<p>Not to freak you folks out, but today, July 1, is the first day that ERAS (Electronic Residency Application Service) is open. While a lot of students, including me, have already put thought and work into the residency application process, this essentially marks the formal opening of the process. For those of you who'd like to take a virtual peep over the shoulder of someone who's going through the process, I'd thought I'd try to periodically write about what I'm tackling.</p>
<p>Best of luck shades :)</p>
<p>Yeah good luck Shades</p>
<p>Time flies so fast, doesn’t it?! It seems that you were deciding among your final two choices just yesterday and now you are ready to move onto the next stage. Congrats!</p>
<p>Ohhh! This will be good. Thanks a lot for doing this. Waaay off my GPS.</p>
<p>Thanks for offering to do this, we’ll be there 12 months from now and the insight will be greatly appreciated.</p>
<p>Shades…sorry for not keeping up this past year (intern year and such - pretty much my excuse for everything at this point). But…</p>
<p>obligatory what are you doing when you grow up question</p>
<p>with the follow-up: any further fellowship options?</p>
<p>and the final compulsory question - looking to stay close to current school?</p>
<p>In all seriousness though, try to enjoy the process. My condolences if you’re doing Couples Match. While match is certainly stressful, particularly for the competitive fields, remember that things will end up the way they’re supposed to. If you’re staying close, remember those reasons and that they if they have merit today, they’ll have merit next year after your first overnight call. If you’re looking far and wide, enjoy the chance to see a bunch of places you’ve never been before. And when it comes time for the match, don’t try to game the system, listen to your heart, and remember no place is perfect. If you’re not finding flaws then you’re missing something. In the end, I think it’s better to go to a great program than a great city, you can always move after you’ve gotten awesome training. I can promise you that no matter what field your doing, you’ll be busy enough that even mediocre nightlife and attractions will be sufficient to fill your free time.</p>
<p>As for the rest of 4th year, nothing is as good as it seems - except the fourth year of med school. Challenge yourself, but make time for fun things too. </p>
<p>If there’s anyway I can help, PM me.</p>
<p>mmmcdowe, Icarus, mcat2:</p>
<p>Thanks for the well-wishes!</p>
<p>curmudgeon:</p>
<p>It should be way off your radar. It’s your DD, yes? She should be focused on establishing good relationships with classmates and professors and learning as much as she can in her classes. It wouldn’t hurt to begin exploring some career options through shadowing, but she shouldn’t feel any pressure to “declare” a choice.</p>
<p>eadad:</p>
<p>That’s exactly why I’m doing this!</p>
<p>BRM:</p>
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<p>Cue nervous laughter here. In March when I had to make my fourth-year schedule, I was only thinking about medicine and anesthesia. I was pretty darn sure surgery was out of the question, so I made room for my medicine sub-i and an advanced anesthesia elective and then packed my fall schedule with required fourth-year rotations. In May and June I did surgery and I loved it, so about a week and a half ago, I started the process of trying to rearrange things to make room for a surgery sub-i. I’d consider it only a partial success - I did get the sub-i, but it’s not until October/November, which is pretty darn late.</p>
<p>At this point, I’m pretty sure I want to be the OR, so I’m thinking anesthesia or surgery, but I’d like to make sure that medicine isn’t for me. If I can’t decide by September 15, which I think is a real possibility, I may just submit ERAS for both surgery and anesthesia and then decline interviews or not rank programs when I’ve finally made up my mind. It’s a little more work, but I want to be sure I’m making the right choice.</p>
<p>As for fellowship, I have so little idea about specialty that talking about fellowship seems goofy. But since you asked, now I’m thinking that if I do medicine, I’d like to be a hospitalist. If it’s anesthesia, maybe no fellowship at all or maybe something like critical care or cardiothoracic. If it’s surgery, maybe trauma/critical care.</p>
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<p>Another great unknown. I’ll probably apply to the hospital system in my hometown, as well as places in the NYC-Boston area. I imagine I’ll also look at DC and Baltimore, and I’ll probably look at places down the East Coast as far as the Carolinas. Not sure about places in CA - the state government is so dysfunctional, I don’t know if I could deal with living there.</p>
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<p>No couples matching for me, thank God. And I’m trying to keep fun in mind, but this last week of scheduling hell has really stressed me out.</p>
<p>Shades…</p>
<p>nothing wrong with applying to both surgery and gas programs. My roommate in med school, her husband applied to programs in anesthesia, psych and ophtho - along with transitional programs, and he went on interviews to at least one program in each specialty. In the end, he quickly dropped psych, went on an equal number of ophtho and anesthesia programs but only ranked anesthesia programs when it came Match time. While I wouldn’t necessarily recommend flying by the seat of your pants like this, you do have time to figure it all out.</p>
<p>Today was the start of my medicine sub-i, the first fourth-year rotation I have. It’s odd to realize that I’m no longer at the absolute bottom of the totem pole and that in some ways, I know more than the brand-new interns who are just starting at a new hospital. I’m going to give this 4 weeks my all - by the end, I hope I can rule in or rule out medicine as a specialty choice. My gut feeling? Medicine won’t be the one.</p>
<p>^ please cure people with your heart and care :)</p>
<p>Don’t ignore gut feelings.</p>
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<p>It’s strange how people make important decisions.</p>
<p>I had a dream last night. I don’t remember the details, but I woke up thinking, “I have to get to the OR!” Nevermind that I have no idea why I thought that - whether it was a necessity (for dream-patient-care) or my id trying to tell my ego something.</p>
<p>Now that the first week of my medicine sub-i is over, I think I can make some educated guesses about the future. I think I could do medicine. I believe I could be a great resident and a great attending. I think I’d be reasonably happy with my job. But that’s the kicker - I’d be reasonably happy. I don’t know how often I’d reach that stratospheric, almost delirious happiness that I got a taste of when I was on surgery.</p>
<p>It remains to be seen if I could be that happy in the OR on the anesthesia side of things. Next month, I’ll find out.</p>
<p>I recently downloaded mind mapping software in an effort to keep track of all the things I’ve been thinking about as I approach picking a specialty, picking programs to apply for, and what I’d like to do in the future.</p>
<p>Ok, I’ll bite…as my daughter (who is in medical school) is somewhat attached to a young man going to medical school in another state, in the unlikely event they beat the relationship odds I guess I should ask what couples match is and why one should fear it. Or maybe I don’t want to know?</p>
<p>Couples match is a process by which you can “link” two match lists together. IIRC, the NRMP even gives the applicants a few extra spots before charging extra money.</p>
<p>In theory it’s a nice option to have and allows for couples (or even just close friends) the opportunity to get the most desirable combined outcome (though it may not be highest choice for each individual). </p>
<p>In practice, it’s insanely stressful for everyone I’ve ever met going through it. The stress it ratcheted up even higher if one or both of the individuals want to go into something competitive, taking a high stress situation and making it worse. It’s further complicated by the fact that there are very few academic medical centers that are phenomenal in every field (my medical school was great for Internal Med, barely tolerable for peds, and the center I’m at for residency, the situation is flipped), thus, very often, one person will love a particular location and the other will hate the place with unbridled passion.</p>
<p>Most people I’ve seen go through couples match also end up interviewing at significantly more programs than the average singleton applicant. This means more travel, more cost, and can add more stress if they try to arrange interviews so they fall on the same day. Of course if one person goes there well before the other, then there can be positive and negative biases and feelings of guilt if you show up later and are disappointed by a place your partner has fallen in love with. </p>
<p>Finally, comes putting together the match list itself. There has to be a lot of coordination and double checking to make sure everything is ordered correctly, because an error could be disastrous. The other thing is that couples can put together every permutation of the programs they interviewed at: for example, lets say that Amy and Bobby decided to go through couples match. Amy is going into ENT and Bobby is going into Ortho. </p>
<p>Amy interviews at programs 1-5, and Bobby in programs A-E. There match list could end up looking something like this:</p>
<p>1) Amy 1 Bobby B
2) Amy 1 Bobby E
3) Amy 4 Bobby B
4) Amy 4 Bobby E
5) Amy 5 Bobby B
6) Amy 1 Bobby C
7) Amy 2 Bobby C
8) Amy 1 Bobby unmatched</p>
<p>Figuring all this out and determining what sort of geographic limits are permissible and such is a difficult process, especially since so few cities have multiple programs - particularly in subspecialty fields like ENT. The places that do, tend to be big cities that are popular destinations any ways, thus making it even more stressful for those going into competitive fields. For example, there are 5 ENT programs in Chicago, with a total of 15 spots per year…it’s a little ridiculous. </p>
<p>Lastly, if you add in the final layer of applying to fields that require a transitional year (like anesthesia, derm, radiology, surgical subspecialties, etc), and apply to residency programs that don’t offer ‘categorical’ spots (that is, offer you first year transitional spots along with a spot in the advanced training program) and you can very easily end up separated for a year. I know one couple where they were ecstatic because they got their first choice in the match and they would end up in the same town, but he was doing radiology and had to do a transitional year 1200 miles away before moving back across the country to end up with her.</p>
<p>Because nearly everyone knows someone going through the couples match, and invariably meets people with ridiculous couples match stories while on the interview trail, it’s a plight that garners much sympathy and a healthy amount of “better you than me”.</p>
<p>The couples match is basically designed to try and get to two people in the same city, even if it’s not the same hospital. Since it places further limitations on an already stressful process, it’s a tough thing to go through.</p>
<p>BRM and Shades - Many thanks for the information. I suppose if they make it though years of a long distance relationship they will muddle through couples match. That being said, it is one more complication in two already complicated lives.</p>
<p>Best of luck to you, Shades.</p>
<p>Today was medicine hell (for me). Insurance companies refusing to pay, prescriptions that pharmacies reject on technicalities, patients who want treatment and then refuse recommendations, family members who can’t agree, people who don’t return my pages, and more. Crap like this is definitely the worst part of the medicine, and it’s the stuff that’s not taught in the formal curriculum of medical school. It’s been an on-the-fly education, that’s for sure.</p>
<p>More and more, I’m thinking that long-term care is not for me.</p>
<p>Which undergraduate major may prepare a premed for handling the crap you mentioned? A major that requires you to do an intern in a rough neighborhood before you are allowed to graduate? I know a physics major who was originally trying to do TFA and quickly found out he lacks the skills to handle the classroom. He claimed that the school does not need a science nerd like him at all. It badly needs somebody who can handle the behavior problems of those kids from rough families. Well…I apologize if I am off the topic.</p>
<p>I’m enjoying the free reign that comes with being a sub-i, but it comes with the annoyance of not having the letters “MD” appended to my name. There’s plenty that technically requires an MD to sign off on but in reality, only requires a well-educated fourth-year student - things like putting in orders for drugs or tests, writing prescriptions, or consenting patients for procedures. I’m becoming less and less worried about my ability to be a good intern and more and more confident in my skills at assessing a patient. </p>
<p>Applying for residency is still an anxiety-provoking hump in the road to MD-dom. I started working on my CV this weekend, and it feels surreal to be trying to boil down everything that’s happened to me in the last 3 years down to two pages in size 12 font.</p>