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.

“Unhappy is He Who Depends on Success to be Happy" - Alex Dias Ribeiro, Former Formula 1 Race Car Driver

Age-related professional decline is the last thing many doctors want to think about. Those who have just finish years of arduous training can't imagine that they have only 15 years until they will deteriorate (statistically true), and those of us in middle age don't want to think about our impending, cognitive retreat from medicine. And yet, this fantastic piece in the Atlantic "Your Professional Decline is Coming (Much) Sooner than You Think" by Arthur C. Brooks is a fascinating, well written article about happiness, gifted and accomplished people, and personal relevance with multiple interesting celebrity examples. Brooks also proposes some quasi-solutions (or at least some work-arounds). I strongly recommend this compelling piece for physicians of all ages and stages.

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!

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. 

The Difference between Lazing Around and Laissez-faire

When I was in medical school, I was talking to a friend who was an avid fiction reader. I, too, love to read, but I remember feeling like I couldn't find the time. I told him that I didn't think I could get through medical school successfully if I were reading regularly. I remember he told me kindly, "I don't think I can get through medical school successfully if I'm not reading regularly." 

That comment really sunk in, and I think of it often when I'm focusing on conventional productivity. There's a great, recent New York Times opinion piece by Bonnie Tsui that reflects this idea: We need to relax and have fun in order to be creative and successful (although she points out that fallow time should not be seen as just another life hack; there is great importance in recreation apart from its ability to boost our productivity). Take a peek at her piece here. It's especially important for those entering the demanding career of medicine. 

Brevity is the Soul of Wit -William Shakespeare

I've been editing a lot of medical school, residency, and fellowship essays over the last few months, and I want to give a shout out to the importance of brevity. I focus on a word count of 750 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: Over 750 words for an admissions essay 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.

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

Looking for Podcasts to Spruce up Your Summer Workout?

I'm a jump roper and stair climber, so podcasts are an excellent way for me to keep my mind occupied while I exercise. (I also swim but listening to a podcast underwater is hairy.) Check out my guest spots on the White Coat Investor Podcast, the FeminEm Podcast, and the Hippocratic Hustle Podcast. You can also download them directly from your favorite podcast app.

Other podcast favorites of mine are Serial (especially season 1), S-Town (genius), In the Dark (first season), Wait Wait...Don't Tell Me, and Slow Burn (second season).

 

Enjoy!

The Ins and Outs of Choosing a Specialty: The Generalist vs. The Early Committer

For many third-year medical students, this is a tough time of year. Preparing an ERAS application can be daunting, but it's even worse if you do not know what specialty you want to practice. Here's a short piece I wrote with my colleague David Presser MD MPH called "Choosing a Specialty: The Generalist vs. The Early Committer." And recently, I read a complementary, but non-medical, New York Times article called "You Don't Want a Child Prodigy" that seems like a good follow up to our piece. 

Urgent, Urgent, Urgent, Emergency?

The AMCAS open-for-submission date came and went, and the question I'm getting now is: Should I panic if I haven't yet submitted my AMCAS?

The answer is no - and depending on where you are in the process - yes. Submitting on Day 1 precisely is not worth losing your mind over, so if you didn't do so, please don't kick yourself. On the other hand, submitting very soon is to your advantage because of rolling admissions.

So, if you are wrapping up your work and have your written materials in a superior state, just keep moving and get your application submitted promptly. If you are behind the eight ball and don't feel that you can craft outstanding written materials speedily, consider waiting a year to apply. Every season I encounter re-applicants who, during the previous application cycle, submitted their AMCASes in August or September...thus making them re-applicants :(. 

So... on your mark. Get set. Go!

AMCAS Tips (and Particulars): How to Best Draft Your Work/Activity Experience Description Section

I've had a few clients recently who were confused about the AMCAS Work/Activity Experience Description character limits and how the Most Meaningful Experiences fit in. 

Please remember that AMCAS Experience Descriptions can have up to 700 characters (not words!), while the Most Meaningful Experiences max out at 1325 characters. (Note, then, that the Most Meaningful Experiences are separate from the Experience Descriptions.) 

Here's a short blog with AMCAS Work/Activity Experience Description writing tips and another with Most Meaningful Experiences guidance. Good luck!

How to Use the MSAR to Your Advantage

The Medical School Admission Requirements (MSAR) is an online database that allows users to search, sort and compare information about U.S. and Canadian medical schools. (I hate to date myself, but when I was applying to medical school and used the MSAR, it was a hard copy book.) The 2019 MSAR came out last month, and if you are applying to medical school, I'd recommend purchasing it ($28) because it provides so much information about schools and their admissions statistics. The MSAR allows you sort and compare schools by median MCAT scores, AMCAS GPAs, and other criteria. 

You should use the MSAR to help determine which schools are in your range and which are "reach" schools. While it's fine to have a lot of "reach" schools (if you can afford it), it's critical to ensure you are applying wisely to schools that match your numbers. The advantage of the MSAR is that you can make evidence-based decisions. I've found some applicants have eye-opening experiences when they thoroughly review schools' statistics and either realize that their numbers are low and that they should apply accordingly or, happily, that they have numbers that match with top schools. Either way, reviewing the data is critical to good decision making. 

Locum Tenens: A Nontraditional Path in Medicine

For those pre-meds, medical students, and residents interested in creative ways doctors practice medicine, here is a helpful review of a course on obtaining, maintaining, and effectively juggling locum tenens. For those unfamiliar, a medical locum tenens job allows a doctor to temporarily fill an empty slot (e.g. for someone who is on maternity leave). Locum tenens is an opportunity to do some traveling and make some income, but there are some complications you'll want to avoid. Take a peek at the article. 

TMDSAS: The Old and The New

For those applying to medical school through the Texas Medical and Dental Schools Application Service (TMDSAS), please note that your process is a little different from the AMCAS system: The TMDSAS allows for more expository writing, including the medical personal statement, the personal characteristics essay, and the optional essay. This year, too, the TMDSAS has added on a meaningful activities section, which can include up to three accomplishments, with a 500 character limit each.

The TMDSAS has a different timeline from AMCAS as well. Check it out here. For TMDSAS official application instructions, click this link.  

Yes, I do edit the TMDSAS! Contact me for help. 

Is Your Personal Statement a Little Too Personal?

As medical school applicants are crafting their essays and residency candidates are starting to think about theirs, I'm posting a short piece by a guest blogger today: Dr. David Presser graduated from UCSF Medical School, completed his emergency medicine residency at UCLA/Olive View and his MPH at Harvard. He wrote an excellent primer on getting into an emergency medicine residency. Here's today's blog written by him:

Picture, if you will, a residency admissions committee member beneath a halo of light reading applicant essays in her office at midnight. Caffeine on her breath, crumpled white coat next to her desk chair, she is making steady progress on the never-ending stack of applicant files until she picks up a residency personal statement that begins, “I first became interested in internal medicine when Grandma was diagnosed with cancer…” Pulling out her hair by the fistful, she tosses the file into the trash. That cancer may not have killed your grandma, but it just might have killed your application.

Many students devote a significant portion of their ERAS essays to describing a universal experience that may have piqued their initial interest in a specialty. A residency admissions committee member does look for evidence of how your fundamental connection to humanity will make you an empathetic and skilled physician. The problem comes when an applicant starts to make the reader feel like s/he is providing counseling to the applicant, that is, when the candidate uses language that could strike the wrong reader as inappropriate for a professional application. The admissions committee can handle empathetic writing; however, if they suspect you mistook your essay for the journal under your pillow, they may not be forgiving.

Think carefully about the topics you choose. With all due respect to each of us who has had a family medical catastrophe, you can estimate the prevalence of cancer among the elderly and conclude that starting an essay with the description of a grandparent’s battle with cancer is not going to catch the reader’s attention. Unfortunately, just because it is genuine, it may not be compelling reading or a useful means to distinguish you from the hundreds of residency applicants whose essays share similar themes.

There are exceptions. You can be forgiven for including a common topic if it directly ties into highlighting a unique personal accomplishment. Perhaps grandpa’s prostate cancer diagnosis led you to seek out a research position with a faculty member at your local university lab where you were directly involved in sequencing a promising new molecular marker for prostate cancer. Give the generic topic a brief mention and transition rapidly into how it demonstrated that you are a mover and shaker who took a universal experience and, by virtue of your work ethic and intellectual curiosity, turned it into a contribution to science.

You get a pass on writing about universal experiences if you can pull off a convincing reason to keep the midnight reader going; otherwise, keep your essay distinctive and befitting the professional you hope to become.

Make It Pop: Your Residency or Medical School Personal Statement

Many of you already know that I feel very strongly that 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 a short piece in an old Stanford Magazine to be an interesting reminder of what a dedicated writer can do with a personal statement intro. 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.

Note that these introductions catch the reader's attention, while also saying something about the writer's qualities and/or sense of self. For help with your personal statement, contact me. 

International Medical Graduate (IMG) 2019 Match Statistics Are Out

The ECFMG® recently published 2019 Match statistics for International Medical Graduates (IMGs). In the 2019 Match, only 59.0% of U.S. citizen IMG participants were matched to first-year positions. Of those IMG participants who were not U.S. citizens, only 58.6% obtained first-year positions (Source: ECFMG®) While the percentage of IMGs matching was slightly better than last year, IMGs still face large challenges in the residency application process despite the US physician shortage.

Start Your Engines...

The medical school cycle is revving up, and it's (past) time to get started on your application. Here's an article I wrote for Student Doctor Network called "Ten Ways to Improve your Medical School Application." The piece includes statistical truths, strategies for optimizing your approach, and philosophical guidance. 

Worth a Look: Medscape Female Physician Compensation Report 2018

Medscape's annual Female Physician Compensation Report is out, and it's thought-provoking on many levels. Among the findings from the 7600 female respondents:

The discrepancy in pay between the highest paid female physicians and the lowest is no small thing. Female plastic surgeons make $518K per year compared to Public Health and Preventive Medicine docs who make $180K. 

Also, to my surprise, 50% of plastic surgeons are now female. (Only 8% of orthopedists are.) My field of emergency medicine is low at 21%. 

Male primary care doctors make more than women in the same fields. Male specialists also earn more than their female counterparts. The disparity extends to several racial and ethnic groups as well. 

What I also found very interesting is that to answer the question "What is the Most Rewarding Part of Your Job?" more women than men felt knowing they are making the world a better place was most rewarding (27% versus 20%), and more men than women said that being very good at what they do was most rewarding (26% versus 21%).

There's more! Check it all out here. 

As Featured on WCI...

Looking for a podcast for your daily drive or work out? Check out the White Coat Investor (WCI) podcast, where I was recently interviewed. For those of you who aren't familiar with WCI, it's a website/blog/podcast founded by James Dahle MD, an emergency physician whose interest in personal finance and the FIRE (financial independence - retire early) movement has sparked a slew of physician devotees. My interview focused on how Insider Medical Admissions helped me create autonomy and flexibility while balancing a clinical career and a family. Check it out here or on your favorite podcast app. 

Why did ERAS crash during SOAP?

Congrats to all of those who Matched last week! And kudos for those of you who managed to make it through this year's difficult SOAP.

During SOAP (Supplemental Offer and Acceptance Program) last week, the server crashed, leaving many applicants and programs confused and scrambling (no pun intended). The 2019 Match Week and SOAP schedule was, therefore, revised such that all SOAP offer rounds were postponed and limited to Thursday, March 14.

At the time of this writing, it's unclear what happened. Rumors are that the volume of participants was greater than in past years, leaving ERAS/AAMC unprepared. This might be the case with the opening of many new medical schools and a continued, relative dearth in the number of residency spots available. Read this article for a controversial - but interesting - take on why. 

We'll probably have to wait for this year's Match numbers for any answers.

Race to the Bottom (In a Good Way)

Thanks to NYU's announcement that it will be eliminating tuition at its medical school, other institutions are reassessing their costs and graduates' educational debt, as some experts predicted. Recently, Kaiser followed suit with a free tuition plan for their new medical school in Pasadena. Now, Yale is making overtures as well, lowering the financial burden for needy students by covering more costs with scholarships, instead of loans. Keep your eye out for what will likely be a revolution as more and more medical schools note that to compete for strong applicants, they must offer robust financial support. 

Fee Assistance Program

As the 2019-20 medical school application process ramps up, I want to remind candidates about the Association of American Medical Colleges' (AAMC) Fee Assistance Program (FAP) and Insider Medical Admissions' available discount for those with a current FAP. The FAP is designed to offer help to individuals with financial limitations who cannot pay the MCAT registration or AMCAS application fees without financial support. 

If you think you are eligible, it's worth applying for an FAP grant early: If an applicant submits his/her AMCAS prior to receiving a decision on his/her FAP application, that candidate will be ineligible to receive the FAP for the AMCAS. In other words, the candidate will not receive a refund.

For more information on the FAP, please click here. I offer reduced rates for applicants demonstrating financial hardship through a current AAMC FAP grant. After researching the issue, I believe Insider is the only medical consulting company who currently supports a discount for FAP grant recipients. (I apologize if I'm missing a company.) Once you have been granted the FAP and thus, can prove receipt, please feel free to contact me for more information.

Med Schools Have No Patience for No Patients

For those undergraduates who are starting to think about their medical school applications, I will tell you a secret: One of the biggest weaknesses I advise candidates on is their lack of clinical experience. I've seen students with outstanding MCAT scores who did not get into medical school on their first try. They had little or no patient experience.

So, ensure your application has robust clinical activities. Some suggestions:

Scribe
Clinical Care Extender
EMT
Low Income Clinic Volunteer
Hospice Volunteer
Veterinarian's Assistant (a great way to get hands-on procedural experience)
Phlebotomist

If you are not excited about getting clinical experience, it is time to question your interest in a career in medicine... which is exactly what admissions committees will do if they don't see that experience :).

Take a look below at my Guru on the Go© Video about this topic.

Flaunting our Failures?

The New York Times had a recent, thought-provoking article for perfectionists, overachievers, those with impostor syndrome, and any combination of the above. "Do you Keep a Failure Resume?" is a great reminder that chronicling our failures (something that isn't encouraged in medicine) can help us determine what the operational roadblocks were to our successes so that we avoid those obstacles in the future. (Perhaps the issue was lack of preparation or speeding through a project unnecessarily.) Reviewed in retrospect, an "anti-portfolio" is also a good reminder that a failure is sometimes the first step to a success in another realm.

Doctors are Crispy

The annual Medscape Burnout Survey is out and the news this year is  - again - somber. More than 15,000 physicians were surveyed in 29 specialties, and 44% of the respondents reported feeling burned out. Urologists made a jump up to the number one burnout specialty with a rate of 54% - with neurologists close behind at 53%. My field of emergency medicine was at 48%, compared to 45% last year. (Click here to see the 2018 Medscape Burnout Survey.) Women are more burned out than men at 50% versus 39%. 

For the brave of heart, take a look at all of the 2019 results here.