The Week I Spent 138 Hours in the Hospital and What it Means for your Residency Application

During my internship, on my surgical rotation, I once spent 138 hours in the hospital in one week. If you think this isn't mathematically possible, I will tell you that I was on call from Monday morning to Tuesday evening, from Wednesday morning to Thursday evening, in-house on Friday, and then on call from Saturday morning until the next Monday morning. (I had to stay in-house that Monday until evening rounds were over too.) As you can imagine, I was barely human by the end. How this schedule was good for patient care is beyond me.

I thought of that ghastly time recently when reading this oldie-but-goodie article in the New York Times called "How Job Stress Can Age Us" written by Dr. Dhruv Khullar. The author reports on a study, "Physician-Training Stress and Accelerated Cellular Aging" that assessed the DNA of 250 first-year medical residents around the country. Researchers examined the saliva samples of these residents, focusing on their telomeres - the bumpers at chromosome ends that prevent DNA damage - before and after the first year of residency. Researchers found that the DNA of first-year residents aged six times faster than normal. 

Six times faster.

I found this both shocking, upsetting, and validating. Residency training is as hard as we think it is. 

What I would strongly recommend is that you compare residency programs' hours as you decide where to apply and before you create your Match list this coming winter. Strangely, many applicants don't even consider this important issue when making decisions about their next three to five years. Also, many residencies support physician wellness programs and night coverage. Especially in the setting of severe burnout among doctors, your happiness should be a primary factor in your career choices. If you're not sure, consider your shrinking telomeres. 

What Kind of Job Do Female Emergency Physicians Want and How Might that Affect Your Career Choices?

Recently Dr. Thomas Cook, a program director in South Carolina, wrote an article in Emergency Medicine News describing a study about my field - emergency medicine's - workforce. 

The data found interesting differences between male and female emergency physicians. For respondents, geographic locations was the only factor that was "very important" to more than half of the women (52%) but only 42% of the men. Interestingly, compensation was "very important" to 49% of the men and only 27% of the women. Proximity to family was "very important" to 38% of the women but only 27% of the men. 

Currently more than 50% of medical students are women and yet only one in three chooses emergency medicine for a career. Nationally, only 25% of emergency physicians are women. Using data to better understand what women emergency physicians are seeking might help the field improve the gender gap. 

Applying in Two Specialties

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.

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.

As always, contact me for help. 

Five ERAS Platform Quirks to Heed

On September 1, 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.

Now That You've Gotten an Acceptance to Medical School...

Congratulations to all of my clients who will be starting medical school soon. This is a tremendous achievement. For those who hope to matriculate in the next year or two, I might recommend this Varsity Tutors piece that I wrote several years ago and the follow up article. The "medical school paradox" is a tough one to crack, but if you prepare in advance, you'll have an excellent head start and a professional advantage.

Something You Probably Haven't Considered Could Have a Huge Impact on Your Professional Happiness

A recent article in Emergency Medicine News caught my eye. Emergency physician Dr. Tom Belanger conducted a small study (n=573) in which he crafted a nine-question Likert scale survey and then attempted to predict emergency physicians' employment structures based on respondents' answers. He used statements like "I am paid fairly," "I am secure in my career," and "Emergency medicine is a good career" in his survey.

In medical school and residency, I thought little about employment structure, which can include democratic, hospital employee, contract management, independent or locums, academic, resident, or government systems. As a student, I was so focused on what specialty I would choose and was so influenced by the academicians I worked with that I didn't even consider that I could choose a field in which I might be happy in one employment structure and discontent in another. 

Belanger found that employees of contract management groups (CMGs) tended to be the most negative respondents, and owners of CMGs were not far behind. On the other hand, owners of democratic groups were the most positive in almost every aspect. 

In this study, all respondents were in the same specialty and yet, employment structure divided respondents with regard to their career satisfaction. Belanger's graphs are worth viewing in his piece, but the take-home point for medical students and residents is the importance of the employment structure in which you ultimately work, a topic that may not have even crossed your mind until now. 

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 grades. In reading the article, residency applicants should reflect on how important the content of their letters of recommendation is, especially in the setting of medical school grades that may be inflated or simply inaccurate. The 2020 NRMP Program Director Survey 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.

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

For many third-year medical students, this is a challenging time of year: Contemplating an ERAS application can be daunting, but it's even worse if you don't know what specialty you want to practice. Here's a short piece I wrote with my colleague David Presser, MD, MPH called "Choosing a Specialty: The Generalist vs. The Early Committer," and here's a complementary (non-medical) New York Times article called "You Don't Want a Child Prodigy" that's a great follow-up piece.

An Oversupply of Emergency Physicians?

When I applied in emergency medicine (EM), I had only two other classmates submitting applications to the field. EM wasn't a very popular specialty, although that would change as the show ER became hotter. Although enthusiasm for the field has generally increased over my career, medical students' interest in EM has waxed and waned.

Recently an eight-organization consortium of EM groups analyzed the field's workforce, demonstrating an oversupply of emergency physicians likely to appear over the next decade. There are a number of reasons proposed, including the proliferation of EM residencies and inappropriate use of physician extenders. Take a look at this piece in ACEP Now for detailed information, especially if you see EM in your future.

AMCAS Opens for Submission on Thursday

The AMCAS open-for-submission date is this Thursday, May 27. While submitting on Thursday is to your advantage because of rolling admissions, getting that application in at 9:30am EST on May 27 is not worth losing your mind over, so if you simply can't, please don't kick yourself.

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

Expert Writing Tips

With AMCAS' submission open date fast approaching (on May 27), I thought I might lower the boiling point a little by offering an amusing group of writing tips based on the wit of the late author William Safire and copywriter Frank LaPosta Visco. Enjoy!

A writer must not shift your point of view.
Always pick on the correct idiom.
Analogies in writing are like feathers on a snake.
Always be sure to finish what
Avoid alliteration. Always.
Avoid archaeic spellings.
Avoid clichés like the plague. (They're old hat.)
Avoid trendy locutions that sound flaky.
Be more or less specific.
Comparisons are as bad as clichés.
Contractions aren't necessary.
Do not use hyperbole; not one in a million can do it effectively.
Don't indulge in sesquipedalian lexicological constructions.
Don't never use no double negatives.
Don't overuse exclamation marks!!
Don't repeat yourself, or say again what you have said before.
Don't use commas, that, are not, necessary.
Don't be redundant; don't use more words than necessary; it's highly superfluous.
Eliminate quotations. As Ralph Waldo Emerson once said, "I hate quotations. Tell me what you know."
Employ the vernacular.
Eschew ampersands & abbreviations, etc.
Eschew obfuscation.
Even if a mixed metaphor sings, it should be derailed.
Everyone should be careful to use a singular pronoun with singular nouns in their writing.
Exaggeration is a billion times worse than understatement.
Foreign words and phrases are not apropos.
Go around the barn at high noon to avoid colloquialisms.
Hopefully, you will use words correctly, irregardless of how others use them.
If any word is improper at the end of a sentence, a linking verb is.
If you reread your work, you can find on rereading a great deal of repetition can be avoided by rereading and editing.
It behooves you to avoid archaic expressions.
It is wrong to ever split an infinitive.
Never use a big word when a diminutive alternative would suffice.
No sentence fragments.
One should never generalize.
One-word sentences? Eliminate.
Parenthetical remarks (however relevant) are unnecessary.
Parenthetical words however must be enclosed in commas.
Place pronouns as close as possible, especially in long sentences, as of ten or more words, to their antecedents.
Placing a comma between subject and predicate, is not correct.
Proofread carefully to see if you any words out.
Prepositions are not words to end sentences with.
Profanity sucks.
Subject and verb always has to agree.
Take the bull by the hand and avoid mixing metaphors.
The adverb always follows the verb.
The passive voice is to be avoided.
Understatement is always best.
Use the apostrophe in it's proper place and omit it when its not needed.
Use youre spell chekker to avoid mispeling and to catch typograhpical errers.
Who needs rhetorical questions?
Writing carefully, dangling participles must be avoided.

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 can match two categories. When that happens, lean on the clinical categories, 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.  

How To Craft Stand-out Most Meaningful Paragraphs

Back in 2012, seemingly out of the blue, a new component appeared on AMCAS®. Applicants were being asked to identify up to three of their most significant extracurricular experiences and support their selections with more writing. The instructions stated:

This is your opportunity to summarize why you have selected this experience as one of your most meaningful. In your remarks, you might consider the transformative nature of the experience, the impact you made while engaging in the experience and the personal growth you experienced as a result of your participation. 1325 max characters.

Now the Most Meaningful Paragraphs are par for the course, but applicants routinely make a few avoidable errors in crafting them. Here are tips to do your best work:

1) Don’t merge the descriptors with the Most Meaningful Paragraphs; they are separate sections: You can complete descriptors for up to 15 activities with a maximum of 700 characters each, plus up to three Most Meaningful Paragraphs with a maximum of 1325 characters each. The fact that these are two different tasks might seem clear to some, but every year, I receive AMCAS drafts to edit with merged descriptors and Most Meaningful Paragraphs. 

2) Don't use patient anecdotes in your Most Meaningful Paragraphs: Most medical school applicants have patient vignettes to share, which means that a patient story does not distinguish an applicant from the masses of other candidates. Also, these patient stories can sound trite or even inadvertently condescending. Talk about yourself instead. (See below.)

3) Don’t repeat what you've written in your descriptor. The Most Meaningful Paragraphs are an opportunity to delve deeper into your achievements. Let’s say you're showcasing your experience as a teaching assistant (TA) who was promoted to head TA or simply asked to return the next semester. Highlight teaching achievements that propelled you to get the lead position or the return invite. Did you offer an unconventional way of learning the difficult material? If so, what was it? Did you provide service that was above and beyond what was required? If so, what exactly did you do and how did it help your students? Did you get excellent teaching reviews? By delving deeper, you can truly demonstrate the “transformative nature of the experience, the impact you made while engaging in the experience and the personal growth you experienced as a result of your participation.” Make sure you address at least one of the three topics mentioned in the prompt - transformative nature, impact, and/or personal growth - in your Most Meaningful Paragraph. 

Bottom line: The Most Meaningful Paragraphs are an opportunity for you to demonstrate your distinctiveness and worthiness for medical school. Write substantively to make sure you don’t waste the opportunity to further your candidacy.

Ten AMCAS Mistakes You Absolutely Want to Avoid

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

1. Don't write to write, and don't fill to the maximum character count unless necessary. 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 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, and 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.

You Can't Be It If You Can't See It

I had the great opportunity to see the film Black Men in White Coats last week as part of an HMS alum event. The documentary follows several African American male doctors and, in particular, the founder of the Black Men in White Coats organization Dr. Dale Okorodudu, a pulmonary and critical care physician. Here's the trailer for the film. 

African American men represent only 2% of all physicians, and they are applying to medical school in lower numbers than decades ago. Dr. Okorodudu is trying to improve those numbers through his organization's efforts, including impressive outreach to kids.

If you have a chance to see the film, I highly recommend it. 

What Makes New Yorker Articles So Good?

I have a dear medical school friend who gifts my family the New Yorker every year at the holidays. The New Yorker is one of the best Chanukah presents we receive, and we get to appreciate it weekly, which makes it even better than the usual candy and fruit baskets. What makes New Yorker writing so good is that the journalists offer facts and then let the reader make his/her own assessments. A subject's own words or the description of his/her home office or clothes or even gait tells it all. There is no need for convincing.

Currently, as I'm editing medical school essays, I'm reminding my clients of the importance of that principle in writing a strong personal statement. To an admissions reader who hasn't yet met you, you are what you've done. It's the facts that matter. You need to use substantive examples of your achievements to demonstrate your worthiness for a potential medical school position. Evidence is persuasive; use it!

Tomorrow Belongs to Those Who Can Hear it Coming: AMCAS is Opening Next Month

This year's AMCAS application will open on May 3 at 9:30AM EST, and candidates will be able to submit their AMCAS applications beginning on May 27 at 9:30AM 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-seventh; it means you should start early enough that you are offering 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 times 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.

How to Use the MSAR to Your Advantage

The Medical School Admission Requirements (MSAR) is an online database that allows users to search, sort, and compare information about U.S. and Canadian medical schools. The 2021 MSAR is out, and if you are applying to medical school, I'd recommend purchasing it ($28 for one year and $36 for two) because it provides so much information about schools and their admissions statistics. The MSAR allows you to sort and compare schools by median MCAT scores, AMCAS GPAs, and other criteria.

You should use the MSAR to help determine which schools are in your range and which are "reach" schools. While it's fine to have a lot of reach schools  (if you can afford it), it's critical to ensure you are applying wisely to schools that match your numbers; in other words, do not apply to reach schools at the expense of those in your range. 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.

 

White Coat Investor Podcast Interview

Two years ago this week (which may seem like a lifetime ago), I was honored to be the featured interviewee on the White Coat Investor (WCI) podcast. For those of you who aren't familiar with WCI, it's a website/blog/podcast founded by James Dahle MD, an emergency physician whose interest in personal finance and the FIRE (financial independence - retire early) movement has sparked a slew of physician devotees. My interview focused on how Insider Medical Admissions helped me create autonomy and flexibility while balancing a clinical career and a family. Check it out here or on your favorite podcast app. 

On Your Mark. Get Set. Go: It's Match Week.

At 11am EST today (8am here on the West Coast) applicant Match statuses becomes available and SOAP starts. If you're looking for a way to distract yourself with interesting material, take a listen to last week's wonderful Planet Money podcast on matching algorithms called "The Marriage Pact." The episode starts with a reference to my alma mater Stanford (go cardinal), reviews an innovative dating algorithm, and touches on the NRMP Match system.