Wednesday, March 2, 2011

The strangest way to get a job...

So it's clearly been a really long time since posting here. If you haven't gotten an invite to my family blog and want one, send me your email address and I'll hook ya up. But, back to medicine in this forum...

So, residency. It's the looming black cloud that follows four intense years of medical school. It's also a job. A paying job. For that, I couldn't be more excited. It's a lot of hours. Only recently have the "rules" (aka guidelines) changed to mandate the maximum 80 hour work week. This is as an average of 4 weeks. It's acceptable and expected that on occasion you'll go over that 80, but basically you shouldn't make a habit of it. I have chosen to pursue a residency in Ob/Gyn, which is typically one of the more hours-intensive residencies, up there with general surgery. Call for OB tends to be physically demanding. You don't frequently get to sit in front of the computer and write notes and answer pages, you have to be on your feet, often in the OR, often doing procedures. All this being said, there is absolutely no field I could envision myself doing except this, and there is no such thing as an easy residency, so taking these four years (in the case of OB) and making the absolute most out of them is just what needs to be done. I would never choose a field based on perceived difficulty of residency, it isn't worth it in the long run.

Now, how does one get this dream job, you might ask? Well, this is the strange thing. After working your butt off for 3 and a half years of medical school, you begin to apply to residency programs. Generally speaking, you apply to one field. However, some folks do apply to several fields if they can't decide, or one field is very competitive and they want to cover their bases. The application is done online and is submitted to however many programs you'd like to apply to.

The programs then start to respond and ask you to come out for interviews. Now, this is not like getting a job out of, say, law school. There is no schmoozing, there is no wining and dining (generally). There is you paying out of pocket for the interview times that are available by the time you rsvp for an interview spot. There is you paying for a hotel and a rental car and making arrangements for your travels. For most average fields, folks do about 10 interviews give or take. This number can change greatly if you are 1)applying in an incredibly competitive field like dermatology or 2)applying as a "couple" where both members of the couple are applying into a field in medicine and need to live in the same area. Both of these things make it more difficult to match, so you need to apply to more programs.

So, you go to interviews. Meanwhile, you still have to make sure you are completing any course work you need to finish. At the interviews you generally have a dinner the evening before the interview day where you meet some of the residents, the other applicants who will also be interviewing, and sometimes faculty. This dinner is always about balance. Balance between asking too many questions and not enough. Balance between looking "fun" and having a drink with the residents and looking stupid and having too many. Balance between getting there too early and being the only applicant and getting there late and looking like a slacker, and by the same token leaving to early and looking to eager to get out and leaving late and being that awkward hanger-on that just can't get the hint. The next day is an interview day which usually includes a tour of the facility and 3-5 interviews with faculty and residents. Then you'll usually book it to the airport to get out of there.

After each interview you try to make notes about the place, the people, the program, etc. Some people go to such lengths as to make complicated spreadsheets with numerical values assigned to each category and a tally of total points. I just wrote about the general feel of a place, could I see myself working with these folks in close quarters for long hours for 4 years?

After all your interviews are done the end game comes into sight. Ultimately how this whole deal is decided is remarkably similar to Greek rush in college. Applicants make a rank order list, where they rank each program they interviewed at (or if you're really nuts you list programs you didn't interview at...they will not rank you). The programs will also make a list of the applicants they interviewed in the order that they would like to accept them. This is all due in late February. For us, Feb 23 at 9pm EST sharp! From this date until "Match day" some sort of black box computer program sorts through all this, matches up who wants to be where, and presto-chango, you will become a resident! Signing up for the match is a legally binding congtract, so you better not list somewhere that you really don't want to go. You need to be willing to move wherever you list on that rank order list.

Sometime between your interviews and the due date for the rank list, it is generally accepted that students should send "love notes" to the programs they are most interested in and thank you's to all their interviewers. Some programs will send love notes back and there is a strange kind of courtship that goes on, all the while walking a thin line that the National Residency Match Program deems within the rules. You are never allowed to outright ask a program where you will fall on their list, just as they are not allowed to solicit this information from you. Both parties are allowed to voluntarily offer this information, but even that can be deceiving. For example, a program might tell an applicant "you have been ranked to match at this program." Well, that sounds great! Maybe they should be first on my list so I can for sure match there. Not so fast! Think how different it would sound if they wrote to a different student "we have ranked you in our top five, and you will match here if you rank us number 1." Apparently two different students from last year's class got these two messages. Knowing these are both possible, it makes it awfully hard to interpret what they tell you. And to make it worse, so many of the programs will give you absolutely no guidance at all, in part to not influence your decision, and partly to abide by the rules of the match.

Applicants are informed of whether or not they matched (but not where) on March 14th. If you did not match, you will then join the "scramble." That is, you will be left to scramble into one of the positions that did not get filled. This may or may not be in your field of choice! Match day is when you actually find out where you matched if you were able to match without scrambling.

Match day this year is March 17th. I'm hoping it's lucky since it's St. Paddy's day. The process on that day is neuroses inducing as well! It's not mandatory to go to match day, but it's a big deal and most of the class does attend. Family is invited as well. We are having it at Invesco Field this year at an indoor conference room. A nice lunch is going to be served, etc. The weird part is the ceremony. The program starts at 10am (and the bar opens as well) with some speeches by professors we've chosen and a toast from the dean. Then, and this is the crazy part, at 1pm EDT EXACTLY, you are allowed to open the envelope that contains the location of your residency assignment. Again, you don't have to open it there, you can bring it home or whatever, but most people choose to open their envelope with their class. This makes the atmosphere at the luncheon totally bizarre. There are people screaming with joy, there are people crying with joy, there are people screaming in agony and crying in desparation. It is the strangest, and most electrifying, environment I've ever seen (I had the honor of going to last year's match and helping to plan this year's). Last year they had all the envelopes on a table and everyone ran up like a herd stampeding. This year we will have them in a goodie bag at the tables (covered in very noisy cellophane so no one thinks about opening it early...). We are doing this 1)so no one gets trampled and 2)because programs often text message their new incoming interns at the 1pm EDT marker, and a lot of folks thought it was kind of anticlimactic to find out in a text while you were waiting to get your envelope.

With only 2 weeks to go until the big day, I am starting to feel the effects of the stress. Let me just say that a few weeks ago, I would not have been awake after 11 when the baby is still waking up repeatedly throughout the night. When I do sleep, I have nightmares about ending up somewhere I truly didn't want to be. I worry about having to move my husband and my daughter, I worry I won't be happy. It's a huge weight on my mind. To make matters worse, we have a mandatory two week class through next Thursday that puts us all captive in a room, our anxiety feeding off each other. It's just insane. We've had beautiful weather lately, and hopefully it holds out, maybe I can burn off some steam since we just inherited a running stroller from some family friends.

No matter what happens, on March 17th, green beer will be had. Probably in fairly large quantity. The in-laws are taking la nina so we can have a night out and if you're in town and want to join, shoot me a line so I can tell you where we'll be. I'll either be celebrating or crying into said green beer, but you are welcome either way!


The Maiden Metallurgist said...

My god, this sounds remarkable. So many variables, and this huge life change presented like a big surprise. No wonder you aren't sleeping. Good thing you are a good sport.

Ania said...

Gook luck to you! I hope you get matched with your top choice!

PGYx said...

It's a crazy process that requires way too much energy, money, and time away from 4th year coursework! It was by far my most stressful time during med school. I'm confident you'll match at the right program and wish you tons of peace, relaxation, and fun during the remainder of the year.

bazin! said...

Good luck! Aren't you glad Mines prepared you for rush? Are you going to tell us your top choices? I might be around to help you drink beer.