Monday, March 19, 2018

Match Day and Financial Security

First, congratulations to all of my residency applicant advisees: I am thrilled by the enormous success the Match brought to these candidates in a variety of fields. If you have not yet updated me, please send me an email.

Second, now that residency applicants have a professional plan for their next few years, they also need a financial plan. You could choose to work many fewer years, work in an environment you prefer, or go to part-time if you start to make good financial decisions right now. is a financial literacy blog for the newly minted physician. (Yes, you.) Here's a recent blog entry about how to simply start to manage your financial portfolio without a financial advisor (even if that portfolio is tiny or you have significant debt). You can use Dr. CrispyDoc's advice and call up Vanguard or Fidelity (I get no kickback from them) and tell them you need help setting up what you have read. Whala! You are already making good decisions that will earn you compound interest and give you more control as you move through your career.

Here are more posts from Crispy Doc on finances, early retirement for doctors, raising a family, career choice, hedge funds, Costco and more.

Monday, March 12, 2018

An Offer You Can't Refuse

I speak to a few lucky medical school and residency applicants who are asked to write their own letters of recommendation. If you have this opportunity, first, realize that it is not unethical to write your own letter if you're asked to do so. If you'd like to explore the scruples of this issue, take a look at this New York Times ethicist column about this topic.

The mistake I see candidates make in these situations is that applicants don't write strong enough letters for themselves because they feel awkward about showcasing their accomplishments fully. If you have the opportunity to write your own letter, craft a glowing one. Be effusive and full-throated in your remarks about yourself. Remember that the letter-writer can choose to tone down the recommendation if she doesn't agree. But if she does, you've utilized an opportunity fully and bolstered your candidacy tremendously.

Monday, March 5, 2018

Bias in Residency Evaluations

There's a scary, but important, recent article in the Journal of Graduate Medical Education by Mueller et al called "Gender Differences in Attending Physicians' Feedback to Residents: A Qualitative Analysis." As you might have guessed, male and female residents were given - on average - very different types of evaluations from faculty. Here's a link to the study and a podcast with an interview of the physician-authors.

Monday, February 26, 2018

Pre-Meds (and Others): Don't Make a Promise you Simply Cannot Keep

My mom told me an interesting story recently: She is a retired lawyer - not in medicine - but her anecdote resonated with me:

Years ago, a legal job applicant indicated on his resume that he spoke two languages, in addition to English. Unplanned, the interviewer to whom the candidate was assigned also spoke those languages and proceeded to speak to him in those languages during the interview, only to find that the candidate spoke both poorly at best.

As you can imagine, the applicant was not hired.

I frequently see applicants indicate on their curriculum vitae or their AMCASes that they speak languages fluently. If you do speak a language in addition to English, good for you and great for your candidacy. However, if you indicate that you are fluent, please be ready for your faculty interviewer to conduct your entire medical school interview in that language if s/he pleases.

Monday, February 19, 2018

The Rank Order List Deadline Is Imminently Approaching: Check Yourself Before You Wreck Yourself

This is an important reminder that Wednesday (February 21) at 9am EST is the rank order list certification deadline. I'd recommend submitting today or tomorrow morning to be safe. Waiting until the last minute and making impulsive changes to your list is not a great idea.

Please make sure to avoid simple missteps in creating your rank order list. Improving written materials and interview skills is important, but all of that work can go to waste if applicants do not understand basic strategies for the Match. In November or 2015 the NRMP published an article called, "Understanding the Interview and Ranking Behaviors of Unmatched International Medical Students and Graduates in the 2013 Main Residency Match" in the Journal of Graduate Medical Education. The data is especially important for IMGs who represented the majority of unmatched candidates.

Sadly, the authors found that some applicants made strategic errors including the below:

- Not attending all interviews, thus failing to capitalize on every opportunity to market themselves.

- Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.

- Misunderstanding the Match and ranking programs at which applicants did not interview.

- Failing to rank programs based on true preferences or ranking programs based on the perceived likelihood of matching.

It kills me to read about these mistakes :(. Here is an explanation of the Match algorithm. If you do not understand how the Match works, it is absolutely critical that you learn about it to avoid destructive errors.

Monday, February 12, 2018

Yes, Sleep is a Medical Necessity

I found this short piece, "A Call for Sleep" to be an interesting and honest read. Throughout my life, I've had non medical people tell me that I should be used to a lack of sleep because of my training and night shifts (which I, thankfully, no longer do). If someone has fasted before, that doesn't mean she doesn't get hungry when she doesn't eat!

For applicants, I'll again say that it's critical to consider lifestyle and priorities when choosing a specialty.

Monday, February 5, 2018

Read the Fine Print

A few years ago, a medical school applicant told me the following story:

This pre-med decided to write follow up notes to all the schools at which he had interviewed, usually a good idea. However, he was upset to receive a brusque note from one of the institutions telling him that a) he should have read their policies; they do not allow post-interview contact and b) he was rejected from the school.

I found the school's note pretty severe, and I strongly suspect the post-interview contact was not related to his rejection. (As an aside, he successfully and happily matriculated at another school.) But this story is a reminder that it's important to read institutions' policies about post-interview contact. Most places welcome written updates, but it's essential to confirm before you send.

Monday, January 29, 2018

No One Wants to be your Second Choice for High School Prom Date

Imagine you're back in high school, planning to ask out a fellow classmate to the prom. You approach your potential date, "Would you be interested in going with me to the dance? You're my second or third choice." 

Not very compelling...The same is true for letters of intent: I've had several applicants ask me if it's okay to say that an institution is their "second or third choice" or "one of my top" picks. 

That does not sound very flattering. Instead you can say something like "I would be thrilled to be at your institution," or " I’m confident I can make a positive contribution." In other words, you don't need to lie (which I never recommend); but you don't have to shoot yourself in the foot either.

I do edit letters of intent and have been busy with them this season. Let me know if you need assistance.

Monday, January 22, 2018

After Your Residency or Medical School Interview: Is there Value in a Second Look?

After interviews - if permitted by the institution - there are several ways you can communicate with a medical school or residency. My favorites are brief thank you notes and well-written letters of interest.

But what about the "second look?" I've had many mentees ask me if re-visiting a school or training program after the interview day is valuable. Unfortunately, there may not be a definitive answer to this question because how a second look is perceived varies by institution.

The cons of the second look are cost and time. And perhaps even worse, there is the risk that you are imposing on the school or program. You don't want your request for a second look to work against your candidacy. On the other hand, the pros of a second look are a demonstration of interest and enthusiasm that many schools and programs are seeking.

If you are a pre-med and are wait listed at a medical school, I would generally recommend a second look if you can swing it. After all, you have every right to visit the institution you may be attending. If you go for a second look in this scenario, make sure to do a formal visit: Let the admissions office or Dean's office know you would like to spend the day and ask if you might have an opportunity to meet with students and even an admissions officer to support your candidacy.

If you are a residency applicant, it's hard to say if a second look will help or not. A residency director friend of mine says that a visit from someone who travels from far away might improve a candidate's standing by a few slots on the rank list at her program. That sounds like a tepid endorsement at best... If you are considering a second-visit, make sure to speak to the program coordinator. S/he might advise you against it or, on the contrary, let you know it's appreciated by the residency director.

As we all know, the residency and medical school interview scene is already stressful and expensive, so unless you are a wait listed pre-med - with all other things being equal - I generally would not push yourself hard to do that second look.

Monday, January 15, 2018

Pre-Med? Avoid a Big Mistake

Several years ago I was hired by a re-applicant who wanted to better understand why she did not get into medical school the prior year. She had a 3.9 GPA and a 40 on her MCAT (100% percentile). Yet, she had been rejected from all medical schools.

I looked through her materials and discovered the problem. The applicant had no clinical work at all. She had never been in the room with a patient. Many of you know that I like the saying, "No one wants to hire a chef who hasn't been in the kitchen." She had fallen prey to exactly that adage.

We talked, and I advised her regarding options she had for obtaining clinical experience. Fast forward a year: The client completed a robust clinical activity and was readily accepted to medical school (and felt more confident about her career choice).

If you are a pre-med, note that robust clinical experience is critical. Working as an EMT, in a good clinical care extender program, formally as a scribe (where you can also make some money), or in a low-income clinic are just some ideas for obtaining excellent clinical exposure. (Although you might think free clinics would be thrilled to have a pre-med volunteer, many understandably require one-year commitments.) Shadowing is a mixed bag: Medical schools don't know whether you're second-assisting in the operating room or just standing in a corner being ignored. If you choose to shadow, make sure you highlight any true clinical experiences and skills gained in your written materials. Other popular options for clinical experience include international work (although the activity is usually short-lived, which makes it less robust) and working as a volunteer in a hospital (although it might be more clerical than clinical, depending on the position. Do your research before accepting a "clinical" job). I've also had advisees who became certified, practicing phlebotomists and others who worked in veterinarians' offices to obtain procedural skills.

More important than getting into medical school (gasp), getting robust clinical experience will help you ensure you've made the right career choice. Simultaneously, you'll demonstrate to admissions officers that you can handle the heat.