How the Show ER and New Residency Programs Change the Economy of a Specialty

Here's an interesting piece called "Are There Too Many Emergency Physicians?" by Thomas Cook MD, an emergency medicine program director. Dr. Cook chronicles the growth of emergency medicine residency positions from a total of 1821 in 2015 to 2488 in 2019. This rapid growth in the field may lead to an oversupply of emergency physicians.

The paradox here is that only recently there was a shortage of emergency physicians. And back when I graduated from medical school in the mid-1990s, almost no one was applying for emergency medicine. In my class of around 150 students, there were three of us. As the popularity of the show "ER" waxed, the number of applicants to the field swelled. Then, years later, the field contracted again. 

Other fields have also recently seen a boom in the number of residency spots, including family medicine, psychiatry, and anesthesiology. Of course, opening up more residency positions is a good thing for medical students (especially international medical graduates) and patients, but the growth in certain fields may lead to a change in the economy of those specialties. It will be an interesting experiment.

Mom and Dad May Think You Have Good People Skills, But That's Not Enough When It Comes to Interviews

Every year I am hired by re-applicants for medical school and residency who tell me that the year before they received multiple interview invitations, thought they performed well on interview day, but then were left with no offers in the spring. 

This is the truth: Interviews are hard. You need to strategically respond to criticisms of your candidacy, showcase the strengths of your application, be prepared for awkward or even - sometimes - illegal questions, all while seeming fresh and enthusiastic.

There are applicants who spend months studying for their MCAT or Boards, but don't spend even an hour practicing for their interviews. It's a naive disconnect. 

If you can mock interview with someone who has been on a medical school admissions committee for years or a faculty member who has strong experience with residency applications, go for it. If not, check out my mock interview services here. Don't rely on a friend or family member with no experience.

Here is a funny, less-than-one-minute, stop-motion video to guide you on this topic. 

The Week I Spent 138 Hours in the Hospital

During my internship, on my surgical rotation, I once spent 138 hours in the hospital in one week. If you think this isn't mathematically possible, I will tell you that I was on call from Monday morning to Tuesday evening, from Wednesday morning to Thursday evening, in-house on Friday, and then on call from Saturday morning until the next Monday morning. (I had to stay in-house that Monday until evening rounds were over too.) As you can imagine, I was barely human by the end. How this schedule was good for patient care is beyond me.

I thought of that ghastly time recently when reading this article in the New York Times called "How Job Stress Can Age Us" written by Dr. Dhruv Khullar. The author reports on a study, "Physician-Training Stress and Accelerated Cellular Aging" that assessed the DNA of 250 first-year medical residents around the country. Researchers examined the saliva samples of these residents, focusing on their telomeres - the bumpers at chromosome ends that prevent DNA damage - before and after the first year of residency. Researchers found that the DNA of first-year residents aged six times faster than normal. 

Six times faster.

I found this both shocking, upsetting, and validating. Residency training is as hard as we think it is. 

What I would strongly recommend is that you compare residency programs' hours before you create your Match list. Strangely, many applicants don't even consider this important issue when making decisions about their next three to five years. Also, many residencies support physician wellness programs and night coverage. Especially in the setting of severe burnout among doctors, your happiness should be a primary factor in your career choices. If you're not sure, consider your shrinking telomeres. 

Managing Difficult Medical School Interview Questions: Rehearse Your Elevator Pitch Now

An important key to preparing for tough medical school interview questions is realizing that a) interviewing is a skill and b) practice improves performance. Every year too many medical school (and residency, fellowship, and dental school) candidates expend tremendous energy assembling fantastic applications, only to undermine their chances by approaching the interview with twisted laws of entropy and enthalpy: They prepare for it with maximum randomness and minimum energy.

Once you’ve done adequate groundwork, the medical school interview represents your opportunity to distinguish yourself and impress your interviewers as the type of candidate they’d love to have at their institution.

That’s not to say every interview will be full of hugs and puppy kisses. Like the story of the interviewer whose window was nailed shut, there may be uncomfortable moments and even illegal questions. With a bit of preparation, you can learn to hit these curveball questions out of the park. Let’s explore an example that has come up in the not-so-distant past.

Rehearse Your Elevator Pitch

While most interviewers take the time to read your application materials in advance, don’t be offended by the faculty member who did not prepare, is blankly flipping through your application right there in front of you, and who asks open-ended (and dreaded) medical school interview questions, such as “Tell me about yourself” to be brought up to speed. View it this way: These faculty members are offering you the opportunity to define how you’d like to be remembered.

Your goal should be twofold: 1) to persuade them how much you’d add to their institution and 2) to make their job easier by giving them the bullet points they’ll need to persuade their peers about your candidacy’s worthiness. When your interviewer sits around a table advocating on your behalf, steer her to use terms that will be germane to your candidacy. Are you the, “global health advocate who volunteered with Mother Teresa and ran his school’s homeless food program?” Or perhaps you are the “first generation college graduate who held premier leadership positions in medical school?” Help your interviewer help you.

In the end, difficult interview questions are less intimidating if you both prepare well and have an attitude that they are an opportunity to clarify and further your candidacy. For help, secure your Mock Interview slot with me. I'm booking a few weeks in advance, so sooner is better than later.