Quality Couch Time & My Travel Agent Training

The last three weeks have been gloriously empty! No rotations, no interviews, no schedule, no plans, no hospital, no school, no nothing! Nothing but delayed showers, leisurely mornings with tea, public radio, DVD's, dinner with friends, occasional trips to the gym, long hours on the couch with books, trips to the farmer's markets around town and dinners made at home with purchased ingredients. This is the first time in years I truly have felt that I am "off", able to relax and enjoy my life. My life... something that has seemed barely memorable and is just now surfacing again in my mind. I had one task to attend to during this entire time... planning my residency interview offers around the country. Thus begins my training as a travel agent...

It is amazing the amount of details that need to be attended to when trying to plan out a tight, efficient and cost effective travel itinerary. As an example, I have 4 interviews on the east coast that I accepted and planned them all within a week such that I could make one flight only for all 4. I had to find tickets that were not only in my budget, but that minimized my time out there and arrived and left at proper times. In addition, I had to avoid any connecting flights that take me through airports that often succumb to weather delays. Like a stack of dominoes, if I miss one connection the entire lot tumbles. Finding the best tickets utilized two airfare search engines and then scouring the individual website for the airlines until I found 2 one-way tickets that made it cheap and efficient.

Now that I would actually arrive on the East Coast, I needed transportation that would take me to all the distant cities I needed to visit. Given the time of year, I decided I needed a 4WD vehicle to make sure a minor snow squall did not delay me. I found out during this search that the rental car industry is amazingly fickle. The rates change from moment to moment and often all that is required to lower them is a simple request, alteration of a car type or simply a second search on a different rental agency page. I called some agencies that lowered their prices drastically simply because I said that another agency offered me a lower rate (which was true, but they never verified it). After a little digging around I found that the mid-size SUV was cheaper than the compact SUV (?) and that if I went through my credit card's "concierge" service I got the best rate. By the way, I also found out that using this concierge service not only insures my rental for more than my actual auto insurance, but that there is no deductible.

That is another entire conversation, the over-insuring of the entire country in many ways specific to travel and automobiles, which I think is funny when you consider the under-insuring of the healthcare realm... Anyway, always reject the rental insurance. Your auto insurance covers you and if you only have liability, then use your American Express. It covers you for $100,000 without deductible AND they have roadside assistance. Leave your AAA card at home!

Finally, I needed to arrange lodging. I was quite lucky in that three of the four residency programs I am interviewing at offered me lodging! All I had to do was arrange it. This is often the case with smaller programs that may not be as competitive with some of the larger programs, so they want to lure you out to an interview. This is fine with me because I already made a decision to only apply to smaller programs. Nothing in Boston, New York, LA, etc.... Just don't want to live in those big places. I think that my happiness will depend more on being in a place I enjoy living in with people that want me there and that are courting me rather than vice versa. Trying to be the biggest fish in the biggest pond is fine if you don't want a life, I decided that being a larger fish in a slightly smaller pond surrounded by a beautiful city and friendly people will bring more happiness than some fancy name on my CV down the road. So, it was easy to find lodging by and large and was very cheap. The fact that I had saved so much money so far on this one East Coast trip allowed me to find a nice place to stay in the one city requiring a hotel without worrying too much about my budget. In addition, I have 2 days off in the middle of this trip and will be staying with friends in Boston. More free lodging that will cost me only the price of some nice dinners and friendly company! Can't complain...

So, now I have airfare, auto rental, lodging and all the addresses of all location accurately placed in my GPS for my driving pleasure upon arrival. Total cost . . . probably about $1100 for these 4 interviews. Really, not bad. I have also put together data on all programs from the three big resources (SAEM, EMRA and FREIDA) for emergency medicine along with their own PR that they sent me, all condensed on a two sided sheet of paper. I am ready to interview and be interviewed and although I don't look forward to the travel now that I am comfy here at home, it is only a few weeks of flights and sort of exciting to think that one of these places will be my home, new family and life for the next three years, and maybe more. I can safely say right now that I have my number 1 top rank choice for residency already picked. I doubt anything will displace it from the top of my list, but my big task now is to find at least 5 other programs that I can rank with the confidence that I will be happy at any of them. The stats show that 88% of students from my school applying to Emergency Medicine get one of their top 3 residency picks, wich is as good a chance as anyone can hope for. I am hoping that no matter what, I will likely get something in my top 5 and if I rank at least 10 programs I will pretty much be guaranteed to match. So.... here begins the roller coaster. Stay tuned for interview trail tid-bits emailed from my hotel rooms from around the country...

The Sour Taste of Rejection

Well, so much for the pleasant absence of residency rejections. I have been checking my email obsessively for news one way or the other on the 9 programs I am waiting on. I have received my first two rejections now. One was at a program that I was just not that excited about honestly and so my heart was not exactly broken. It was a good location though, and that is frustrating. The second came today after I called the program yesterday in hopes of assuring them of my interest. This was a program I did not know much about but was excited to see. I know only what I had read on their website and a few of their specific details excited me. I am bummed out now that I am getting rejections because that seems to signal to me that most programs have filled up their initial interview slots and are now sending out rejections. I get the feeling that this means I may not get good news from the remaining 10 programs I applied to.

It is hard to not start internalizing this process to some extent. You see friends around you getting interviews and rejections, but you start to notice little things. Did they get offers sooner? Did they get more? Fewer rejections or rejections only from places very hard to get into? Do they have more interview offers than you? Why? After 4 years of hard work, am I a good and competitive EM applicant or a less desirable one? What does this mean? I think most of us in medicine base a lot of self-worth on our work, how we compare and the competitive nature of medicine in general. This match & interview process is simply one more to adjust your sense of self worth based on the actions of others... I am trying very hard to keep this all separate from who I am as a person but it is very difficult.

It is also difficult to not have a lot of emotion riding on the fact that a computer somewhere is going to dictate where you live and who your friends are for the next 3 years. At my age of 38, this is a little unnerving since I feel very overdue to start living my life. If I end up somewhere I am not happy and can't see myself staying, it means I am resigned to yet another temporary 3 year stint somewhere. I want to buy a house, get a dog, plant a garden... all the things one does when planting roots. If I know I will pick up and move again in 3 years it makes it hard to feel connected to the place you are in. I have a lot riding on my top residency choice right now. It is in a good location for me, with good people and at a program that I feel will train me well. I can't ask for anything more but with this years evidently large pool of applicants it means I am competing with a much larger crowd and I worry my eggs are all in one basket.

PS: Good article on medical student burnout (i.e. stress) at the NY Times...

Residency Interview Waiting Game

As most of you know, I am in the process of applying for my residency in Emergency Medicine. There are about 146 programs all around the country and I applied to 20 of those. I have heard some students apply to 40 programs or more and some apply to less than 10. It is an expensive process and unnerving in many ways, so I decided 20 programs would be enough... but is it?

So far I have had two interviews at programs that I did away rotations at. Both away rotations were at programs I was considering high on my list. One of those programs turned out to be exactly the perfect fit and it is top on my list at this point, the other was not quiet right for me but will probably still be ranked. Most places offer you an interview if you do an away rotation simply out of courtesy, so I don't consider those as "offers" since I was already there on away rotation. Since the rest of my applications have been in at the other 18 programs and since my "Dean's Letter" has come out on November 1st I have only received only 7 offers for interviews! I am starting to get nervous... In this last week I expected most of the other programs to make offers or send rejections. I know that I applied to many competitive and great programs and I did not apply to many "safety" programs or places that I would most likely be guaranteed and interview, so my stats may be skewed a bit. It is hard to know where I stand. So far, I have not received any rejections, so that calms me a bit...

Interview season is so stressful for a number of reasons, but mainly for me it is because after a long, hard 4 -5 years either preparing for or in medical school I finally arrive at the beginning of my chosen career and the chance to start my life again. Students at UW that are interested in EM are forced to move to another state because we don't have our own EM residency. That means our future happiness for the next 3 years depends on finding a program that is not only strong in training, but that is in a city you want to live in with new friends to make and overall a place that you "fit" into. Programs all have slightly different takes on specialty training and some are just better fits than others, much like dating. All programs are accredited and I am sure I will be competent no matter which program I go into. What is hard is having to choose the right program, the right city to live in, etc... all that from a single interview and day seeing the town. It is like committing to marriage after a night of speed-dating. It is all about both applicant and program finding the right match and that is why it is called "The Match". I will let you know as more program offers roll in and how things on the "interview trail" go as the month rolls along.

PS: People often ask me what "The Match" is all about and how it works. It is a little confusing, but here is a nice synopsis if you are curious...