Osteopathic Medicine

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.

**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

Interview Invite/Rejection Season

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

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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

 

I’ve got 99 problems

It’s the third week of September. The DO residency applications have been open for a couple months, but the MD residency applications have just opened for submission a couple days ago.

I feel like everyone in my class has got their application stuff together, at least judging from the non-stop influx of social media posts I’ve been getting for the past week or so. Me on the other hand, am a hot mess.

I actually decided to apply to two specialties. I guess this isn’t entirely uncommon, but the biggest problem this is causing me (other than killing my bank account) is that 1.) I have to write another personal statement from scratch, and 2.) I’m short some letters of recommendation. Since I’m limited geographically, I’m applying to both the DO and MD match. This means my DO application for my second specialty is incredibly late and this isn’t even taking into consideration how late my letters are going to be. I know people that were getting interviews in July for this specialty, and I’m going to submit an application for it in the middle of September. Why?

Because I’m scared I’m not going to match if I only apply to one specialty. I’d rather drop the money now with a later application in a second specialty than realize in November that I don’t have enough interviews and scramble to apply to more programs as a last-ditch effort. Trying to add more programs then would really be too late. The real issue I had to think about was before applying to a second specialty was, “Could I see myself in this field? Would I be happy if I matched in this instead?”. And my answer is yes, mostly because the two fields are actually similar with a bit of overlap.

The anxiety is real- I’m having some problems sleeping. I seriously considered even taking a clinical/research year and applying for the match in 2018 so I could give myself a mental break, but I don’t think it’s feasible at this point. I feel like I’m stuck in a 50 foot deep hole where the only escape is to climb out. The problem is that I keep falling back in.

 

-NB

 

Audition 1, complete

I finished my first audition rotation. I’m not sure how my fellow sub-intern and I survived a whole month of it, but we did. Honestly I think that it was one of the rougher ones that we’re going to have. I anticipate the rest of my rotations from here on out to go smoothly.

I think I ended the rotation on a good note. I tried to work especially hard the last two weeks once I got used to everything so that I could leave a positive impression. I received good feedback from the residents, most saying they hope to see me back during their interview season- hopefully a good sign. Despite how hellish the rotation itself was, I’m actually kind of sad to leave. I’m going to miss the craziness of the floor, having my own patients that I can manage, being constantly judged and under scrutiny of my seniors (okay maybe not that). I even received a compliment from Ms. Never Satisfied Senior Resident towards the end. I’d like to think that she noticed how I improved, or at least that I tried.

I also did have a chance to sit down with the Program Director and talk to him about my interest in the program. I think the meeting went well. I mentioned in a previous post that one of my top choice programs essentially rejected me before I even auditioned. This is that program. I think some people will say that I’m being too over the top/neurotic by meeting with the PD, and I probably would have thought the same thing-  but this is audition season. Sometimes you just have to do what you gotta go, even if it makes you uncomfortable. I haven’t received an official rejection from the program yet so I’m going to try to be positive and say that I still have a (teeny tiny) chance here. And as long as I have even the tiniest chance of an interview, I’m going to go all out. Not just at this program, but any program that I’m interested in.

It’s not over until it’s over.

-NB

First 2 Weeks of Auditions

Now that I’m in the thick of my audition for this month, I though I’d write a little reflection of how it’s been going.

It’s been stressful. So very stressful.

An audition rotation is kind of like a 31-day interview. You need to be at the top of your game 100% of the time. You need to assume that all the people you interact with- nurses, interns, residents, attendings- are watching your every move. If you mess up on one thing, it will stick with them for a long time and it’ll be harder to make a good impression.

For the most part, I’ve been getting along with all the residents except for this one senior. Sometimes she’s incredibly friendly and talkative with me as we discuss random non-audition related topics. Other times (maybe when she’s more stressed out) she will call me out on things I’ve done that are not to her liking by prefacing with the phrase “You know, since you’re auditioning, you have to…”. I’ve directly worked with her several times, and each time I feel like a complete idiot. I always feel regretful about something I did whenever I work with her, because she always comments about what I’m doing wrong or what I should be doing better. I talked to one of the interns who told me that she’s notoriously not good with students, usually yelling at them or publicly humiliating them until they have to excuse themselves because they start crying. He told me that if the only thing she’s done to me is give me criticism, then it might mean I’m not doing as bad as I think. Yeah, we’ll see about that. I still have two weeks of my audition left and will mostly likely work with her at least one more time, so I’m trying to really take to heart what she’s told me so that I can show her I’m capable of improvement.

In regards to working with residents, I’ve been trying to anticipate their needs beforehand and be helpful as much as possible.

“NB, I need you to see the patient in Room 1 and write the admit note. Then tell me your orders so we can review them”

“I already wrote the note and I just finished the orders for your review”

“NB, I need you to get the patient to release medical records and add them into the chart”

“I already had the patient sign the release and the records are being faxed to us right now”

I feel proud of myself for being proactive and getting things done before I’m asked, but this is really all just common sense, and all the other M4s who are auditioning have been doing the same thing- it doesn’t really set me apart.

One thing that is putting me at a disadvantage though is auditioning at a hospital I’ve never been to. Some of the M4s I’m with have rotated here as M3s, and they know how everything runs and where to find what they need. Meanwhile, my co-sub intern (who also has not rotated at this hospital before) and I feel like we were being thrown into the rotation, especially during the first week. I think the hardest part was that everyone expects a lot from us since we are fourth years; they just don’t know that we’ve never been here before and that it’s all new to us. It’s almost like we are M3s all over again.

We’ve also found that there has been little to no guidance on how to do things. We were not given a on-service orientation. During the first week when a resident would tell me to do something, I would enthusiastically reply, “Absolutely, I’ll do that right now” while simultaneously thinking, “Okay I guess I’m going to wing this too”. I really depend on the nurses, axillary staff, and more experienced M4s to help me out. There is definitely a steep learning curve, I think even bigger than the learning curve between M2 and M3 year. It makes me wonder if my core rotation site provided adequate training to my past M3 self, or if this is just an incredibly high-volume, high-stress, figure-it-out-as-you-go type of hospital. I’m thinking more of the latter. It is a county hospital after all.

Something else I did was re-introduce myself to the Program Director. My interaction with him this month is pretty limited, so I’m thinking of scheduling some kind of meeting with him. I am interested in going to this program, so I hope it goes well. It could also backfire, or have absolutely no effect on my chances of matching here.

Anyway, deep breaths. We’re halfway done.

 

-NB

Boards And Audition Rotation Woes

They say that every medical student will have at least one moment of self-doubt, one moment where they wonder if this is all going to pan out. I recently had one of these moments a couple days ago.

I had to push my board exam back, putting me at a disadvantage when it comes to my applications since now programs will not get my scores until after October 1st. To make matters even worse, I’ve essentially gotten rejected from my top choice program-one that I’m going to be auditioning at. I got in contact with the program and pleaded with them to reconsider. However the person I talked to told me that since they’re the only program for that specialty in the whole state, they get an extremely high volume of applicants and because of that they have to essentially pre-rank applicants based on COMLEX level I and level II (which I don’t have) alone. I get that it’s competitive but to not even give me a chance when I haven’t auditioned yet seems a little unfair. Plus, this ‘requirement’ is stated nowhere on their website or in any email correspondence I’ve had with them.

Now it’s too late to cancel and pull another audition rotation out of my ass, so I’m pretty much just stuck. I still need a Letter of Recommendation from that institution, so I do still need to work hard. But it’s extremely discouraging to be getting bad news so early in the cycle.

I used to wonder if some of my classmates had slipped through the cracks of the medical student selection process. How did some of these people get through the interview? But nowadays I find myself wondering if I am the one who doesn’t belong here. Lately I’ve been feeling like a fraud.

I really, really, really hope this all works out in the end.

 

-NB