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!

Residency Interviews AKA nationwide beer, food, and wine tour

I’m about a third of the way through my interviews. I’m sure other fourth years will agree when I say that the interview season is exhausting. It’s not even the stress of the interviews themselves, but rather the non-stop traveling and driving. It really starts to take a toll after a while. The nice thing is that I’ve gotten to travel to states that I’ve never been to before and have been able to explore each area and get to know the people and local attractions. I mean, I might be living there for several years so it’s important that I actually enjoy what the city has to offer. I’ve found that it’s somewhat insightful to ask my Uber driver what they like or dislike about the city. They’re a pretty unbiased source and have nothing to do with my ranking, so I like to ask them some of the more sensitive questions that I don’t feel would necessarily be appropriate to ask a program director or resident.

As for interview day themselves, they’re all set up in almost the exact same way. It always starts off with a presentation or meet and greet by a program director or someone else high up there on the academic ladder. Something I’ve noticed is that they really try to sell the program. It’s clear that they’re trying to recruit us and make sure that we rank them. I feel like when was going on medical school interviews, the other applicants and I were the ones trying to convince the admissions committee to accept us. But for residency interviews, we kind of just sit back, answer some questions they ask and the rest of the time is spent with the Program Director, faculty, and residents trying to impress us. I’m not going to lie- it feels nice.

After the introduction, the actual interviews take place. My interviews have been relatively relaxed and conversational. There have been only a couple times where I was asked an off the wall type of question, but even then they’re definitely not on the same level as some of those weird questions I got asked for medical school. The day ends with a tour of the hospital, and a lunch usually in the company of current residents and faculty. On average the day lasts probably for no more than 5 hours. My shortest interview day was 4 hours and my longest was 8 hours (yeah, I know).

For my first interview, my neuroticism forced me to prepared excessively. I read everything about the program, I reviewed my CV, re-read my entire application, the works. Then when I had the actual interview, I felt so underwhelmed that I stopped preparing so much for my following interviews. Now I just take a little bit of time the night before to read about the program and think about how to tailor my responses appropriately.

Some questions I’ve gotten a couple times that annoy me to no end are: Why medicine? Why DO school? and Why did you decide to be a doctor?

Oh I’m sorry, I thought I was interviewing for residency, not medical school 

…is what I’m thinking in my head. It takes everything in me not to roll my eyes when they ask me one of those questions. Instead, I enthusiastically nod and give my response, which is the exact same response I gave 4 years ago for medical school interviews. How groundbreaking.

Another thing about interviews: love letters. I’ve gotten some emails from either a PD or the DME with whom I interviewed with that day thanking me for visiting and that they think I will fit in well/will be a great addition to the program/that they hope I rank them highly. They also manage to integrate a specific topic we talked about during the interview, whether it was one of my hobbies or future career aspirations. It’s a nice gesture, but I take these emails with a massive bag of salt. In no way does it change my opinion of a program, or my ranking.

Anyway, I need to go send some thank you emails. Only a couple more months of interviews left…

 

-NB

Interview Invite/Rejection Season

How it feels when a program you like sends you a “we will not be interviewing you” email:

Since the MSPE came out, I’ve received a wave of interview invites in my second specialty and a wave of rejections in my first specialty. At this point I can safely say that applying to two specialties was a good idea. I have enough interview invites in my second specialty to be considered “safe to match”, but not enough to be safe in my first specialty. I would absolutely be freaking out right now had I only applied to one. We’re still in the middle of the cycle, so it will be interesting to see what pans out for specialty #1 within the next month or so.

Time to go pray to the ERAS deities.

 

-NB

 

October 1st

I now have more interviews in my second specialty than I do in my first, which I guess goes to show that it was a good idea to apply to those programs. I’m not getting much love in my first specialty, presumably because I don’t have my Level II scores yet and because programs wait for the MSPE to be released. I also think my educational background and activities are more fitted for my second specialty, which is probably part of the reason why I’m getting interviews even though I applied relatively later.

Speaking of the MSPE, it’s recently been the center of concern for my class. For those who don’t know what an MSPE is, it’s essentially an official academic record of your performance during your first three years of medical school. It includes a blurb about what makes you a unique/great applicant for residency programs, the comments that attendings wrote in your evaluations (whether they were good or bad), along with some fancy charts and graphs that visually show programs how you stack up against the rest of your class. Basically, it’s part of your residency application and is necessary to make it “complete” for review.

Historically, the MSPE is not released by medical schools to residency programs until October 1st of the application year. Once they’re released, the residency programs review applications again with the MSPE and decide whether or not to give applicants interviews. Of course you can get an interview before October 1st without the MSPE. This obviously depends on the program, specialty, and whether the program is AOA or ACGME accredited. However, generally speaking, without the MSPE, programs will not offer interviews.

This brings us to the problem: supposedly many student’s MSPE’s had errors. Some were minor, like grammar and punctuation mistakes (although these should still be fixed immediately). However, some were huge- we’re talking incorrect grades, such as documenting a Pass when you actually got Honors, an “In Progress” grade when all the paperwork has been turned in, incorrect applicant name, and evaluations from the wrong preceptor, just to name a few. Of course, my class was furious, and with good reason. Supposedly (and this is a huge supposedly that probably depends on 1,000 other factors) some programs will auto-reject applicants if they don’t have an MSPE submitted by the time they review the application. Now, the MSPE errors aren’t the school’s fault. We were told that there was some kind of glitchy problem with the website that attendings use for submitting our evaluations. Whether this is actually true or not I’m not entirely sure, but I think my class is lucky in that October 1st actually fell on a Saturday this year. Meaning that no one in any residency program was actually working on the 1st to review applications. Therefore, there’s some buffer time to fix any mistakes and upload a 100% correct MSPE before residency programs download applications on Monday, October 3rd. At least, that’s what I’m thinking.

So to my fellow classmates that are also kind of freaking out: I think we will be okay.

Of course if I get an influx of rejections in my inbox tomorrow then I was wrong and we’re screwed.

Just kidding; I think we’ll still be okay.

-NB