Wednesday, March 14, 2012

A Quick Recap of the Career Path So Far

I find out where I am going for residency the day after tomorrow. 

But before I get into that, I thought I would back up and give a quick recap of US medical training.  I know the whole process is confusing, as various relatives and Quaker meeting members ask me how it works every time I see them.

Ok, so, say you want to be a doctor.  We’ll start at college – you will need a four year undergraduate degree.  What can you major in?  Turns out, anything you want.  I double majored in Biology and Drama.  (People are always asking me how I am going to use my Drama degree.  I use it to act like I know what the hell I am doing.) 

There are some prerequisite courses, like Organic Chemistry that tend to be of the “weed people out” variety.  It almost worked.  I had this amazingly terrible Organic Chemistry professor – he didn’t seem to know any organic chemistry (drew some amazing molecules where carbon had five bonds) and sometimes forgot to wear pants to class.  (Literally, he showed up in boxers and dress socks and a button-down shirt.) The school hadn’t given him a relocation allowance and so he slept in his car in the parking lot of the gym, though I am not sure if it was out of protest or economic necessity. 

It was all just sort of wacky and annoying until The Incident.  He left a mercury thermometer inside a very hot melting point apparatus all afternoon, eventually breaking the glass thermometer.  My classmate went to pull the thermometer out and saw that it was broken.  The professor insisted that it was an alcohol thermometer and that the student had broken it by pulling it out of the melting point apparatus at an angle.  The professor made him clean up the (clearly beading and metallic) liquid with paper towels.  It turns out that much of the mercury was actually vaporized at this point and so the student was inhaling mercury vapor the entire time.  He ended up being hospitalized for several days and losing all his hair and having some neurological effects.  I am not sure why or how there was not a massive lawsuit about this.

Anyway, if you survive Organic Chemistry (literally and academically), you get to take the Medical College Admissions Test, or MCAT.  Oh god that thing was fun.  And by fun, I mean a torturous pain in the ass.  Nothing on that test is remotely useful in medicine.  There’s physics and I don’t even remember what else.  Some sort of essay question.  The scores go from 15 (worst) to 45 (best but statistically unattainable).  I think they usually say 30+ is pretty safe for med school admission. 

Then, you apply to med school.  Lots of personal statements and official transcripts.  Your personal statement will probably explain how you want to “help people.”  Of course you do.  <pats your head>

When you decide to apply to med school and where to apply, you won’t know anything useful about medical school, because of course you have not been there yet (unless you are a time traveler).  Now that I have been to medical school, I can tell you they are all probably pretty much the same.  I picked mine based on the fact that Charlottesville was a prettier place to live than Philadelphia or Baltimore.  I probably should have weighed being close to my family and paying less tuition a bit more heavily than I did, but there you go.

Another thing I knew nothing about was that there are two types of medical schools in the US.  Allopathic schools award the M.D. and are historically more “science-y” while osteopathic schools award the D. O. and are historically more “touchy-feely.”  The jobs each can have upon graduation are indistinguishable.  My undergraduate advisor just told me to apply to allopathic schools because they are theoretically more prestigious.  Clearly, I should have researched this a bit more.  I think it would have been slightly easier for me to find philosophically aligned peers and mentors at an osteopathic school.  Oh well.

Anyway, once you pick a medical school and get accepted, you complete four years of medical school.  Traditionally, the first two years are your classroom or “pre-clinical” years.  They will be absurdly difficult.  I assume these years are some sort of hazing, as much of the information you are required to memorize is quite useless for actually treating patients.  Try not to focus on this, just accept the experience for the hoop-jumping that it is and trust that you will learn real patient care ….eventually.  I spent a lot of time reinventing my note-taking and studying style, bemoaning how difficult it was, and questioning if this was the right path for me.  I recommend not wasting quite so much time on these things, as all they did for me was produce some very dark, Sylvia Plath-esque writing pieces. 

After the second year, you will take Step 1 of the United States Medical Licensing Examination (USMLE).  It’s an eight hour multiple choice test.  Somehow, after first and second year I sort of enjoyed this test.  The test review materials were well-prepared compared to our course materials, and the test is standardized, not written by a bitter research PhD who has been saddled with lecturing needy medical students about the nerve conduction system in the giant electric eel. Still, the fact that I enjoyed it is concerning to me.  Perhaps I am becoming a robot.

During the first two years there is usually some sort of workshop during which they teach you, “how to talk to patients,” and “what to do with your stethoscope.”  Invariably, throughout training, half the attendings you talk to will think that a really good physical exam can locate a brain tumor and diagnose appendicitis and tell what you had for breakfast.  The other half of the attendings you work with will just order a CAT scan of every patient.

Finally, after Step 1, the clinical years start.  During third year, you rotate through all the various specialties such as internal medicine, obstetrics & gynecology, pediatrics, surgery, etc.  These rotations or clerkships are 4-8 weeks in length and each is followed by an exam called a “shelf.”  Third year is really the only year of medical school actually worth the tuition, as you get to act like a real live doctor and learn a ton of stuff that is actually useful in caring for patients.  Also, if you went into medicine to “help people,” you will enjoy actually getting to talk to people again. 

On the other hand, this year has high potential for burn out – mostly because you realize the asinine hierarchical brown-nosing culture of the pre-clinical years does not disappear during the clinical years.  But now, the casualties of this culture of ass-kissing entitlement and priviledge are real people, your patients.  I don’t know what to tell you – the whole thing made me have a mental breakdown.  Um, stand up for your patients where you can and otherwise just try to keep your chin up.  Don’t forget to feed yourself and sleep – the culture of medicine does not value these things but they are still important for all humans.

Moving on, fourth year is full of “elective rotations,” meaning it could be like an extension of your third year, or it could be full of “fluff.”  Some of the more obnoxious nose-to-the-grindstone type people will insist that you should work as hard as possible during 4th year. To some degree, I see their point – getting your money’s worth and learning useful things are always good.  On the other hand, 4th year is a great time to recharge your batteries before residency, travel, apply for residency, interview for residency, and generally stress out about residency for a full year before it starts.

So, after medical school comes residency – a stage of medical training in which you are officially a doctor but you are not an independent doctor, you are still in training.  To apply to residency, first you have to pick a specialty, which is a whole post in itself.  I picked Family Medicine, which is a 3 year residency.

Then you apply.  Dig out that personal statement you wrote about wanting to help people. Add paragraph about something you learned in medical school.  Stop agonizing over it.

The application process is all online through a program called ERAS.  You pay about ten bucks a pop for ERAS to send your application to the various programs.  How do you know what programs to apply to?  You don’t.  Because you don’t know anything about residency yet, since you haven’t been there (unless you are a time traveler).  I don’t have any further advice for you, since I haven’t been there either.  I will get back to you on that.  Oh, but you aren’t crazy, all their webpages DO look the same.

After the applications are submitted, you sit back and wait for interview offers.  Proceed to lose your mind and spend all your money traveling all over the US interviewing at various programs.  My only advice for this stage: buy a suit that you like and always pack snacks.  I was extremely lucky, my husband happens to be unemployed and enjoy driving, so he was able to drive me to most of my interviews, help out with logistics, etc.  All I had to worry about was dazzling them with my brilliant personality.  Ugh.

Anyway.  That is the process that gets you to the glorious day that happens the day after tomorrow: the match. 

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