Happy Chinese New Year!

Take Care little Sister 2012 leaves 2013 by =ShadowSaber on deviantART

新年快乐!  恭喜发财!  身体健康!!

Happy Chinese New Years everyone.  The Year of the Dragon now gives way to the Year of the Snake.

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Apologies for the lack of posts of late.  Transitioning from interviewing and vacation back to rotations is tough, and to a surgical sub-internship no less!  My hatred for surgery is nowhere near as intense as it was last year, though my . . . displeasure for surgery is 90% in the hours (specifically how early I have to wake up).

That said, this surgery site is pretty chill all things considered.  I love taking the surgeries that don't have a resident in them because I get to be first assist and do more (and see more).  The attending surgeons here let me do a fair bit more than I was allowed to as an M3 last year.  I can see how one would love doing surgery; however, I still hate waking up before 5am and standing for hours on end putting strain on my lower back.  I should start doing some yoga . . .

More posts coming up soon (hopefully).  I have an unfinished one drafted.

To Be Wanted . . .

It's such a weird feeling (for me) to be wanted.

What I'm most caught off-guard by during these residency interviews is just how much the program wants me (I suppose that makes sense, otherwise they wouldn't invite me for an interview).  Still, I'm left awkwardly speechless when an interviewer enumerates the various things I've done in med school and react amazed when I describe them.  It's almost embarrassing.

Up until now I've received little recognition outside my circle of friends and faculty advisors for the things I've done.  Everything I've done felt like it was being quietly conducted in the shadows outside the glowing praise of my institution at large.  I never received an award or anything of that sort, and I doubt I ever will - I simply don't have the overwhelming popularity to bring visibility to the things I champion.

But at almost every interview I've been asked to describe (in some detail) the community advocacy work I've done for the Asian and LGBT communities.  Some interviewers are more keen on hearing about the health literacy project I did in the Asian-American community, others are eager to hear about the cultural competency training I forwarded in LGBT health education, and still some want to hear about my involvement on a state policy level.

At one of my recent interviews, my interviewer asked me, "How are you able to do all this?"  And I began to reply that I was lucky and these opportunities fell into my lap in such a way that I couldn't turn them down.  He cut me off and corrected me that I instead "seized the opportunities."  I never thought of it that way, but I suppose he's right.

As these interviews wind to a close, I'm more and more certain of what I bring to a residency program.  This wasn't crystal clear at the beginning, but now I know.  Programs didn't choose me because of my grades or Step 1 score (verily, I'm positive that many programs rejected me based on those criteria), but rather the extensive community outreach and advocacy work I've done.  I'm glad that the 11 places that chose to interview me saw beyond the numbers to something more important that I can bring.

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P.S. For anyone applying to residency programs, everything you write in your ERAS application is fair game for interviewers to ask you about - and they will ask you about them, so know your application stone cold.

Interview Trail - Part 1: First Impressions

H DeVos Children's Hospital 2 by ~dharvell on deviantART

I hope everyone's had a happy holiday so far and looking forward to the New Year!  Almost as soon as 2013 starts, I hit the interview trail again.  But before that, some first impressions on Part 1.  There are things I've come to realize that are personally important to me when choosing a residency program, as I'll be stuck where I match for at least the next 3 years.  So in no particular order:

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1. Location

Location, location, location.  This is huge.  More so than I initially thought.  You want to be in a city and an area of the country you can see yourself living in for the next 3+ years.  Weather and geography are major filters for many people.  Some people really want to live on the west coast, or the east coast, or NYC in particular (not entirely sure why . . . no one can survive there on a resident's salary).  Others, like me, cast a wide net over huge swathes of the country to see what might fit best.

2. Hospital

The hospital you'll be working in is very important.  Is it old?  Recently renovated?  New?  Does it have readily accessible computers?  Does it use an EMR (electronic medical record)?  Are there good ancillary staff (nurses, pharmacists, etc)?  What is the patient demographic?  One of my filters is that I only chose free-standing children's hospitals because I felt that I'd get the best pediatric training at those tertiary referral centers.  Also, children's hospitals are all so colorful and friendly!  Adult hospitals are dull and depressing in comparison (particularly the VA).

3. Residents

You'll be working up to 80 hours/week with your co-residents.  You'll interact with them more than you do your friends or family.  They will become your family.  What kind of residents are at the program?  Do you mesh and fit in with them?  What kind of person are you?  While everyone in pediatrics is universally nice, I can definitely see myself fitting in with the residents at some programs more than others.

4. Curriculum

The ACGME dictates the fundamental curriculum for all residents.  The money is in the details.  Some programs are well designed, with a ward structure that residents are happy with, and a ton of flexibility to explore interests.  Other programs are rigid or else in so much flux it makes one anxious.  I've definitely come across some interesting and innovative ward structures.  Also the size of the program can be important.  There are small (1-9 residents) programs, medium (10-19 residents) programs, large (20-29 residents) program, and ginormous (30+ residents) programs.  In what environment might you thrive?  Does it matter to you at all?

5. Benefits

A residency is a job, and it behooves the applicant to have some inkling of the benefits.  How much do they pay their residents?  Does the hospital cover medical/dental insurance, or do the residents pay a portion out of pocket?  Amount of vacation/sick leave?  Is there free parking?  IS THERE FREE FOOD?!  I didn't realize how important the latter was to me until I encountered a program that did not feed its residents.  All the applicants looked at each other and were like, "What is this? An adult program?"

6. Gestalt

At the end of the day, trust your gut instinct about a program after you've visited it.  Some of my friends have created Excel spreadsheets to "objectively" score programs to determine their rank order list.  But the gestalt of a place trumps all that.  I've walked away from programs feeling very good about them - they treated the applicants well, I enjoyed my interactions with residents and faculty, they gave a nice tour of the hospital, they answered all our questions and more - whatever it might be, it's definitely a good sign when you walk away from a program feeling really good.  I've also walked away from programs where I'm like "Hmm . . . not sure what to think about this place" or "I really can't seem myself working here."

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I'm only in the middle of mine.  I've heard from many other applicants that after about the 4th one they're just like, "Okay, I'm tired of this now.  Everything's blurring together."  But here I am after my 6th one and I'm still excited to go on my remaining 5 interviews and each hospital stands out fresh in my mind (we'll see if that changes later, lol).

I think the reason why is because I listened to my advisor's advice (that's what they're for, right?).  And he said that I'll get competent training anywhere because the ACGME demands it, so it's more about how I feel about the place.  Thus I try to explore the city a bit the day before the interview and really feel out the residents and see what makes them tick and whether I "belong."

Residency interviews are so much better (and more fun) than med school interviews (at least for pediatrics/internal medicine - not as much for surgery I've heard).  You are selected for an interview because they want you there.  The interviews are mostly a get-to-know-you and to convince you to go there.  To be honest, it's weird to be complimented and feel wanted, that what you've done outside the classroom and outside rotations mattered.  I can't even count how many times I've been told that the whole process favors the applicant (as long as the applicant isn't a dick).

P.S. The hospital in the picture above is very nice on the inside.  And the people are amazing.

Let The Journey Begin

And so it soon begins, the traveling across the country to visit and interview at residency programs.  And then to create a rank list from my most preferred to least preferred programs.  And finally, letting the Match dictate where I'll end up for the next 3 years of my life.

One interview down, nine more to go.  First to southern California, then to Michigan, then to Philadelphia, then Delaware, and then Chicago.  I didn't get interview invites at several programs I really wanted to have the opportunity to interview at (i.e. Kaiser North in Oakland, CA, UCSF, U of MI, UW-Madison, DC programs), but no matter; 10 interviews is plenty to match.  According to NRMP statistics, I only "need" to rank about 8 programs to virtually guarantee myself matching somewhere.

You may wonder what "matching" means.  Basically, I get interview invitations from residency programs that I send my application to.  Of the programs I interview, I create a rank list of which programs I most to least want to end up at.  Meanwhile, the programs create a similar rank list of which med students they want as residents from most to least desirable.  Then each party submits their list to NRMP and through some computer alchemy, it matches applicant and program.  This is a binding contract, so wherever the match dictates, the applicant must go for residency.  I've heard that the process favors the applicants, insofar as most applicants get one of their top 3 choices or so.

Still, it's a daunting thing.  I've come to accept that I'm almost a second-tier applicant and hence am out of the running for many of the more competitive residency programs.  And that's unfortunate but whatever.  I'm hoping to fall in love with a few programs, as people keep saying will happen.  We shall see.

Let the journey begin!  But first to finish packing . . .

Redefining the Republicans?

As we all know, President Obama won re-election and Democrats solidified their majority in the Senate, with the House of Representatives still Republican dominant.  And as much as I dislike politics, I couldn't help but read some post-election commentaries, such as this, "Christian Right Fails to Sway Voters on Issues."

The current Republican party is so far to their end of the extreme it's no wonder that they failed to win the election.  This got me thinking.  What is meant by "conservative" and what is meant by "traditional?"  These in and of themselves aren't sinister terms that should be tabooed.  Indeed, many people may consider themselves conservative or traditional but still be alienated by the current gestalt of the Republicans.

Economics

I've read that Republicans tend to favor market forces and believe in individual responsibility.  These are things that many people can rally behind.  They are less in favor of government hand-outs and give-me's, and as such are likely to be more restrictive on social safety nets for the poor or disenfranchised.  Still people can rally behind that notion when they believe they shouldn't "rely" on the government to pull themselves up or have seen others abuse the system.

Taxes
Republicans generally are in favor of less taxes on (preferably) everyone, but the current Republicans want tax cuts for the wealthy to a fault. Wealth is really a matter of perspective.  How much does one need to live comfortably?  How much does one need to enjoy life?  Yes, money is hard-earned, but taxes exist for a reason and without them, many things in society would simply cease to function.

Health Care
Republicans are united against "Obamacare."  Fine, I get that.  It's not a perfect bill.  But if you're going to attempt to repeal it, you better have a viable alternative ready to go as soon as it's gone, because the status quo isn't benefiting anyone.  Is health care a right?  Is it a basic right?  A civil right?  Is it a privilege?  Is access to health care a right?  These are philosophical questions that our society must determine.

Abortion
Alright, Republicans are generally anti-abortion.  Fine.  But I take issue when they say they're "pro-life."  They are not pro-life.  If you're going to oppose abortion, you better set up a support system for the children and mothers whose lives are affected.  If you're going to oppose abortion, you must make it okay for a single mom without a high school degree to give birth.  This takes investment, time, infrastructure, and of course money.  If you're truly pro-life, you'd campaign to have all kids vaccinated.  You'd campaign to have every child be in programs such as Head Start and Birth to Three.  You'd campaign to help single parents find jobs or tax credits for education.  You'd campaign to offer prenatal care at Planned Parenthood, not cut its funding across the board.  This is truly pro-life.  But it all costs money, and where does that come from?  Taxes.

Family
Republicans are pro-family.  But really, aren't we all?  Their problem is that they haven't kept up with what a "family" can be these days.  Yes, a family may be the nuclear family of parents and children.  But it can also be an extended family, where one lives with aunts, uncles, and/or grandparents too.  It can be a single parent home.  It can be a gay or lesbian couple.  All studies suggest that it matters less what kind of structure the family consists of, and more the love and care provided by that family.

LGBT
Republicans are against LGBT rights at large, but particularly gay marriage.  It doesn't hold much water with me from a legal perspective.  There is a difference between a civil marriage and a religious marriage.  Churches and other places of worship may refuse to consecrate a gay marriage, but that doesn't mean that the state should refuse as well.  In America where we profess to be open, accepting, and tolerant of all religions - where we believe in separation of church and state - where is all that here?  The same arguments made against gay marriage is exactly the same arguments made against interracial marriage several decades ago.

Minorities
The Republican party has a dearth of minority representation, and it has so far made little to no attempt to attract minorities.  It's really a shame.  Many African-Americans, Asian-Americans, and Latino-Americans likely agree with the Republican's economic stances and their sentiments about family.  Yet the Republicans have managed to alienate all of these groups.  Immigration reform, if done well, would begin to sway some Asians and particularly Latinos to the Republicans.

Environment
Republicans should be truer to the word "conservative" when it comes to environment.  The US has one of the greatest natural resources on the planet, and while it's something that we should tap into, it's also something that we should protect and cherish.  Investment into alternative energy would definitely open up job opportunities and drive innovation.

Education
There's a distinctly anti-education sentiment in the Republican party these days.  I do believe everyone should have the opportunity to attend college/university if so inclined.  I do believe we should invest in recruiting more people to become teachers, and to hold schools accountable (to a degree, this a very complex topic sufficient for its own post).  Teachers and their unions shouldn't be made out to be the bad guys.  It's not easy being a teacher.  If the Republicans don't do something to advance education, the US will continue to slide further and further behind.

Anyway, this post is long enough.  The point I wanted to make is that the Republican party, at its core and true to its moderate members, is not a bad thing.  But they've drifted so far from where they should be that they've become hypocritical.  Perhaps this election has kicked their butts sufficiently to see that what they're doing isn't working and will never work.

And this is a nice article to end on, "The Great Experiment."

Solitude

I am a single man - an individual -
undaunted by public displays of affection,
unshaken by the pairing and coupling of others.
These symbiotic relations have made them weak,
their freedoms restrained, their hearts softened.
Who needs that?

I can, at a whim, drive to nowhere
and gaze at the light of the stars,
observing the music of the heavens.
I would take in the awe and majesty
of the universe unfurled around me,
and know the meaning of life.

I can hike into the woods
and embrace the beauty of nature -
the sound of crunching leaves, the fires of autumn,
the soundscapes of brooks and creatures.
I would be one with the breath of the trees,
and know peace and solace.

I can lay on the warm sands of the beach
and listen to the rhythms of the rolling waves.
I would dig my toes into the sand,
feel the wind and sun on my face -
close my eyes, inhale deep,
and know relaxation.

I can stay in on a cold winter day
and bake a warm pie while sipping hot tea.
I would curl under a blanket on the couch,
watching the snow falling ever so gently.
I am content and satisfied,
as this is comfort.

I run on my own schedule,
my time is mine, my thoughts and actions are mine.
I need no reminding of the pairing and coupling
that defines the life-course of others.
I am a single man - an individual -
and I with nothing more than to share it with you.

Check & Check

Step 2 CK: check. (Did 20 points better than on Step 1, woot!)

Step 2 CS: check.

Letters of recommendation: check.

ERAS application: check.

Schedule my first few residency interviews: check.

Haven't actually gotten a residency interview invitation in a while now, and it's making me nervous.  I applied to 29 programs, which most people have told me is overkill for pediatrics (on average, people applying to pediatrics apply to about 15-20 programs).  I really need to hear from more programs NOW.

I'm on pediatric anesthesia right now.  For the past month I've been on my vacation month (for another post), so coming back to starting at 6:30am is a bit of a shift.  It's been a good experience so far.  I like getting the opportunity and practice of putting IV's in babies and kids, as well as manage the airway.  I like being able to see a diversity of pediatric surgeries because I can migrate from OR to OR each day and see something totally different than if I were just on one surgical service.  Everyone I've interacted with has been very nice and (usually) patient with me.

But I have to say, some people have got to stop trying to make me question why I want to do pediatrics.  Yes, I will be making about 1/4 to 1/3 of your salary.  No, it's definitely not for the money, that's abundantly clear.  I'm well aware that I'll be making among the bottom salaries as far as physicians go.  That said, I will make more money than both my parents' salaries combined.  And I see absolutely no need to "upgrade" my lifestyle.  Yes, I will come out with far more debt than both my parents, but I don't doubt that I'll have the ability to pay it off (annoying rough as that may potentially be).

Anyway, there were some cases I've seen that have definitely reaffirmed some of the reasons why I choose to pursue pediatrics (for another post).  And who knows, if I get bored or burnt out, pediatric anesthesiology might be an option, as it seems almost 1/3 to 1/2 of the staff peds anesthesiologists here apparently started off as pediatricians.  Hmm . . . I must pick their brains on this.