The Medical School Wait List: Can Anything Be Done?

Just when you’ve completed your interviews and feel that you can finally sit back and relax a little because – after all – the rest is out of your hands, you may be surprised by a medical school wait list notification. What can you do?

1. Realize that getting into medical school has become increasingly competitive year by year. Being wait listed is infinitely better than being rejected, and thus a positive, despite the anxiety is causes.
2. Send a letter of interest. Let the school know of your continued enthusiasm and your new accomplishments. Ensure the letter is well written, streamlined, and brief. If the school is absolutely, positively your first choice, let the admissions committee know that. Feel free to send more than one letter if you are on a medical school wait list for months.
3. Ask the school if you can set up a second look. A supplementary visit indicates to the institution that you are serious, and it offers you more data in making your decision if you're later offered a spot.
4. Do not neglect your other options. Don’t focus all of your attention on this institution to the exclusion of others: Ensure you are well-prepared for any late interview invites at other medical schools.

5. Ask a well-positioned faculty member who knows your work to make a call or send an email on your behalf. This tactic is especially helpful if the supervisor has a connection to the institution. (I do not recommend that a family friend who hasn't worked with you contacts the school.)
6. Plan for last minute notice. At some institutions, applicants are offered slots off the medical school wait list throughout the summer. I’ve even heard of acceptances being offered the day before school was to begin. Would you be able to change your living situation, move your personal belongings, and uproot if this were to happen? Be prepared. 

Medscape National Physician Burnout Report 2020 is Out - Yikes!

The Medscape National Physician Burnout & Suicide Report 2020 has been published, and its results are as interesting as past years'.

The report's most burned out specialty was.... drum roll please...urology. Fifty-four percent of urologists surveyed reported burnout. Next came neurology (50%) and nephrology (49%). The least burned out fields were public health and preventive medicine (29%), ophthalmology (30%), and orthopedics (34%). Note that my field of emergency medicine is not in the top 5 this year. (Congrats.) However, a whopping 43% of emergency physicians report burnout. 

This year Medscape compared burnout in Millenials (25-39 years old), Generation Xers (40-54), and Baby Boomers (55-73). According to the survey, Generation Xers are the most burned out at 48% compared to 38% for Millenials and 39% for Baby Boomers, although there may be other age-related, non-career issues that lead to burnout in the Xers like caring for children and aging parents.

Women suffer from significantly more burnout than men (48% versus 37%). 

Take a look at the Medscape National Physician Burnout & Suicide Report 2020 slide show yourself, and check out my Kevin MD piece on burnout here. 

No One Wants to be your Second (or Third) 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 or third choice."

Not very compelling...The same is true for letters of intent: I've had several applicants this cycle (and in past years) ask me if it's okay to say that an institution is their "second or third choice" or "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’m confident I can make a positive contribution." In other words, you can stay honest while not shooting yourself in the foot.

I do edit letters of intent and have been busy with them of late. Let me know if you need assistance.

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.

New Year's Resolution: Ten Ways to Improve your Medical School Application

It's the beginning of the year and, thus, a great time for pre-meds to redouble their efforts toward their medical school 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? Start your own social justice initiative. 

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

Here is an article that will give you direction but also leeway to be a happy applicant - not just a strong one. 

Selling Yourself

A recent, interesting article in the New York Times written by two professors - one from Harvard and one from Yale - reviewed a study they published in the British Medical Journal that finds that male-led scientific teams were up to 21 percent more likely than women-led teams to use positive adjectives to describe their research findings. Importantly, they also found that the greater use of positive language by male-led teams was linked to more citations. 

In the NYT article, the authors point out that in many realms and fields women have been found to use language that is more tentative than men. I have found this to be true when I conduct mock interviews as well. I note that, generally, women applicants are less willing to showcase their achievements, which I do believe adversely affects their candidacies. I try to counter that in practice with applicants. 

Of course, there is an alternate assessment of this issue: The "Lean Out" crowd feels that women should not have to conform to men's patterns. While I strongly agree in theory, I have witnessed the disadvantage of being overly modest in the application process. 

This is a good discussion for your next coffee break with a friend!

Residency Applicants, Thinking about How to Create your Rank Order List? Check out this easy advice.

For those of you who are starting to think about your Match rank order list, please make sure you follow this simple strategy: Rank your first choice first, your second second, your third third, etc.

In other words, your most successful approach is to create your list in order of your real preferences. Although the Match algorithm is mathematically quite complicated, because the process always begins with an attempt to match an applicant to the program most preferred on the applicant's list, you do not want to try to "game" the system. For example, I've had applicants tell me that they plan to rank a less preferred institution higher because that program has more residency slots. That's a no-no. The applicant will actually be harming him/herself with that strategy.

Here's a video the NRMP created last year to better explain the Match algorithm. Here's also a less-than-one-minute Guru on the Go© video "NRMP Ranking to Avoid a Spanking" to emphasize your optimal strategy.

Beauty is in the Eye of the Beholder, but Risk Should Not Be...

A little off the beaten track for the holidays, here is a great NYT article called "You Could Die Today. Here's How to Reduce that Risk." It is a fantastic conversation starter for patients and family members in your life. 

Bad Advice Turned on Its Head

The end of the year is a time for reflection and a time to consider what will make you happy in the upcoming twelve months - and beyond.

When I was a medical student applying for emergency medicine residency programs, a well-meaning dean gave me some bad 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. 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 extremely 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 (gasp). 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 coming year.

Even More AAAS Fellowship Opportunities

Earlier this month I blogged on the American Association for the Advancement of Science (AAAS) Mass Media Fellowship, which I had the benefit of during medical school. The AAAS opportunity changed my life in many positive ways. I would be remiss if I did not highlight other AAAS fellowships that science students and professionals can enjoy. If you are interested in policy, are a star student with a disability, or are a woman researcher looking to fund her studies, the AAAS has a fellowship for you to consider. These and more can be found on the AAAS fellowship page. 

The Residency and Medical School Application Process: Moving Past Impostor Syndrome

First described by psychologists Drs. Suzanne Imes and Pauline Rose Clance in the 1970s, impostor phenomenon occurs among high achievers who cannot easily internalize their successes. They often externally attribute their accomplishments to luck and worry that others will eventually realize they are frauds.

Recognize this phenomenon of self-doubt?

You are not alone. Although many people suffer in silence (as they do not want to be revealed for what they perceive to be major deficiencies), the syndrome is quite common, especially in medical school. According to one 2016 study, almost a quarter of male medical students and nearly half of female students surveyed suffered with impostor syndrome. The phenomenon can be associated with depression, burn out, and anxiety. The American Psychological Association offers a few tips for overcoming impostor syndrome including speaking to mentors, recognizing what you excel at, and talking to a professional if necessary. 

Here's a fun article on imposter syndrome by Joelle Borhart MD, the Associate Program Director at Georgetown University. 

Paid Summer Opportunity: AAAS Mass Media Fellowship

Looking for something different to do this summer? The American Association for the Advancement of Science (AAAS) is again offering their Mass Media Science and Engineering Fellowship, a 10-week summer program that places science, engineering, and math undergraduate and graduate students at media organizations across the nation - places like NPR, the Los Angeles Times, and WIRED.

I was an AAAS Mass Media Fellow in 1995. The program was truly fantastic and life-altering.

Take a look here for program details, including dates, eligibility, and funding. 

Applications are due by January 1st, so get moving!  

Your Residency Application: What to Do if You Receive No or Few Interview Invitations?

1. Don't panic.

2. Try contacting - in a professional manner - all institutions to which you have sent your ERAS. You can send an email and call. When you call, be calm, respectful, and enthusiastic. Do not demand to speak to the program director. Let the person who answers the phone know that you are very interested in the program and would appreciate the opportunity to interview. Offer to be on an interview wait list if necessary.

3. Prepare for the Supplemental Offer and Acceptance Program (SOAP). Note that SOAP is not a separate program from the residency Match. So a) your main residency Match user status must be active and b) your credentials must be verified by the Rank Order List Deadline in order to participate in SOAP. Here is more information on SOAP. 

4. Make a plan for what you will do if the Match and SOAP don't work out for you. What will you do next year? How will you improve your written materials, interview skills, and overall candidacy? If heaven forbid, you do not have success in either the Match or SOAP, please consider getting help from me or a faculty member who is experienced in residency admissions - the sooner the better to improve a candidacy and prepare for a re-application.

Responses from Program Directors are as Valuable as the Email They're Written On

A strong residency candidate asked me to review an email a program director (PD) had sent him after interview day. The candidate wanted to know if I had any insights to the intent of the PD: Was the PD sending a generic note or was he really interested in the applicant?

I told the applicant honestly, who knows and who cares?

I wasn't trying to be dismissive. The point is that it is impossible to know what a PD is thinking. Unfortunately, I've seen applicants heartbroken by false hope they read into a PD's comments. More importantly, what a PD says should not affect your rank list anyway. The algorithm requires you to put your first choice first and your second second, etc. (More on that in a future blog post.)

As they say, kisses aren't contracts and presents aren't promises. Ignore those PD notes because they don't guarantee a thing and don't change management. 

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

This time of year, when the residency and medical school interview processes are in full swing, many of us feel overwhelmed. Here's a brief but thoughtful piece regarding balance. As you consider your future career, 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 that in order to guide yourself in the right direction.

Accomplished, Not Lovely

A few years back I went to hear the author Nicole Krauss speak about her novel Forest Dark. I am a big fan of Krauss' writing (especially the History of Love in case you are looking for something wonderful to read). The day I heard the author speak, she had published an opinion piece in the NYT Sunday Magazine called "Do Women Get to Write with Authority?" In the article, Krauss speaks about the lack of authority that women writers have compared to men, and specifically, how female artists' work is often characterized as "lovely," a word she describes as lacking in "independent power."

I must admit that I sometimes use the word "lovely" (both for women and men) when I like someone. But Krauss made me think about the word in the context of achievement - not personality - and her point is well-taken.

What does this have to do with medical school and residency admissions? When you interview, you want the faculty member to leave the table saying you were "accomplished," not "lovely." Many applicants miss this point: You don't want to simply be liked; you want to be seen as worthy. It's important that you focus on that important goal as you practice for interviews.

Silent No More

My colleague and friend Dr. Resa Lewiss (of FeminEm podcast fame) wrote this compelling opinion piece with Dr. Katherine Sharkey regarding sexual harassment of women in medicine - its prevalence, its professional and emotional consequences, and the need to stop it. The article is worth a read. 

White Coat Investor Scholarship Winners Announced

For the past few years, the White Coat Investor has funded a scholarship for full-time professional students, including those in medical, osteopathic, dental, law, pharmacy, nurse practitioner, physician assistant, optometry, and podiatry schools. The goal is to both reduce the winning students' debt burden and spread "an important message of financial literacy throughout medical, dental, and other professional schools."

This year's first place winner's essay is here. It's great and worth a read. Second through fifth places can be found here. Keep your eye out for next year's contest. The financial support is significant. 

A Medical School Applicant's Secret Weapon

I heard a recent piece on  NPR's "All Things Considered" called "Uncovering A Huge Mystery Of College: Office Hours." The broadcast argues that taking advantage of the opportunity to develop a one-on-one relationship with a professor can bolster a student's college success. Yet, many college students are too nervous to attend office hours. 

Despite what some students consider a nail biting experience, office hours for pre-meds are particularly important because they provide a means for professors to get to know students so that those faculty members can write strong letters of recommendation. I have a doctor friend who told me that he went beyond traditional office hours: During his undergraduate years, he got acquainted with a few professors by inviting them to lunch at his dorm. He had to call several times before one professor got back to him, but once they did have lunch, my friend's opportunities really expanded. That professor realized my friend's intellectual potential and good nature and offered him a position on an honor committee and a strong medical school recommendation. 

As they say in the NPR broadcast, "... when you go to office hours, you're actually letting the professors do their job."

Residency and Medical School Interviews: What Is the One Thing You've Learned...?

I was with my children at a four year-old's birthday party a few years back when I met the grandfather of the birthday-boy. As it turned out, before retiring, the man had been on the admissions committee of a prestigious California medical school for decades.

So, I asked him, "Looking back at all of those years of experience, what is the one thing you learned from interviewing medical students?"

The man chuckled and said, "They have no idea what they're getting themselves into."

In life, we never really have an idea what we're getting ourselves into, but I think of this man every time I practice the question "What will you like least about being a doctor" or "...least about being a [insert your medical specialty here]" with my medical school and residency applicant clients, respectively. Saying you'll love everything about being a physician or psychiatrist or pediatrician or internist sounds disingenuous and naive. You need to show that you have some idea what you're getting yourself into.

Having said that, I would avoid tacky topics like money. And talking about how horrible night shifts are is not going to win you many points. But a sophisticated applicant can infer what the challenges will be in medicine or in her specialty and can express them with aplomb.

...As with everything, practice in advance.