After You Get In

The AAMC recently published a piece called "Congratulations, you got into medical school! Now what?" in which staff writer Bridget Balch lists seven tips for rising first-year medical students. You can see the article here.

The author makes several suggestions, including leveraging the orientation and embracing the academic challenge, but I would highlight her recommendations to find mentors and prioritize your health.

Identifying strong mentors not only affords you the potential for good letters of recommendation and little-known opportunities, but also doing so can support you when medical school is a terrible grind. Mentors can be especially important role models for women and those in traditionally underrepresented groups. The key is to assert yourself and overcome feelings of insignificance. Many faculty are eager to meet and guide students.

With regard to physical and emotional health, I've written recently and many times in the past about clinician burnout and depression. Medical school can be a time of significant contraction in your life. Make sure to care for yourself physically and seek mental help when needed.

In the meantime, before school starts, take a well-deserved break!

Aim for All Stuff and No Fluff

The goal of your written materials (and your interview) is to distinguish yourself from everyone else to demonstrate that you are worthy of a competitive medical school or residency slot.

Therefore, it's critical that you avoid flowery or trite language, as using it does the opposite of making you distinctive. Recently, I read a piece by Lisa Miller called, "When Did Everything Become a 'Journey'" about the overuse of the word. Miller cites Northern Arizona University linguistics professor Jesse Egbert who notes that "journey," as a noun, has almost doubled in American English since 1990. 

In her piece, Miller also includes a wry quote from a Los Angeles clinical psychologist who describes the word "journey" as "eye-rollingly cheapened." In editing personal statements, I see the word used frequently – maybe once in every four essays I revise.

Good writing takes a lot of time - brainstorming, outlining, and many drafts. Make sure your written materials are the best they can be by being diligent about your process (and by getting professional help).

Avoid These Ten Common AMCAS Mistakes

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

1. Don't write to write. 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, dramatic, 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; plus, 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. Choose the right category for each activity, so you get "full credit."

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

How to Avoid AMCAS Verification Delays

The AAMC recently posted a piece with tips on how to avoid delays in the AMCAS verification process. The link to the article is below, but I've created an outline of their recommendations here:

1) Submit all of your official transcripts – including college courses taken during high school. The AAMC notes that transcript issues are the most common cause of verification delays.

2) When completing your application, include alternate names that appear on your official transcripts so AMCAS verifiers can readily match your transcripts with your application.

3) While this is not a requirement, the AAMC recommends you use the Transcript Request Form (TRF) to match paper transcripts to your application. The TRF can be found in the application's Schools Attended section.

4) When requesting e-transcripts, ensure you provide your accurate AAMC ID and Transcript IDs to avoid problems matching your transcripts with your application.

5) Make sure to fill out your coursework exactly as it is printed on your official transcripts (including abbreviations, grades, and symbols) and in chronological order. Include all courses - even ones you took more than once, you withdrew from, and/or you did not excel in. The AAMC recommends you order a personal copy of your official transcript early so you can complete the coursework section accurately.

6) If you are reapplying, resubmit all of your transcripts and your letters of evaluation, even if nothing has changed since your last application.

7) Proofread your AMCAS(!), as there are limited changes you can make once your application is submitted.

Here is the AAMC article.

How to Adeptly Complete the AMCAS Other Impactful Experiences Section

Last year the Association of American Medical Colleges (AAMC) gutted the AMCAS Disadvantaged Status section, replacing it with the Other Impactful Experiences, which allows for a broader approach to challenges that can adversely affect an applicant's life and candidacy. 

In other words, when you're considering the Other Impactful Experiences essay, consider financial barriers, but also issues like learning disabilities, immigration experiences, caregiving roles, etc. Here is some guidance from the AAMC.

Emotional PPE

Back in February, I showcased the sobering results of the Medscape Physician Depression and Burnout Report 2024: Of those doctors surveyed, 53% reported burnout and 23% depression. And those disturbingly high statistics had increased from the previous year. 

I recently listened to a Stanford Medcast Episode interview of Ariel Brown PhD called "Physician Distress Miniseries – Emotional Health Support for Health Care Workers." (You can get CME credit for listening to the podcast and completing the quiz afterward.) According to the session, each year in the United States, one in 10 physicians think about or attempt suicide and around 400 die by suicide. 

At the start of the pandemic, Dr. Brown started a nonprofit with Massachusetts General Hospital Anesthesia Program Director Dr. Daniel Saddawi-Koefka, called The Emotional PPE Project. The organization provides free and confidential psychological counseling for healthcare workers. Here is the website.

Applying to Residency this Cycle? Don't Forget the New AAMC Fee Assistance Program for Residency Applicants

Here's a quick reminder that the Association of American Medical Colleges (AAMC) is expanding its Fee Assistance Program (FAP) to residency applicants this year.

The good news is that if you were previously approved for the AAMC FAP, you will automatically get a 60% discount on your residency application for this ERAS season.

The bad news is that current medical students are not eligible to apply for the FAP even if they now have financial challenges that they did not have prior to medical school or if they qualified before medical school but declined to apply for the FAP benefits.

The AAMC says they are going to survey "the student affairs community" to understand "if and how" they can further expand the FAP for residency applicants.

Here is more information with some frequently asked questions.

Try a Residency Bootcamp

I was recently speaking to a medical student with excellent foresight, who was asking me what he could do to prepare himself for residency. I suggested reviewing the basics – perhaps by perusing a favorite clinic handbook – of how to work up common chief complaints like chest pain, shortness of breath, abdominal pain, back pain, among others. It was timely, then, that I read an article about Transition to Residency classes offered at the majority of medical schools. These intensive courses help medical students refresh their knowledge about clinical approaches, so they can hit the ground running when internship starts. 

If a Transition to Residency class is robust and offered at your institution, I would recommend taking it.

Also, when thinking about preparing for residency, I advised the student to consider ways to make life as smooth as possible: When I was in training, I splurged to pay for a laundry service. I never missed the money; instead of spending my downtime at a laundromat or an apartment complex laundry room, I was able to sleep a little more. 

Of course, I had to be frugal during residency, as many others do, but doing one or two things that can make your life better can pay dividends.

Check Out the AAMC Virtual Medical School Fair

The AAMC (Association of American Medical Colleges) will be holding a live informational medical school fair this Wednesday, April 10 through Friday, April 12. There will be sessions on financial issues like loans, budgeting, and scholarships and some advice from current medical students and admissions officers. Registering also affords you 15% off a one- or two-year subscription to the Medical School Admissions Requirements (MSAR®) website.

You can register here. I offer individually-tailored, one-on-one assistance, but there's no downside to hearing more general tips from the AAMC itself.

Major Changes are Needed to Head Off a Worsening Physician Shortage

 The AAMC recently published a report estimating that the United States will face a physician shortage of up to 86,000 doctors by 2036.  

A variety of issues are contributing to the problem, including the lack of adequate residency slots. A bipartisan bill called the Resident Physician Shortage Reduction Act of 2023 (H.R. 2389/S. 1302) has promise but has yet to progress through Congress. The legislation would gradually increase the number of Medicare-supported residency slots by 14,000 over the course of seven years.

Other issues are at play, including an aging American population, one that requires more healthcare. Additionally, doctors who are 65 and older make up 20% of the physician workforce, and those between age 55 and 64 constitute 22%, meaning that many doctors are reaching retirement age. 

A cohort also left clinical medicine during and after the pandemic, and, in a related issue, burnout is very high for those who stayed. A whopping 49% of doctors surveyed through the annual Medscape questionnaire reported being burned out.

The opaque medical school admissions process and the very high cost of medical school are also barriers.

Anecdotally, I hear of many family members who wait weeks or even months to see a physician. Most of those people live in urban areas; the problem is significantly worse in rural locations. Becoming a physician is a noble endeavor, but without structural support, many talented students will pursue other fields. We can't blame them.

My Five Year Anniversary with the White Coat Investor Podcast

Looking for a podcast episode for today's drive to work? Check out my take on entrepreneurship, creating autonomy and flexibility, and balancing clinical practice with raising a family on the White Coat Investor (WCI) podcast. The interview initially ran in March 2019, but the content is still highly relevant for those considering alternatives or enhancements to clinical careers.

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 sparked a slew of devotees. Check out my podcast episode here (where you can also read the full transcript) or listen on your favorite podcast app. 

Leverage the MSAR for Your Benefit

The Medical School Admission Requirements database (MSAR) is an online resource 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, the MSAR was a hard copy book.) The annual MSAR usually comes out this month or next; if you're applying to medical school, I'd recommend purchasing the 2024 version when it's here because it provides so much information about institutions and their admissions statistics. The MSAR allows you to compare schools by median MCAT scores, AMCAS GPAs, and other criteria. (Of course, how institutions utilize the MCAT score is variable, which contributes to the shameful opaqueness of the medical school admissions process.)

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.

 

The Medical School Admissions Process is Totally Broken - From Start to End

The medical school admissions process is cruel. I recently told that to a strong applicant who was "ghosted" by five institutions this cycle. Poor or absent communication is only one of the problems. The lack of clarity about selection criteria causes confusion, and expensive supplementary applications that generate money for schools are sometimes exploitative.

Check out my Doximity op-ed piece "The Medical School Admissions Process is Falling Short," and feel free to leave a comment on the site about your experiences and opinions.

One Billion Dollars

I was super impressed with the news that Albert Einstein College of Medicine Professor Ruth Gottesman is donating $1 billion to her institution to make tuition free for all medical students going forward.

In 2019 NYU made medical school tuition free. Subsequently, the demand to go to their institution skyrocketed, as did their matriculants' median MCAT and AMCAS GPAs. According to the most recently published MSAR, NYU's median total and BCPM GPAs were both 3.96, and their median MCAT was 522. A similar phenomenon will occur with Albert Einstein School of Medicine.

The tremendously generous donation by Professor Gottesman allows earnest individuals interested in caring for our communities to become physicians without excessive debt. Of note, Albert Einstein offered to rename their school to include "Gottesman," but the professor declined, a choice which adds to her stature in my mind.

No One Wants to be your Second Choice for the High School Prom

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

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.

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

This Has Been a Weird Cycle

I founded Insider Medical Admissions in early 2007, and, looking back, I'm struck by the fact that this is one of the longest medical school admissions cycles I remember. What I mean by that is I have applicants who were admitted to medical school in early fall, and, simultaneously, there are some who are still being invited for interviews at top schools, scheduled for this month and early March.

I've seen late invitations in the past, but they were few and far between. This year, it seems almost routine to be interviewing into the late winter.

If you're facing an interview this month or next, check out a couple of articles I wrote for Student Doctor Network years ago that have survived the test of time: One is about how to skillfully manage difficult interview questions and the other will teach you how to transform your candidacy's liabilities into assets. 

I'm still offering mock interviews this cycle, so contact me for help.

  

How Sesame Street Can Help You Write a Good Medical School Personal Statement

I learned an interesting fact years ago: When small children don't understand something, they will simply tune it out and start to engage in another activity. That's why great shows like Sesame Street use professionals to make sure their content is precisely age-appropriate. Children - and adults - don't like being confused, and you can’t blame them.

In their personal statements, some medical school candidates make the mistake of referring to an accomplishment without explaining it. This is understandable since we are all intimately familiar with what we've done. The problem is that the vast majority of application readers are way too busy to do independent research or go back and forth checking an applicant’s supporting documents if she writes something that isn’t crystal clear.

I remember a talented candidate I advised who showcased an award she had won. She listed the name, but didn’t explain what it was. When I asked her, she told me the award was an academic honor given to only the top 1% of students out of several thousand. I was impressed! And, I asked her to rewrite the section so that her admissions readers would give her the credit she deserved for that extraordinary accomplishment. Because the medical school admissions process is so competitive, what you fail to adequately explain counts against you.

On a related topic, don’t expect a reader to understand something in your essay because it’s explained in your AMCAS activities. Different faculty members will approach the application in different ways, so – to get “full credit” for your accomplishments - you need to assume that your reader is seeing your essay first, independent of your AMCAS activities. Ensure your personal statement can stand alone and doesn't rely on your AMCAS Activities section for clarification.

Contact me for help with your written materials. I have read thousands of essays, and I personally review every document sent to me.

The Medscape Physician Depression and Burnout Survey 2024 is out and the News Isn't Good

For the last several years I've made sure to blog on the annual Medscape Physician Survey that chronicles physician satisfaction. Unfortunately, it's pretty much always bad news.

If you're an optimist, you'll be happy to hear that burnout rates were lower than last year. You may remember that the numbers skyrocketed during the pandemic. Last year 53% of physicians surveyed reported burnout and 23% reported depression. This year the numbers are 49% and 20%, respectively. If you're a pessimist, you'll notice that those numbers are still very high, with approximately half of the doctors surveyed reporting burnout. That's a very big number.

Of note, emergency physicians are the most burned out at 63%, and the runner-up is obstetrics and gynecology at 53%. Plastic surgeons are the least burned out at 37%.

See more stratification and data by taking a look at the survey results here.

Which Specialties Have the Biggest Gender Gaps During Residency? You Will and Won't be Surprised.

The AMA recently published a short piece based on 2022-23 data culled from their National Graduate Medical Education Census: They evaluated which medical specialties were most popular among male and female candidates who were entering residency. They then extrapolated as to which specialties are going to be increasingly female- versus male-dominated.

Female-dominated specialties included obstetrics and gynecology, pediatrics/psychiatry/child and adolescent psychiatry (combined), pediatrics, allergy and immunology, public health and general preventive medicine, and dermatology.

I wasn't surprised that pediatrics or obstetrics and gynecology were female-dominated, but I found it interesting that dermatology - which is so well remunerated - has more women residents than male residents. Historically, women were relegated to lower paying fields.

Male-dominated specialties included orthopedic surgery, interventional radiology, neurological surgery, diagnostic radiology, and urology.

The AMA reports that specialties that offered a near equal balance of men and women in residency included neurology, general surgery, and psychiatry. Again, as someone who trained in the late 1990s, it's a joy to hear that general surgery is now a well-balanced field in terms of gender. On the whole, when the AMA included specialties, subspecialties, and combined specialties, they report that women account for 48.2% of trainees.

For more details, you can check out the AMA piece here.

There's a New and Improved ERAS Fee Structure on its Way

The AAMC recently announced an updated fee structure for the next ERAS cycle with the goal of lowering total application costs and simplifying the current cost framework, which has been criticized for its complexity. In theory, the change should be an improvement for this year's applicants.

Essentially, residency candidates will pay $11 per application for up to 30 and $30 per application for 31+. Of note, the structure restarts for any new specialty. So if you plan to apply to two, your costs will be higher.

The AAMC estimates most applicants will see discounts of up to 36%.

The old system was triple tiered. You can see it here. Of note, as I previously blogged about, this year the AAMC will also expand their Fee Assistance Program to include some residency applicants, a first.

You can see the new ERAS fee structure in graphic form here.

Make Sure to Read the Fine Print

Many years ago a medical school applicant told me the following story:

The student sent follow up notes to all schools where he had interviewed, usually a strategic move. However, he was very upset to receive a brusque note from one of the institutions telling him that a) he should have read their policies; they do not allow post-interview contact and b) he was rejected from the school.

I found the school's note extremely severe – almost cruel – and I strongly suspect the post-interview contact was not related to his rejection. (As an aside, he successfully and happily matriculated at another school.) But this story is a reminder that it's important to read institutions' policies about post-interview and post-waitlist contact. Most places welcome written updates, but make sure to confirm before you reach out.

Consider Ten Ways to Improve your Medical School Application

New Year's resolutions are notoriously hard to realize. But there are smart tips for executing them, including making sure goals are specific and truly achievable within a reasonable time frame. That's why starting early on your medical school candidacy is important. The beginning of the year is a great time for pre-meds to redouble their efforts toward their academic and professional goals. 

As always, I recommend a very focused approach that allows you to do more of what you want and less of what you don't. Think research will help your candidacy but don't like being in the lab? Consider public health or clinical investigations. Think volunteerism will bolster your application but don't like being one of a crowd in a group project? Select a setting that allows you to work independently: Several of my clients have chosen to volunteer on a crisis line – from home.

There are definitely necessary elements to any robust medical school candidacy (clinical experience, strong grades, a reasonable MCAT score), but being a pre-med can also be fun, mind-broadening, and career-affirming.

Here's a piece I wrote for Student Doctor Network showcasing ten ways to improve your medical school application. The idea is to give you direction but also leeway to be a happy applicant - not just a strong one.

Diversity in Medical School?

The AAMC recently published a piece about racial, socioeconomic, and gender diversity in 2023-4 medical school classes. The good news is that there's some more representation of those from Latino and Native American backgrounds. 

African-American student enrollment remained mostly stable.

Women matriculants rose slightly to 56.6%. Economic diversity was still a problem. See the article here for details.

Interestingly, those who entered medical school in 2023-4 had a median undergraduate GPA of 3.84, which was even higher than in previous years.

A Bad Prognosis for Emergency Medicine

I read a fascinating piece by Dr. Thomas Cook in the December edition of Emergency Medicine News. In it, he cites work done by Cameron Gettel, MD who devised an interesting way to assess the attrition rate of emergency physicians (EPs): Gettel and his colleagues used data from the Centers for Medicare and Medicaid Services (CMS), noting which healthcare providers stopped billing CMS for emergency medical services. Gettel used this information to calculate the attrition rate for EPs. What he and his colleagues found is that the EP attrition rate was approximately 5% prior to the pandemic while it shot up to approximately 8% in urban spots and more than 11% in rural areas during the first year of the pandemic.

Using information from the American Board of Emergency Medicine, Gettel found - shockingly - that the median age of attrition for male EPs was 53.5 years and for female EPs was 43.7 years in 2019. This means that the median EP career was around 23 years long for men and fewer than 14 years long for women. Wow!

It's absolutely critical that medical students who are considering a career in emergency medicine think about what their professional trajectory might be, considering the short median lifespan of the typical EP.

For more information on this interesting topic and how attrition might affect the job market, the need for physician personal finance training, and who applies to emergency medicine, see Dr. Cook's piece here.

For Pre-Meds Applying in the Next Cycle, What IS Solid Clinical Experience Anyway?

Getting into medical school has gotten so competitive that it's increasingly important to have a strong candidacy with excellent grades and robust extracurricular activities. As I've mentioned in previous blog entries, one mistake I see pre-meds make is that they are so focused on leadership and research, they forget a critical component - clinical experience. To prove you want to be a doctor, it's essential you obtain clinical experience for a significant period of time - not just a health fair or two. Good grades will not make up for a lack of clinical experience. Here are some ideas for obtaining strong clinical experience:

EMT (some universities have EMT classes and/or jobs on campus)
Participate in a good hospital clinical care extender program
Work at a low-income clinic
Certified Medical Assistant
Certified Phlebotomist
Certified Nursing Assistant
Work at a hospice
Scribe (usually a full-time job)
Veterinarian's Assistant (a great way to get hands-on procedural experience)
Volunteer for a crisis text/phone line (might need to be paired with an in-person clinical experience)

Shadowing is a mixed bag: Medical schools don't know whether you're second-assisting in the operating room or just standing in a corner being ignored :(. If you choose to shadow, make sure you strategically delineate your clinical experience in your written materials.

If you're not excited about getting clinical experience, it's 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.

Do your research before accepting a "clinical" job so you ensure you'll really get a satisfying experience and show admissions committees you can handle the heat.

Medical School and Residency Admissions: It's Not Personal

When I was in my second year of medical school, a third-year student (who later also went into emergency medicine, as I did) came to speak to our class about being on the wards. He gave an animated talk about how important it was to recognize that when residents, attendings, or nurses hollered at us on our clinical rotations, 99% of the time, it wasn't personal. He likened the situation to Boston traffic - how drivers lean on their horns for little cause because they are simply frustrated about their days. 

It's not personal, he said.

I say the same to those I mentor. Candidates get an interview at one highly ranked institution but rejected at what is considered a lesser one with no clear cause. Faculty interviewers mix applicants up with one another; some turn up wholly unprepared - reading students' applications for the first time during the interview itself. Remember: It's not personal. This process is arduous and cruel, and most candidates, faculty, and program coordinators are tired and doing their best in a dysfunctional system. 

The AAMC Will Expand the FAP to Include Some Residency Applicants

The American Association of Medical Colleges has announced that they will expand their Fee Assistance Program to certain residency applicants starting with the 2024-5 ERAS application season. At that time, the FAP will include residency candidates who were previously approved for the program during their medical school application process. The qualifying candidates will receive a 60% fee discount on up to 50 ERAS applications. This is great news for medical students who have severe financial needs. The AAMC reports that it will be providing more information in the following months.

Is Getting into Medical School Harder than It Was Before or Does It Just Feel Like It?

Last cycle, over 52,000 brave candidates applied to medical school, with just under 23,000 matriculating. While getting into medical school is extremely competitive, the number of applicants has actually decreased from two years ago when over 62,000 individuals applied to medical school (and the number of matriculants/spots has stayed almost the same). People attributed that peak in applications to the Fauci Effect, a trend that motivated individuals to simulate medical leaders and contribute to the health of society in the setting of the pandemic. In reality, it's unclear why numbers rose significantly that year. But since, applications have declined. The problem for candidates is that the number has decreased only to levels that are about equal to those pre-pandemic and still higher than the 2014 cycle when there were under 50,000 applicants. 

Having said that, there are more open medical school slots than there were in the past. In the 2014 cycle, 20,343 individuals matriculated out of 49,480 (41.1%). This past year 22,981 matriculated out of 52,577 applicants (43.7%).

None of these statistics take into account the fact that a more competitive applicant pool may have emerged over the course of the last decade. In other words, the whole achievement level of the application cohort may be stronger than it was in the past.

Bottom line: Looking at numbers alone, it is easier to get into medical school than it was during the anomalous cycle two years ago. Furthermore, although there were more applicants, it is slightly easier to get into medical school now that it was about a decade ago because there are more spots. 

That conclusion is likely reassuring for upcoming applicants, while at the same time, maddening for any of this year's candidates who have received a recent rejection. 

Either way, getting into medical school is extremely competitive.

Beware: Smart People Can Offer Dumb Advice

Thanksgiving is a time for gratitude and reflection. It's also a time to consider what will make you happy in the future.

When I was a medical student applying for emergency medicine residency programs, a well-meaning, smart dean gave me foolish 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. I would argue that where you live for medical school, residency, or fellowship is as important as the quality of the institution. The reasons are several-fold:

1. Medical education/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 education/training is extremely stressful, and you want to be in a city where you have social support.
3. Medical education/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've 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 might not want to relocate your family.

Not everyone gets the opportunity to go to medical school or train in a residency and fellowship program in a city she likes. But you can make choices that will increase your chances. Consider these options - and your happiness - as you practice gratitude this week and make professional decisions this coming year.

How to Turn the Elephant in the Room into a Cuddly Kitten

No application to medical school (or residency) is perfect, which is why it's important you have a well-considered strategy for managing interview questions about gaps in your candidacy. Addressing a bumpy freshman year or a suboptimal first MCAT attempt with aplomb can make a big difference in how an interviewer and admissions committee perceives you.

Check out this KevinMD article I wrote a few years back that specifically addresses how to be upfront about a major deficiency in your candidacy and how to demonstrate — with evidence from the remainder of your application — that the weakness is not representative of your abilities.

AAMC MCAT Prep Workshop – November 8

The AAMC is offering a free webinar "Preparing for the MCAT® Exam" on November 8 at noon PST/3 PM EST. They're publicizing that the session will include tips for creating a study plan, low-cost prep resources, a demo of their free MCAT Contact Outline Course, and time to ask questions. You can register here. (You will need to create a free AAMC account if you don’t have one.)

As an aside, if you believe you qualify for the AAMC Fee Assistance Program (FAP), make sure to apply for it early. This year's deadline is December 8. The FAP covers the MCAT, but the grant is not retroactive.

Pay Inequities Based on Gender and Race Persist in Emergency Medicine

This piece by Dr. Starr Knight on discrepancies in pay for women and black emergency physicians is important but disturbing. The problem has been long-standing and continues, according to recent studies cited in the piece. One 2023 survey found that the average annual income of women emergency physicians was more than $43,000 less than that of their male counterparts. 

Of note, some have argued that differences in hours and part-time versus full-time status account for the pay discrepancies, but a 2017 paper using multivariate linear regression models demonstrated that those reasons are not a valid explanation for the discrepancies. 

See more sobering data in Dr. Knight's article.

Congratulations and Congratulations

I've heard from several clients who have already been accepted to medical school this cycle. Congratulations! I've also heard from several clients who have been waitlisted. Congratulations! The waitlist can feel like a disappointment, but it's important to see it for what it is – a potential acceptance.

One of the hard parts of being on a waitlist is the uncertainty. We humans like to be in control! One way to alleviate this discomfort is to do something. Assuming the school you're waitlisted at allows communication through their portal, email, or snail mail, I recommend sending a letter of interest (LOI).

When writing your LOI, 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 school
   
3. Showcasing any updates to your candidacy. (If you don't have updates, you should still write the LOI.)

LOI errors to avoid:

1. Don't include generic content about the institution's advantages, meaning don't waste valuable "geography" telling a medical school admissions officer what makes his/her institution special. Using precious space this way is an opportunity cost, keeping you from fully showcasing what makes you a compelling applicant. Instead, a good technique is to link one of your particular accomplishments with a distinctive opportunity at the institution. For example if you've done cancer research, make sure to showcase it and point out that you'll contribute to the renowned oncology center the institution is associated with.
2. Don't focus on how the school will help you. ("Your medical school will assist me in reaching my career goals.") Your angle instead, should be on how you will be a contributor to their institution. For example, you can detail how one of your leadership experiences has given you the tools 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 the old jargon "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 multiple institutions with different goals (i.e. if you are placed on another waitlist, to request an interview, or to demonstrate your interest post-interview at another medical school). You can also modify the letter and send it to your top choices because, if you are not making a commitment to one school, then you can honestly use it for multiple institutions. 

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

Highly Recommended, Paid Summer Opportunity - AAAS Mass Media Fellowship

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

The 10-week summer program places science, engineering, and mathematics students at media organizations around the country, including National Public Radio, the Los Angeles Times, and WIRED. Fellows learn to communicate complex scientific issues for the lay public. They are provided a stipend of $8000 for the summer, plus travel expenses to and from AAAS and their media sites.

I worked at the Oregonian in Portland and had a tremendous time learning how to write and edit effectively. I also gained an appreciation for the impactful influence journalists can have on medical and public health topics. The Mass Media Fellowship is really an amazing program.

Applications for this year's AAAS Mass Media Science and Engineering Fellowship just opened on October 1 and will remain available through January 1, 2024. Check eligibility requirements and apply here.

Medical and Dental School Interviews: Preparing for your MMI

Although the majority of medical and dental school interviews are still traditional, some institutions utilize a multiple mini interview (MMI) platform. The MMI is a format that uses several timed stations 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, an ability to diffuse a heated situation, a capacity to admit wrongdoing, or reporting an impaired supervisor.

It's important that you practice MMI questions before you go to your medical or dental school interview. Even if you have excellent social skills, there are techniques you should hone to expertly manage the challenging MMI format.

Get y'ERAS in Gear

Last week (on Wednesday, September 27) program directors began reviewing MyERAS applications and MSPEs. Residency applicants often ask me about the timing of ERAS submissions. These are my thoughts:

1. Yes, getting your ERAS in early helps. As one of my program director friends points out, since the residency application is arguably one of the biggest steps in one's medical career, getting the application in as early as possible should be a given. 

2. On the other hand, if your application is not in its best shape, then waiting a week (meaning this week) is preferable to submitting a suboptimal ERAS that will be tossed into the "do not invite" pile. I would suggest not going past this week, however.

Contact me for help with residency mock interviews.