Monday, February 8, 2016

Physician Heal Thyself By Getting Help

I wrote recently about burnout, which affects 37.9% of doctors, as compared to 27.8% of the general population, according to an Archives of Internal Medicine study.

Beyond burnout, suicidality is a major problem for doctors. Physicians have much higher suicide rates than the general population with male doctors at 70% higher and female physicians at 250-400% higher, according to a JAMA piece.

For the younger cohort in the profession, things are also rough: Fifteen to 30% of medical students and residents screen positively for depression, according to Medscape, and suicide is the number one cause of death among medical residents.

Excessive work burdens and expectations, lack of a perceived internal locus of control, and isolation from friends and family can all lead to clinical depression among medical students and trainees. It’s critical to take note if you see symptoms in yourself or colleagues, including hopelessness, withdrawal, anger, recklessness, anxiety, substance abuse, excessive feelings of guilt, and inability to concentrate. Realizing that many others are in the same boat and that most institutions have psychological counseling options can be a relief. Additionally, a national resource is the National Suicide Prevention Lifeline at 1 800 273 TALK.

Monday, February 1, 2016


Just a reminder that if you have received few or no residency interviews, it's time to start getting ready for SOAP.

On March 14 SOAP begins, but you need to understand how it works and be prepared for its brisk schedule prior to that.

Here is the main residency Match calendar. Here is an article on the history and basics of SOAP. And finally here are NRMP® video tutorials on SOAP.

Monday, January 25, 2016

Choosing a Specialty and a Life

During the winter season, I spend time talking to a lot of residency applicants about their future specialty choices: Want the majority of your time to be in the operating room or in the clinic? Like procedures?

But another fair and reasonable approach is to consider lifestyle. A recent New York Times piece noted that 50% of physicians are burned out. Burnout is particularly severe among emergency physicians and critical care doctors.

As you go through your third-year clinical rotations ask yourself if you can find a role model who fits - not just your professional goals - but your personal ones. Ask to meet individually with faculty members for their opinions on their fields' pros and cons.

Considering the growth in patient volume and the continued dearth of physicians, it's critical to determine whether you can see yourself happy in a busy, lifelong career in a particular field.

Monday, January 18, 2016

Match Ranking is (Strategically, but Not Emotionally) Easy Peasy

Getting into residency is hard. Understanding how to rank programs for the Match is easy. Thanks to a Nobel Prize winning economist and his colleagues, the current Match algorithm ensures that your desires are the priority over the residency programs'. What this means practically is that you should rank your first choice first, your second second, etc. There is no need to try to play the system.

I've had applicants tell me that they plan to rank a less preferred institution higher because that program has more residency slots. That's a huge no-no. The applicant will actually be harming him/herself with that strategy!

Please see my Guru on the Go® video "NRMP Ranking to Avoid a Spanking" below for a fun summary and the NRMP® website here for more details about how the algorithm works.

Monday, January 11, 2016

Improve Your Medical School Candidacy: Prove you can Handle the Heat

Getting into medical school has gotten so competitive that it's important to have a strong candidacy with excellent grades and robust extracurricular activities starting early in your college career.

One mistake I see pre-meds make is that they are so focused on leadership and research that they forget a critical component - clinical experience. No one wants to hire a cook who hasn't worked in the kitchen. If you want to prove that you want to be a doctor, it's essential that you obtain clinical experience for a significant period of time - not just a health fair or two. Good grades will not make up for a lack of clinical experience.

Working as an EMT, in a good clinical care extender program, 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.

To create a plan for your medical school candidacy, secure a Strategy Session with me here.

Wednesday, January 6, 2016

How Do I Evaluate My Score from the New MCAT?

Assessing your score on the new MCAT is not easy. The AAMC has no plans to release an MCAT conversation table from old to new scores, as their position is that the tests are not comparable.

With the old test, the conventional wisdom was that getting a 30 or 31 (approximately the 85th percentile) was the threshold to aim for, as it represented the allopathic medical school new matriculant average. Until we see who gets into medical school this year and what their corresponding scores are, it's hard to know what the "new 30" is.

Having said all of that, using last year's MSAR should still help you decide whether you need to re-test. An option for those committed to medicine who don't score at or above the "new 30" is osteopathic medical school, an institution that shows a great commitment to primary and holistic care and a (limited) leniency with MCAT scores. (Students entering osteopathic medical schools in 2013 had an MCAT score of 27. Their average GPA was 3.5 compared to 3.69 for incoming allopathic students.) Here is a great New York Times piece about DO schools.)

We have to take a wait and see approach to assess scores from the new MCAT, but it is key that you ensure you give yourself enough time to study and that you prepare effectively.

Monday, December 28, 2015

Understanding How the Match Works is Critical for Succeeding in the Process

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. This month 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 a simple 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, December 21, 2015


The end of the year is a time for reflection and a time to think about what will make you happy in the upcoming year.

When I was a medical student applying for emergency medicine residency programs, a well-meaning dean gave me some bad advice. I was determining the order of my rank list and was particularly concerned about one program that had an excellent reputation but was in a city I didn’t like. The dean told me, “You’ll be so busy during residency it won’t matter where you live.” Luckily, the advice rubbed me the wrong way, and I wholeheartedly disregarded it. Where you live for your medical training - medical school, residency, or fellowship - is as important as the quality of your training program! The reasons are several-fold:

1. Medical training is extremely time-consuming, and you want to be in a city you can enjoy fully when you’re able to blow off steam. 

2. Medical training is extremely stressful, and you want to be in a city where you have social support.

3. Medical training is not completed in a vacuum. Your personal life continues. If you’re single you may meet someone and end up staying in the city where you have trained for the rest of your life (gasp). If you’re in a long-term relationship you may decide to have children or may already have them. Down the road you may not want to relocate your family.

Not everyone gets the opportunity to go to medical school or train in residency and fellowship programs in a city s/he likes. But you can make choices that will increase your chances.