medical school

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

grats yo

congrats, C-L!

Interestingly North Dakota has about as many residency spots as you might guess (from last year's data, 18 Family Medicine, 4 Internal Med, 4 Psych, 3 General Surgery, 8 Transitional Years and 2 Prelim Surgery) so really I think we've found the one flaw in Todd Buchholz's theory, potentially, IF Todd Buchholz's theory has any flaws.

I guess we could advise the unmatched people that a career in fracking could be theirs.

yay C-L!

my dude

u r killin me smalls

c'mon, man! inquiring minds NEED TO KNOW

haha either way he has to be blind drunk by now, right?

haha mabes

apparently there is a mixer tonight at the TOP OF MPLS's TALLEST BUILDING

one of the more stellar/qualified bros i know got his fifth pick :-/

I am relatively sober! (For now)

I got my #1 Neurology and #3 Prelim! (UCLA and Maryland, respectively)

Several of my friends are featured in this: http://www.wjla.com/articles/2012/03/matching-day-for-medical-school-students---what-about-romance--73861.html
(But I do not think I can see me anywhere)

Partyin, partyin' yeah!

MY MAN

gettin down on fri-day

fri-day fri-day

Seven a.m. its 0445 oh god why, waking up in the morning
Gotta be fresh, gotta go downstairs
Gotta have my bowl coffee, gotta have cereal NOTHING ELSE
Seein' everything, the time is goin'
Tickin' on and on, everybody's rushin'
Gotta get down to the bus stop lol there is no bus now but w/e
Gotta catch my bus, I see my friends (My friends) schedule and realize its a call night and i forgot contact lens solution god DAMMit

yay again C-L!

niiiiice

Oh wow congrats that is so awesome!!!!!

Strong work, Dr C-L. Well deserved, I'm sure.

otm. those were some great posts. and congrats on the picks too i guess?

I started today by finding out that one of my patients died overnight. But everyone else was either stable or improving, and one lady in particular seemed about as happy as I've ever seen her. So on balance, it was a pretty good day to have my last day of clinical rotations in the hospital as a medical student.

The suddenness of the end of medical school is really quite remarkable. There were some days in there where it seemed like it was never gonna end and now it has pretty much ended. USA! USA! USA!etc

v sorry to hear about yr patient, man, i've definitely had that a few times (esp jarring is the "come back on monday, ask about X, who looked well on friday")

congrats, though! now gimme all the answers to the shelf

Any situation where patient is dry with BP like 80/40 = give IV NS before doing anything. Even if their sodium is like 120 or 150. That is my primary lesson from studying for the Medicibe shelf with USMLE World.

yeah i feel like 'push fluids' is kind of a safe go-to intervention

btw by 'shelf' i mean all the shelfs