Great Podcast Episode for the New Year

I've blogged before about Four Thousand Weeks: Time Management for Mortals by Oliver Burkeman. This wonderful nonfiction book is targeted at those of you who – like me – are productivity geeks. However, unlike other time management authors, Burkeman recommends you surrender to the fact that you cannot get everything done and that traditional time management strategies, which are supposed to help you multitask, will fail and cause anxiety. He recommends recognizing that our lives are finite and that we make choices about our time accordingly.

Burkeman was recently interviewed by Ezra Klein, and I strongly recommend listening to their conversation, especially now, at the beginning of the new year. I found it extremely affecting.

With regard to the book's title, four thousand weeks is how much time the average human has on this earth.

Letters of Interest: No One Wants to be your Second Choice for the Prom

Imagine you're back in high school, planning to ask a fellow classmate to the prom. You approach your potential date, "Would you be interested in going with me to the dance? You're one of my top three choices."

Not very compelling...The same is true for letters of interest or, really, any outreach to medical schools or residency programs: Over the years, I've edited many letters in which applicants mention that an institution is "one of my top" picks.

Avoid that type of language. Instead you can say something like "I would be thrilled to be at your institution," or "I am confident I can make a positive contribution." In other words, you can stay honest while not shooting yourself in the foot.

p.s. I'm a huge Flight of the Conchords fan. See this song for reinforcement.

Let me know if you need assistance with a letter of interest.

Is Making Medical School Tuition-Free Doing What it's Supposed to?

Six years ago, when Kenneth and Elaine Langone generously donated $100 million so that students could attend NYU Medical School tuition-free, the philanthropists' main goal was to encourage more graduating doctors to enter primary care fields. 

Fast forward: In 2024, the number of NYU graduating medical students who went into primary care was about the same as it was in 2017. Furthermore, in the interim, the number of African-American students has declined – although the number of Latinos grew slightly. Additionally, at least in the first two years of the experiment, the percentage of incoming matriculants categorized as "financially disadvantaged" fell from 12% to 3%. 

One thing that has improved is NYU's rankings and reputation.

All of this begs the question: Is making medical school tuition-free the most effective way to increase the number of primary care practitioners and improve equity?

See this clearly-written Atlantic article by Rose Horowitch for a deeper dive into the query. She was also recently interviewed by Kai Ryssdal on NPR's Marketplace. 

Some Medical Institutions are Offering their Trainees Coaching

I was just reading an interesting piece by the AAMC's Stacy Weiner on coaching for medical students and residents. The idea is that – beyond advising – students can benefit from the attention of skilled listeners to help them develop individualized plans to achieve short- and long-term goals. 

In the article, Dr. Dana Dunne, the director of coaching at Yale School of Medicine explains, “A coach mostly asks you questions. ‘How do you know when you’re doing well?’ ‘What does success look like for you?’ ‘What has helped you make decisions in the past?’" The AAMC article also highlights Colorado University's Better Together program. The Better Together website addresses assistance with issues like imposter syndrome, time management, perfectionism, and burnout.

What a great opportunity! All things being equal, choosing an institution that has accessible coaching makes sense when you're considering which medical school or residency to attend.

Two Hundred New Residency Slots Open

For a long time there has existed a bottleneck in the physician training system with more medical students graduating than residency spots available. This phenomenon has been one of the contributors to the physician shortage in the United States. 

In an effort to begin to relieve the problem, in 2021 Congress passed the Consolidated Appropriations Act Section 126 to expand the number of Medicare-supported residency slots. 

Last month the Centers for Medicare and Medicaid Services announced a list of hospitals that were awarded 200 new residency positions under the Act. About seven in 10 of the positions are going to primary care and psychiatry training programs. 

You can read an American Association of Medical Colleges (AAMC) news article about the new slots here. 

Introducing NRMP's Rank Order List Lock Pilot

In October I wrote a blog entry about the benefits of virtual interviews. One issue that has come up is the concern that those who choose to do in-person interviews may have an advantage compared to candidates who interview virtually. The NRMP has noted this worry and is, consequently, instituting a voluntary Program Rank Order List Lock pilot for internal medicine, pediatrics, and vascular surgery for the 2026 Main Residency Match cycle.

The idea is that programs can choose to finalize their certified Rank Order Lists and then provide time for interviewed applicants to come in-person, thus reassuring candidates that visiting or not visiting will not affect their candidacies.

Here is a statement from NRMP regarding the voluntary pilot. It's an interesting idea, and I'm curious to see how it will play out.

Sleep As a Vital Sign

“Without enough sleep, we all become tall two-year-olds.” — JoJo Jensen, Dirt Farmer Wisdom

As a resident, I spent one horrible week on my surgical rotation clocking 138 hours in the hospital...and I slept only 6 1/2 of those. By the end of the week, I had decided to quit residency. Fortunately, a good night's sleep helped me turn that decision around.

I recently heard an interesting AMA Journal of Ethics podcast called "Sleep as a Vital Sign" with Dr. Lauren Hale from Stony Brook University. In her interview, she clarifies the distinction between sleep medicine and the study of sleep as a public health issue, the latter of which is her academic interest. She offers policy recommendations to decrease morbidity and mortality from sleep deprivation, like eliminating daylight savings time and making school start times later. She also touches on how the lack of sleep adversely affects medical professionals. 

The podcast episode is brief and interesting. Plus, you can get CME credit for listening :-).

Mistake or Needed Break: Should You Take a Gap Year?

Recently, I've advised several premeds who are trying to make decisions about the utility of a "gap year" – an elective, non-curricular period between college and medical school. There are important professional, financial, and personal consequences to consider before making the decision. Here's a piece I wrote for Wolters Kluwer that offers guidance. 

Love Letters and Janet Jackson

Letters of interest (LOI) - or what some applicants jokingly call "love letters" - can be used in several types of situations:

1. Residency and medical school applicants who want to make an impression post-interview before decisions are made about their candidacies.
2. Medical school and residency applicants who have not yet been invited to interview. (Please do your research because a few schools forbid post-AMCAS/pre-interview contact.)
3. Medical school applicants who have been waitlisted.

When writing your letters of interest, you should have the following goals:

1. Restating your strong enthusiasm for the institution.
2. Positioning yourself as a distinctive candidate who can contribute fully to the institution.

Errors to avoid in LOIs are:

1. Don't include generic content about a specific institution's advantages. There is no reason to spend a paragraph or more telling a PD or medical school admissions member what makes his/her institution special. ("Your faculty is strong and your trainees are collegial" or "You are a world-renowned institution.") Using your precious space this way is an opportunity cost, keeping you from fully showcasing what makes you a compelling applicant. Having said that, it is very reasonable to link a particular interest of yours with a specific opportunity at an institution. For example if you have done cancer research, make sure to mention how you will contribute to the renowned oncology program the institution is associated with.
2. Don't write about how the program or school will help you. ("I know your residency will make me into a great doctor.") The focus should, instead, be on how you will be a contributor to their institution. For example, you can detail how a specific leadership experience of yours has given you the skills to make you a future leader at this institution. (It's the "What have you done for me lately?" Janet Jackson principle.)

Finally, let me say that I find the term "letter of interest" to be better than "letter of intent" because, generally, I don't recommend you let institutions know what your intent is (since it might change). Note that with a letter of interest you can create one general letter that you modify and send to different institutions with different goals (i.e. requesting an interview or demonstrating your interest post-interview). You can also modify the letter and send it to your top choices because, if you are not making commitments, then you can honestly use it for multiple institutions. 

For those of you interested in LOI assistance for medical school or residency applicants, please contact me.

A Great Opportunity for College Students Interested in Medicine

Applications for the Summer Healthcare Professionals Education Program (SHPEP), a Robert Wood Johnson funded opportunity for college students interested in healthcare professions, are open. SHPEP specifically targets students from economically or educationally disadvantaged backgrounds and those with demonstrated interest in issues affecting underserved populations. The goal is to help college freshmen, sophomores, and juniors apply and matriculate successfully to health professions schools. SHPEP is housed at 11 universities across the country with different start dates – but all over the summer. Housing, meals, stipend, and travel expenses are all paid.

Take a look at the program in more detail here. The application deadline is February 5.