Life after medical school

It occurs to me that most people outside of medicine don't really know how the medical education system works after medical school. So here is a combined primer/update.

Upon completing medical school, you are an MD, however you cannot practice clinical medicine without supervision until you complete a minimum of one post-graduate year. Typically, this is accomplished by entering into a residency program. The vast majority of people complete a full residency, upon completion of which you sit the board exams in a particular specialty (or specialties). If you pass that exam, you are then "board-licensed" in that area of medicine. You can further specialize within that category of medicine by completing a fellowship and sitting sub-specialty boards.

Example: You could complete an internal medicine residency to become a board-licensed internist and subsequently complete an endocrine fellowship to become a licensed endocrinologist.

You cannot complete a fellowship without first completing a residency. Theoretically you can practice medicine without board licensure, however you would never get the malpractice insurance required and no hospital would hire you/give you privileges.

Okay, so how does a medical school graduate get into a residency program? The answer is the national residency match process. In your final year of medical school you apply to residency programs at a variety of hospitals using a central database called the ERAS. You fill the application out once and select the programs at which you would like to be considered (and pay $$). Generally, people apply to only one type of residency (ie anesthesia, pediatrics, ob/gyn), however occasionally people will apply to a less competitive option in case they do not get a spot in something coveted (ie, someone applying for dermatology may also apply to internal medicine).

Programs that found your application compelling will invite you to interview with them. An interview involves flying out to the hospital the day prior, attending a dinner with current residents the evening prior, followed by a full day of interviews/presentations/tours. You pay for this yourself, so you can imagine that a person who interviews with 10-12 programs will burn though a chunk of change accomplishing this. Interview season is November-January.

In February, the applicants submit a ranked list of places they interviewed at. The list does not have to include all the programs, however, not ranking a program means you would refuse to work there even if given an offer. Applicants cannot rank programs at which they did not interview. Simultaneously, each program ranks the applicants they interviewed. Again, they do not have to list all the people they interviewed, but they cannot list someone who did not interview.

In March a computer goes through and attempts to create the optimal pairing of applicants to programs. If multiple programs rank an applicant, the applicant is generally assigned to the program they preferred. If no programs rank an applicant high enough, that applicant will not get a residency placement (ie they will not have a job). On March 16th, 2012, all applicants will get an email telling them where they have been assigned. If an applicant did not match, they are generally notified the Monday prior and they go through something called the scramble.

So, where am I in all of this? Well, I'm applying to a combined residency program, called medicine-pediatrics. It's four years in length. At it's conclusion, I will sit both the internal medicine and pediatrics board examinations (ie I will be double-boarded). I applied to 19 programs and was offered interviews at 14 of them. I completed 11 interviews, but have not yet settled on what order to rank them.

Places I interviewed: UPenn/CHOP, Univ. Minnesota, Univ. Maryland, Univ. Michigan, Georgetown, Brown, Baystate (Tufts), UCLA, USC, UNC, Univ. Rochester

Places I declined to interview: UCSD, Vanderbilt, Univ. Chicago

Places I was rejected: Brigham & Women's, Mass Gen, Yale, Duke

Places I never heard anything from: Univ. Pittsburgh

Little m, big P

It occurs to me that I haven't really talked about residency applications, which actually comprise a lot of time and mental energy during the beginning of M4 year. I'm applying for a medicine-pediatrics residency. It's a four year program, at the end of which you sit the boards for both internal medicine and pediatrics. You are then eligible for any fellowship in either medicine or pediatrics, though 60% of graduates go into primary care. Not me - of course - I will be headed to fellowship.

There aren't very many med-peds residency programs, and each one takes very few candidates. Thus, this residency is competitive because demand outstrips supply. Nevertheless, my advisors tell me I will match.

For those of you who don't have relatives in medicine, I will briefly mention what "the match" is. Basically, as a 4th year you apply to some residencies. The ones interested in you will invite you to interview. You rank all the places you interviewed. The hospitals rank all the people they interviewed. It goes into a big computer program called the NRMP. In March you get an email telling you where you matched - not all the places, just the one place you will go to. It's not a choice and you are not guaranteed to be chosen anywhere. Rather appropriately, this process causes a tremendous amount of anxiety - will I match at all? Will I match somewhere I actually want to go?

Right, so I've been told I will match, it's just a question of where. My current list of programs is 19 deep and I hope to get 10 interviews. I've had to get four letters of recommendation, two of which must come from the chair of the peds dept. and the chair of the internal medicine dept. I have to get a letter of endorsement from the dean of the medical school as well. I have to put my CV and all my publications into the online program (one item at a time). I have to provide transcripts and copies of my USMLE step 1 and 2 scores. I have to write a personal statement and include a photo. I have to pay money (of course). All of this gets submitted September 1st, so you can imagine the past three months have been spent getting all of this together. But soon - so soon - I hit submit and then... I wait. Wait and hope. Hope for interviews.

I will keep you updated.

Drumroll please...

The deposit has been paid and all other applications withdrawn. Starting August 3, I will be attending the University of Michigan Medical School. Go Blue!

For the Lost addicts: This was foreshadowed years ago... when I was 6 and lost part of my finger in the door and it grew back ala Wolverine in X-men... and the Michigan football team is the... Wolverines.

Choosing a School

I am sitting in the law library (view from my chair, right) working on my biochemistry term paper on dentatorubral-pallidoluysian atrophy (DRPLA), but my mind keeps wandering. I have now heard from all my medical schools and must begin choosing where I want to spend the next four years. I have narrowed it down to three at which I have been accepted: Michigan, Mt. Sinai or UPitt or two at which I have been waitlisted: WashU or UPenn.

I am content to live in any of the above cities and they will all cost me about the same amount of money, so how do I choose? I am so paralysed by the decision that I have actually asked several of the attendings I know at the hospital to rank them for me (which they did: Upenn got 3 votes and WashU got 1 for the top spot).

I think what makes it so difficult is that I would be happy at any of these schools. All of them set me up well for the future; there is no wrong choice. I am extremely fortunate to be in this position and I recognize that. But I still have to choose. And I am still stuck.

In the meantime, this paper still needs to be written. Back to biochem.

Medical school admissions update

Left: Chasing sunset on a plane to St. Louis.

Applications completed: 23
Interviews offered: 12
Rejections: 3
Acceptances: 3

Go Blue!

I'm in!

A common sight recently...

No plane.

...awkward...

About five minutes into my (non-Harvard) medical school interview...

Faculty interviewer: Have you ever been to Boston before?
Me: Yes, once. It's a great city.
Faculty interviewer: Was it to interview at Harvard medical school?
Me: ... yes.
Faculty interviewer: What did you think? You're exactly the type of person they like.
Me: Well, I think has good and bad qualities like every other school.
Faculty interviewer: What about UPenn, when are you interviewing there?
Me: I don't have an interview there.
Faculty interviewer: Yet. My daughter went there. She lived in University city. You don't want to live in the ghetto though. She almost went to Columbia, are you interviewing there?
Me: They have not invited me either.

I actually ended up liking the guy, but what a stressful start!

A month of travel

Someone emailed to remind me I haven't posted in a month. True. And I have no excuse because my hotels had internet access. I was in Pittsburgh, Boston, and Atlanta to interview at medical schools and in Vegas to, well, blow off some steam.

For those of you keeping score, I have 9 interview invites, 2 rejections, and 12 haven't-heard-yets.

Tomorrow I have my neuroanatomy midterm (yikes) for which I am incredibly unprepared. This is partially due to travel and work and partially due to my going to Vegas instead of studying.

Vegas was phenomenal. I gambled (and won - Pai Gow!), first with someone else's money (what better way to learn) and then with my own. I ate (a lot), I sunned by the pools (tan = no, bikini debut = yes), I watched sports and drank beer in the sports book (go Steelers go Rockies), and I went clubbing (VIP, skybox: balcony over the dance floor = awesome). I took a red eye back, went straight to work and ended up in bed by 8:30pm (totally exhausted) for a nice 11.5 hour snooze. Four days of fantastic.

Flash back to now... sore arm from a flu shot, totally unprepared for a midterm, pre-lab to write and more travel to come. Oh, and I'm cold (not a surprise).

The next two weeks: Nov 5-6 Boston, Nov 7 NYC, Nov 12-13 Cleveland, Nov 15-16 Ann Arbour

If I get in somewhere (two letters potentially on their way) - you bet your cute little butt I'm gonna post.

Medical school admissions update

# applications initiated: 27
# secondaries received: 25
# secondaries completed: 22
# confirmed complete apps: 20

# interviews offered: 6
# acceptances: 0
# rejections: 1

YAY!

# of schools applied to: 25
# of secondaries received: 19
# of secondaries completed: 8
# of interview invites: 1

Application update

Anyone who has been following this little blog over recent months knows that I am applying to medical school at the moment. Or rather, medical schools. My amcas has been verified and 23 schools now have my application... scary! I've begun working on secondaries, which pretty much just ask you to re-hash your amcas under different word count limitations.

Paperwork seems to be my theme at the moment (thus no cool medical stories) because work has been nothing but IRB and NIH reporting recently. Two of the three doctors in the group are away (Korea and Geneva) so all is quiet on the Neuro front.

The personal statement

This is a slightly unusual post. Rather than telling you a story, I am writing you a request.

It is recommended that as many people as possible read your personal statement and give you feedback and so I say - if you are willing to read my personal statement and send me feedback, I would be glad to send it to you. Provided you are not also applying to medical school and plan on stealing it if it's good.

Interesting tidbit - our advisor adminished us to not make our personal statements too self-centered. It's a personal statement, how can it not be self-centered?