The Start of Being Employed (…I Hope)

8 10 2013

This afternoon, during a particularly tedious breast reduction surgery, it struck me that I haven’t written in a very long time.  That seems to happen quite a bit; with my schedule, I have to actually make time to write, and I have been doing a poor time of that lately.

Many things have happened since I last wrote.  The biggest change is my return to full-time medical school as a “real” 4th-year student, but not far behind in magnitude was beginning the process of residency applications.

The residency application process is a lot like sorority rush.  In simple explanation, applications are sent using a common application system (like the Common App for college or AMCAS for medical school) to all of the programs you are interested in.  Then the program sorts through the applications they’ve received through a combination of electronic filters, and they offer interviews to the candidates who make it through the screening process.  Students then schedule and complete a series of interviews, usually between 5 and 15 (often more, depending on the specialty).  Each program scores its interviewees based on a unique system to that institution—each program develops its own, as I understand it—and compiles a master rank list of everyone they are interested in having as a resident.  The students rank the programs they have interviewed at as well.  Both rank-order lists are turned into the National Residency Match Program and put into a computer with the thousands of residency programs and tens of thousands of applicants.  An algorithm is run, and the computer spits out a match.

The beginning of the ERAS (Electronic Residency Application Service) was pretty underwhelming and tedious.  Every activity is catalogued, every qualification and award described, and there is even a section for personal interests.  The student uploads the personal statement, the medical school uploads photos and transcripts, boards scores are released, and each person writing a letter of recommendation uploads their letters separately into the student’s application.

No sweat.

Then comes the task of selecting the programs you want to apply to.  This was something I’d been working on more or less since I decided I wanted to go into pediatrics, a little at a time.  I thought that this approach would make things a lot less overwhelming when the time came to push that “Apply to Programs” button.  False.  I did come up with an elaborate spreadsheet detailing every program I was interested in, including everything from the cost of living in the area to the boards pass rate of the residents to the additional opportunities provided (some have really cool international medicine or advocacy programs) to whether the program provides medical insurance.

When the time came to submit, I felt confident in my choices (18 programs, which is a larger number for pediatrics).   Then that seed of doubt took hold, quickly grew into the rarely seen Kudzu vine of strangulating anxiety, and I sat with my heart racing, looking at my list of 18 reputable residency programs wondering if my best fit program was even on my list, and, if it was, would they even look at my application?  So I did what many students in that position would do.

I panic-applied to an additional 6 programs, just in case.

Friends who went through this process last year say that’s a waste of money (they charge by the program after the first 9, with the cost per program increasing as the total number increases), and in the long run it might turn out that way.  Right now, the peace of mind is priceless.  Outside of this whole crazy process, it’s really easy to downplay the stress of it all, but trust me: in the throes of this chaos, it’s really easy to be overcome with anxiety and doubt.  Especially considering the following graph:


Yes, this effectively scares the crap out of me most of the time, which is why I avoid looking at it.  Avoidance is totally a healthy coping mechanism, right?

The programs I applied to are a good mix of academic and community programs in cities of varying sizes with as few residents per year as 10 and as many as 40.  I’m not totally sure yet where I will fit in—that’s what the interviews are for—but I wanted to apply to a solid mix.  One of the pediatrics directors at my home institution helped me out a lot with selecting programs to apply to, suggesting a solid mix of 1/3 “reaches,” 1/3 “maybe-but-maybe-not” programs, and 1/3 programs I have a solid shot at.  This is a pretty standard tactic for those people who are reasonably competitive with respect to their specialty.  In Derm, for example, every person applies to all of the country’s 90+ programs and hopes for maybe 10 interviews.

Another variable is how quickly after ERAS submission programs start asking for interviews.  I think this depends on how competitive the candidate is, the medical specialty, and the program itself.  One of my peers is applying in surgery, and while we submitted our applications on the same date (Sept 15), he did not start hearing about interviews until last week—he currently has 2 scheduled.

My first interview offer came only 2 days after the applications were submitted, and I was stunned both by the rapid turnaround time and by the program itself—The Rainbow Babies/UH/Case Western Reserve program out of Cleveland.  I hadn’t expected anything that quickly, but it was a very pleasant surprise nonetheless.

Now, just over 3 weeks in, the offers have slowed down, but I feel incredibly fortunate; I’ve had 15 offers from fantastic programs.  Two of these are programs that I almost didn’t apply to because they felt so far out of reach, I only applied because I didn’t want to regret not trying down the road.  I’m looking forward to the actual interviews with nervous anticipation, and my first one is in just over 2 weeks.

This is kind of a fun cartoon, again from the Cartoon Guide to Becoming a Doctor:


It’s good for a few chuckles, right?

The one thing I’m not looking forward to?  The cost.  Most places I’ll be able to drive to, but the drive is still upwards of 9 hours for a number of the interviews.  Anything over that, I’ll fly or take the train or a bus.  One saving grace is that pediatrics programs often foot the bill for a hotel or B&B (10 of my interviews are providing a night of accommodations at hotels, 2 offer significantly discounted rates at their ‘partner’ hotels, and the 2 that I would have to pay for are in locations where I can stay with friends).

Overall, the process has swung pendulously from extremely gratifying and joyous to the low of paralyzing terror.  Now that I have a solid number of programs who are actually interested in meeting me—and let’s be honest, I’m not AOA or even in the first quintile of my class—my mind is overall much more at ease than it was 3 weeks ago.

I’ll be sure to keep you updated!




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