Happiness: Part 2

Last week I posted about happiness. Unfortunately, I have recently spent a lot of time at an academic medical center with a sick family member. The hours I’ve spent there have made me think further about contentment in medical school and residency.

What I noticed about this highly academic hospital is that the care is outstanding, but the atmosphere is much more collegial than the setting in which I trained. The doctors and nurses are extremely bright and competent. They are also kind and approachable.

The institution at which I trained (and it may have changed in the 12 years since I left) did not have this culture. I experienced unchecked sexism, arrogance, and standoffishness. As I interacted with the physicians and nurses recently, I realized that I probably would have been much happier at an institution that better matched my personality. (Having said that, I met many of my dearest friends and my husband during medical school, residency, and as an attending, and I would not change any of that.)

Bottom line: Yes, reputation is a factor, but culture is really key. You can oftentimes train at an equally excellent place where you will happily fit in.

After all, we’re talking years of your life here. 

Happy Medical Training: An Oxymoron?

Medical school and residency training usually decrease one's happiness for several reasons. Happiness researchers have demonstrated that a feeling of control and the amount of spare time one has both correlate with happiness. Both of those factors are limited during med school and residency. Relationships are also correlated with happiness, and those can be squashed during medical training as well.

I'm not trying to be a downer here! I want to encourage applicants to consider this happiness quotient when selecting an institution and training program. If you are able, maximizing your contentment by choosing an institution that fosters your greatest happiness is key. Geography; proximity to family, friends and community; and a location that provides an opportunity to enjoy hobbies during limited free time is significant.

Excellent training is important, but, in the end, many programs turn out equally qualified clinicians. At least consider your well-being as a factor in selecting where you might be for the next three plus years of your life.

Do-It-Yourself Exit Strategy: How I Stitched Together My Own Golden Parachute

Over a decade ago, I was seated in the emergency department with a colleague when I inquired about another one of our physician co-workers I'd not seen in a while. “Oh, she’s on the Mommy Track,” my colleague said and picked up another chart, without giving his words a second thought. To me, selecting a career path that sacrificed career advancement for more time to raise children was legitimate. My colleague’s pejorative “Mommy Track” made it clear that to him, it was not.

At that sad moment, I resolved to pursue a non-clinical supplement to my emergency department work, colloquially known as an “exit strategy.”

Read more on Student Doctor Network here...

DO vs. MD

Thinking about a medical school application for 2018, I’ve had a few industrious pre-meds ask me about DO school. There was an excellent article in the New York Times a few years ago about what doctors of osteopathy do and how their admissions criteria are different from allopathic schools’. It’s here and worth a read.

The topic of DO schools is an enormous one. A few quick points many candidates don’t know about DOs:

1. Many doctors of osteopathy practice medicine just like allopathic doctors do. I do per diem emergency shifts at Kaiser and work with many DOs. Candidly, I usually do not know which colleagues have osteopathic degrees and which have allopathic ones unless I see a prescription blank or a signed computer note.

2. If applying to osteopathic school, candidates are generally better off with at least one (strong) letter of recommendation from a DO supervisor.

3. Osteopaths currently take the COMLEX for their board tests, instead of the USMLE. If an osteopathic medical student wants to enter an allopathic residency, s/he may need to take the USMLE in addition to the COMLEX. On the other hand, there are many allopathic residencies that accept the COMLEX. Also, there is talk that in the future (when exactly is unclear, however) there may be just one board test that both groups take.

4. The osteopathic Match occurs before the NRMP Match, a fact that can be difficult for osteopaths applying to both types of residencies. If those applicants are successful in the osteopathic Match, they cannot enter an allopathic residency. If, on the other hand, they wait and enter the NRMP Match, they run the risk of simply not matching.

Again, this topic is complicated and nuanced, but the DO option is a great one for some applicants.

Haven't Heard Back from a Medical School or Residency Program? Here's What to Do.

One of the more frustrating aspects of the medical school and residency admissions processes is the lack of response from some institutions. There is no obligation for medical schools or residency programs to reply to a candidate, which leaves applicants in limbo.

If you have not heard back from medical schools or residency programs to which you've applied, I recommend that you contact (preferably call) the institutions to inquire about your status.

After I offered that advice to a residency applicant I was advising, she emailed me to say she obtained an interview in a competitive specialty with a phone call. Another said she received two preliminary interviews with simple emails. (I recommend calls over emails, however, because it's hard to ignore someone on the other end of a phone line. Still, if you simply can't bring yourself to call, an email can be effective.)

I've seen this phone call strategy work for medical school interviews as well: Several years ago I helped a strong applicant who had been rejected by a top medical school. He thought he was a very good fit for this particular institution, so he called the school to make his case. Surprisingly, after the applicant's phone call, the school granted him an interview, reversing their original rejection. Ultimately, after being initially rejected, this applicant was admitted to that top school. Of course, this is an exceedingly rare occurrence. But to me, the moral of this story is that it is worth being assertive in the application process.Now, if the school or program explicitly asks in written materials that you don't contact them about your status, then calling is not a good idea.

An additional strong option is to send an effective update letter or letter of recommendation from an influential writer (alumus, for example). I do edit letters of update/interest for medical school and residency applicants, but even if you choose not to use my services, I recommend sending a well-written, strategic note in addition to making a phone call.

This process is an uncertain one, but asserting some small bit of control can be useful (and comforting).

Some People Have Real Problems

The residency and medical school application processes are anxiety-provoking, but in honor of Thanksgiving, I'm posting this guest blog from CrispyDoc David Presser about a truly stressful, heartbreaking choice a patient recently had to make...

Years ago, I bought an album because the title caught my eye: Some People Have Real Problems. I was browsing used CDs in a music store back when both of those existed, and I felt the universe trying to restore perspective to my personal pity party.

Fast forward a decade, and I had fallen off the wagon again into whining doctor mode: headed into my second weekend night shift in as many days. The first night had been a killer, where the spigot of patients opened to a steady gush around 1 A.M. and all four of the late shift docs stayed several hours past the end of their shift to flush the proverbial toilet that our waiting room had become.

 

Read more of this article...

So Easy for You to Do: Medical School and Residency Interview Thank You Notes

A few years ago a medical school applicant wrote me to say that the dean of the school at which she had recently interviewed called her to tell her that he was impressed with her candidacy and the hand-written thank you note she had sent. The client thanked me for my help and the thank you note tip I had given her. As you might have guessed, she was admitted to that medical school.

Writing a thank you note after a medical school or residency interview is so easy for you to do, and it can go a long way. 

Now, I get asked by clients what the best way to send post-interview thank you notes is - email or snail mail. I strongly advise sending your thank you note by good old USPS. The reasons are:

1) Email may be viewed as lazy. Handwritten notes demonstrate you've put some time into being appreciative.
2) Email can be deleted without much thought. Emotionally, it's harder to throw someone's handwritten note in the trash.

Get your handwritten thank you notes in quickly. The night after you've completed your interview or the next day is a good time to write and send.

Emergency Medicine: Queen, Rodney Dangerfield, and George Clooney All Rolled into One

Check out the below, a great post called "We Are the Champions?!" written by Crispydoc (Dr. David Presser) on burnout in emergency medicine, a field that towers over the others in burnout statistics:

It’s official: a study published in the Mayo Clinic Proceedings showed that as of 2014, Emergency Medicine (EM) took the top slot for physician burnout (59%).  Suck it, critical care (50%). In your face, OB/GYN (56%).  We’re #1, we’re # ...huh?

How did my beloved field of EM win the race to nowhere?  When I was in medical school, the pioneering faculty insisted that EM’s reputation for early burnout was based on the fact that those docs who’d burnt out had trained in another field, couldn’t hack it in their chosen specialties, and ended up woefully underprepared to spend their careers in EM.  As a medical student, I saw EM transform from Rodney Dangerfield disrespected to George Clooney sexy.  A full 13% of my class at UCSF matched in EM.  We smugly believed we knew what we were getting into, and we took for granted our ability to work as lifers.

Read more of this article (and see an awesome Queen video to boot)...

Your Residency Application: What Do Program Directors Really Want?

Imagine that you're a program director (PD) going through scores of ERASes and interviews. What questions would you ask yourself as you assessed each residency candidate to avoid big headaches?

1) Can this person do the job? Is s/he competent?

2) Will this person "play well with others" and not create complaints from patients, faculty, or other services.

3) Will this person stick with the program and not leave prematurely? A PD does not want to scurry around to fill an open call schedule/ residency slot.

As you approach your interviews, consider how you can demonstrate your competence and collegiality, as well as your commitment to the field and the residency program. For the former, ensure you showcase academic successes, extra curricular activities that demonstrate teamwork, and - if asked - hobbies and reading materials that demonstrate your personality. For the latter, highlight research projects in the specialty, sub-internships, and knowledge about the program and city.

Making sure the PD knows you are not going to cause him/her trouble is at least half the battle.

White Coat Investor Scholarship Winners Announced

For the past few years, the White Coat Investor has funded a scholarship for full-time professional students, including those in medical, osteopathic, dental, law, pharmacy, nurse practitioner, physician assistant, optometry, and podiatry schools. The goal is to both reduce the winning students' debt burden and spread "an important message of financial literacy throughout medical, dental, and other professional schools."

This year's first place winner's essay is here. It's great and worth a read. Second through fifth places can be found here. Keep your eye out for next year's contest. The financial support is significant. 

I Believe

I was recently speaking to a friend who is a law professor at a prominent institution. He teaches first-year law courses and thus, meets students when they are just entering their careers and not yet polished. He was telling me that he is taken aback by how many of his students use "I believe" before their statements in class. The preface "I believe" diminishes the student's point; my friend is looking for persuasive pronouncements, not thin opinions. 

Consider this issue when interviewing. Note the difference between "I'll make a strong medical student" and "I believe I'll make a strong medical student." The latter introduces that inkling of doubt you don't want to impart.

I have advisees who worry about saying "um" or "uh" during interviews. (I advised a pre-med who, in preparing for interviews, asked his girlfriend to gently slap his hand every time he said "um" so he'd experience negative consequences. Yikes!) As I tell my mentees, I'm not worried about an "um" or an "uh." (Note President Obama, well-known to be an excellent orator; he inadvertently uses vocal pauses when he speaks.) 

Instead, the key to a persuasive interview is to have confident responses that are bolstered by persuasive evidence. 

What Is the One Thing You've Learned...?

I was with my children at a four year-old's birthday party a few years ago when I met the grandfather of the birthday-boy. As it turned out, before retiring, the man had been on the admissions committee of a prestigious medical school for decades.

So, I asked him, "Looking back at all of those years of experience, what is the one thing you learned from interviewing medical students?"

The man chuckled and said, "They have no idea what they're getting themselves into."

In life, we never have any idea what we're getting ourselves into, but I think of this man every time I practice the question "What will you like least about being a doctor" or "...least about being a [insert your medical specialty here]" with my medical school and residency mentees, respectively. Saying you'll love everything about being a physician or psychiatrist or pediatrician or internist sounds disingenuous and naive. You need to show that you have some idea what you're getting yourself into.

Having said that, I would avoid tacky topics like money. And talking about how horrible night shifts are is not going to win you many points. But a sophisticated applicant can infer what the challenges will be in medicine or in her specialty and can express them with aplomb.

...As with everything, practice your answer in advance.

Accomplished, Not Lovely

Last week I went to hear the author Nicole Krauss speak about her recently-released novel Forest Dark. I am a big fan of Krauss' writing. The day I heard the author speak, she had published an opinion piece in the NYT Sunday Magazine called "Do Women Get to Write with Authority?" In the article, Krauss speaks about the lack of authority that women writers have compared to men, and specifically, how female artists' work is often characterized as "lovely," a word she describes as lacking in "independent power."

I must admit that I sometimes use the word "lovely" (both for women and men) when I like someone. But Krauss made me think about the word in the context of achievement - not personality - and her point is well-taken.

What does this have to do with medical school and residency admissions? When you interview, you want the faculty member to leave the table saying you were "accomplished," not "lovely." Many applicants miss this point: You don't want to simply be liked; you want to be seen as worthy. It's important that you focus on that important goal as you practice for interviews. 

As an aside, I have not gotten a hold of Forest Dark yet, but I would strongly recommend Krauss' Great House and History of Love.

Four Ways to Save $ in the Medical School and Residency Interview Processes

1. If you are ambivalent about an institution, schedule your interview later. By late-season you may decide not to interview there at all, saving you some money.

2. Group your interviews geographically. If you think this is impossible, consider this: There is nothing wrong with calling an institution you are waiting to hear from and politely letting the assistant know you have been invited to interview at a nearby school/program. Let him/her know you can only afford to fly out to the area once and ask if the admissions committee/ residency might be willing to let you know now if the institution will be offering you an interview. Believe it or not, this technique sometimes works.

3. Check out travel web sites daily or better yet, set an alert on Kayak or Google flights. Occasionally, a low price is available only if you catch it quickly.

4. Consider staying with students/residents if the institution offers. Hotels can be expensive, and sometimes you can gather useful information about the school/program this way. Just beware that anything you do or say may be repeated to the admissions committee/residency. (Make sure to write a thank you note.) 

Don't Let Other People Freak You Out

I started Insider Medical Admissions over a decade ago, so I've been in admissions consulting for a while. I'm pretty good at spotting trends. Every year about now I start getting emails from clients saying they're worried about their lack of (or minimal number of) interview invitations. Yes, even as early as mid-September folks are concerned. They say they have a classmate who says he's gotten an interview invitation or they read online that others are being contacted with invites.

Sure, it's possible some people are getting very, very early interview invitations. But, it's rare and should not affect your confidence. After all, according to Amy Cuddy, whom I've referenced before, confidence is the name of the game when it comes to interviews. 

So, simply stop checking online and minimize conversations about interviews with others. If you are in the thick of the season and you still haven't gotten any interviews, then you'll need to reassess and act. But for now, put in ear plugs. This process is so very stressful; you certainly don't need to seek out more anxiety-provoking information (and who even knows if it's accurate anyway!). 

ERAS 2018 Timeline: Don't Lose the Forest for the Trees

As many of you well know, September 6 was the date that candidates could start applying to ACGME-accredited residency programs (and September 15 will be the date that ACGME-accredited residency programs start receiving applications). I am a big fan of getting your ERAS in on the early side: It demonstrates commitment, and when I was reviewing applications as an Assistant Residency Director, I found my workload was lighter earlier, allowing me more time to spend on those initial applications.

Having said that, do not over focus on an early application such that your written materials are suboptimal. Every year I encounter panicked candidates who want to submit their poorly written documents simply to get them in, shooting themselves in the proverbial foot. 

Find a balance. Yes, submitting early is wise, but not at the expense of your candidacy's success.

Medical School Interview Questions: How to Handle the Illegal Ones

In the United States, a professional interview is subject to basic legal rules. Specifically, admissions officers should refrain from asking medical school interview questions that are not relevant to the position the interviewee is seeking. Questions about race, religion, sexual orientation, and marital or family status fall into this category.

If you are asked these types of questions, you can simply answer - if it's not distasteful to you - or respond by addressing the intent of the question without revealing personal information. ("I think you're asking if my home life will affect my ability to carry out my medical school studies or my clinical duties. I can assure you it won't, and I’ll complete my full tenure here at your school.")

If you have the opportunity to give feedback to the institution about your medical school interview questions or experience, you can consider doing so after the interview. When I was interviewing for residency, I was asked by a faculty member if I had a boyfriend. After the interview day, I talked to a faculty mentor at my school who reported the situation to the other institution. The faculty member who asked me the illegal question was no longer permitted to interview.

Difficult Interview Questions: Learning to Hit a Curveball Out of the Park

You put your heart and soul into your compelling, charismatic personal statement; you showcased your accomplishments and drive to succeed in your activities section; and you demonstrated the endorsement of respected faculty allies in your letters of recommendation. Now your hard work has paid off and helped you get a foot in the door: You’ve been invited to interview at your dream medical school or residency program.

Like the ghost stories we told around a campfire as children, interview horror stories have a certain inexplicable staying power. I can still recall a friend’s recounting of an acquaintance’s experience in an Ivy League faculty member’s office: The acquaintance was asked to open the window, only to find (after sweating bullets for several minutes) that it was nailed shut. This trick was allegedly this professor’s cruel attempt to assess how the interviewee coped with adversity. Some weeks later, I recounted the tale to a mentor, who told me that the same story had made the rounds 20 years earlier. The power of this terrible tale faded once I recognized it for the myth it was. This ability to demystify the medical school or residency interview is crucial to framing it as an opportunity for showcasing your strengths. Read more...

Women, Make Sure you Practice Before Heading off to your Medical School and Residency Interviews

I found this article about the need for women to be seen as warm in order to be seen as confident troubling, but it's worth noting the facts so that you can strategize accordingly. Previously, these authors published data that women tended to rate their abilities accurately, while men tended to be overconfident about theirs. All of this is to say, that women (and men!) need to practice interview skills prior to the big day. Growth mindset and power posing are also important concepts to review before you interview. 

Medical School and Residency Interviews - Power Posing

As medical school and residency interviews approach, I want to remind everyone about Amy Cuddy, the Harvard faculty member who speaks about the psychology of power, influence, and nonverbal communication. Her research shows that a "fake it until you make it" philosophy and "power posing" practices improve your performance in interviews. Cuddy's TED talk has been viewed over 42 million times.

NRMP® Data Suggests Residency Applicants Should Apply Broadly

In their publication Impact of Length of Rank Order List on Main Residency Match Outcome:2002-2016, the NRMP reports that matched applicants consistently have longer rank order lists than unmatched applicants.

What that means to those approaching the residency application process is that candidates should throw a wide net in choosing programs at which to apply. Of course, there is a cost to this strategy, and that expense needs to be balanced. However, if you can afford it, starting out with more options usually will provide more opportunities to interview and thus, the ability to create a longer rank order list.

Are you a Residency Candidate Applying in More than One Specialty? Read this.

If you're planning to apply in more than one field, you have a challenging road ahead of you, and you should strategize accordingly. Remember that, although your ERAS activities cannot be individualized to different residency programs, your personal statement and letters of recommendation can. Demonstrating commitment to each field through your essay and letters will be a challenge, so take time to write thoughtfully, and make sure you speak candidly to your faculty recommenders.
 
Above all: Ensure that you assign the correct specialty-specific documents to the correct programs!

Allopathic Residency Candidates, Check out this Super Useful AAMC Data

I recently found this AAMC website that provides USMLE Step 1 and Step 2 CK Scores of (2015-2016) first-year residents by specialty. You can look up your desired specialty and then cross check your Step 1 score with your Step 2 score. The chart tells you how many applicants (and what percentage) successfully matched with those Step numbers in your desired specialty - helpful for predicting application success in a chosen field. Check it out.

How to Draft a Strategic Residency Personal Statement

Each year residency applicants ask me if they need to showcase their accomplishments in their residency personal statements if they've already drafted strong ERAS activities sections. The simple answer is yes.

First, remember that you don't know at what part of your application the readers will be starting. If a residency director peruses your personal statement first and it's thin and boring, you'll have lost that reader from the beginning.

Also, note that the faculty members seeing your application are reading many more ERASes than just yours. If you only mention an important achievement once in your application, the program director might simply forget your accomplishment. After all, s/he is reading hundreds of similar applications. Your readers need to be reminded several times of your candidacy's strengths. (You'll mention those accomplishments again in your interviews.)

To a program director who hasn't yet met you, you are what you've done. You need to use substantive examples of your achievements to demonstrate your worthiness for a potential residency position. Evidence is persuasive; use it!

Looking for a Laugh?

Over a decade ago the American College of Emergency Physicians solicited its members to submit a true story to the television show "Untold Stories of the ER." Lo and behold, my story was chosen, and my husband and I were invited to act in a fictionalized rendition of my tale. If you're interested in seeing it, check out Netflix's "Untold Stories" episode 17.
Enjoy!

Be an Adult: Don't Accept Helicopter Parenting

Check out this hilarious (and sad) piece in the New York Times about helicopter parenting and note that two of the anecdotes are physician related. (Can you imagine interviewing for an attending position with your dad present?)

My policy at Insider is to work exclusively with applicants (not parents or spouses) to maintain confidentiality, avoid redundancy, and ensure candidates assume primary responsibility for their work. It's a winning strategy.

Reading this Article Could Make You Wealthier than Working Long Hospital Shifts

Work smarter, not harder. Read this funny, informative Student Doctor Network article by CrispyDoc on financial literacy for the newly minted physician. Have little idea what an "alternative asset class" really means? Don't know which is a bear- and which is a bull-market? This piece is for you. Learn that do-it-yourself investing is not that hard with the technological tools now at our finger tips and start saving so that you can gain financial independence early and avoid burnout.

Also, make sure to check out CrispyDoc's awesome blog for tips on financial independence and finding your mojo in and out of medicine.

Inaccuracies in Medical Student Grades Translate into Residency Application Strategy

Here's an interesting article by Dr. Pauline Chen on medical student grades. In reading the article, residency applicants should reflect on how important the content of their letters of recommendation is, especially in the setting of medical school grades that may be inflated or simply inaccurate. The 2016 NRMP Program Director Survey supports the importance of letters, as well, with statistics. Make sure your letters are very strong; remember that mediocre letters should not be a part of your residency package.

Writing Your Own Residency or Medical School Letter of Recommendation: Is it Ethical?

It's not infrequent that an applicant tells me that a letter of recommendation (LOR) writer has asked the candidate to draft his/her own letter because the writer is "too busy." I notice that medical school and residency applicants are a bit sheepish as they tell me about this arrangement. Have no fear: You are not doing anything unethical. (Here is an old piece by the New York Times ethicist Ariel Kaminer regarding this exact topic.)

If a faculty member asks you to write your own letter, not only should you do it, but you should do it with zeal. Make sure you showcase the accomplishments that distinguish you from other candidates and highlight traits that are important for your future career path. Use honest - but bold - adjectives to describe your best qualities.

Remember that the letter writer has final say, so even a busy faculty member might modify the letter. Keeping this fact in mind might alleviate your (unnecessary) guilt and should encourage you to write the strongest letter you can. (It's harder to go from outstanding to mediocre than from outstanding to excellent.)

Medical School Help: What are the Next Steps Once the AMCAS is Submitted?

Once your AMCAS is in, what can you do next to best prepare for what's to come in the medical school admissions process?

Here are a few tips:

1. Start to draft secondary essays. Even if you haven't yet received the prompts, you can begin to craft responses to common themes like "how would you add diversity to our school?" and "describe an extracurricular activity that might be of interest to the committee." Good writing takes time, but if you wait for the onslaught of secondary applications, you won't be able to impart your essays with your highest quality effort.

2. Get a head start on preparing for the medical school interview. Practice, practice, practice. Start mocking up answers to interview questions so that you distinguish yourself.

3. Consider what you want. Do some soul searching to determine what you are really seeking geographically, philosophically, and educationally. You want to make considered decisions when the time comes.

A Book that Will Break your Heart and Renew your Commitment to Medicine

This is a stressful time for medical school applicants and residency candidates alike. I recently wrote a piece for Student Doctor Network with five suggested books for training doctors, reads that might relax you a bit while you learn something about your future career. I want to add another recommendation: Paul Kalanithi's When Breath Becomes Air. Get ready to cry your eyes out, while appreciating beautiful prose and insightful content. Paul Kalanithi was diagnosed with metastatic lung cancer when he was a senior neurosurgery resident at Stanford. He chronicles his short life in a book that's hard to put down. 

Insider Medical Admissions Searchable Blogs

Have a specific medical school or residency admissions question? Don't want to rifle through blog entries individually?

I've been writing my blog since 2008 and have a wealth of answers to your questions - all free.  But many folks do not know what I have two platforms on which my blog is published.

The first is on my website here. The entries are all tagged, so you can pick a topic and search using that tag.

The second is on Blogger here. This one allows you to search any phrase in the right margin (about a third of the way down the page).

Either way, feel free to use the blogs to get your questions answered easily and quickly.

Ten AMCAS Mistakes You Absolutely Want to Avoid

Here's a quick and dirty list of AMCAS Work and Activities section errors to avoid at all costs:

1. Don't write to write, and don't fill to the maximum character count unless necessary. While you want to include many strong achievements, you do not want your AMCAS to be so wordy that your reader is tempted to skim.

2. While you need to be brief, don't write in phrases; use full sentences. It’s a formal application, and you want to make your written materials as readable as possible.

3. Don't assume your reader will carefully study the "header" section (including the title of the activity, hours, etc.). Make sure your descriptor could stand alone: Instead of "As an assistant, I conducted experiments..." use "As a research assistant at a Stanford Medical School neuroscience lab, I conducted experiments..."

4. Don't be vague or trite. Make sure you spell out your accomplishments clearly and substantively. If your reader doesn’t understand an activity, you will not get “full credit” for what you’ve done. Make no assumptions.

5. Avoid abbreviations. Again, you want to be formal, and abbreviations you think are common might not be familiar to the reader.

6. Write about yourself and your role – not an organization. For example, don’t use the space to discuss Doctors without Borders. Use it to discuss the specifics of your role at Doctors without Borders.

7. Avoid generalities and consider using numbers to be persuasive. Saying that the conference you organized had 300 participants says it all.

8. Don't merge the descriptors with the most meaningful paragraphs because they are separate sections: You can complete descriptors for up to 15 activities with up to 700 characters each plus up to three most meaningful paragraphs of up to 1325 characters each.

9. Unless your PI won the Nobel, avoid using supervisors' and/or doctors' names in your descriptors as they will be meaningless to the majority of your readers.

10. Get help. Do not submit your medical school application without having it reviewed. You do not want to showcase suboptimal materials for a process that is this important and competitive.

Be A Dirtbag Millionaire

For many of us, medical training means taking on significant debt and learning to manage complex personal finances. Many financial advisors "specialize" in physicians (like wolves who specialize in sheep?), and young doctors have a reputation as easy targets. 

How can you defend yourself against financial predators, kill your debt early, and learn to manage your own portfolio? (And where can you even learn what a portfolio is?) Crispy Doc offers a blog dedicated to financial literacy for the newly minted physician with an emphasis on early financial independence for doctors.  

Check out his blog, and learn from Crispy Doc's recent Student Doctor Network article. 

Brevity

I've started editing a lot of medical school essays of late, and I want to give a shout out to the importance of brevity. I focus on a work count of 700 or fewer for my advisees for a few reasons: First, I've found that that number is just the right balance of content and streamlining. Under 700 words for an admissions essay leads to a lack of substance, and more lends itself to meandering writing.

Second, your reader is likely stuck reviewing tens or even scores of applications in a short period of time. S/he is looking to spend as little time as possible on your written materials, while still getting a good flavor for your candidacy. Don't burden your reader with verbiage.

Here's a helpful trick: Imagine AMCAS or ERAS is charging you $10 per word. How would you keep costs down?

DO vs. MD

As the medical school application date looms nearer, I’ve had several pre-meds ask me about DO school. There was an excellent article in the New York Times a few years ago about what doctors of osteopathy do and how their admissions criteria are different from allopathic schools’. It’s here and worth a read.

The topic of DO schools is an enormous one. A few quick points many candidates don’t know about DOs:

1. Many doctors of osteopathy practice medicine just like allopathic doctors do. I do per diem emergency shifts at Kaiser and work with many DOs. Candidly, I usually do not know which colleagues have osteopathic degrees and which have allopathic ones unless I see a prescription blank or a signed computer note.

2. If applying to osteopathic school, candidates are generally better off with at least one (strong) letter of recommendation from a DO supervisor.

3. Osteopaths currently take the COMLEX for their board tests, instead of the USMLE. If an osteopathic medical student wants to enter an allopathic residency, s/he may need to take the USMLE in addition to the COMLEX. On the other hand, there are many allopathic residencies that accept the COMLEX. Also, there is talk that in the future (when exactly is unclear, however) there may be just one board test that both groups take.

4. The osteopathic Match occurs before the NRMP Match, a fact that can be difficult for osteopaths applying to both types of residencies. If those applicants are successful in the osteopathic Match, they cannot enter an allopathic residency. If, on the other hand, they wait and enter the NRMP Match, they run the risk of simply not matching.

Again, this topic is complicated and nuanced. If you’d like to discuss your candidacy and the DO option, contact me for a Strategy Session.

Make It Pop: Your Residency or Medical School Personal Statement

As I've written many times, the personal statement should be substantive and crafted in a persuasive essay format. Yet, the introduction is a place where you can let your hair down (to a point) and write in a narrative fashion.

It helps to start your essay with a "clincher," something that will convince the reader your statement is worth reading:

I found this short piece in an old Stanford Magazine to be worth a read. The author compiled a list of first lines from the application essays of Stanford's newest college class at the time.

Some of my favorites:

Unlike many mathematicians, I live in an irrational world; I feel that my life is defined by a certain amount of irrationalities that bloom too frequently, such as my brief foray in front of 400 people without my pants.

When I was 8 years old, I shocked my family and a local archaeologist by discovering artifacts dating back almost 3,500 years.

As an Indian-American, I am forever bound to the hyphen.

Time to Take A Reading Break

It's a stressful time of year for you, pre-meds. (Then again, maybe all times of the year are stressful for your cohort, unfortunately.) Why not take a break from crafting your personal statement, starting your AMCAS activities, gathering your letters of recommendation, studying for finals (and maybe the MCAT), and attending all of your extracurricular activities to read a book? Here's a piece I wrote that was featured last week on Student Doctor Network regarding great books to read for doctors in training.

Your Residency or Medical School Application: Maybe Leadership is Overrated

As an Assistant Residency Director at Harvard, I often heard my colleagues ask, "Will she be a leader?" or "Can we count on him to show leadership qualities?" when we discussed applicants.

 

But maybe being a leader or even an extrovert is not what we should be seeking in all applicants. Poor leaders can bully, be arrogant, and may ignore excellent advice. In academics, I saw many leaders who were not role models in their behavior or scruples.

 

Here's an interesting New York Times piece about the need for introverts and even followers in college admissions. I found the story about the young woman who tried to overhaul her personality and activities to fit the admissions mold to be particularly telling.

Residency Match!

Congratulations to so many successful Insider Medical Admissions applicants in dermatology, plastic surgery, internal medicine, psychiatry, anesthesia... and many others. You should feel good about your hard work.

 

And speaking of hard work... It's time for third year medical students (and graduated IMGs) to get started on a plan for this coming Match season. As of this writing, I have a few Strategy Sessions slots left in April. Advising discussion topics at this time of year should include creating a fourth year schedule, if/where to do away rotations, potential letter writers, crafting an outline for a personal statement, understanding how to write solid ERAS activity descriptors, reviewing an individual's prospects in a desired field - using data, and producing a timeline for the application process. Also, note that some applicants contact me to discuss their current indecision about what field to pursue, and that's fine too; those conversations should happen soon.

 

Here is a list of my residency services. Contact me for help.

Congratulations!

Many congratulations are due to those residency applicants who had a successful Match. I would really appreciate hearing from this year's clients regarding their Matches. 

On a related note, unfortunately, as of July 1, the Accreditation Council for Graduate Medical Education (ACGME) will allow first-year residents to work 24+ hours without a break. I'll come out as saying that I think this is a very poor idea.

I remember a horrible week during my internship in which I worked 138 hours (absolutely true). I still have nightmares about the experience. I also remember surgical resident friends who were "rewarded" with operating the morning after being on-call all day and night.

 

Here's an NPR piece and a Forbes piece on the topic. Extreme hours lead to danger for patients and residents and keep talented folks out of medicine.

Residency Applicants: The Big Day is Approaching

Here's a condensed version of this week's Match schedule from the NRMP website:

Today 

11 am EST: Applicants learn if they matched via email and the R3® system. SOAP-eligible unmatched and partially matched applicants have access to the List of Unfilled Programs in the R3 system.

2 pm EST: SOAP applicants can start preparing and sending applications in the AAMC ERAS® system. Applicants cannot communicate with a program until contacted by that program.

Wednesday

SOAP Round 1

12 pm EST: SOAP Applicants begin receiving offers by logging in to the R3 system. Applicants accept or reject offer(s) once all offers have been generated.

2 pm EST: SOAP Applicant deadline to accept or reject Round 1 offers in R3 system.

2:05 pm EST: List of Unfilled Programs updated in R3 system for SOAP-eligible applicants.

SOAP Round 2

3 pm EST: SOAP Applicants begin receiving offers in the R3 system.

5 pm EST: SOAP Applicant deadline to accept or reject Round 2 offers.

5:05 pm EST: List of Unfilled Programs updated in R3 system for SOAP-eligible applicants.

Thursday

SOAP Round 3 

9 am EST: Applicants begin receiving offers in the R3 system.

11 am EST: Applicant deadline to accept or reject Round 3 offers.

SOAP ends 

12 pm EST: List of Unfilled Programs accessible from R3 system and updated to include unfilled programs not participating in SOAP. All applicants who are unmatched or partially matched have access to List of Unfilled Programs. Programs not participating in SOAP can be contacted by unmatched or partially-matched applicants, including applicants who were not SOAP-eligible.

Friday - Match Day

1 pm EST: Applicants learn the location of program(s) to which they matched via email and in the R3 system.

Using SOAP to clean up the NRMP Match

I'm very hopeful that all blog readers who are residency applicants will be Matching successfully this year. But it is worth understanding how the NRMP SOAP (formerly called "the Scramble") works.

Years ago, when I was an applicant, the Scramble was all that unmatched candidates had... and it was not great. For a quick history on the Scramble's transition to SOAP, check out this article.

For details on this year's SOAP (and Match week) schedule, check out this PDF that includes great details.

Planning Your Residency Application for 2017-18

It's that time of year when some folks are awaiting their Match, while others are getting ready for the upcoming ERAS season. Here's a piece by Dr. David Presser and me, "Choosing a Specialty: The Generalist vs. the Early-Committer," originally published on the Student Doctor Network site, regarding the huge endeavor of making the first critical step in preparing your candidacy (and future career!):

Many students arrive at medical school with a bias that their liberal arts education has instilled, namely, that they should survey everything before deciding on their specialty. Before medical school, students matriculate at colleges that pride themselves on providing a diverse exposure to a variety of subjects: Computer science majors experience the canon of Great Literature before pursuing a life of code, and English majors can take “Physics for Poets.”

For a generalist student sampling from the buffet of medicine, it can be jarring to sit in lecture next to a classmate who declares on the first day of school that she intends to become an orthopedist. These early-committers appear to have whittled down their choices from day one. They magically become apprentices to a faculty member in their chosen specialty by the first quarter, have a publication by their first year, and seem to possess an intuitive roadmap for applying to residency that the generalist cannot read.

So who is right, the generalist or the early-committer? In life, as in medicine, the answer is – it depends. For clarification, let’s start to explore the problem by seeing what residency directors prioritize in their selection of candidates:

The 2014 NRMP® Program Director Survey, which amassed responses of the directors of all programs participating in the Main Residency Match, demonstrates that – in all specialties – 69% of programs cite “perceived commitment to specialty” as a factor in selecting applicants to interview. That 69% is more heavily favored than reputedly important factors like Honors in the specialty clerkship, Audition elective in the residency’s department, and even Pass USMLE Step2 CS. Furthermore, on a mean importance ranking scale from 1 (not at all important) to 5 (very important), those directors ranked perceived commitment as 4.3. The 4.3 mean importance ranking is greater than USMLE Step 1 score, Letters of recommendation in the specialty, and Honors in clinical clerkships. For certain competitive fields, demonstrating commitment is even more important. Take neurosurgery at 80%/4.6.

So, one could make the argument that making the specialty decision early is the way to go. If a generalist ends up deciding that he will only be happy in a hyper-competitive specialty like dermatology or orthopedics, and finds himself compared to early-committers with a slew of same-specialty letters of recommendation and multiple publications, it seems he is at a disadvantage.

However, being a gung-ho early-committer has its problems too, and those headaches can last a lifetime. Some of these future doctors find out too late that they have dedicated themselves to the wrong field, and that their motives for pursuing a specific specialty (my mother and grandmother were both general surgeons) were not enough to warrant life-long regret over not entering pediatrics. This issue is not a small one. While data regarding the number of residents who switch specialties is lacking, websites for off-cycle residency positions have proliferated, including forums here on Student Doctor Network. And while physician dissatisfaction is not an exact proxy for specialty-specific miscalculations, it is notable that certain specialties have much higher rates of burnout, and that the ability to control work hours (much harder in certain specialties) is increasingly found to play an important role in reducing stress, and therefore, burnout among physicians. The Medscape Physician Lifestyle Report 2015 showed that U.S. physicians suffer more burnout than other U.S. workers with 46% of American doctors surveyed reporting the problem. Critical Care and Emergency Medicine doctors have the highest burnout at 53% and 52%, respectively. Psychiatry and Dermatology have the least at 38% and 37%. If a student commits to the “wrong” field too early and sticks with it, she may make enduring mistakes in job fulfillment and a suitable lifestyle.

Moreover, anecdotally, the authors have seen many doctors switch fields. Personal acquaintances through our emergency medicine residency programs included residents who matched in orthopedics and plastic surgery, only to transfer into emergency medicine residencies several years into the game; several emergency medicine residents who switched into other fields (orthopedics, psychiatry, pediatrics); an internist who completed his training before undertaking an additional residency in emergency medicine and pursuing an academic career; and a former chief resident in emergency medicine who, after serving in the armed forces during the Iraq and Afghanistan campaigns, returned from his tour of duty and re-trained in dermatology, in part, so he could spend more time with his family.

The bottom line is that there is no right answer about whether to be a generalist or an early committer when selecting a specialty, except if a highly competitive specialty is even remotely in the cards. In that case, a medical student should position herself accordingly and early.

Ideally, one would know for sure what his perfect specialty is on arrival at medical school and pursue appropriate faculty mentors and research opportunities. But life is not that simple. How, then, should a medical student go about selecting a specialty, a choice that will affect his job satisfaction, future income, and lifestyle?

One suggestion is to start thinking about specialty choice earlier than third year. Granted, there is a lot on the to-do list the first and second years of medical school. But in the summer after first year, most students have some freedom. That summer would be a good time to do some shadowing or commit to a project to see if being in the operating room is enjoyable. Starting a research project in an appealing field (especially if it is competitive) is a good option as well. If a student has whittled potential interests down to a few specialties, erring on the side of tailoring the first summer experience to prepare for a candidacy in the one that is most competitive is wise. In other words, it’s easier for a would-be dermatologist to become a born-again internist than the other way around. But even if a medical student can simply start to decide whether a surgical or non-surgical field is more suitable for her, something will have been accomplished.

Another suggestion is to arrange meetings with multiple doctors in different practice settings in appealing fields. This tactic is best started early (first or second year), but even during third year, it’s a plan worth pursuing. A medical student should interview physicians about the worst parts of their specialties and listen carefully. Then, that student should try to find someone in a field who embodies the life she envisions for herself. If – after speaking to a good number of doctors in varied practice settings – she cannot find a role model who fits the life she hopes to lead, it may be worth avoiding that field entirely.

Finally, if it’s affordable, consider a year “off.” Schools are increasingly flexible with their curricula, allowing students to take a year to pursue research scholarships, travel grants, and other academic pursuits. Considering how little exposure medical students get to different specialties in third year, asking them to choose their field at the end of it seems demanding. Taking extra time to make a considered decision is a reasonable option.

The statistics show that program directors are seeking commitment to their fields, which is understandable, considering their goal is retaining and training residents. However, committing early can be a treacherous path. Until the medical education system changes, students are stuck between a rock (of residency application strategy) and a hard place (of potential job satisfaction). Seeking resources outside the conventional system through extracurricular exposure, research, faculty mentorship meetings, and even a year away from school can help a student make a critical life decision.

Remember: Finding the right specialty is in many ways a matter of luck – mentorship, early exposure, and fortuitous experiences. As the ancient Roman philosopher Seneca famously stated, Luck is when preparation meets opportunity. Whether generalist or early-committer, the wise students evaluates the pros and cons of each approach, deciding with eyes wide open and leveraging the opportunities that luck provides.

NRMP Rank Order List Deadline Fast Approaching

Residency applicants, please note that the NRMP rank order list deadline is this Wednesday, February 22. Rank order lists must be certified by 9 am EST. After that, you can sit back and relax because there is little to do except wait.

Geography is Giant

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. As I've said in a recent blog entry (and others in the past), 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.

After Your Residency or Medical School Interview: What's the Value of the 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 that 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.