Category Archive: Residency

Tips for the USMLE Step 3

Categories:

Step 3

July 6, 2015

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Master the Boards Step 3

 

The USMLE Step 3 represents an interesting paradox in medical education: it is the board exam whose results are the least important, but whose content is the most important. Maybe we medical students and medical educators have our priorities backwards? Here we have an exam that determines if you can competently diagnose and treat patients, and it is an afterthought when compared to an exam that tests whether or not we can memorize with perfection the Kreb's cycle. Does anyone else see a problem here? The truth is, you can not completely blow off Step 3 or you are in for trouble. Here are a few pointers on how to prepare for the exam

 Scheduling

Ideally, everyone should take Step 3 in the second half of intern year. This will give you ample time to hone your inpatient hospital skills, something that will be critical for the new Computer-based Case Simulations (CSS), but not too much time to forget everything you learned in medical school and internship. Too often I meet specialists who are taking Step 3 at the end of their residency. There is nothing about a 5 year orthopedics residency (or any other residency) that will prepare you better for Step 3. To put off the exam for many years of residency will leave you unprepared and you will have lived with a weight over your head unnecessarily. 

Remember, USMLE Step 3 is written specifically for the broad training culminating at the end of your internship. Technically, after your internship, if you pass Step 3, you can be licensed to practice medicine in the United States. Do whatever you can to get the test done during your internship.

Studying

You are going to be busy as an intern. If you have free time, you will want to sleep or relax; the last thing you will want to do is study for another board exam. You will not need much time to prepare for this exam, but you cannot completely blow it off. You need to find a way to reject the old saying, "two months for Step 1, two weeks for Step 2, two pencils for Step 3". If you think this way you are likely to waste your time and money. Let me illustrate two reasons why you should consider a small amount of studying: 

  1. Most of you will focus either on children or adults during internship. You must be prepared to answer difficult questions about all age ranges on Step 3. If you are out of practice in pediatrics, study up.
  2. Very few of you will take care of OB/GYN patients during your internship. This is something else you will need to study
  3. The CSS is unique and has many quirks that you have not experienced yet. You MUST take the time to familiarize yourself with the format and how to succeed. If you do not prepare for this strange new testing format, you could make some logical choices during your exam that will not count. You simply need to spend a couple of days learning about the test itself and taking some of the CSS practice questions through the ACGME website. There is a great review of the CSS format and some of its nuances here. 

Questions

As I have said before about other USMLE board exams, there is no substitute for a great question bank. Both Kaplan and USMLE World have great Q-banks, though I tend to prefer USMLE World. If you spend a solid week or two on questions, you will be more than ready.

Books

I think that one or two good review books can help a lot. The main goal of a review book will be to re-familiarize yourself with the specialties that you have not thought about in two years (pediatrics vs. adults, medicine vs. surgery, OB/GYN vs. everything else). Below is a list of books that I found useful. Again, you probably only need one or two of these.  

  • Updated June 2015

1. First Aid for Step 3:

I am a sucker for the First Aid series. Even for Step 3 I think they produce a fantastic review book. You should know, there are many residents who prefer the two books below (or others) to the First Aid for Step 3 book. What draws me to this book is that it contains a brief review of all required specialties and a great review of the CSS format with great CSS practice questions all in the same book.

 

2. Master the Boards USMLE Step 3:

I have always been impressed with review books written by Conrad Fischer, the author of this book. Master the Boards for USMLE Step 3 is no different, it is a great review of the entire exam. I also highly recommend this book.

3. Crush Step 3:

Many residents swear by the Crush series for Step 3. One downside is that they seem to be branching into two separate books, the main Crush Step 3 book for the clinical content, and the new Crush Step 3 CCS book as a primer on the CCS question system. So, you might end up buying two book if you go with this brand, but I have never met someone who regretted studying from Crush Step 3. 

 

 
 
 

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When should I schedule USMLE Step 2?

Categories:

Fourth Year, Step 2, The Match

July 2, 2015

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Calendar

One of the important questions all medical students have to answer in their fourth year of medical school is when to take the USMLE Step 2 exams. The answer to this question depends on each student's individual circumstances. Let me list a few pointers that might help you in making your decision. At the onset let me state that I do not know of a good reason to not release your scores to residency programs. Everyone should release scores, to do otherwise suggests you are hiding something. If you don't want your scores to be known by potential residencies, you simply need to schedule the test after your information is sent to programs, this is a much better alternative. 

After you have decided on a time to take the test, check out my list of the best resources to study for Step 2 CK.

  • The only nationwide deadline facing medical students is that prior to obtaining a license and starting internships and residencies, students will have to pass the USMLE Step 1, Step 2 CK, and Step 2 CS. So all medical students will have to pass these exams before July 1st after their fourth year. However, most medical schools have their own deadlines. If your school requires both Step 2 exams to be done before January 1st of your fourth year, you need to plan accordingly.
  • The next question you must answer is whether or not you need your Step 2 CK score to be available when you are applying for residency. There are two situations where this might be the case. If you are applying to a competitive residency and your Step 1 score is not impressive, most people recommend doing everything you can to obtain a great Step 2 CK score to send to residency programs. Alternatively, no matter what residency you are applying to, if your Step 1 score is below the national average (usually ~218 or below), most people recommend sending a Step 2 CK score to potential residency programs so they know you have passed the boards and will be eligible to start residency on time. If you fit into either of these situations, you should take Step 2 CK before the end of September in order to have the score available during residency application.
  • If you have a deadline from your school but you do not need to send a Step 2 CK score report to your potential residency programs, there are still some scheduling conflicts to consider. Students applying to early match residencies or other competitive residencies will spend most of the months of November and December interviewing. Available interview dates in these situations are usually sparse and difficult to manage. The last thing you want is to miss the only available interview date at a top choice residency because you have Step 2 CK or Step 2 CS scheduled the same day. If you can move your Step 2 dates earlier or later, I would recommend doing that. If you have a January 1st deadline like many schools but will be interviewing in November/December, consider taking your Step 2 exams in the September/October time period.
  • It is important to remember that Step 2 CS is not a very important exam for most fourth year medical students. The vast majority of students pass the exam and there is no numeric score released to students and residency programs. Therefore, it is in your best interest to simply schedule this exam when it interferes the least with your interviewing and clinical rotations.
  • If you are trying to cram your Step 2 CS or Step 2 CK in December before a deadline, beware of unpredictable winter weather. I have known a number of students who missed clinical duties or interviews as they were stuck in the airport after the Step 2 CS exam. Many of you will be traveling to cities prone to snowfall (Chicago, Philadelphia), so bear that in mind when scheduling.

If you have any other advice for the four year students reading this, please post below. Good luck to everyone and don't forget to check out my list of the best books for Step 2. 

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Spotlight Interview: How to Match in Physical Medicine and Rehabilitation

Categories:

Choosing a Specialty, How to match in....?, PM&R, The Match

May 30, 2015

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PM&R Vintage

 

A Physical Medicine and Rehabilitation (PM&R) Resident’s Perspective:  From an interview with a PM&R resident from Ohio.

 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the PM&R match?

Matching in PM&R is not as competitive as some fields, such as radiology, neurosurgery, dermatology, etc. However, it also used to be a relatively unknown specialty. Medical student exposure to PM&R has improved and the number of applicants seems to be steadily increasing, so it is becoming more competitive.

 

  •  What must a student do to match well in PM&R?

A student looking to match well in PM&R should focus on the same things students would pursuing other specialties. Like any specialty, doing well on boards is important. Most programs have now instituted board score cut-offs for applicants, which are around 200-220 for USMLE Step 1. In general, students should perform well on their clinical clerkships throughout medical school, and a rotation is PM&R is preferred. Strong supportive letters of recommendation, including one from someone in PM&R, is preferred. At least some exposure to or participation in research is also a plus.

 

  • What are residencies looking for in a PM&R applicant?
PM&R residencies look for all the usual strengths in an applicant like good board scores and academic performance, good clinical performance on your clerkships, research exposure, etc. In my experience, PM&R residencies also tend to appreciate individuals with additional interests like sports and music. There are many in PM&R who followed non-traditional paths to medicine and may have had other careers first. Personality is also very important, as it takes pretty caring and compassionate people to be providers for individuals with disabilities as well as an ability to work with a multi-disciplinary team. In addition to a student's application, their interview day with a residency program will be very important

 

  • What should students look for in a PM&R residency?

If you are pursuing PM&R but not yet sure whether you want to do a fellowship, look for a well-rounded PM&R program with opportunities for exposure to the subspecialties. I looked for a program with a good balance of inpatient and outpatient clinical duties and wanted exposure to all the major areas: Sports/MSK, stroke, TBI (traumatic brain injury), SCI (spinal cord injury), amputation and pediatric rehab. I also looked for programs that had an ultrasound curriculum, as well as plenty of exposure to procedures including electrodiagnosis (EMG), botox, interventional spine and baclofen pumps. Beyond curriculum, the deciding factor in residency programs for me was finding a good “fit.” I paid close attention to interactions with residents, students, fellows and faculty on interview days to try and get a feel for whether this was a place I would like to train or not. 

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Like any other specialty, having a well-rounded application is important. Although board scores are important and used as a screening tool, residencies want to see much more than that. Do at least one rotation in PM&R, even if you have to arrange an away rotation. Also try and have at least one Letter of Recommendation from someone in PM&R. I looked for well-rounded programs to rank, but ultimately my rank list came down to finding a good fit on my interview day. Pick a program where you can see yourself being both well trained and happy for 4 years

 

  • What do you wish you knew before application/interview season?  

Although I did a lot of practice interview questions before my interviews, one question I didn’t have a great answer for was “So what is a Physiatrist?” I struggled with this question because the scope of our field is pretty broad, but having a decent answer will help guide your personal statement and save you the embarrassment if asked on the interview trail

 
  • What other advice do you have for students applying for PM&R residency?  

People like to say “plenty of money and relaxation,” and although the lifestyle is good there are long days and hard days. We take care of very sick patients, many of which have experienced something catastrophic, and as their physiatrist we can be their greatest advocate or on some days just their cheerleader. In PM&R, you have to be willing to wear many different hats. Also, make sure you write “PM&R” NOT “PMNR,” and know how to pronounce “Physiatrist.”  

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: How to match in neurosurgery

Categories:

Choosing a Specialty, How to match in....?, Neurosurgery, The Match

May 30, 2015

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Recklinghausen neurosurgery

 

A Neurosurgery Resident’s Perspective:  From an interview with a neurosurgery resident from a top program in the Midwest.

 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • How competitive is the neurosurgery match?

Neurosurgery is among the very competitive specialties. Still though, I think that 80% of U.S. grads match somewhere.

 

 

  •  What must a student do to match well in neurosurgery?

All students should rotate at their home institution as well as at least one away rotation (almost everyone in my medical school class did at least two away rotations).  Boards are important.  Research and publications are very well looked on, as is performance on the sub-internship.  Being a good sub-intern is not about how much you know, but rather how hard you work, how willing you are to be at the hospital constantly, and how easy to get along with you are.

 

  • What are residencies looking for in a neurosurgery applicant?
The answers are the same as what I mentioned earlier. As a resident, I want someone who’s going to work their tail off on service and not let down the rest of the team.  

 

  • What should students look for in a neurosurgery residency?

Make sure the fit of your personality matches the department.  Seven years is a long time to be miserable if you don’t like the people, no matter how prestigious the place. 

 

  • Do you have any advice on the application, letters of recommendation, personal statements, or how to rank programs?

Letters of recommendation should be from neurosurgeons (it’s a very small world), or research mentors. Perhaps other types of surgeons can write your letter of recommendation if you’ve worked with them a lot.   Other letters really won’t count for anything.  You should get one from the chair at the places where you rotate.  It doesn’t matter if you didn’t really work with them at all; they will solicit feedback from the residents and staff you did work with and their letter serves as a summary of your time there.  

 

  • What do you wish you knew before application/interview season?  

It’s well worth it to interview at a lot of places and get a “tour” of neurosurgery.  It really is a small world and you’ll run into people over and over.  

 
  • What other advice do you have for students applying for neurosurgery residency?  

It’s an awesome privilege to be able to do this stuff. Good luck!  

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: Why did you choose neurosurgery?

Categories:

Choosing a Specialty, Neurosurgery, The Match, Why did you choose....?

May 30, 2015

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vintage neurosurgery
 

A Neurosurgery Resident’s Perspective: From an interview with a neurosurgical resident from a top program in the Midwest. 

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to neurosurgery?

I knew pretty early on that I enjoyed surgery.  I liked surgery rotations, liked the satisfaction of work that was both mental and physical, liked that there is a lot of instant gratification in surgery, being able to (sometimes) fix something in a very immediate way.  Within surgery I think I could have liked a lot of rotations, but I ultimately gravitated to neurosurgery because I liked seeing people who came in pretty dramatically ill, and sometimes we were able to help, or at least mitigate the badness.  I liked the intensity of it, as well as the variety; there’s everything from tedious microsurgery for brain aneurysms to giant spine cases where you’re using big power tools.  The common denominator is that most of it is pretty high stakes.  

 

  • Describe a neurosurgeon's typical work day?

In general, days start early and end late.  As a resident I usually get in around 5:30, and the day ends when the cases are over and evening rounds are done.  Sometimes I’m out by 6, but more often substantially later.

 

  • What type of lifestyle can a neurosurgeon expect?  

Many neurosurgical problems (trauma, ruptured aneurysms, cranial or spine infections) need to be dealt with right away, whether it’s the middle of the night or the weekend.  There are some neurosurgeons that have more regular schedules than others, but most have a substantial amount of call.

 

  • What is the potential salary of a neurosurgeon?

I honestly don’t know exact numbers, but I do know it is generally high, even for surgical specialties.  I think that shouldn’t factor too much into your decision to go into it though- It’s nice to know you’re going to be well compensated, but I’ve got to think a lot of the long, off-hour, painful cases would be utter misery if your only motivation is that it pays a lot.   

 

  • What is the job market like for neurosurgery?

I don’t know- I’ll tell you when I’m closer to completing residency!  One thing to be aware of is that in general, private practice docs do more spine surgery, and more of the cranial work is done at Academic Institutions. 

 

  • What can you tell us about neurosurgery subspecialties?

Subspecialty training after residency can be in pediatrics (1 year fellowship), endovascular or open vascular (1-2 year fellowship), spine (1 year), tumor (1 year), functional (1 year), peripheral nerve (1 year).  

 

  • What are the potential downsides of neurosurgery that students should be aware of?

A large part of neurosurgery can be trying to help people with chronic pain, and they can be a challenging population.  Neurosurgeons suffer from some of the highest malpractice rates in the country.  There is much discussion in neurosurgical circles about the decreasing reimbursement for our procedures.  Much of patient volume in private practice is spine.  

 

  • What else would you tell medical students who are considering neurosurgery?

A lot of people say “only do neurosurgery if you couldn’t do anything else.”  I’m not that dogmatic, but you need to realize it’s a pretty heavy lifestyle commitment  

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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FREIDA: Also a Great Resource to Compare Specialties

Categories:

Choosing a Specialty, Specialties, The Match

December 31, 2012

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FREIDA Online is a fantastic resource for any medical student. I recently wrote about how students can compare individual residency programs using FREIDA's various different variables.  The database is not limited to comparing individual training programs; it also allows students to compare different specialties.  

The "Specialty Training Statistics" section provides basic statistics about training in each specialty. Variables presented for each specialty include:

  1. Number of residency programs in the US
  2. Length of training programs
  3. Average number of interviews performed by each residency program
  4. Total number of residents
  5. Gender Gap for each specialty
  6. Average number of faculty per resident
  7. Average number of work hours per week for each specialty
  8. Average number of days off per week  (THESE LAST TWO ARE VERY IMPORTANT!  COMPARE SPECIALTIES!)

LINK HERE

 

The "Graduate Career Plans" section of FREIDA provides information about the careers plans of each of the medical specialties.  Variables presented for each specialty include:

  1. Percentage of residency graduates pursuing further training
  2. Percentage of last year's graduates who are in private practice
  3. Percentage of last year's graduates who are employed in academic settings
  4. Percentage in the military
  5. Percentage employed as basic scientists
  6. Percentage who are unemployed

In each case, the statistics are taken from the most recent graduating class and the database is updated each year. 

LINK HERE

 

Read these data carefully.  I found that the "Hours Per Week" section was very useful and very realistic!

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FREIDA: A Great Resource when Applying to Residency

Categories:

Fourth Year, Residency, The Match

October 31, 2012

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Applying to residency is equally exciting as it is stressful. I found myself searching for any information I could find about different programs and what made each program different.  During my hours of searching I found that the AMA’s site, FREIDA ONLINE, was one of the most useful resources.FREIDA is an online database of all ACGME regulated residency and fellowship training programs.  The FREIDA database is searchable by specialty or by state.  The amount of information available for each program is truly staggering, here is just a short list of some of the information you can find out about each training program:

 

  • Program director name and contact information
  • Length of the program
  • Institution and hospital affiliations
  • Size of the residency
  • Number of applicants interviewed
  • Number of faculty
  • Average work hours
  • Weeks of call per year
  • Amount of didactic lecture
  • Salary information
  • Vacation weeks
  • Benefits information

Now that I know the inner workings of my residency, I looked back at the FREIDA profile to see if the information is correct, and I can vouch for the database, it is spot on.  They provide an analysis of the averages of many of those statistics for each specialty. So, you can compare the ‘hours worked in a week’ of a program you are interested in with the national average. Click here to access the ‘training statistics’.

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Spotlight Interviews: What is a Transitional Year Residency?

Categories:

Residency, Anesthesia, Choosing a Specialty, Dermatology, How to match in....?, Neurology, Ophthalmology, Radiology, The Match, Why did you choose....?

September 11, 2012

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A Transitional Year Resident's Perspective: An interview with a transitional year resident from the Ann Arbor, Michigan.

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty. See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What is a transitional year residency?

Transitional Year (TY) residencies might be the least well known residency option after medical school. The TY is a one year residency with a general focus which prepares recent graduates for advanced residencies. To understand where a TY fits in, you must understand that there are a number of residency programs that do not start specialty training until the 2nd year after medical school graduation (i.e. PGY2). These specialties include anesthesia, dermatology, neurology, physical medicine and rehabilitation, radiology, radiation oncology, and ophthalmology.

Each of these residencies begin their specialty training after a resident's intern year. Many of these residency programs will combine the intern year (PGY1) with the advanced specialty training. In these cases, the resident will remain in the same residency throughout their training and there is no need to complete a transition year residency. However, there are programs in each of these specialties that do not start training their residents until the second year after medical school (PGY2). These programs require their residents to complete an approved intern year prior to beginning specialty training. Approved intern years include a year of preliminary medicine, preliminary surgery, preliminary pediatrics, or a transitional year residency.

 

  • How is a transitional year residency different from other intern years?

The goals of training are basically the same among all intern years; we all learn hospital based patient care. Surgical interns take care of patients before and after surgery in the hospital, medicine interns take care of medical patients in the hospital, pediatric interns take care of kids in the hospital. A transitional year resident will take care of all of the above. The transitional year aims to be a broad hospital-based training. TY residents will spend various months working on medicine, surgical, OB, pediatric, outpatient, ED, ICU, and elective rotations. The great asset of a TY is that it provides more flexibility, allowing residents to focus on their interests. I am interested in research and was able to complete two months of intense research during my intern year: something no one from an internal medicine, surgery, or any other residency could say.

 

  • Are Transitional Year Residencies easy?

Not all TYs are made equally. It is a well known fact that there are some pretty cush TY residencies out there. However, there are also some very difficult TYs. To illustrate this fact, last year I interviewed at a number of TY residencies of varying difficulties. The easiest one had 4 required inpatient months, one outpatient month, one ED month, and 6 electives. Sign out during inpatient months was 3pm. When you were in the ICU you covered 2-3 patients, and you were NEVER on call the entire year. In contrast, I interviewed at a big hospital TY where there were two MICU months where you covered 15 patients, 6 required inpatient medicine months, 2 surgery months, a busy ED month, terrible call, and three 'electives' which were all time consuming. In general, however, the answer to this question is yes. Transitional years are FAR easier than prelim surg residencies and quite a bit easier than prelim medicine residencies as well.

 

  • Is the training as good at a Transitional Year Residency?

Absolutely, if you choose the right place. Many months this year I have more free time than I did in medical school. I have found that with the free time I am actually reading and studying a ton. I think that you MUST take call to learn how to be a doctor during your intern year. I am not sure how you can become a 'well trained' doctor if you never take call during your intern year. Being on call at night is when you really have to make decisions and you really learn a ton. You don't need 11 months of inpatient work to become a great radiologist or a great ophthalmologist. However, 6 solid months of medicine/surgery will certainly prepare you for your next level of training. Then you can spend the other half of the year becoming great at something else: research, pediatrics, surgery, golf, sleeping, etc etc

 

  • Describe a typical transitional year schedule?

Everyone must do: 1 month in the ICU, 1 month ED, 1 month outpatient, 2 months general medicine. I believe the rest is up to the residency program. Most programs end up giving 3-5 months of electives.

 

  • What are the potential downsides of a Transitional Year?

Not many! More free time, less stress, more fun…what's not to like. I guess one downside is that it closes some doors if you choose to switch specialties. For example, if you were doing a preliminary medicine year at an academic center and decided you wanted to do medicine instead of anesthesia, the switch would be easier. After completing a TY year you can only go into the specialties I listed above.

 

  • How competitive is the Transitional Year match?

It is actually very competitive. There are not many spots, and they are all coveted because they represent less work, more free time, more electives, and a much easier year. Also, imagine all the applicants trying to get spots: future radiologists, ophthalmologists, radiation oncologists, dermatologists. This is not a list of ordinary applicants. Matching into a TY is about as hard as matching into radiology or ophthalmology.

 

  • What are residencies looking for in a Transitional Year applicant?

I asked my TY program director this exact question and this was his response: "We know we will only have you for one year. However, during that year the TY class will take care of about 50% of all the patients in this hospital. So, it is in the hospitals best interest to have someone who 1- will work hard without being asked, and 2- will maintain the great patient care that we have at the hospital." I think those two things are exactly what all programs want. I think item #2 may touch on competency a little bit, but is mostly referring to your interpersonal skills.

 

  • What should students look for in a Transitional Year residency?

Whatever you want to look for in a TY year. That sounds cliche, but as I said above, not all TYs are made equally. Do you want a chill year at the risk of missing out on training? You can find that. Do you want to do pediatrics as well as medicine and surgery? You can find that.

 

  • Is there anything you wish you knew before application season?

I interviewed at a few places that had both TY years as well as preliminary medicine years but the curriculum was exactly the same. In other words, if you match into the preliminary medicine year, you still have the flexibility that the TY residents at the same program have. All of these programs will let you apply to both the TY and the prelim med year after your single interview. These are great programs to find because even though there is no difference at all in the curriculum, the preliminary medicine years are a bit easier to get into.

 

  • What other advice to you have for students applying to a Transitional Year?

Good luck, intern year is exhilarating, fantastically rewarding, difficult, and very very short. Enjoy it. Read The House of God (amazon link), there is no better time than intern year. Also, watch the first season of Scrubs where the characters are interns…it is incredibly realistic!

 

 

Editor's Note: Applying for residency or preparing for your interviews? I highly recommend First Aid for the Match, The Successful Match: 200 Rules to Succeed in the Residency Match, and The Residency Interview: How To Make the Best Possible Impression .


 

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Spotlight Interview: An Orthopaedic Surgeon’s Job Description

Categories:

Residency, Choosing a Specialty, How to match in....?, Orthopedic Surgery, The Match, Why did you choose....?

August 18, 2012

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An Orthopedic Surgery Resident's Perspective: An interview with an orthopedics resident from the West Coast

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Orthopedic Surgery?

I feel like you can learn a lot about a specialty based on what you see in the attending physicians of that specialty. The orthopedic attendings, for the most part, seemed happy. There are many sub-specialties in Ortho and was interested in nearly all of them. The patients' prognoses in many cases were very good. Patient’s lives were improved dramatically by Orthopedic intervention.

 

 

  • Describe an Orthopedic Surgeon's typical work day?

Long. Orthopedic Surgery is no place for individuals looking for a structured 8 to 5 job. Attendings often work harder than residents. First and foremost, the patient comes first and your day ends when the work is done.

 

  • What type of lifestyle can a an Orthopedic Surgeon expect?  

It's not dermatology. Call and nights vary between sub-specialties, but generally if you are asking this question, Orthopedic Surgery may not be the right choice for you.

 

  • What is the average salary of an Orthopedic Surgeon?

Also varies from specialty to specialty. Generally speaking Orthopedic Surgeons are some of the best compensated surgical specialists, but that should only be a perk. Don’t go into Orthopedic Surgery for the money, times are changing.

 

  • What is the job market like for Orthopedic Surgery?

The market varies amongst subspecialties. Hand Surgery and Sports Medicine are amongst the most competitive now, but are also rather saturated. Generally speaking, our aging population bodes well for our job security for the next couple of decades at least.

 

  • What can you tell us about Orthopedic Surgery sub-specialties?

Residencies currently range from 5-6 years with 1 year fellowships available in: Shoulder, Hand, Spine, Tumor, Joints, Sports Medicine, Pediatrics, Trauma… About 85% of current residency graduates are going onto Fellowship training.

 

  • What are the potential downsides of Orthopedic Surgery?

Be prepared to work hard and not complain.

 

  • What else would you tell medical students who are considering Orthopedic Surgery?

With a good work ethic and the right motives, Orthopedic Surgery will offer a rewarding lifetime of challenge and service.

 

  • How competitive is the Orthopedic Surgery match?

Very, with the caveat that interpersonal and personality traits cannot emphasized enough.

 

  • What are residencies looking for in an Orthopedic Surgery applicant?

You will need to reach a certain threshold of competency/test scores (different programs weight each of these differently). The rest is studying and hard work. Away rotations are usually weighted pretty heavily and should be considered a month long job interview. Dress appropriately, prepare for cases/clinic, show up early, etc.

 

 

  • What should students look for in an Orthopedic Surgery residency?

I would want to feel fairly comfortable with the people you interact with. You will be spending a good chunk of your life with them. Also, ask them the appropriate, but difficult questions. I always appreciated programs that seemed to be up front and honest.

 

 

  • Do you have any advice about the residency application?

Spend plenty of time on your personal statement and have it proofread by several different people. Another thing that I found useful was to offer to draft letters for those you ask…chances are good they are probably busier than you are.

 

  • Is there anything you wish you knew before application season?

Give every day your best shot. Otherwise stop worrying. The rest takes care of itself. No amount of worry will do anything but shorten your life span.

 

  • What other advice to you have for students applying to Orthopedics?

Good luck! It is a stressful, but dynamic time in life.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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Spotlight Interview: Why Did You Choose Anesthesia? (Pittsburgh Resident)

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Residency, Anesthesia, Choosing a Specialty, Why did you choose....?

July 9, 2012

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An Anesthesia Resident's Perspective: From an interview with an anesthesia resident from the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania.

Part of an interview series entitled, "Specialty Spotlights", which asks medical students' most burning questions to physicians of every specialty.  See what doctors from every specialty had to say about why they chose their specialty and how to match in their residency.

 

  • What attracted you to Anesthesia?

I was attracted to the intimate patient care, to a specialty that is procedurally oriented, and to a specialty that requires a working knowledge of physiology and pharmacology.  I saw a lot of energy in the fact that anesthesiologists need to have the ability to control all aspects of a patient's response to surgery in real time.

 

  • Describe an Anesthesiologist's typical work day?

This depends on the type of practice you will ultimately choose. Generally, anesthesiologists arrive early-ish (like 6:30-7am) and are usually done when all surgeries are finished for the day (this can range from 3pm- 6pm depending on working environment).  Weekends and nights are infrequent, but some call is generally taken at least early in your career.

 

  • What type of lifestyle can a Anesthesiologist expect?

The lifestyle is very good. Like I said, weekends and nights are usually free unless you need to take hospital call, which is infrequent at worst.  If you end up at a private practice at an outpatient surgery center you can expect to work from 7am until 5pm Monday thru Friday!

 

  • What is the average salary of a Anesthesiologist?

250k-450k per year.  Some jobs will start you as high as 400k if you will move to a 'less desirable' location.  Salaries are lower for big cities, just like all other specialties. More details at http://www.gaswork.com

 

  • What is the job market like for Anesthesiology?

Excellent.

 

  • What can you tell us about Anesthesiology Sub-specialties?

Most fellowships are another 1-2 years after residency. The most common fellowships are pain management, pediatrics, critical care medicine, and cardiovascular anesthesia.

 

  • What are the potential downsides of Anesthesiology that students should be aware of?

There is some concern over liability, but this is no different than Ortho, neurosurgery, ob/gyn, and many other specialties involved in surgery..  The concern that CRNA's will take all the work away is commonly overstated.

 

  • What else would you tell medical students who are considering Anesthesiology?

Work hard in all rotations, and especially on your anesthesia rotation.  Commonly an anesthesia rotation is one where you can go home at lunch and no one notices, but it pays huge dividends if you get noticed working "late" (like til 4pm).  Actively seek out procedural opportunities on all rotations.  Try to do related rotations like pulmonary consults and pain management. You definitely should complete an ICU rotation and you should do you best to excel at it.

 

Editor's Note: For more help choosing a specialty in medicine, I highly recommend one or both of these two great books. I found both very useful.

 

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