Highly Recommended Paid Summer Opportunity

I was an American Association for the Advancement of Science (AAAS) Mass Media Science Fellow in 1995 (during medical school). The program was truly fantastic and life-altering.

Applications for this year's AAAS Mass Media Science and Engineering Fellowship just opened on October 1 and will remain available through January 2, 2023. The scholarship is a 10-week summer program that places science, engineering, and math undergraduate and graduate students at media organizations across the nation - outlets like NPR, the Los Angeles Times, and WIRED. I worked at the Oregonian in Portland and had a tremendous time, learning how to write effectively and edit. I also gained an appreciation for the amazing public health influence journalists can have. It's really an amazing program. 

Finding - and Redefining - Balance: It's Not about Better Multitasking

This time of year, when residency and medical school interview processes are revving up, many of us feel overwhelmed. Here's a brief but thoughtful piece I've saved over the years; it's about balance. As you consider your future career choices, it's worth thinking about issues the author covers like clarifying what brings you joy, considering your goals while understanding they will change, and defining balance for yourself.

In this day and age, one can choose a traditionally tough specialty but work in a practice setting that allows for some autonomy and flexibility. But you need to know what you want, and you need to give yourself the room to explore those goals in order to guide yourself in the right direction.

How to Turn Bad Advice on its Head

As you get to know different institutions during this interview season, I encourage you to take the opportunity to reflect and consider what will make you happy in the upcoming years.

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

1. Medical training is time-consuming, and you want to be in a city you can enjoy fully when you have a few moments to blow off steam.
2. Medical training is 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. 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. Consider these options - and your happiness - as you make professional decisions this interview season and in the coming year. 

Residency and Medical School Interview Questions: How to Answer that Icky Decade One

"Where do you see yourself in 10 years?" the interviewer asks you, and you squirm...

A physician-administrator once complained to me that whenever he asked potential new faculty hires where they saw themselves in a decade they always said they were interested in global health or teaching. "Most of them have nothing in their CVs to support their interest in international work or education," he remarked. "They just say it because it's sexy."

When asked where you see yourself in ten years, consider how you might demonstrate a clear trajectory. Throwing out activities just because they sound appealing doesn't make you look professional or your candidacy seem well-synthesized. The idea is to have a path you can back up, defend, and easily justify. This doesn't mean you're stuck with what you've done even if you didn't like it. You could point out that having tried myocardial bench research, you realize that your real interest is in clinical investigations of new cardiac markers.

Many medical school applicants say they don't know what field they want to go into. Of course not! And many residency applicants don't know if they want to do a fellowship. That's okay. Again, the point is to focus on your previous strengths and achievements and leverage them.

Contact me for help with tough interview questions. (If you're planning to seek mock interview help from me, please do it now. I'm booking several weeks in advance.)

We Need to Decrease the Stress and Inefficiencies Associated with the Residency Application Process

Inefficiencies in the residency application system have been a problem for many years. While the AAMC and NRMP have made efforts to improve the process, including the move from the Scramble to SOAP a few years back, the lack of adequate slots for a large number of candidates leads to a tremendous amount of unnecessary stress and waste. With the introduction of virtual interviews, hoarding became a new problem.

To their credit, the AAMC is considering some reforms to the system. Allowing applicants to identify favored residency programs, called "preference signaling" through the supplemental ERAS, for example, has improved candidates' abilities to get interviews at chosen programs. Additionally, some specialties – with AAMC's support – have implemented a common interview invitation release date and a minimum response time for invitees. In the latter case, for example, most surgery programs provide candidates a minimum of 48 hours to accept or reject an invitation, such that applicants don't need to sleep with one eye open, jumping to respond to an invitation to avoid the wait list. There has even been a consideration of capping the number of interviews each applicant can have to avoid interview hoarding.

I recommend reading this piece on proposed reforms to the system. Having gone through the stressful process myself, I wholly support strategies that would increase transparency and decrease unnecessary anxiety. 

Medical and Dental School Interviews: Preparing for your MMI

While the majority of medical school interviews are traditional, some institutions (including dental schools) are using the MMI platform. The MMI (multiple mini interview) is a format that uses several timed stations (yes, even virtually) to assess applicants' interpersonal skills and judgment.

A few things to note about MMI interview questions:

1) They are not always medically-related. You may be asked to manage an everyday problem (e.g. a disagreement at the supermarket).

2) They are not always situational. You need to be prepared for conventional questions too (e.g. what are your three greatest strengths?).

3) Schools are trying to assess whether you can skillfully employ important techniques and demonstrate professionalism. Underlying topics might include your ability to offer effective counseling, your understanding of patient-doctor confidentiality, your ability to diffuse a heated situation, or your capacity to admit wrongdoing, etc.

4) Make sure you know what structure the school is using and employ the right mindset: Working with an actor is different from executing a group project, which is, in turn, different from answering questions about your opinions. 

5) Practice MMI questions before you "go" to your interview. Even if you have excellent social skills, there are techniques you should hone to expertly manage the challenging MMI format. Contact me for help. 

How Do I Strategically Apply in Two Fields?

Occasionally I help residency applicants who are applying in two specialties. This tactic can be strategic in specific scenarios, but it also makes the process more complicated. Here are some quick clarifications to help:

1) Different personal statements can be assigned to different programs. This means you can assign your ob/gyn essay to ob/gyn programs and your internal medicine essay to internal medicine residencies. Of course, in this case, you need to have two versions of your statement in the first place, and you need to ensure you assign correctly. 

2) Different letters of recommendation can be assigned to different residency programs as well. (A maximum of four letters may be assigned to each program.) You'll either need to have letter writers for different fields, letter writers who will craft two types of letters, generic letters (less compelling), or a mix of these approaches.

3) You will have only one MyEras application. It will go to all of your programs. Note that if you list your membership in multiple ob/gyn organizations, for example, that will be viewed by your internal medicine readers as well - and might make them question your commitment to IM.

Contact me for help.

Five ERAS Platform Quirks to Heed

On September 7th, ERAS will open for submission, so it's time to get moving on your written materials. Let's briefly cover five quirks of the ERAS platform to help you get through the drafting process. The ERAS platform...

1. Does not support italics. While journal articles and some phrases (e.g. "summa cum laude") should be italicized, don't be surprised when you can't.
2. Prompts you for a supervisor for each activity. In some cases, you simply may not have one, but whenever you can, name someone. A name validates the experience.
3. Prompts you for average hours per week for each activity. It can be difficult to calculate this number for certain experiences, especially those that are intermittent, but it's worth making your best estimate rather than leaving the question blank.
4. Offers space to include a "reason for leaving" for each activity. Don't skip this section, but keep your answers brief.
5. Limits you to 1020 characters for experiences, 510 for the interruption in the medical training section, and 510 for each of the awards sections. Be aware of these limits as you write, so you are not furiously cutting later.  

For tips on how to craft your ERAS, check out these 15 ERAS tips.

Contact me for help with this weird, wild process.

Don't Let Other People Freak You Out

I started Insider Medical Admissions over 15 years ago, so I'm pretty good at spotting trends. Every year about now I start getting emails from premed clients saying they're worried about their lack of (or minimal number of) interview invitations. Yes, even as early as late August folks are concerned. They say they have a classmate who says he's gotten multiple interview invitations or they read online that others are being contacted with many invites.

Sure, it's possible some people are getting tons of 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!).

The NRMP is Considering a Two-phase Residency Match

Recently the NRMP requested public comment on the concept of a two-phase residency Match. In part, the plan would mitigate weaknesses in the Supplemental Offer and Acceptance Program (SOAP), which provides the opportunity of unfilled positions to eligible unmatched residency candidates. SOAP replaced the Scramble, an inferior system from years ago. SOAP still has its weaknesses, however, including an expedited timeline for decision-making by candidates and programs.

See a full description of the proposed two-phase residency Match here. Of note, the first Match Day, which would be analogous to the current Match Day, would occur a month earlier in February. Accordingly, interview season would be shorter. 

The plan has many benefits, but it would require some adjustments in candidates' and residency directors' calendars and thinking.

Managing Difficult Interview Questions: Rehearse Your Elevator Pitch Now

An important key to preparing for tough medical school, residency, dental school, and fellowship interviews is realizing that a) interviewing is a skill and b) practice improves performance. Every year too many 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 interview represents an 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 faculty member whose window was nailed shut, there may be uncomfortable moments and even illegal questions (although I suspect the latter are rarer with virtual interviews). 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 questions, such as “Tell me about yourself” to be brought up to speed. (A now-attending I helped prepare for residency interviews several years ago recently told me that the best advice I gave him was not to be shocked when interviewers were completely ignorant when it came to his candidacy.) 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.

Charting Outcomes in the Match 2022 is Out

The NRMP recently published their Charting Outcomes information for 2022; data I keep bookmarked and which I would recommend applicants review. The reports (for MDs and DOs) separate results into specialties and include extremely helpful information, including what mean board scores, number of contiguous ranks, and number of research experiences were for those who successfully matched - and those who did not.

It's important to make sure you are in the range for your intended field and to compare the competitiveness of different specialties if you are seeking to apply in two fields.

Here is the MD report and the DO one.

Winning Strategies for Medical School Interviews

I've heard from several medical school applicant clients who've already been invited to interviews - in July! Congrats. If you're seeking my help with interview prep, please hire me at your earliest convenience; I'm scheduling 2 or 3 week in advance. 

Check out this piece on how to most effectively demonstrate your distinctiveness during your interview to show you are worthy of a competitive med school spot. And below are a couple of cute, under-one-minute Guru on the Go videos to reinforce the importance of practicing:

It's not luck; it's skill that will help you succeed!

Don't Accept Helicopter Parenting

Check out this bizarre (and sad) article from 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?)

Along those lines, I'd recommend the New York Times best seller How to Raise an Adult by Julie Lythcott-Haimes for any parents who read this blog. (Disclaimer: Julie was one of my frosh resident assistants at Stanford.) Julie gave a great interview on Fresh Air last year. 

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 been a winning strategy. 

Optional Secondary Essays: Are They Really Optional?

I've recently received several questions about optional secondary essays and their necessity.

The beauty of an "additional comments" section is that it is intentionally vague. It's your chance to provide details, context, or qualifications that the structure of the application didn't allow you to present. For that reason, I lean toward using that space to both highlight who you are and any exceptional aspect of your candidacy that you'd want a reader to know before making an interview decision.

So, one good option for these essays is to pick something completely nonmedical that distinguishes you and is nowhere else to be found on your application. In this case, the essay can actually be fun to write.

Of note, sometimes people use this type of a prompt to explain one major deficiency in their candidacy. I only recommend that if there's a big elephant in the room: In other words, in general I tell applicants – throughout the process – to avoid highlighting weaknesses. The goal is to demonstrate distinctiveness and worthiness, so negatives are usually left out. But sometimes someone has a big problem like a low MCAT score that is an anomaly that's worth addressing head on.

Bottom line:  Since an interview isn't guaranteed, don't save your best material for an in-person meeting. Get your foot in the door. And as always, make sure that your essay is substantive and not fluffy.

15 ERAS Tips to Boost your Residency Candidacy

It's July, which means it's time for residency applicants to start thinking about their ERASes. Here are tips I've cultivated for crafting the best application:

1. Include relevant pre-professional accomplishments from college. If you conducted research, for example, list and describe it. Do not include high school achievements unless they were truly unique (worked at the White House, sang on Broadway, published in Nature).

2. While you want to include many strong achievements, you do not want your ERAS to be so long that your reader is tempted to skim it, so avoid small activities (like an afternoon health fair). 

3. Keep your descriptors to approximately five to seven sentences. Fewer can look lazy and more can look self-indulgent.

4. Use full sentences. It’s a formal application, and you want to make your written materials as readable as possible.

5. Avoid abbreviations. Ones you think are common might not be familiar to the reader.

6. Avoid contractions; they are too informal for an ERAS. 

7. Make sure you spell out your accomplishments clearly. If your reader doesn’t understand an activity, you won't get “full credit” for what you’ve done. Make no assumptions - not even that the reader has reviewed the experience's introductory information (location, name of activity). 

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

9. Use numbers to be persuasive. Saying that the conference you organized had 500 participants says a lot.

10. 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.

11. Do your best not to leave the "Medical School Awards" section blank. Even if you have to simply include clerkships in which you obtained honors (or high honors), fill that section out.

12. If you have not already, consider joining your specialty's national organization and listing it under the "Membership in Honorary/Professional Societies" section. If you are applying in two fields, take this advice, though. 

13. Try to end your entries with a sentence about how the experience you just described will help you as a future specialist. Making that connection for the reader furthers your candidacy. 

14. As with all good writing, avoid redundant language. Having the word "research" three times in two lines is distracting and demonstrates a lack of originality. 

15. Get help. Don't submit your residency application without having it reviewed by someone with a lot of experience. You do not want to put forward suboptimal materials for a process that is this important and competitive.

Understaffing is Affecting Patient Care

I am only middle aged, and yet, so many of my cohort, including myself, have recently left clinical medicine. There are layer upon layer upon layer of reasons: Even before the pandemic, burnout and discouragement about the current healthcare system were big problems amongst providers. Then, COVID facilitated more departures because of the need to stay home to care for children or even illness and death, sadly. Finally, the national workforce shortage and economic cuts have led to a real crisis in our medical system.

See this piece by Dr. George Hyde, a pediatric resident at Harbor UCLA, as he describes how understaffing is directly harming patient care.

"Why Our School" Secondary Essay: How to Get Started

Secondary essay prompts vary, but there are a few that are standard fare. See my recent blog entry for guidance on the familiar "diversity essay." "Why do you want to attend our school?" is also a common topic pre-meds will encounter.

Medical school admissions officers want to be assured that you know their institution, are seriously considering it, and will fit in well there. In approaching the "why-our-school" question, do your research on the institution and link something specific about you with the school's philosophy, curriculum, patient population, and/or extracurricular programs.

For instance, if you were a teaching assistant for chemistry in college, you might link your use of the Socratic method with a school's tutorial-based learning. In that way, you demonstrate knowledge of the school, show that you connect well with it, and showcase your accomplishment.  

The paradox here is that - although you are theoretically focusing your essay on one school - because so many institutions have overlapping philosophies, curricula, and objectives - you can oftentimes use the same essay framework for many different schools.

That's one strategic way to cut down the overwhelming workload that secondary applications present.

Secondary Essays: The Diversity Prompt

I’ve had several questions recently on how to approach secondary essays, so I'll address some common prompts over the next month or so in this blog.

In considering your strategy and content for the diversity prompt, I’d recommend you ask yourself the following question:

What ethnic, religious, racial, gender, language, socioeconomic, or sexual orientation aspects of me, my family, or my experience make me distinctive?

Please note that experience is part of the question I have posed. An applicant I mentored a few years back wrote to me concerned that she did not fit into a minority category and thus, could not answer the prompt effectively. I suggested she consider an experience that targeted the prompt’s theme, and she wrote a strong essay about her successful efforts to increase diversity during sorority rush. When I applied to medical school, I crafted one of my secondary essays on my experience hearing Spike Lee speak on my college campus. 

Don’t be afraid to think outside the box.

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

Once you've submitted your AMCAS, 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 drafting 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.

Inaccuracies in Medical Student Grades Translate into a Residency Application Strategy

Here's an oldie-but-goodie New York Times piece by Dr. Pauline Chen on medical student grade inaccuracies. In reading the article, medical students should reflect on how important the quality and content of their letters of recommendation are for residency applications, especially in the setting of medical school grades that may be inflated or faulty. The 2020 NRMP Program Director Survey (which is the most current version) 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.

An Offer you Can't Refuse: Writing Your Own Letter of Recommendation

In the last few weeks, several medical school applicants have contacted me saying that potential letter of recommendation writers are asking the candidates to write their own letters.

If you have this opportunity for medical school, dental school, residency, or fellowship, first, realize that it is not unethical to write your own letter if you're asked to do so. If you'd like to explore the scruples of this issue, take a look at this New York Times Ethicist column about the topic.

The mistake I see candidates make in this situation is that applicants don't write strong enough letters for themselves because they feel awkward about showcasing their accomplishments fully. If you have the opportunity to write your own letter, craft a glowing one. Be effusive and full-throated in your remarks about yourself! Remember that the letter-writer can choose to tone down the recommendation if s/he doesn't agree. But if s/he does, you've utilized an opportunity fully and bolstered your candidacy tremendously.

Medical School Applications are at their Highest Level Ever

In 2021, medical school applications from first-time candidates increased a startling 18%. More than 62,000 students applied to medical school in 2021, compared to approximately 53,000 the year prior. It's unclear what caused such a large jump: It's possible the pandemic was not a factor and that many students had planned to apply prior to COVID-19's emergence. After all, it takes many years of planning to have a ready candidacy. Or perhaps individuals may have been inspired by healthcare workers' dedication during the beginning of the pandemic. Interestingly, there was a significant increase in applications from Black and Hispanic students, which is encouraging.

With increasing numbers of candidates, medical schools will be more selective about which applicants they accept. Perhaps some students will consider physician assistant training as an alternative, however, enrollment there is up as well.

Take a look at this short piece by Dr. Thomas Cook, the Program Director of the Emergency Medicine Residency at Prisma Health in Columbia, for more analysis.

Is There a Doctor on Board?

Those are words no physician wants to hear. Even as an emergency physician, I hated the few times I heard that phrase. Fortunately, the passengers I tended to were not terribly ill, but this story, written by a medical student who cared for a critically ill passenger, is well told and worth the read.

Choose the Right Category for your AMCAS Experiences

AMCAS provides 18 categories in which you can classify your experiences. They are:

Artistic Endeavors
Community Service/Volunteer – Not Medical/Clinical
Community Service/Volunteer – Medical/Clinical
Conferences Attended
Extracurricular Activities
Hobbies
Honors/Awards/Recognitions
Intercollegiate Athletics
Leadership – Not listed elsewhere
Military Service
Other
Paid Employment – Medical/Clinical
Paid Employment – Not Medical/Clinical
Physician Shadowing/Clinical Observation
Presentations/Posters
Publications
Research/Lab
Teaching/Tutoring/Teaching Assistant  

Sometimes an activity matches two categories. When that happens, lean on the clinical classificiation, if applicable. (For example, if your activity is both Leadership and Community Service - Medical/ Clinical, choose the latter.) If clinical is not relevant, then choose the category in which you have the fewest activities.

A client who came to me as a re-applicant a few years back told me that a school from which she was rejected indicated that they had not counted a clearly clinical activity as clinical because she had classified it differently. So be sure you consider the categories deliberately in crafting your AMCAS.  

Rolling Admissions: What's the Big Deal?

This year's AMCAS application opens on May 4 at 9:30 AM EST, and candidates will be able to submit their AMCAS applications beginning on May 28 at 9:30 AM EST. 

Because of rolling admissions, submitting a complete application early in the cycle has distinct advantages at many schools. That doesn't mean you should submit suboptimal written materials on the twenty-eighth; instead, you should start early enough that you're presenting your best work.

Rolling admissions means that a school takes applications in the order in which they are received and makes decisions about interviews and then acceptances, accordingly. So, as time goes by, there are fewer interview and admissions offers remaining to be made. Think of an auditorium whose doors open to allow guests in. Those in the front of the line get the seats, and those who come later may not have a chair to sit in. 

If your application is not complete, your candidacy may not be evaluated early when there are more opportunities for interviews and admissions. So, if you have not already, get started immediately. It could make a huge difference in your available opportunities. 

Study Shows Women Earn $2 Million Less Than Men in Their Careers as Doctors

A survey of 80,000+ physicians estimated that women make 25 percent less than their male counterparts over a 40-year career, according to a New York Times article. The troubling findings were published in a paper in Health Affairs. Of note, factors like specialty, type of practice, and patient volume were controlled for. Had they not been, one of the authors said, the discrepancy would have doubled. The salary gap starts at the beginning of women's careers and then only worsens.

According to the Times article, the pay gap is wider among healthcare practitioners than among those in computer and engineering jobs. Considering that, women pre-meds who are on the fence about a career as a doctor have every right to seriously consider another profession...

Positively Influence your Letters of Recommendation by Making the Job of Letter Writing Easy

When pre-meds, residents, nurses, and physician colleagues asked me to write them LORs when I was Assistant Residency Director, the first thing I requested was that they send me background information to make my letter robust…and my job easier. Accordingly, whether you are applying to medical school, dental school, residency, or fellowship, I strongly recommend you create a “LOR packet,” which can include the following:

1. A brief, well-written cover letter defining all of your important accomplishments
2. Your curriculum vitae (CV)
3. Your personal statement in its final form
4. Your transcripts.

With regard to the cover letter, keep it streamlined. No one will skip the beach or her two-year-old’s birthday party to read your exhaustive biography :), so you want to thank the writer and highlight your pre-professional achievements on one page. The point of the cover letter is to supplement a writer’s knowledge of your candidacy and offer flattering content for inclusion. A college professor may know that you made the only A in an organic chemistry class, but her LOR for medical school will be more complete, and she will demonstrate a more intimate familiarity with you if she knows enough to write that you volunteer regularly at a homeless shelter.

With regard to the CV and personal statement, these make useful supplements to the LOR packet only if they are in professional and final form. Don’t include rough drafts, as poorly organized background information leaves your writer the impression that you are a disorganized person. Also, only include the transcript if it bolsters your candidacy, demonstrating academic achievement. Don’t shoot yourself in the foot if you have some bad grades you’d rather not showcase.

Bottom line: An applicant who offered me a list of her accomplishments in a tidy, accessible package was more likely to get a strong, comprehensive letter that was submitted promptly. She also distinguished herself from the majority of candidates who requested letters without demonstrating a comparably sophisticated understanding of the demands this process made on my time. If you can make a letter writer's job easier, your forethought is likely to pay dividends in the letter you receive. The savvy applicant can take subtle advantage of her ability to "lead the witness."

The Single Most Important Thing Applicants Should Focus on in a Medical School Application

Varsity Tutors interviewed me a decade ago regarding mistakes to avoid in a medical school application, best undergraduate majors for pre-meds, how to approach MCAT prep, and the most important factor a medical school applicant should focus on in her candidacy. My answers still hold true today and might improve your angle on the process. Take a look at this short interview. (Note that there are some typos in the piece that are not mine ;)).

AMCAS opens in three and a half weeks!

Time to Take A Break

It's a stressful time of year for those applying to medical school; I'd recommend taking a reading break between your application obligations. 

Here's a piece I wrote for Student Doctor Network regarding great books for doctors in training. (Additionally, I'd include When Breath Becomes Air as a must read.)

Also, I just finished a (non medical) novel called The Lincoln Highway that was truly magnificent. 

Enjoy!

NRMP Match

Congrats to all those who successfully matched the week before last! The NRMP just published statistics from this year's Main Match:

Of interest, there were 42,549 applicants who submitted certified rank order lists in this year's Main Match, and 34,075 of those matched to PGY-1 positions (80.1%). This was a 1.6% increase over last year.

The NRMP also reports that out of 39,205 total positions offered, 36,943 filled (94.2%), and of 36,277 first-year positions offered, 34,075 (93.9%) filled. These rates were similar to last year's. Of 6,087 total certified programs, 5,367 filled (88.2%), which was a decrease from last year, per the NRMP.

For more numbers, take a look at this NRMP press release.  

Studies Show that Physicians are More Likely to Use Negative Terms in Black Patients' Medical Charts

Here's a disturbing and important New York Times article detailing two studies showing that physicians were more likely to use negative language in the medical record about Black patients than about those of other races. 

Medical notes from emergency departments and inpatient settings were more likely to use this pejorative language, possibly because of a lack of long-standing relationships with patients.

Along these lines, a term like "refused" should not be used in the medical record. If we, as medical professionals, believe the patient is truly in charge of his/her body, "declined" is an appropriate replacement.  

Medical School Letters of Recommendation: Asking the right people

For those applying to medical school this cycle, if you haven't already, it's time to start asking for letters of recommendation (LOR).

Beyond simply fulfilling requirements, you want to get the strongest letters you possibly can from the most influential writers. Choosing the right individuals can be a challenge, and advisees often ask me what to look for in a letter writer. Here is my suggested wish list for potential letter-writers:

1. Explicitly state they will write you a strong LOR

2. Senior faculty

3. Weighty academic titles
4. Well known in their field
5. Spent significant time with you
6. Experienced letter-writers

Of course, all of these qualifications are not possible for all writers. But the more of these you can garner the better. 

With regard to #1, don’t be afraid to ask a potential letter-writer if she will write you "a very strong" LOR. It may seem awkward at the time you ask, but, believe me, getting a wimpy letter will be much thornier. If the faculty member says no, hesitates, or tells you in March that she has to plan her Thanksgiving get-together ;), politely thank her and move on. Although disappointing, acknowledge that she has done you a huge favor. You are far better off avoiding her letter, and you now have the advantage of substituting a stronger LOR written by someone who loves you.

With regard to #2 through 4, admissions officers are human just like the rest of us: Receiving a LOR from an accomplished, known colleague will be weighed much more heavily than one from someone deemed less successful and unfamiliar. If you are better connected to someone without a title, consider asking the professor (a more senior person who has a weightier title) if she would consider writing the LOR with significant input from your closer contact (i.e., the TA who taught your section, or the postdoctoral fellow who directly supervised your research project). That way you get a LOR that includes insight from someone who knows you, signed by a name that packs a punch.

Fee Assistance Program

As the 2021-22 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 that 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.

Final Tips for Making Your Match List

Applicants must have their rank order lists certified by 9 pm EST this Wednesday (March 2). As I've mentioned in a previous post, the algorithm for the Match is relatively simple.

The bottom line:

1. Rank programs so they represent your true preferences. Your first choice should be first. Your second should be second and so on. Do not try to "outthink" the system, as it will only be to your disadvantage.

2. Because of the way the Match algorithm works, what programs think of you (or what you think they think of you) should have zero bearing on how you make your rank order list. 

3. Except in highly usual situations, rank all programs at which you interviewed. If you would truly rather not match than be at a specific program, then that program should not be on your Match list; however, do think carefully about the prospect of not matching, entering SOAP, and possibly having to reapply next year.

4. Prioritize your happiness.

Medscape's National Physician Burnout Report 2021 is out - and it's Troubling

The Medscape National Physician Burnout & Suicide Report 2021 is now available, and it seems rather evident that the pandemic has negatively affected physicians who were already under a lot of stress, especially those in critical care medicine.

More than half of critical care physicians report being burned out (51%), and critical care ranks as the highest specialty in the burnout questionnaire, followed by rheumatology (50%) and infectious disease (49%). Those numbers compare with last year's report at 44%, 46%, and 45%, respectively. This year, my field of emergency medicine (EM) was at 44%, which sounds high, but, sadly, EM was not even in the top ten burned out specialties. That gives you an idea of the severe scope of the problem.

Women reported burnout at 51% compared to 36% for men, and while this disparity has been present for many years, the discrepancy between the genders was greater in this most recent report.

Seventy-nine percent of those surveyed relayed that their burnout started before COVID, while 21% reported after. Bureaucratic tasks and too many hours at work were the major reported contributors to burnout.

Take a look at the Medscape National Physician Burnout & Suicide Report 2021 slide deck yourself for more interesting details, and check out my Kevin MD piece on EM burnout here.

Your Residency Application: Six Factors to Prioritize When Creating your Rank List

Creating your Match rank list can be absolutely agonizing because it feels like so much is at stake. Sometimes it helps to step back and look at the big picture. Below, I briefly note a few important considerations when making your list:

1. Make sure you understand how the NRMP algorithm works. See my previous blog post regarding errors to avoid at all costs. The key is to rank in the order you want - first goes first, second goes second, etc.

2. Consider your happiness and life balance. Blasphemy perhaps, but I would argue that they are more important than the strength of the training program.

3. Reflect on the culture, geography, size, and even maturity/age of the program. Think about whether you will fit in.

4. Consider whether you could spend your whole life at the institution or in that program's location. It's a lot to grapple with, but many residents graduate and stay for the rest of their careers.

5. Decide whether you liked the program director, chairperson, and faculty generally. They could make or break your happiness and success.

6. Realize that most programs will train you well if you work hard. Their prestige and quality may be more similar than you think. For that reason, note that your personal preferences and intuitions are paramount.