How to get into Residency (Part 1)

Congratulations on reaching fourth year!!

You are nearly at the finish line, at the foot of your MD degree, and your hard work is about to pay off. So don’t give up and don’t fret; the worst is almost over. You have just one more bridge to cross… and I promise that you can do it! You can and you will match.

I have been in your shoes, and I’ve struggled through similar anxieties that you may be facing. From debating which specialty to apply to, to worrying about not matching, to figuring out how to do the damn application, the list can go on! The ultimate reason I wanted to put this Q & A together is so you can avoid some of the pitfalls that I encountered, and can enjoy the ride (and many flights) that are coming your way.

Some background on my match stats (i.e. why you should and can read my advice): I matched into my number 1 transitional year program through the regular match, and into one of my top 5 ophthalmology programs through the early match. I’ve done not one, but two applications: the snail mail method of SF Match, and the electronic application of ERAS. (And I’ve been equally stumped by both at times.) I am also currently an intern and loving it. Honestly, I couldn’t have found a better place. But it took a tremendous struggle and work to get to where I am, and I don’t want you to face the same hurdles I did. Without further ado, let’s talk!

1. How do I pick a specialty? 

I am going to be very honest and practical with you. Don’t do something because you should do it, do it because you love and will enjoy it. Figure out what you value (is it money? having a life? becoming the top of your field?) and draw the line with what you’re willing to sacrifice to get there. Because the thing about medicine is it is a long and lifelong journey, and while you can switch between specialties, it is hard to do so later on. And yes, it is difficult to know these things as a medical student, so you have to make sure you are making the most educated decision you can.

Don’t be afraid to ask people about their lifestyles, about the bread and butter they see, and what they like and dislike most about their specialty! There will be no perfect specialty, just one you are willing to make yours. One of the reasons I picked ophthalmology was because the residents were the happiest I knew and seemed to regret it the least. (Though looking back, it may have just been partially the Wills Eye effect, haha.) 

To help with selecting a specialty, you first have to figure out if you want to play an active role or supportive role for your patients. The supportive roles are specialties like radiology, pathology, anesthesiology. While you affect the care and diagnosis of the patient – you will not be the primary caretaker, so if developing patient relationships is very important to you, these specialties may not be for you.

The active roles can be further divided into medicine and surgery or both. This depends on whether you prefer to work in primary care, or in the acute setting (hospital/ER/surgery), or with your hands. It is also said that internal medicine is for those who can never decide – you can continue to sub-specialize until you find an area you like.

2. What if I’m stuck between two specialties? How do I pick where to apply to? 

The two most important factors that will play into your decision making are these: location and lifestyle. When I started medical school, I fully believed that I could live and breathe medicine, that I could spend my entire life in the hospital and it would be all I needed. However, it was only when third year rolled around, that I realized – there is much more to life than just work. There are friendships and relationships and family and hobbies that are just as important.

So depending on your personality, you have to think about what you want in a future career. Will it be in research and academia? Or outpatient, or both? Usually the specialties that offer the better lifestyles and flexibility, are the ROAD(E) specialties or in primary care. (Of course, after you are an attending, you will be able to dictate your schedule. However, the years of training should also be accounted for.)

On the flip side, location is also very important. Do you have a significant other, family, or friends you want to stay close to? Or prefer to live in the city or the country? If you decide to pursue a competitive specialty and are an average applicant for that specialty, be aware that you may have or may not have to sacrifice location.

In summary:

  • if you have a specialty you would regret not pursuing – go for that specialty. If you feel that your stats are perhaps not high enough, discuss with your adviser about ways to maximize your chances, such as taking a year off and building your resume. If you really fall far, you may want to consider applying to a backup field at the same time, depending on how you feel about not matching.
  • If you like two specialties equally, but one provides a better work-life balance – go for the one with the better lifestyle. Of course, this is my personal opinion, but from my experience, being able to maintain a good work-life balance is crucial to overall happiness.

3. Okay, I’ve decided want to sub-specialize. How do I pick between a transitional year or preliminary year program? What is the difference? 

First, the difference between preliminary and transitional years is this: a prelim year tends to contain more medicine months (i.e. in the ICU, CCU, inpatient floors) whereas a transitional year tends to be more similar to fourth year (i.e. few inpatient months with more elective time.) But just because a program is a prelim program does not mean it may be harder than a TY program! Some prelims programs are structured to be easier than some TY programs – so make sure to do your research (SDN is a great resource, and PA has some great programs to apply to!)

All I will say on the topic of deciding between the two is this: you will spend the rest of your life learning and working in your sub-specialty. In this intern year – do you want to work as hard as a medicine intern even if you are not going into medicine or would you rather learn at your own pace, and have the freedom to delve into specialties you may never be able to in the future? There is no right or wrong answer – just one that fits you.

This leads to my next point: I wish I had spent more time on selecting prelim/transitional year programs on my ERAS application. I selected programs based off of location, without much research, and applied to WAY too many. For example, half my list were California programs (hey, one can dream); however, the majority of my interviews came from regional hospitals close to my location. Had I known, I would have applied to fewer locations further away. I also applied to way too many preliminary programs as back up, and ended up canceling all but one, after realizing they didn’t offer what I was looking for.

Tip: These programs offer frequent interview dates. I recommend scheduling them (if you can) after your advanced specialty interviews; this way, you can have an idea of where you many end up, and cancel interviews accordingly.

Tip: You do not need to go to every interview! If you can match into your advanced specialty, you will absolutely match into a prelim or TY program. I ended up going to 8 transitional/prelim interviews, and found it was more than enough.

Tip: Contact programs you are going to be in the area for! For example, if you are interviewing in Boston for an advanced specialty, contact the program director of the prelim/TY program and see if you can squeeze in an interview before or after! They may have spots available and it is always worth a shot.

Tip: Follow up with the program you are most interested in. Program directors like it when the people they like want to come. Instant points.

Inside the Doctor Life

“Wherever the art of Medicine is loved, there is also a love of Humanity.

Yesterday, we pronounced a death. A patient who wanted to die on her own terms, on hospice. Her wispy breath, extinguished silently, only to be met by the clamor of sobs in a room filled with sadness,

Today, we brought back a life. The rapid compressions on her chest, the shocks from the defibrillator, and rapid oxygen from the intubation tube slowly, but surely coaxing back her soft, sweet pulse.

On the hospital floor…

To my right, is a twenty year old struggling to fight disease and addiction. Her short life, marred by drugs, was being cut even shorter by the giant of the autoimmune deficiency syndrome attempting to consume her. But family was there, armed for the battle with her.

To my left, is a centerarian, face marked by wisdom and of years lived, questioning, always questioning why she was still alive, why she was the only one left. No family, no close relatives; everyone was gone, as was rapidly deteriorating, her mind.

Behind me, is a patient with a pre-renal acute kidney injury. No significant past medical history combined with youth, translated to an easy, smooth recovery. Only saline, and adequate hydration, was necessary.

Ahead of me, is a patient with a simple complaint – abdominal pain. Yet, a complicated history combined with advanced age, necessitated a full work up that revealed metastatic cancer. Only time would be his medicine, and would give him his final peace.

//

This sampling of patients above, are just examples of the ones I see every day. I’ve had to learn to collect my emotions, and be able to move forward to the next patient and concentrate on them, despite what may have just occurred in the room next door. I’ve been learning to give orders, listen to my seniors, collaborate with consultants, and most of all – manage my patients.

And it is not easy.

There have been days when I’ve come home exhausted and utterly, emotionally spent. And then there are days when the stress and the work accumulates up so much during the day, because I want to do well for my patients, do well for my team, not let anyone down, try to be a superhero, but am meeting so much resistance and coordination and the disease won’t listen!! – that I can feel the hot tears threaten to build – and my deep breaths  and counting begin.

But then there are the moments that make this profession so incredibly worth it.

I gave out a hug today. It meant a lot me. It represented a goodbye, a battle well fought, but a war just beginning, and a discharge well deserved. An I’ll see you later, but not here.

And sometimes these moments can feel far and few in between. But we live for them – we remember them – we keep them, so that when things do get hard, we have them.

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Also, too many conditions that I see in the hospital are preventable.

If every person knew how much they mattered to someone else, knew how much they were loved, and would continue to be loved – how much better care would they take of themselves? 

Would they still take the drugs that provided the quick fix, the fast high? Would they still be non compliant, skip appointments or would they begin to eat healthy, exercise? There are so many scenarios.

And it just breaks my heart. Every. Single. Time.

This is why when I feel like I am running out of juice, I am running out of love, I am running out of patience – I remember who gave me my life, who blessed me with health and this job. Suddenly, I realize I owe so much more than what I give out. And that’s why I’m here… I’m going to continue to pour out love, because it doesn’t come from just me.

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Terminal.

What would you do when the one you love most has a terminal illness?

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While going through my drafts today, I came across this piece I wrote as a third year medical student. I don’t share stories as often as I would like, but since starting residency, I’m grateful I recorded this down. I’m once again, reminded that all my patients have unique stories. They are more than their disease; they are daughters and wives, husbands and sons. And it is my responsibility, as a physician, to care for them to the best of my ability.

//

“They says it’s suicide.” 

“You think? Well, I heard she was found down on the floor with empty pill bottles around her…”

“Oh her poor soul!”

My ears perked as I slowly made my way around the nursing station that, this morning, was filled with commotion and whispers about the patient I was about to see. I knew the basics: a woman in her mid fifties had been found unconscious in her home, brought into the ER by a concerned husband (not unusual)… and was now sitting behind the door of the room across from me. I was to screen for depression and the possibility of a suicide attempt.

I took a deep breath. If the first week of psychiatry had taught me anything – it was this: anything was possible.

And true to form, what I discovered was so different than what I was expecting.

//

“Why does everyone keep asking me about the car crash?? Like I said, the other car ran into me!” She howled, as she pulled her hands close to her eyes, covering her face.

“I’m sorry, ma’am but I have to ask…” I trailed off. We had heard from the husband that she had been in a car accident a week prior, and had told him that there was another driver who ran into her car on the highway. A few days later, he received a police report that detailed an entirely different story. She had ran her own car into a tree, and flipped it over.

I tried an alternate approach.

“Tell me about your family.”

//

I soon learned about her family: her grown children and their different personalities and careers, their own families, and her increasing grandchildren. Through her words, I could sense her dedication to her loved ones.

But we too quickly reached the present, to the current change in events.

Suffering from poorly controlled diabetes, she had a complicated leg amputation earlier this year. She lost her job soon after, and had been slowly losing her sight. Now, she was practically blind. On top of that, during this hospital admission, we discovered she had suffered a stroke as well.

And then, there was… her husband.

“My first marriage, oh – it was so young and stupid. We stayed together ten years before I was able to leave him. I was 17 when I got married, you know? Too young, too naive to know anything. But Jorge, this marriage… it was for all the right reasons. We married for love…” her voice cracked, “but it’s been too short! Only two years…”

“What do you mean?” I whispered, captured by her story.

“He… he was just diagnosed with terminal cancer. They found it too late. He has… about a month. I don’t know. Maybe shorter?” She broke down sobbing. “I don’t know what I’m going to do without him. I can’t be without him. I’d have nothing.”

“Would you hurt yourself if he were gone?” It almost felt cruel to ask. (But in psychiatry, you see, this is the number one question we had to ask to rule out suicide.)

“No.” she shook her head vehemently, “I have my family, and I have to be there for them.”

//

After her interview concluded, we diagnosed her with natural bereavement, which is to say – it is normal to grieve. Sadness is part of the human condition – if we try to treat it, and make it go away; what is there left of us?

Too often, in medicine, we over diagnose. We ask questions and we speak, but we forget to listen. Sure, we hear the words, but we don’t understand. Instead, we respond by placing our own judgement and interpretation onto the patient, forgetting to look and listen.

Today, I don’t know what became of that patient, or of her husband. But I am thankful for these special hours I was able to spend listening to her.

If I were to write a book on dating…

It would go something like this.

For sh*ts and giggles; a satire. 

Chapter one: Why Looking for Mr. Right is like Looking for the Right Bra. (Or Jeans.)

Does he boost your assets and make you look good? Or does he diminish your worth? Is he too tight, too controlling? Or is he just not the right fit? Is he going to last or is he just there for eye candy? So many questions, not enough VS personnel.

Chapter two: Size matters.

Who your potentials are depends on the size of your pool. Even in the smallest fish tank, a guppy may seem appealing. But put him in an ocean – does he still stand the test? If not satisfied, then expand your pool. (Why else is online dating so popular… make the world your oyster.)

Chapter three: It all comes down to go-fish.

Forget poker, this game is all about fishing. When a guy isn’t serious, he’ll catch a shiny pretty fish to show around and then toss back. But when he is – then he’s looking for a trophy fish. Be that trophy fish.

On the flip side, if you want to catch him – you must always throw some bait. If he doesn’t bite, he’s not interested. (Fish ALWAYS bite something they like.) If so, move on. There are always more fish around.

Chapter four: Sometimes, you have to set sail.

Is he a sailor? And you only walk on land? Are you an introvert? He an extrovert? Do you love music, and he loves racing? Sometimes, you have lower your guard and try something new. You never know what you can discover when you decide to step foot on the boat; perhaps that treasure map was right – x really marks the spot.

Chapter five: To park well, park early.

My mother once told me, men are like parking spots. The best ones in the front? Well, they go fast, and they go first. There’s this thing about being too picky – in the end, you’re left in the back of the lot because no other spot was “good enough.” Tough luck.

Chapter six: The Golden Rule.

To be respected, you must first learn to respect yourself. Have confidence, be honest, and be straightforward. Don’t give excuses; sometimes when there is no chemistry – there is no chemistry. But when there is, don’t be afraid to go after it. Good luck. ;)

River Flows in You

I love this piece. Funnily enough, when I was younger and in the high school Yiruma craze – I never had the patience to fully learn a single song of his. I would always “practice” whichever songs were assigned to me, and leap off the chair the moment I hit the hour on the dot. And for the past 6 years, I quit playing myself when I started teaching piano to my siblings.

Yet, I couldn’t resist that itch when I noticed this song in my brother’s repertoire. A couple hours of practice later, here is my recording.** :) Not bad for 6 years away from the keyboard! And while it’s not perfect and no where near the composer’s sound… I’m satisfied. Here’s to achieving childhood dreams!

**Please forgive the creaking from my pedals! 

A New Chapter

The doctor is in.

IMG_0607Ahh, I still get the chills whenever someone calls me Doctor Mao. :)

It’s been such an unbelievable journey… but luckily, I’ve had the best friends and the best family who have surrounded and supported me every step of the way! THANK YOU!!

I wish I could post pictures and do a shout out to everyone here on my blog (you know who you are!) – but I’m sure it would be too embarrassing, so here is but a sampling (aka the ones who have no say. ;)

IMG_0693IMG_0641(Photos all credits to S.) 

It’s unbelievable to think that this dream that started in high school, has finally come true. Six long, but fruitful years later. So many things have changed in this time… yet the important things have remained.

I still remember struggling to decide between a certain Blue Devil University and Penn State… and am so glad I chose the latter! Little did I know, it would form some of the best years of my life. A place where I would meet lifelong friends, share late nights, and watch reunions morph from birthdays into marriages. (3 weddings in 2 weeks is currently my new record.)

At Jefferson, I learned about the art of medicine from talented professors, met and cared for patients, some who have changed my life, and fell in love with city life – especially the wining and dining aspects.

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So it’s with the utmost sadness to think that this chapter of my life is slowly coming to an end. But that just means another is about to begin

Here is what I’m looking forward to:

1. Work. So, what’s next? 

Well, I’m glad to say that I get to stay in PA for one more year! I’ll be working as a Resident-Physician in Reading, PA – starting next week! Ah! While nervous about beginning as a intern, I am also very excited to finally learn and do and take medical students under my wing. I do of course, plan to visit Philly often and welcome all visitors, with the promise to live this last year in PA to the fullest!

After that, I’ll spend three more years in ophthalmology training in Augusta, GA.

2. Personal Goals

I feel like I’m finally becoming an adult even though I’m years past 18! Haha. Along with gaining my first “real” job, I recently financed my first car, with plans to buy my first house next year. I guess this just marks the beginning of financial responsibility and saving and paying back loans and taxes and perhaps finally learning about a 401k? (Help?!)

3. Relationships

Can you believe it has been almost 2 years since my last real blog post in the love category? If you don’t believe me, just click the archives. It’s shocking to me even, considering how I first built this blog on giving (mainly unsolicited) love advice!

To be honest, 2 years ago was when I had dabbled in dating and realized that it wasn’t the right time for me yet – that I wanted to focus on growing as a person (spiritually, mentally, physically) and on relationships that were important to me: the friendships.

But now that I’ve hit in my mid-twenties, have a career ahead of me, and know where I’m going – that I’m realizing that this now is the time. And I’d like to think I’m a little wiser now too about love and the like. :)

And the biggest changes are these: I’m learning to let go of pride and being okay with uncertainty, seeing potential before all else and setting standards… and realizing that sometimes, perhaps the good has been here all along…

Till next time! More wedding and travel blog posts ahead~

Eurotrip Part 5: Barcelona

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Barcelona is laid back and richly alluring, with endless streets for exploration and an ability to take on multiple identities. It is part city – part beach, part Spanish – part uniquely Catalan. While its avenues are lined with majestic, “Gaudi” buildings, its alleys are filled with street art and graffiti. Famous chains and smaller boutiques intermingle, and one can get easily get lost in the maze of windy roads.

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M, one of my good college friends, joined us for this last leg of our vacation. We rented the master bedroom of an apartment located near the city center (Placa Catalyuna) at Universistat through Airbnb. The bedroom was huge, with a queen sized bed and a twin sized sofa bed – perfect for the three of us, as well as a kitchen, laundry room, living room and bathroom that was shared with the other rentals. It felt amazing to finally have our own space and privacy to come back to, especially after weeks of hostels!

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Itinerary

Day 1

  • We explored La Boqueria, which is a large outdoor market (and puts Reading Terminal in Philadelphia to shame!) They have an enormous, dazzling selection of fresh produce and meats, as well as fresh juices, desserts, baked goods, and jamon! It is impossible to walk out empty handed. This was my favorite place to go, and I came here daily for fresh juice and a tasty meal! 
  • We also walked down Las Ramblas, one of the most crowded and famous streets of Barcelona that is filled with a variety of street performers/artists. At the port, we reached the Christopher Columbus statue, and also stocked up at Carrefour, my new favorite supermarket. 
  • We ended the evening with a flamenco show, at the Jazz Si Club. The venue was cozy and packed; the cost was 10 euros and included a free drink. 

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IMG_3613Day 2

  • We took a free tour through the Travelers Bar (highly recommended, but this one does require tipping).
  • We explored the barceloneta beach and walked to the less tourist/more residential district of Paral·lel to the street of carrer blai for true local tapas. It was delicious!! 
  • We partied at Razzmatazz, which is one of the largest clubs in Barcelona (at 5 floors, each with a distinct music genre), from 1 AM to 5 AM. What an experience, and a must-do! The club suddenly became packed around 2-3AM, and the majority of people there were foreign (from countries all over the world) and of college age (sad day, that I am in the “older” crowd!)

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food

Day 3

  • After taking the morning to sleep a couple of hours, we took an afternoon paella cooking class with Marta through Eatwith, and it was delicious! I will be definitely be sharing that recipe soon.
  • Because museums are free after 3PM on Sundays, we also checked out the Picasso Museum.

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Day 4

  • Today was dedicated to learning about Gaudi and modernisme. We visited Parc Guell, went on a Gaudi tour, and stopped by the Sagrada Familia (didn’t get the chance to go in this time; would do so next time), Palau GuellCasa Batillo, Placa Reial, and Casa Milia. 
  • The best way to get to know Barcelona is through wandering; we spent the afternoon wandering through Barri Gothic and El Born region. 

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  • We also met up with D, a friend of mine studying in Barcelona, and at THE most amazing tapas! The chef/owner designed our menu: olives, salmon/anchovies/ceviche with crackers, mild goat cheese with bean sprout salad, famous Spanish boiled potatoes with two types of sauce, and four types of cures meat (jamon, chorizo, Catalan salami, beef jerky) with sundried tomato bread, and wine on the house! :) 
  • We ended the evening by walking through Parc Citadella to Port Olympia

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Day 5

  • We tried the famous thick hot chocolate with churros… yummy! 

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  • We ended our last day with a hike up Montjuic to see the castle, the sunset, and the city of Barcelona, one last time. 

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Tips

  • I highly recommend using Airbnb to book a place to stay if you are with a group of friends. You can usually get a place (i.e. a large room to an entire apartment) at a cheaper cost than a hotel and/or hostel room, with much more privacy and space. Our Barcelona apartment cost less than $25 per person per night! To save $25 off your first rental, please register and rent with my link here.
  • If you are going to go clubbing – go big or go home. It is pricey, but Razzmatazz is one of the most famous and worth it’s value! I highly recommend pre-ordering tickets because the online tickets include a free drink! Additionally, subways only open at 7 AM, so have a plan ahead of time for how to get home. We had to the learn the hard way…
  • I would also recommend watching the Magic Fountain light show and visiting the Olympic stadiums.

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