wasn’t that I wasn’t happy for them. Every single one of us had a unique journey and even the people I didn’t like, I respected them enough in a professional sense to be proud that they get to continue their journey. It was more about the fact that I didn’t get to continue my journey with them.

Several months had passed and I hadn’t reached the acceptance stage of grief. It wasn’t until I went to the AAFP National Conference in Kansas City at the end of July that I had realized that I had been in the wrong field all this time. I realized within the first hour of the conference that I had such a wrong idea as to what family medicine and primary care entailed. There are so many opportunities for me as a family medicine doctor, whether it be to provide medical care for a whole family, work as a hospitalist, deal with mental health issues, or even perform procedures. After I didn’t match, I had told myself that something big was in store for me, and I finally believed it. Networking at the expo hall with the residency programs made me realize that I was a perfect fit for family medicine and that there are programs out there that WANT me. As I’m writing this, I can definitely say that I wasn’t supposed to match into psychiatry because I realized that I was meant to match into family medicine (I’m hoping). It feels good to be in that acceptance part of grief!

 

 

Why do you think you didn’t match? What were your step scores? Was your application particularly weak in any one specific area?

I had thought about not giving exact numbers here, but in all honesty, who cares? Step 1 was a 208, and step 2 CK was a 209 (yes, the EXACT passing score). Step 2 CS was a pass and everything was on the first try. I expected my Step 1 score but my CK was an absolute miracle. I had worked harder for CK than I did for step 1 and yet, I was not getting anywhere with my studying. I took a UWorld assessment two days before just to get more questions in and I had about 179. So in two days, my score JUMPED 30 points. (This is NOT a plan I recommend to ANYONE, by the way.) I know I’m a terrible test taker and that in rotations, I shined and my letters of recommendation reflected that.

In addition, I had failed one course in basic sciences, and THAT was a reason why a program didn’t take me. They were too worried that I may not pass step 3 (which I’ll go into below) and therefore, not be able to be licensed. However, my scores were good enough to get some interviews at university programs so I must have done SOMETHING right.

 

 

Do you think the fact that you attended a Caribbean medical school played a factor?

Not at all. The places I had interviewed at were very IMG friendly, as were the residencies I spoke with at the AAFP National Conference.

 

 

What do you plan to do while you wait to apply for the 2017 match?

I am currently a Clinical Teaching Fellow for Ross University. Some of my colleagues know it as “junior faculty” but teaching fellow is the formal title and you better believe I am using that on my CV. For those who don’t know what that is, my role is to act as a standardized patient for the incoming 3rd year medical students and assist other junior faculty in teaching how to handle difficult patients and certain common primary care cases, as well as how to begin to formulate an efficient style of medical interviewing. I also assist in Ross’s Ambulatory Care Competencies elective, where we prep the 4th year students for Step 2 CS by presenting cases and critiquing their notes.

Outside of Ross University, I tutor for Huntington Learning Center (which I have been doing since 4th year of med school), where I mostly do SAT/ACT math and high school subject tutoring in math as well. In addition, I’m getting my MBA in Health Services Management through Keller Graduate School of Management, which is one of the sister schools of Ross University. What’s great about that is that they have an “MD to MBA” program where I was able to get credit for 5 out of the 16 courses, so now I only need to complete 11 of them. In addition to working, I plan on taking Step 3 by the end of October. Needless to say, I only know one speed and it is full speed ahead.

 

 

How are you handling your loan debt?

Some of my loan debt could not be deferred or put into forbearance, so I have been paying that off. However, since starting grad school, I’ve been able to defer most of my loans while taking out more. Thanks, Uncle Sam!

 

 

What words of wisdom would you give to someone knowing what you know now?

Have plans A through Z ready to go from the jump. You don’t want to rely on them, but you want them ready if you have to execute them.

Go to as many networking conferences as you can. I know those things can cost money, but at the very least, go to the big ones run by the specialties to which you are applying.

But most importantly, it’s not a matter of “if” you become a resident, but rather it’s a matter of WHEN. 2016 was not my time and I realize that now. However, come 2017, I will be a better applicant and in a better frame of mind to continue on in the next chapter.

 

 

Thank you Steven for an informative and entertaining interview. I look forward to finding out where you match in 2017.

 

Next week I interview a Ross University graduate who matched into a categorical general surgery position. Be sure to subscribe to my blog, like me on Facebook, and follow me on Twitter so you don’t miss it!