Starting My Last Year of Residency, Starting the Job Hunt, and Oh Yeah I Transferred Residency Programs

Yes, I’m alive. I know it’s been a while since I’ve written anything. I actually have a ton of drafts of all these posts that I started to write but never ended up publishing. This was mostly because I just didn’t had time to finalize any of them, and by the time I did have time, they weren’t really relevant anymore/I wanted to sleep and/or eat instead

But, a lot of things have happened since the last time I posted. I can’t believe the last time was when I was a fresh new intern.

Oh intern me, so many things I wish I could warn you about

I decided to compile a list of things that I’ve done or things that have happened since I last posted. I’d say most of them are positive experiences. In any case, they all helped to shape me into the third year resident that I am today

• I don’t remember if I ever posted about this (maybe on instagram?) but I got my puppy right before intern year, and was able to raise him successfully throughout the year. I get a lot of questions regarding my experience with this, mostly if it’s possible to have a dog when you’re a resident. Honestly, yes you can. But it obviously depends on what kind of dog you get, what your specialty is, how intensive your program is, etc. The highlight of a busy day was being able to come home to a happy doggo
• I took and passed Level 3. Bye bye NBOME
• Lost 8 pounds during my first rotation as an intern. Yes, it was inpatient medicine, yes it was stressful, and no there was not a lot of time to eat.
• There was this one messed up day where I was the only intern on the medicine service when all the IM residents were taking their in-service training exam. I had to round on all the patients from one of the teams and write all the notes. I think I had finally finished everything by lunch time. It actually wasn’t even a ton of patients, I think 13? In retrospect, I’m actually surprised how well that day went
• Survived q4 28 hr calls. This was during one of my hardest rotations as an intern- pediatrics. We had to rotate through Rainbow Babies & Children’s which is the stand-alone children’s hospital for Case Western. I do not recommend commuting home 30+ minutes after not sleeping for that long
• Got physically assaulted by a pt’s family member in the ICU. This happened when I was an intern, in Ohio. Over there it’s considered a misdemeanor for first-time assault on a healthcare worker. I ended up not pressing charges
• made medical errors and got yelled at
• Survived a midwest winter with a rear-wheel drive car and no snow tires. While going to my graveyard ED shift one night, I braked at a red light and slid straight through the intersection. Good thing there were not cars and/or pedestrians
• Ate hospital graham crackers for dinner
• Decided to transfer to another residency program.  I interviewed at a couple places and ended up accepting a spot at Ventura County Medical Center. I’m still trying to figure out how I got so lucky
• ran some bad Tier I traumas that I still think about
• ran codes and rapid responses
• learned how to be the senior on a team while teaching interns and medical students
• emergently intubated patients
• emergently put in lines
• delivered babies without an attending
• first assist on surgery
• took a cockroach out of someone’s ear
• got married!
• started applying for jobs

I’m going to try to post a little more often on both my blog and Instagram account now that I’m finally getting used to the work flow at my current residency program. I’ll also try to be better about answering messages (sorry!). If you guys have any specific topics you want me to talk about, let me know

RS

First week as an intern

Well, I survived 8 straight days of inpatient IM. I’m not going to lie, it’s been a little rough. At my hospital, the interns are responsible for admitting patients and typing up all the notes. This can be a little overwhelming when you also have complicated patients with sh*t hitting the fan and nurses paging you about what you want to do, in which case my answer 90% of the time is “Uhh..let me verify with my senior”. Speaking of the seniors, I honestly have no idea how us interns would survive without them. They have been AMAZING. They’ll help us with notes, admit patients when we’re too busy, and generally just try to make things easier for us. In such a cut throat world like medicine I’m so glad that there are still some good people out there.

On another note, I’m still a little weirded out by being referred to as doctor. I specifically tell the nurses to call me me by my first name. I even feel weird parking in the doctor’s parking lot, or going to the doctor’s lounge to get food. I feel like such a fraud, I’m sure the medical students rotating with us know more than I do.

For the M4s out there auditioning this year- you can help the residents out a ton by seeing patients with us and writing notes. We currently have a fourth year student auditioning with us and she’ll see up to four patients and have the notes already done by the time we finish rounds and noon conference. You guys have no idea how much it helps us out, especially when we’re getting slammed with admissions. Being a team player is a BIG deal. Of course, we’ll put in a good word for you with the chief and program director when they ask for our feedback. I also try to point out some of the interested cases to the M4s so they can see something different than the standard chest pain or heart failure workup.

Anyway, today is my first day off and I don’t get another one for another 8 days, so I’m going to go enjoy myself (read: do laundry, pay bills, basically do adult things), even though all I really want to do is sleep all day. Yay, intern year!

Medical Student to Intern

For the past week, I’ve been in orientation with my co-interns, including those in IM and EM. It’s been pretty chill. We got training in our EMR system and got set up with our dictation device, Dragon. We also had a white coat ceremony, where we each got our shiny, new, long white coats! Yesterday we got our pagers (boo) and were taught how to use them and return a page. I’ve gotten to know a bunch of the other interns, and I can say that we’re a laid back group of people. I’m excited to work with them!

Now that it’s July, we officially start residency. Even though I’m am FM resident, we still have to do 3 months of inpatient IM, which is what I start off with. You can’t see my face but I’m super excited to be starting on inpatient medicine, no really, just…so excited…

I ended up getting the weekend off, so I don’t have my first day until Monday. This kind of worries me in that the other two interns on IM start over the weekend and I’ll have a lot of catching up to do on Monday when I get there. Since I’m FM, I haven’t had to do a real IM rotation for a while, and only did one as an M4 and just our standard core IM rotations as an M3. I feel kind of screwed, and the panic is actually fueling my desire to cram as many internal medicine topics as possible. The other two interns working with me are actually IM interns and I will be the only non-IM intern on the service. This means they’ve probably done at least 6 months more of IM and IM subspecialty related rotations compared to me. Fantastic.

Anyway, I just wanted to say good luck to all the other interns out there who are starting residency. We can do it! Also if any seniors or attendings have tips for surviving intern year, let me know!

Life After Medical School

First off, sorry about the radio silence. The last couple weeks leading up to graduation were all a blur. From trying to hang out with classmates one last time, to getting my recertification in PALS, BLS, and ACLS, to having family flying in, plus coordinating my entire move to my new residency location, a lot of things went on the backburner (like blogging). But now I’m back, with more free time than ever!

Secondly, I’m officially a physician!!!

It feels weird just typing that. I mean, I knew I was going to be a doctor after 4 years of medical school, but it’s still such a weird feeling. I haven’t even changed my email signatures yet; I can’t get myself to. They still say I’m a medical student. The other day I got asked by my insurance agent about what my official job title is, and I hesitated before saying resident physician. There’s just a lot of responsibility that’s implied with that title and I don’t feel qualified. I was a medical student a month ago! The imposter syndrome is real, and I haven’t officially started residency yet.

In other news, I finally added my account-related instagram to the side bar. I’ve been anonymous for the past 4 years, but now that school is over and I care a lot less about people knowing who I am, I figured it was officially time to show the face behind the blog. So hi, thanks for reading and following, and stay tuned for what I’m sure will be posts about me freaking out during intern year.

ACGME Match Update

A couple weeks ago, I flew out to attend my fiancé’s Match Day celebration. It was kind of fancy- it took place in a nice hotel, with a brunch-like spread of mini quiches and smoked salmon on little toasts. Even as an outsider, I could sense how incredibly tense people were. Everyone started off with catching up with their classmates and meeting their families. Once things settled down, the Dean and some faculty members of the school gave a few speeches about how proud they were of the class and that in a matter of minutes- everyone in that room was going to know where they were going for residency training. Once it started getting close to the official envelope opening time, the students all gathered together with their academic groups alongside their faculty mentor. One by one, each student’s name was called and they were handed their respective envelope. They were instructed not to open it until specifically told to. After a couple minutes, everyone chanted and counted down from 10…9…8…7…

My fiancé completely destroyed his envelope trying to get it opened. The result: he matched back home, in Southern California! Although this means we’ll be doing long distance again, we’re both super grateful to have matched at our top training programs. Now I’ve got my own list of To-Do’s for the next month:

• Find a place to live/sign a leasing contract
• Find a mover (my program will pay for part of my move! Yay!)
• Order my long white coat. It’s nice that they actually have a women’s fit option with an adjustable two-button back belt…Pretty sure I’m the only person excited for this.
• Acquire dog. Yes, I am finally getting a dog. I could never justify getting one during medical school- board exams, class exams, other school obligations, rotations, interview season- I could never find the right time to get puppy and raise it. But now, I actually have the time! Moreover since my fiancé is going to be far away from where I’ll be doing my residency, not to mention my close friends and family, I think it will be nice to have some company. If everything goes according to plan, I’ll have a new pup around the second week of June!
• Start selling things. I have so much…crap. Anatomy flashcards, embryology and biochemistry books, old class notes, shelf exam study materials, the list goes on and on. I feel like it would be a huge waste to just toss everything, and I really want to make some more room on my self, so I’m thinking of selling them to other students. If you’re an incoming M1 or a current student, please subscribe for updates as I’ll be publishing a post with a list of things I’ll be selling!

For those curious, Nova also had a Match Day celebration. Although much less formal than other schools, everyone who RSVPed was able to receive their envelopes and open them with friends and family. I heard it was a lot of fun!

Congrats to my classmates! We’re almost done!

-NB

**Fourth Year Advice**

Now that I’ve matched I decided to compile a bunch of general advice that I’ve gathered from the past year. A lot of it is from my own experience (and the mistakes I’ve made). I hope it helps someone out!

Auditions

• Apply EARLY. MD auditions are through VSAS, so you will need to submit materials through there. Every institution usually has their own immunization form. Do your research ahead of time and gather all the forms that need to be filled out so that you can just make one trip to your doctor’s office to get the shots and have them fill out all the paperwork. There is also an AAMC universal immunization form that some programs may use, so get that filled out too just in case. Make sure you meet requirements to apply. Some require a USMLE or a minimum passing score. Others may require a Letter of Recommendation or Statement of Interest. It just depends the program, the specialty, and how many applications they get for auditions. Plan ahead!
• DO auditions are not done through VSAS. You will need to cold call/email the medical student coordinators and ask them about availabilities and dates. Again, they may also require different immunization forms to be filled out so you’ll need to do your research. Like MD auditions, it is FIRST COME FIRST SERVE. The DO audition spots go quick since there’s no official date that you can start calling and they generally have less spots. I’ve heard of people calling as early as November of the previous year. If you’re interested in competitive specialties, you must contact these places early since there are limited spots. Primary care fields are generally more forgiving if you end up calling later.
• Auditions early in the cycle (summer) are important because you will need to get a LOR. Make sure to set those up first so you have some audition rotations in the bag. This is especially important for AOA programs as they place more emphasis on auditions. I recommend auditioning at your “top” choice program second or third when you’re more of a seasoned sub-I. This way it will be a little easier to impress attendings and residents.
• During audition season, you’re expected to do more than the average M4. This is the time when you should force yourself out of your comfort zone. Volunteer for presentations, introduce yourself to faculty and the PD, stay late, take on more patients, ask to do things even if you think they’ll say no, teach the M3s, show your passion for the program and the field. Assume that everyone is watching you, because they are!

Letters of Recommendation

• Look up requirements for each program for LORs. Some want a Chair letter, some want one from a separate field than the one you’re applying to, some want at least 2 letters to be from your M4 year, etc.
• It’s a good idea to get a Chair letter just in case a program requires it. Don’t worry about not having interacted with the Chair before. Email them and ask for a letter. They get asked this all the time, so chances are they’ll say yes and then ask to meet with you to get to know you better. Give them your Personal Statement (if you have it done), and your CV, as well as any copies of board exam scores if they need it.
• If you get a letter from someone during M3 year and you don’t have access to ERAS yet, have the attending save the letter on their computer so that they can upload it onto ERAS when you get access.
• The letters you get as an M4 are more important and will carry more weight. Ideally you want to ask someone who you worked with extensively and who has a high academic position/is well-known in the field.

Applications

• There are two matches- the NMS (DO) and the NRMP (MD), but there is only one application (ERAS).
• Fill out the easy bio stuff whenever you have down time during your third year.
• Start getting your CV together second semester of M3 year. The more time you spend on it the less time you’ll be fumbling around on ERAS trying to add things. For all activities, mention your role and why it was significant. It’s not typical to put that on a CV, but I did and then I just copy/pasted onto ERAS with some minor elaboration. Saved me a lot of time.
• Start brainstorming how you want to write your Personal Statement the second half of M3 year. Make it interesting and unique. It should be about 1.0-1.25 pages long with standard margins, 12 pt font, and single spaced. Also, have people read it- not just your friends either.
• Have your board scores in when you submit (or soon thereafter), both the PE and the CE. Assuming you didn’t bomb either, it will give you an advantage over people that don’t have it in by the time you submit applications. Some programs require all boards scores for interviews and for an applicant to be ranked! This goes for any specialty, including primary care fields! Don’t assume just because your specialty is a primary care field that they won’t care when you get your PE or CE scores. It definitely will give you an advantage if you have them in early on in the cycle!
• Releasing USMLE scores: As far as I know, you have to release your USMLE scores only if you applied to ACGME programs. Make sure to double check the rulebook for this one, as it probably varies by year and could be a violation of match rules if you do not disclose all board exam results.
• Applying to multiple specialties: You can apply to multiple specialties, but you will need a separate Personal Statement and set of Letters of Recommendation for each specialty to show you are actually interested in the field. Obviously, this takes some planning ahead of time. If you’re thinking of applying to multiple specialties, try to decide by late spring of third year so you can start contacting people for LORs and starting writing a second PS. Programs will not know you applied to multiple specialties unless you 1.) explicitly tell them or if 2.) the PD of one specialty program happens to also be the PD for another specialty program at the same institution (rare). In this case they’ll see you applied to both when they look into their ERAS account. Also, if you apply to more than one specialty, then you should be 100% okay with matching in either one! Remember you’ll be bound by legal contract if you match!
• If you’re torn between specialties, then apply to both and get a feel for which specialty you can see yourself in during auditions and interviews.
• Be realistic. If you have a red flag on your application, you will need to apply broadly. The application process is extremely expensive, but this is NOT the time to get stingy!

Interviews

• This section is pretty common sense. If you made it to the interview, then it means the residency committee saw something on your application they liked and they’re interested in getting to know you in person to see if you’ll be a good fit for their program. I’m not going to talk about professionalism, because after 4 years of medical school you should know how to act and dress when meeting attendings and residents in a formal setting.
• Pre-interview dinner: Not required, but there is an advantage to going to the pre-interview dinners in that 1.) you’ll feel more relaxed during the interview itself when you see the familiar faces of the residents and other interviewees, and 2.) sometimes residents will drop hints and tips about the interviews.
• Be smart. Do research on the program ahead of time and be able to adjust your answers accordingly. Think about specific things in your application that you can bring up to put yourself in a good light, and incorporate those when you answer questions. You want to convince the interviewer that 1.) you’re a good fit for the program, and 2.) you’re not some psycho weirdo that no one will want to work with. Bonus points if you can sell yourself as an asset. Why would the residency benefit by having you vs. someone else?

Post-interview

• Thank you emails/notes: This is up to the applicant. It’s nice to send a short email thanking the interviewers for their time. You can also handwrite a note if you want and ask the secretary where to address it. Don’t invest any emotion in it- in other words, this isn’t going to move your ranking. It’s just a nice thing to do.
• #1 Ranking email: If you have a program that is clearly your #1 rank, then send an email to the PD expressing why they are your top choice. I also recommend sending this towards the end of the interview season, as sending it early may seem disingenuous, even if it is your #1. For some programs, a #1 email will positively influence your position on their rank list. For others, they won’t care. It definitely won’t lower your ranking though, so if you have a program that you really want to go to, then it can’t hurt to let them know. Like the thank you emails, don’t invest any emotion into it. Some programs have a strict no-contact post interview rule, so they won’t respond to your love letter. Others may just reply with a “cool, thanks”. Don’t read too much into it.
• Top choice email: You can also email other programs that aren’t your #1, but that are still a top choice program for you.
• Phone calls: As the rank list deadline approaches, some programs may reach out to you to let you know they’re interested in ranking you and will try to get a feel for how much you liked their program. If you really liked the program, then let them know so they can take that into consideration when they finalize their rank list.
• Offers outside the match: This only occurs for AOA programs and no longer with ACGME programs. You may be contacted by a PD offering you a guaranteed spot in their program if you sign a contract with them outside of the match (i.e. you don’t submit a rank list). The contract is still legally binding, so think carefully. Make sure to check out the program and see if they filled all their spots the previous years. Programs that have a hard time filling may try to use this strategy to fill their spots- make sure it’s a good program that you actually would want to go to!

Post-match

• Congrats! You matched! You have a job for the next 3-8 years! You can now sit back and relax. If you match AOA, you will automatically be taken out of the ACGME match.
• If you didn’t match, it’s not the end of the world. There’s still the scramble (AOA) or SOAP (ACGME). For the AOA scramble, you have to cold call programs once you receive a list of available positions. For the SOAP, you have three rounds to “apply” for open positions and a limited number of positions that you can apply to. Once you finish the three rounds or if you have used up all the positions you can apply to, you’re done for the cycle.
• If you forgo the AOA match and then did not match ACGME, you can still retroactively scramble for any open AOA positions, although there will significantly fewer positions available by that time.
• AOA programs are legally obligated to email you the contract within 10 working days. Check your email frequently that you listed on ERAS. They’ll be using that to communicate with you.
• Hopefully you scheduled the last half of fourth year to be easier (I know I did), and it’s not jam packed with any sub-I’s! Trust me, you’ll want to take it easy after matching.

Fourth year is both incredible stressful and laid back. The summer months are the worst since you’re getting ready to submit your application, doing audition rotations, and studying for board exams. Then you’re traveling for interviews for months and months and you feel like it’s never going to end. Things start to finally calm down after the last interview and of course when you find out where you’re going for residency. Fourth year is really one hell of a ride. I’m glad the worst is over! If you guys have any questions, feel free to shoot me an email or comment below.

-NB

I HAVE A JOB!

I MATCHED!!! This is what the past 4 years of hard work have all been for – to land a residency position. For those who are curious, the two specialties I applied to were OB/gyn and FM. OB/gyn was incredibly competitive this year, and I received a lot more love from FM programs. My application is definitely more FM-oriented to begin with, so I’m not particularly surprised. As I went through auditions, electives, and interviews, I felt like I just fit better with FM, so in the end that’s what I stuck with. I’m also glad that FM is broad enough so that I can still do women’s health/obstetrics if I wanted to!

I received the “you have matched!” email right before 8 AM EST, which was shortly followed by a call from my new Program Director congratulating me. I also received an email from the hospital administration welcoming all the incoming interns. We were also given important save-the-dates for orientation and were told that all positions for all residency programs at our hospital had completely filled! My FM program took 4 people this year, including myself. I’m very excited to meet my co-interns!

It’s not quite over for me yet though. My significant other goes to an MD school and will be finding out where he matched in March. Luckily, I matched very high on my rank list, at a program half an hour from his #1 choice. Once we found out where I matched, we spent some time reaching out to my program director and faculty at his medical school that have connections at his #1 choice. We really hope we hear some good news in March and that he matches there!

Anyway, I just wanted to end this post by saying CONGRATS to all my fellow DO students who matched yesterday! And good luck to those who are waiting for the ACGME match!

Lastly to current M3s, I will have a post up about some M4 tips that I’ve collected over the past year, so keep an eye out for that!

Now if you’ll excuse me, there are mojitos to drink and sandy beaches to take a nap on. Ah, the perks of living in South Florida.

-NB

Game, Set,…Match?

Our rank list for DO programs was due on January 20th by midnight. Now all we have to do is wait. The turnaround time for the DO match is actually pretty quick, only 2.5 weeks.

I’m having a few post-rank submission regrets, mostly about switching the rankings around, but it’s too late. My rank list is finalized and it is out of my hands. I know people say that we just have to trust the match process, but it’s still a little unsettling to think that my residency position is going to be determined by some computer algorithm.

Anyway, I want to wish everyone good luck in the match! And congrats to those that already know where they’re going for next year!

-NB

2017

We’re officially in the year that my class graduates! I still have a couple interviews left, but it’s the home stretch now. The last step in this crazy residency application process is to go about making my rank list.

As I mentioned in an earlier post, I applied to two specialties that are a mix of AOA and ACGME programs. I’m going to rank all the programs I interviewed at, except for one (it sucked). Since I’ll be entering both matches, it is likely that I will match with the DO match in February and be automatically taken out of the MD match in March. This is okay with me, as I wouldn’t rank an AOA program if 1.) it is likely to get shut down via new ACGME accreditation standards, or 2.) I feel like I would be unhappy completing my training there. As far as ranking, there is now a clear #1 choice for me – one that I didn’t expect at all. I also know which programs I’ll be ranking near the bottom. However, the challenge will be figuring out the middle of the road programs.

T- 10 days until rank lists are due.

Also, to the M3s that I work with: Please do not say/do anything that suggests to the attending that we want to stay later/do presentations/come in extra days. I’m an M4 and the match is less than a month away. I honestly could not care any less about rotations at this point. If you want to do more work, ask the attending once I’m out the door. When you’re an M4, you’ll understand. Thanks.

 

-NB

Sidenote: I finally updated the Resources and Reviews tab. It took forever, but I figured since I’m nearing the end of the med school journey I should probably update it.

Honest Interview Answers

I think by now the M4s are sick of interviews. I’m now 2/3 done with mine. It really is the same song and dance over and over and over again. After a certain point you know what to expect and over time, you develop a perfected answer for every commonly asked interview question. The following is how applicants would answer questions if we truthfully said what we were really thinking.

 

“How was your trip into town?”

Time consuming and expensive.

 

“We have breakfast set up for you guys. Please help yourselves”

I’m already pretty sick of danish pastry spreads and mediocre coffee but I’m going to force myself to consume more because this is an interview

 

“What are your plans after the interview?”

Change into airplane clothes in a cramped hotel lobby bathroom

 

“I’m a resident, feel free to ask me anything you want. I promise I won’t tell anyone”

You seem pretty chill, but I’m scared this is a trap so instead, I’m going to ask you a pretty standard and safe question.

 

“How was the pre-interview dinner?”

• Option 1: It was awkward. Your residents are weird
• Option 2: Residents were cool but one of the other applicants was weird

 

“Describe to me what you’re looking for in a program”

Free food, good pay, no call.

 

“What do you do in your spare time?”

Binge-watch shows on Netflix.

 

“If you’re free from 1-5 you’re welcomed to stay for didactics”

DEAR GOD NO

 

“Do you have any more questions for me?”

No, just like how I didn’t have any more questions 5 minutes ago. Also, spoiler alert: I won’t have questions in 2 minutes when you ask me again.

 

“You’re not from the area. Why did you apply here?”

Because I want a f***ing job next year!