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.

AAMC Virtual Medical School Fair

For those of you applying to medical school this year or next cycle, the Association of American Medical Colleges (AAMC) is holding an online medical school fair on October 17 and 18. Topics for the first day include financing medical school, combined degrees, and a timeline for application. On the second day, medical schools and student groups will be available to answer questions. I'm registered and looking forward to the conference. Of note, if you've not yet subscribed to the Medical School Admissions Requirements (MSAR), you should wait until you've signed up for the fair, as your registration will include a 15% discount on the MSAR database.

15 ERAS Tips to Boost your Residency Candidacy

Below are tips I've cultivated over the years for crafting the best ERAS Experience Section. (Please remember that this year's ERAS is slightly different from past years'. For more information on the changes, click here.)

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. As of this year, you have only 10 slots, so avoid minor activities (like an afternoon health fair). 

3. Write in a streamlined fashion. Avoid verbiage. Of note, as of this year, you can choose three most meaningful activities, but you only have 300 characters for each. So while you want to explain why the activity was impactful, you'll need to keep your writing here especially tight.

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 (position title, location). 

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.

 

AI-Generated College Essays

"I hope this letter finds you well..."

When my family and I played around with ChatGPT - asking it to craft silly letters to different people – every ChatGPT response started with that phrase. I quickly realized that originality is not ChatGPT's strong suit.

On top of the fact that most institutions consider AI-generated essays to be unethical (even plagiarism, at Yale), an applicant's ability to write something distinctive (and persuasive) is really what demonstrates his or her worthiness for competitive university spots.

I found this amusing New York Times piece called, "We Used A.I. to Write Essays for Harvard, Yale and Princeton. Here’s How It Went" reinforced my strong distaste for AI-generated personal statement writing.

Although challenging to craft, your written materials are a tremendous opportunity to showcase your creativity and further your candidacy.

Medical School Interview Tips: What Do Admissions Officers Really Want?

Congratulations to those who have already been invited for medical school interviews. It's early in the season, so if you're an applicant who hasn't been invited yet, don't be dismayed.

Getting into medical school has gotten so competitive; the interview is critical. But what are medical schools looking for during the interview process?

1. They are seeking someone distinctive. Your goal is to distinguish yourself from all of the other applicants by showcasing your accomplishments. Anyone can say s/he wants to help people or is hard working. Fewer candidates can prove it with their pre-professional achievements.

2. They want to ensure you're committed to medicine and that you have an idea of what you're getting yourself into. Medical school is tough; the institutions are not seeking someone who is ambivalent and might quit. Giving examples of your clinical experience can help.

3. The schools want to ensure you're reasonable. They want to see that you don’t have a problem personality, aren’t going to harass your colleagues, aren’t going to cause them embarrassment or extra work. Being professional during the interview day and having strong letters are important.

4. They want to hear you're particularly interested in their institution. You can convince them of your interest by knowing specifics about the school and city.

One would never take the MCAT without practicing first and yet, countless applicants go to medical school interviews without preparing. If you are interested in working with me, please hire me soon, as I'm booking up for September. 

How Might the Supreme Court Decision about Affirmative Action Affect Medical School Admissions

The American Medical Association (AMA) recently sponsored an interesting webinar on how the Supreme Court affirmative action decision might influence medical schools. Invited faculty included representatives from the AMA, Accreditation Council for Graduate Medical Education, Association of American Medical Colleges, University of California (UC) Davis Medical School, and Meharry Medical School. I recommend listening to the recording or reading the transcript. (You can get CME credit for doing so, as a bonus.) 

There are a few points I found particularly interesting: 

1. An African American physician has a likelihood of seeing African American patients at a rate that is approximately 23 to 24 times that of a white physician.
2. Among first-year medical students, 62-63% of African American pupils say that serving an underserved population is what they want to do when they finish their education, whereas white and Asian students are in the twentieth percentiles in reporting that they want to serve those same populations.
3. UC Davis Medical School is employing multiple, creative techniques to improve diversity at their institution, including implicit bias mitigation training and the implementation of a medical school track called Avenue M – focused on applicants who went to community colleges. Consequently, at UC Davis, over 50% of students coming from disadvantaged or underrepresented-in-medicine backgrounds make up their classes.

You can find the AMA webinar and transcript here.

Medical Debt Can Be Crushing

I recently saw a short piece in US News that reported that the average debt among medical school graduates who borrowed for their medical education was $184,000, excluding undergraduate loans. 

There are many reasons to think hard about a career as a physician, and monetary ones are first or second on the list. For those with severe financial need, the AAMC offers their Fee Assistance Program (FAP). (Please note that I also offer a discount for those who have a current FAP grant.)

Most applicants, however, don't qualify for the FAP and may be looking at hundreds of thousands of dollars of debt after they complete their medical education. For many reasons, make sure that a career as a doctor is the right one for you.

Accomplished, Not Lovely

Pre-pandemic, I went to hear the author Nicole Krauss speak about her novel Forest Dark. I'm a big fan of Krauss' writing. 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 highlights the lack of power 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.

With medical school interviews starting soon, you should keep in mind that you want the faculty member you've met to leave 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 critical that you focus on that important goal as you practice for interviews, crafting strategic, substantive responses to potential questions. 

I would strongly recommend Krauss' History of Love (her best book in my opinion), Great House, Forest Dark and To Be A Man.

Four Thousand Weeks

I'm currently reading a fantastic nonfiction book called Four Thousand Weeks: Time Management for Mortals by Oliver Burkeman. Four thousand weeks is how much time the average human has on this earth. That doesn't sound like a lot.

I'd highly recommend the book to those of you who are productivity geeks, folks who are trying to be as efficient as possible with their time - all the time. I'm certainly one of those people.

Unlike other authors, Burkeman recommends that you surrender to the fact that you cannot get everything done and that traditional time management strategies, which are supposed to help you multitask, will fail and cause anxiety. He recommends recognizing that our lives are finite and that we should be in the moment. The author does a fantastic job of persuading even someone like me how important it is to recognize that even if you get your list done, there will always be more items on your next list. 

I'm not much into self-help, but I do recommend this intelligent book.

Important Updates to the Residency ERAS

Other than implementation of the supplemental ERAS for select specialties, the residency ERAS hasn't had many modifications over the past decade. However, this year the AAMC overhauled the application in several significant, positive ways:

1. In past years applicants could include as many activities as they wanted, which put a big burden on both candidates and faculty readers. Applicants didn't know if they should include activities as far back as college (or even high school) and were afraid to leave anything out. Faculty were faced with some applications that were excessively long, chocked full of unimportant information or remote accomplishments. 

This year candidates can focus on as many as 10 experience entries - but no more - and can designate three as their most meaningful (like the AMCAS) with a short, additional description for each. 

2. Applicants will also be able to choose from more "experience types" than they had in past years and will be asked to provide more descriptive information about their activities. 

3. Candidates will have the opportunity to complete an "impactful experiences" section where they can describe any hardships (family, financial, education, etc.).

4. Applicants can communicate their preference for a particular geographic division or for a rural versus urban setting.

5. Candidates applying to specialties and programs who opt in can participate in "program signals" to express particular interest in a residency program. 

In general, I find these changes constructive and helpful. 

For more information, take a look at this summary from the AAMC. Contact me for personalized ERAS help. 

How to Excel During Your (Emergency Medicine) Rotation

Many medical students just starting their fourth years are coping with specialty-specific electives and sub-internship rotations. What are the tricks to making a good impression during these clerkships? Here's a piece I wrote on how to succeed in your emergency medicine rotation; many of the tips translate to other specialty rotations as well. 

A Novel Approach: Reading throughout your Rotations

I had a thoughtful advisee years back who told me about an interesting plan she had made for herself: As she rotated through different specialties during medical school, she read a book appropriate to each field. For internal medicine, she read "Being Mortal," by Atul Gawande. For neurology, she read the classic "The Man who Mistook his Wife for a Hat," by Oliver Sacks. For surgery, she read "When Breath Becomes Air," a beautiful book by Paul Kalanithi. The list goes on.

I was impressed by this contemplative approach to third and fourth year. So many of us are understandably focused on Shelf Exams and letters of recommendation that we don't give ourselves a chance to comprehensively reflect on our subject matter and patients' experiences.

If you have a moment, please check out a few book recommendations I have for those in the medical field. Perhaps my advisee's stellar plan can be one that other medical students adopt. (You'll see that I strongly recommend Cutting for Stone. Dr. Abraham Verghese has a new book out that I'm reading right now called The Covenant of Water.)

"Optional" Secondary Essays: Are They Really?

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 your essay is substantive and not fluffy.

Don't Let ERAS Kick Y'ERAS

Just a reminder for residency applicants: ERAS tokens are now available for IMGs, and all residency candidates can start registering and submitting supporting documents on the myERAS website. Even if you aren't ready to start working on your application, I'd recommend registering and taking a look at what will be required of you. 

Additionally, I suggest you begin researching programs now, if you haven't already. Residency Explorer allows you to compare your candidacy to those of applicants who have successfully matched to specific residency training programs in the past. You can also search the American Medical Association's FREIDA database.

Getting started early will help you develop confidence and a strong plan of attack for the upcoming application season.

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

For many third-year med students, this is a challenging time of year. Preparing an ERAS 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, but non-medical, New York Times article called "You Don't Want a Child Prodigy" that's a great follow up to our piece. 

Moral Injury

It's troubling, but make sure to read this recent piece in the New York Times called "The Moral Crisis of America's Doctors" about physicians' "moral injury." The phrase refers to emotional damage caused to workers – when in the course of fulfilling their duties – they commit an act or acts that conflict with their core values. The piece argues that, in part, our profit-driven system causes doctors moral injury and, in turn, they become depressed and/or burned out.

I remember many times when I had only bad alternatives in directing my emergency patients for follow-up: If they had no insurance, our knowledgeable social workers advised us that our sole option was to send those patients to the public hospital nearby for follow-up care. This meant I would splint someone with a non-operative, non-emergency fracture and advise him/her to then be seen at another hospital's emergency department with a multiple-hour wait because that was the only way to get into the system for the affordable orthopedic clinic. I found this very upsetting and contrary to what seemed right to me: It was so hard on the patients, and it also burdened the already overwhelmed medical system.

If you're interested in recent physician burnout statistics, please see this February 2023 blog on the topic.