medical school

Favorite stupid thing I taught myself on medicine wards was the incredibly reductive guide to etiologies of hypervolemia (especially for hypervolemic hyponatremia): your heart sucks (CHF), your liver sucks (Cirrhosis/Portal HTN), your kidneys suck (ESRD/AKI), or your doctor sucks (iatrogenic fluid overload).

kinda love this, tbh

After one more overnight ER shift tonight, I am free for the next like 6 weeks for nonstop interview madnesses. I am beating up my credit card pretty badly, but other than that, 4th year is basically the best year.

Also now they have let me interview a few applicants for med school, and they are basically all smarter and more accomplished than I was, I think. However, it's too late now I am gonna be a doctor hahahaha suckers!

gotta say, i am doing psych right now (on an inpatient adolescent ward) and dang if it isn't making me think baout thangs

http://upload.wikimedia.org/wikipedia/commons/d/d6/Nervous.gif?uselang=he

LOL I am freaking the hell out and I am basically 100% confident I will match. I would be melting down if I wanted to do like, Plastics or Derm (esp with my grades & board scores)

Today we received an email that said for like the tenth time, "As you should be aware, all 4th year medical students registered with the NRMP match will receive an email tomorrow, Friday, March 9, 2012 notifying you that you are "SOAP eligible." DO NOT PANIC. This email does not mean that you have not matched. It will lay out the SOAP process in advance, so that everyone who does not match will know what to do."

Then it described what happens on Monday and basically Scrambling/SOAPing sounds like it is basically the most insane thing ever.

Good luck with the match!

yes, good luck to you both!!!

i don't even know why i read this thread except <3 evan and C-L

good luck one and all

(I match next year)

yeah i was wondering what you were referring to, you're third year, right?

haha a friend of friend was just talking [via stats updates] about this on fb

gl 2 1 and all

i'll probably get a PGY1 residency, not worrying about it too much right now other than trying to get next february off for interviews

I am distracting myself by thinking of ways we could make it more of a ridiculous spectacle. (My school goes with the "Everybody opens their envelopes at noon, chaos ensues" approach, which is probably less ridiculous than the "people are called up one by one to open their envelope and announce it to the room" option.) My favorite thing is to hire a guy who looks like David Stern and have him open all the letters and announce, "With the next pick in the 2012 Residency Match, the Mayo Clinic Department of Internal Medicine selects..." or whatevs. (I actually ranked Mayo kinda low, btw.) I think a couple of my friends are gonna wear flat-billed Gtown hats and put them on if they match back here. I wanna do my prelim here so I might also participate. Maybe I could get a mustard-colored suit before Friday...

The actual insanest thing is apparently what they do in India state med schools, according to a Psych resident I had, who said that there is a big board full of all the available residencies in all of the state and the class is brought up in GPA rank order to select their preference from what remains. He said he ended up doing Psych in the states because Psych ends up being one of those things that is left over at the end so a lot of the attendings and residents are on their like fifth choice specialty, which makes them not particularly motivated.

i love this thread!

could someone, to an extent, break down what is happening?

Sure, I will in fact give you a brief timeline of the mild chaos that has been my life over the past few months.

So I decided to become a neurologist, which is a three year residency after a one-year internship that sometimes but not always is at the same place as residency. In my case, the combination of being in a relationship out here and knowing that several of my top choices did not offer the combined ("Categorical") internship-residency option led me to apply to a bunch of intern only "Preliminary Medicine" years. All told, I believe I applied to 20 neurology residencies, and 27 prelims.

Of these, I was offered 15 neuro and maybe like 10 prelim interviews, most of which I went to. (I like interviews, although at this point I do hate plane flights with a burning passion.) Pretty much between about Thanksgiving and mid-January I was averaging about two interviews a week (I never did more than three in a week, thank God; some of my friends who did ophtho did three in three days in three entirely different parts of the country, which is insane.)

So on I think February 22nd, or thereabouts, we were required to certify our rank list, i.e. send in our list of the programs we were willing to match to in the order that we liked them. The programs were also required to turn in their list of the applicants they liked the most, in the order in which they liked them. A giant computer somewhere (I like to believe it is a magic computer in the sky) sorts through these lists using an algorithm that is apparently student-favored; i.e., if I rank X #1, and X ranks me #12, but has ten spots, then I will get X unless 10 of the 11 people above me also end up with X as #1. (It gets way more complicated as the matching process goes on.)

The neuro programs I applied to all have somewhere between three and nine residents per class (although the Partners residency, which is the MGH/Brigham & Women's program, has like 17 spots). I sent a letter of interest to the Neuro program and prelim program I was most interested in, and blessedly I also received either a phone call, email, or letter from four programs, including my top two, plus one from a prelim place. It is considered a violation to try and persuade somebody by saying "We will take you if you rank us first", so all of these MASH notes from applicant to program and program to applicant do not explicitly guarantee that I will rank there. However, they are as good an indicator as is known, and at any rate, my home institution has a de facto guarantee that home students are ranked at the top of the list. So I am, thankfully, 100% confident I will have a neuro spot waiting for me on Friday, and like 97% sure a prelim spot will also be there.

If I wanted to do something more competitive, especially with my grades/board scores (which are fine, but are not outstanding), I would be freaking the fuck out right now.

So in about ten minutes we will get an e-mail describing in painful excruciating detail what will happen if we do not match; it is a slightly different process this year so nobody is exactly sure what will happen. It used to be known as "The Scramble" but now is known as the SOAP process; basically what happens is that the unmatched applicants and unmatched programs have a handful of days for reapplication to go down in rapid sequence before actual Match Day on Friday. I can tell you that our school is turning the lower level of the library into basically a War Room for SOAP scrambling next week.

On Monday, at 11:30 am, our school is notified of the students who did not match, and at noon, everybody gets an email telling us to go check on the National Residency Matching Program website to let us know whether we have matched. Our school has indicated that the non-matched students will be called before noon and told to get their ass down to the library. Between 11:30 and 12:05ish, let's say, in three days, every 4th year medical student will be a complete wreck. Most of us will match, so it will all be anxiety for naught, but really, medical school is four years filled with situations of anxiety for no real reason, so whatevs.

Between Monday and Friday at noon, those of us who have matched are left with nothing other than sympathy for those left to scramble (unless they are jerks, in which case, LOL), and the paralysis of not knowing what the answer will be.

On Friday, at 12 noon EST (I believe it is 11 CST/10 MST/9 PST, so everyone knows at the exact same moment, but I could be wrong), we open the envelopes to find out where we spend the next three to seven years of our lives. Chaos ensues. Most people at my school tend to end up happy, and I am in a not-that-competitive specialty with a lot of positive reception on interviews, so I am not like, a mess, but I just NEED TO KNOW ALREADY.

On Friday afternoon/night/Saturday, we party.

And that, ILXors, is how we match.

Addendum: I am now SOAP-eligible, as are several thousand other people, as of right now.

168 hours to go!

That sounds better in so many ways than my drawn-out waiting-to-hear-from-PhD-programs process.

man I am not looking forward to that

you should just wear the sorting hat imo

good grief!

what are the interviews like? full days meeting dozens of people/boards/patients, or a 30 minute chat?

what are the most competitive specialities? dermatology, right? what else? do you know anyone who thinks they won't match?

i have a friend or really friend of a friend hows matching pediatrics which is apparently p tough

it's funny how euro-esque a lot of the american med school process is, just in terms of like the ridiculous top-down structures and paths you have to take

it sounds like mlb

the ROAD to happiness (and most competitive) is comprised of Radiology, Ophthamology, Anesthesiology, Dermatology. basically, specialities that offer a tasty mix of extremely high earning potential, low stress, and decent "lifestyle"

all the surgical subspecialties are tough to match into (vs medicine, where the subspecialization happens in fellowship, by and large)

primary care is generally p easy, with family med and psych at the bottom of the pile

anecdotes:
- friend of mine went into family. applied to 6-7 programs, almost all in state (MN has like 11 FM residencies), interviewed at five, never really stressed about matching
-other friend: going into med/peds. applied to maybe fifteen, interviewed at 8ish, a little nervous
-ortho dude: listed oh about ONE HUNDRED programs, interviewed at under ten, very nervous
-sad rads man: candidate with a flawed app (failed an internal med rotation, low step 1 score) but determined to go into radiology (got a masters in medical imaging during med school), and only listed rads program (over seventy). did not match, scrambled for a surgical intern year, will try again next year

fwiw: "competitiveness" is quantified by the percentage of spots filled by intl graduates. that is, as an American student, you are automatically prioritized over a foreign grad kinda no matter what. and if you apply to a dizzying number of programs in a non competitive specialty, you are assured a spot practically.

also FYI I don't know the exact number, but you're only allotted so many programs on your application. After that, it costs extra to add additional programs. So these rads/ortho peeps are paying significantly more for the application process than the family med ppl, which I'm sure only makes the process more unbearable

Dermatology - meh. My impression of the specialty: ordering biopsies for ten thousand samples of tissue from 'suspicious' moles every year. Removing one or two thousand of them when the results come back (mostly inconclusive, but better safe than sorry). Actually helping maybe 30 people a year to avoid cancer, but you'll never know which 30 they were.

also 30: the number of hours you work a week

then multiply by ten thousand and you have your annual salary

hahaha

Dudes it is Friday, where is C-L with the news?

next friday!

oh whoops

So interviews typically consist of the same basic elements:

--The night before, the residents and applicants go out for dinner, somewhere usually really nice. (In unrelated news, I gained like 15 pounds this year and now my dress pants fit very tightly.) The stated intent of this is to allow a forum for applicants to ask questions of the residents outside of the hospital, the unstated goal to identify people who are problems (drunks, super weirdos, etc.) I almost never asked questions about residencies for a few reasons:
1) I am not really fond of asking direct questions, especially when I think the answer will be canned.
2) Someone else will ask the basic stuff worth knowing about, always.
3) I would rather just talk about normal people stuff like TV and sports; if the residents are unable to do this then basically that is a huge red flag (because I do not wish to attend a program full of wieners)

--The actual interview day typically begins with an introduction from the program director, which can be pretty informative if the place is big on a particular philosophy and sometimes is like "We have a hospital, with patients, who are sick. Our city is nice."

--There is a tour. When this occurs early on (a couple places gave it before the resident dinner), I am fine with it. When it is the last part of the day, everyone is thinking "Oh my God I could not give less of a crap about what the call rooms look like, please just let me go."

--I had anywhere between two and six interviews for Neuro; Prelims sometimes had two, sometimes had one, and sometimes had nothing. The places with six tended to be of the 10-20 minute range; I think the longest I was scheduled for was maybe a half-hour but I am certain I went 45 a couple times because I am a talker and I talk. This is where things got real for me; you get the best sense of what the program is about and what they're looking to do when you talk to the Program Directors and especially the Chairmen/Chairwomen. To me (again coming from a not-that-competitive specialty), these were not particularly stressful, and felt less like a job interview than a mutual feeling-out session; I was going to be who I was and if it didn't work out for a program, that's fine, I had others. (This was less of an issue in residency than it was in med school; neurologists are my chosen people, whereas there were a couple med school interviews I had that were super-awkward.)

--They feed you again, for lunch. Everyone becomes somewhat disturbed when I go back for my fifth Coke Zero/Diet Coke of the afternoon.

--Generally some closing remarks are given, but with some of the interview-heavy places, you were free to go after your last one. You then get to write thank you e-mails/letters to everyone you talked to; I also threw out a handful to the program coordinator people who were super-helpful, so in the end I wrote I dunno like a hundred. They were mostly form but I liked to use the second paragraph to talk about a particular moment of the conversation.

--Flights/driving/etc. In unrelated news, American Express sure does like me now, Hotwire is a superior rental car option, and flying to the Midwest almost always ends up being cheaper to come in to Chicago or Minneapolis and then rent a car.

And for the other question, the people who are seriously sweating things are in general less socially outgoing about the process than those of us who feel pretty much locked to go somewhere. I'll bring the subject up, but if they get uncomfortable I back off.

I think actually Plastic Surgery is the hardest thing to match to given that there's under 100 residency spots (versus maybe 20,000 med students per year at 125 MD schools and 20ish DO schools, plus the Caribbean et al) and everyone who wants one is a total all-star, although there is a backdoor method post-residency if you do general surgery (or probably also ENT). The other surgical specialties are difficult as well, which is why it was a real good sign that of the five people in our class doing ophtho, four of them landed their #1 choice. (Ophtho and Urology have an early match, as does the military.) Derm is difficult. Rad-Onc is difficult due to a very small number of spots, and the people hoping for those spots having an unreasonably high likelihood of having done hella cancer research already. In most other things, the "top" spots (big fancy prestige programs) are hard to obtain, but there's enough to go around where you can find something somewhere. In general if the list of current residents is full of people who went to MD-granting schools other than the one affiliated with the hospital, it is a difficult place to get in. (There are plenty of awesome DO and foreign medical grads, but in general if a program is half-filled with them, it is probably not drafting from the same pool as like Hopkins or UCSF or wherever.)

I enjoy this process more than I should, so I write lots. <3

do dermatologists really only make 5 figures?

30 x 10,000 = ?

C-L you are better than my guidance counselor, thanking you

haha my math sucks xp

welcome to medicine

I saw a dermatologist recently, she told me my largish scalp mole was a 'fried egg' mole and was okay

only gourmands or ppl that hate food go into path, I can't decide

Anesthesiology is low-stress?

Sure. One for you. One for me. One for you. One for me.

Anesthesia is considered low-stress; the operating room is stupidly stressful sometimes around the operating field, but around the head of the bed people are just hangin out, monitoring vitals, takin breaks when they need to (which you cannot do when you are scrubbed in). If you're willing to show up super early, you also get to leave super early and do cool shit like intubate people and do nerve blocks). Based on the anecdotes of my classmates there seems to be a pretty close relationship between the sorts of people who do ER and the sorts of people who do anesthesia, incidentally.

I think I've been reading too much Gawande. Iirc he paints it as stressful in the extreme, but maybe that was in the part about litigation.

ER docs are pretty nuts ime

Oh, also, to one of gbx's earlier points about the amount you pay for applying to extra places. This year, it broke down like this:

For $85, you could apply for anywhere from one to ten places in any given specialty. To apply to places 11 through 20, the extra cost was $8 each; for 21-30, $15 each, and for 31 and beyond, $25 each.

This worked out well for me; I applied to 47 places, all told, but 20 were in one specialty (so neuro was $165), and the prelims ended up being 25 Preliminary medicine (for $240) and 2 Transitional Years ($85). I spoke with a dude who applied to 50ish ortho programs and dropped over $1000 for the privilege. We also had to pay some extra money for our board scores to be released, and like $50 to activate something or other with the match process itself (I dunno, I don't care, I just paid when they tell me to).

Fourth year also is noteworthy for Step 2 CK ($500ish) and Step 2 CS ($1100ish), with Step 2 CS requiring travel expenses unless you happen to be in Philadelphia, Atlanta, Houston, Los Angeles, or Chicago. (I took CS on December 27th while in California for the holidays, and stayed with my parents, so I saved that, at least.) For those of us who took a national application strategy (My top 4 places are in four different time zones), plane flights and hotels and rental cars also are a serious thing. If I had been one of those people who just stayed along the eastern seaboard I would have saved myself some grief and money, but I am not East Coast people, alas. I had the good fortune of having several hotel rooms comped by the programs, at least; I balled pretty hard when it was not my own dime, and rolled the dice with Hotwire otherwise.

Basically, though, money, time, and motivation are the limiting factors in the scope of your application. People apply to 100 programs, and people do even more ridiculous interview strategies than mine, but somewhere around January we all are broke and exhausted, and you start to reassess.

Also my guess is that doing anything at Brigham and Women's (where Gawande works iirc) is probably a stressful place to do your thing because that whole MGH/B&W/BI zone is serious business.

Update! E-mail recieved about an hour ago:

Subject: Did I Match?

Congratulations! You have matched.

* Reggaeton Horn *

mazel tov!

:D

I hear North Dakota has dr. jobs