At this point I've covered pre-med, applying to med-school, and what goes on in years1-2 and 3-4 in med school... so now that you've successfully completed all of your required courses, rotations, and steps 1 and 2 of the board exams, you're almost a medical school graduate, and (gasp) a real live doctor. But what has to happen to get yourself a job after graduation.... otherwise known as residency training. Well, it's pretty complicated and stressful actually, and it all starts with what, for some people, can be an agonizing decision... what kind of doctor do you want to be? At first glance it seems like this should be an easy decision... but let me say this: I'd say at least half of the people who enter medical school thinking they want to be one kind of doctor ultimately decide over the course of the four years, that they'd rather be a different kind.
Case in point - I always wanted to be an OB/ GYN... in college I did a semester-long shadowing experience with a gynecologic oncologist (he dealt with cancer of the lady parts - ovarian, endometrial, etc), during the first two years of medical school I was vice-president and the president of the OB/GYN interest group... but then I got out on third year rotations, and once I was actually experiencing the day to day realities of being an OB/GYN, I realized it wasn't for me. I loved OB - prenatal care and delivering babies is awesome - and I didn't mind office GYN (PAPs, pelvic exams, etc), but I hated (in fact despised is probably a better word) GYN surgeries. I knew that if I had to spend a significant portion of the rest of my life (because let's face it, OB/ GYN is really a surgical specialty) doing vaginal hysterectomies I would lose. my. shit. I would end up pulling out my own hair and being miserable.
So here I was, having spent at least the last 5-10 years absolutely certain I knew what kind of doctor I wanted to be, and this was completely ruined for me inside of 6 weeks. Now what? I had to choose something else I wanted to do....surgery: nope - I like being able to sit, and pee, and eat when I want to; ER: not bad but I didn't want to miss out on continuity of care; internal medicine: interesting, and I really like inpatient medicine (ie taking care of patients in the hospital) but I'd miss out on working with kids; Pediatrics: I like the kiddos, their insane parents not always, and I love, love, love the elderly and I would miss out on working with them.... and then somewhere toward the end of 3rd year it dawned on me... hello, family medicine! It combines pediatrics, adult medicine, geriatric medicine, OB/ GYN, inpatient medicine, outpatient medicine, continuity of care.... ta da! Perfect combination!
In some circles family medicine has the reputation of being the specialty people go into when they don't have good enough grades to get into any other specialty. In my opinion family med is one of the most challenging fields of medicine - you have to know SO much about so many things and you're constantly switching "hats" as a provider - delivering a baby one minute, admitting a patient to the hospital the next, then back to the office to see a 70 year old with high blood pressure and chest pain, followed by a 3 year old well-child physical. I was lucky enough that my grades and board scores were good enough that when it came time to apply to residencies, programs could see that I wasn't choosing family medicine as a "last resort," but that it was truly something I wanted to do.
Anyway.... once you've decided on what specialty you'd like to go into, you next need to apply. There is a lovely service that handles all the applications for all the medical students (and foreign graduates trying to obtain residency spots in the US) for all spots in all residency programs... whew! Their website can be found here. On this site you create your profile with all your demographic info - name, date of birth, medical school, address, phone number, email, anticipated graduation date, etc - and upload such things as letters of recommendation, and (here it is again) your personal statement,and where your school will submit such things as your dean's letter. There is also an area for you to request that all of your scores from the various steps of the national board exam to be submitted to this application service.
A word about letters of recommendation and your dean's letter. You will be asked to either waive your right to read these things or not. There are many schools of thought about what is the right thing to do, and ultimately the decision is yours. For what it's worth, here are my 2 cents: waive them. That way programs will know that you did not influence their content in any way. That being said, there have been horror stories about schools submitting dean's letters with incorrect information, and if you waive your right to see it you will never know it's there and could potentially be sand-bagged by it. In the end - do what you feel is real.
For this round of the much reviled personal statement, they no longer want to know "why do you want to be a doctor," they want to know "why do you want to be this kind of doctor." Again, originality will stand out, but you also don't want to be too outlandish...if you've never written a poem before now is not (I repeat NOT) the time to start! Give consideration to what the specialty is all about, and why this appeals to you/ why you think you would make an excellent physician of this type. Why is this field of medicine where your passion lies? Also, think about the program itself, and why you want to go there/ why you would be a good fit there. Please note it is OK for you to talk yourself up a little bit.... but don't over inflate yourself too much to the point where the person reading your personal statement is left thinking "bullshit," or "what a pompous ass."
Osteopathic students have one additional step: you can choose to apply via the osteopathic match, the allopathic match, or both. Some residency programs are osteopathic only, some are allopathic only, and others are dually accredited. If you're only applying to one type of program, only apply via that match process. If you're applying to both types, or to dually accredited programs, apply via both matches. Keep in mind that the osteopathic match actually takes place about a month before the allopathic program, and that you may have a better chance applying to dually accredited programs via the osteopathic match (since they have separate slots reserved for DOs through the osteopathic match, and for MDs through the allopathic match, and if you apply through the allopathic match and all of the DO slots have been taken through the osteopathic match you will likely be SOL; also if you do match into a dually accredited program through the allopathic match, you won't get credit from the AOA - American Osteopathic Association - for your intern year unless you do a whole lot of ridiculously complicated paperwork, and even then it's no guarantee... all of this is very confusing, and if you want more specific information, feel free to comment below).
Once everything is uploaded and ready to go, it's time to designate programs to receive this packet of information. But how do you actually choose which program is right for you? Well, there are several factors to consider. As with real estate, one important factor is: location, location, location. If there is a certain area you want to be in and that is more important than other factors, then apply only to programs in that area.
Other things to consider are the size of the program - how many residents are there per year and overall? Do you want a smaller program or a larger one? Another consideration: do you want to be in an academic teaching hospital - typically larger, in a city, and with an emphasis on research - or in a smaller community hospital - typically more rural, not affiliated with any one particular school. One other thing to think about is do you want a program that is unopposed - in other words, the only program at a hospital. This is a particularly important aspect to think about when applying to family medicine programs. If you do a family medicine residency at a hospital that also has residency programs in internal medicine, OB/GYN, and/ or pediatrics, you may (and I say may, because I know for a fact that this is not the case at all programs) end up being second in line for inpatient admissions (both adult and pediatric) or deliveries, etc. Just something to think about.
OK so your application is ready to go, and you've elected which programs you want to send it to. Now comes the part where you pay a bunch of money to have the application sent out, and then you wait to hear back from programs. You will either be invited to interview, or not.... or in some cases inconsiderate programs will just not get back to you all together (shame on them, what would their mothers say about their manners?). Interviews typically involve dinner the evening before with some of the current residents - informal, but be on your best behavior because I'm sure that what goes on at these dinners gets reported back to the residency and factors into their decision about you at least a little bit. This is a good chance to ask a few of those burning questions of the residents such as: are you happy here? would you choose to come here again? etc. That being said, don't grill them like it's the Spanish Inquisition - you will come off as overbearing and more than a little crazy. Most residency programs will put you up at a hotel for the night, so after dinner that's where you'll head. Use the time to do your homework - read up on the various aspects of the program you're about to interview at - get to know the things that make them unique, and find the obvious answers to the questions you have that, if asked the next day, will only serve to make you look unprepared (ie how many residents do you have here?). Get a good night's sleep, and make sure that fancy suit is ready to go (kudos to you if you can still fit into the same suit you wore for medical school interviews! No easy feat... and yes, it still counts if you have to pull on Spanx underneath to get that zipper to close).
The actual interview day usually begins with a welcome/ introduction, sometimes includes attending morning report or sign-out, and almost always includes a tour. You will undoubtedly hear from the program director, and maybe a resident or other faculty member. Then you will get to the nerve wracking part - the interview(s) themselves. Places that I interviewed at, for the most part, had a series of low-key conversational interviews with a faculty member or two and a current resident or two. Be prepared to discuss your personal statement, any research or extracurricular activities you participated in in medical school, and any less than stellar aspects of your record (disciplinary action, poor board scores/ board failures, extending your medical school program beyond 4 years, etc).
***INTERMISSION***
Still with me? This post is becoming something of a marathon! Hang in there... it's important and confusing stuff for those of you getting ready to go through this process.... I'm trying to write about the stuff that I wish I had know before/ when I was going through all of this!And now back to our regularly scheduled programming.....
So, you're done on the interview trail, and now you have to sit back and try not to bite your fingernails down to bloody nubs while awaiting match day. Make sure you've registered for the match or matches you will be participating in.... more demographics, more money. The website for the allopathic match is here, and the website for the osteopathic match is here. Don't forget to create your "rank order list" (just like what it sounds - a list of the residency programs you hope to match into listed in order of preference), and to certify it by the deadline.
You submit your list of programs, and programs submit their list (again in order of preference) of the applicants they're interested in... and some magical computer program somewhere does some sort of voodoo and matches the two together to come up with the most favorable combinations possible for the most number of applicants/ programs possible and compiles the all-important match list.
If you've applied through the osteopathic match, you will find out both whether or not you've matched, and where all on the same day via the same email. If you've applied through the allopathic match you will learn your fate roughly a month after the osteopathic match, and will learn whether or not you've matched a few days before you find out where (if you were lucky enough to match). If you did not match, you can do what is known as "scramble," which is where you look at the list of programs that have unfilled spots, and submit your application to these programs again and often times do phone interviews, and then hope to match there.
A few things to note: if you've applied via both the osteopathic and allopathic matches and you match into an osteopathic program during the osteopathic match which takes place (as I've said) about a month before the allopathic match, that match is binding, and you cannot then go through the allopathic match. So choose how you rank your programs carefully and wisely. I'll use myself as an example. I registered with both matches, and ultimately decided that I wanted to rank 5 programs (note: you do not have to rank all the programs you interviewed at - if you went somewhere and thought "uh, thanks but no thanks," leave them off your list). Of those 5 programs, three were dually accredited, and two were allopathic only. My first choice was leagues above the rest in terms of my desire to go there, and it was dually accredited. As I explained above, I had a better chance of matching there if I went through the osteopathic match. My second and third choices were allopathic only, so I couldn't rank them through the osteopathic match. My fourth and fifth choices were dually accredited as well, but much much lower on my list of choices than my second and third.
What was I to do? I didn't want to rank my 1st, 4th, and 5th choices in the osteopathic match in case I didn't match at my 1st choice and ended up stuck in my 4th or 5th choice without even having a chance at my 2nd or 3rd choice since the osteopathic match is earlier and binding, so I would have had to have withdrawn from the allopathic match. In the end I took a bit of a gamble. I ranked only my 1st choice in the osteopathic match, and ranked all the others in the allopathic match. Luckily it worked out, and I matched into my 1st choice and didn't even have to worry about the others.
While MD students have it somewhat easier in terms of ranking programs, osteopathic students have the advantage of essentially having 4 chances to match: the osteopathic match, the osteopathic scramble, the allopathic match, and the allopathic scramble.
So here I sit, having completed medical school, matched, and graduated, and as of 3:30 this afternoon having completed my residency orientation. I'm on the eve of my first shift as a real, live doctor.... or resident at least. One of my attendings here was coaching us on what to say if patients ask if we're real doctors: "Yes, I am a doctor, and now I'm getting extra training in family medicine." Very truthful, and very tactfully put.
Tomorrow I start a month of what is known as "Night Float." I will be working nights from 5PM until 7AM taking care of all the patients admitted under our services in the hospital, answering after-hours phone calls from patients, delivering babies, going to codes, and admitting patients who come into the ER and need to be hospitalized. Thankfully I will have a second and third year resident alongside me at all times, but tomorrow night is still going to be a huge shock to the system... especially when I introduce myself as "Doctor" to that first patient. Despite the fact that tomorrow is also my birthday and I will be 28, I still don't feel old enough to have earned that title....I'll let you know how it goes!
1 comment:
You are amazing Doctor Benoit! Happy Birthday, Love, Maggie :)
Post a Comment