Starting Residency
One of the things that they never mention when you are getting ready to go to medical school is what residency is about. Some people have ideas about what residency is, and some people are completely clueless. You can usually find these people on SDN with about 3 posts asking something like “How do I become a neonatologist”. That being said, the schools just sort of assume that you know what you are getting into. They have long sessions devoted to helping you get your ERAS (residency application) set up, your NRMP (matching service). They don’t mention what happens after you match (or if you don’t).
After you match or scramble, your residency position of choice sends you a packet of information that you have to fill out. If you have ever tried to join the military, the paperwork is basically the same. Some states are ridiculous about what they want, others noticeably less.
First, you have to apply for a limited license, so that you can practice as a resident. Each state has their own form for this, but they all have the basics. One state in particular has you list every single job you have ever had, along with all schooling, any periods where you weren’t in school or had a job, and probably your thoughts if you would like to put them on paper. They also make you go down to the local jail so you can be fingerprinted (twice!) at the same processing center as the other drug dealers. Sometimes you get to stop in the middle of yours so that they can take care of people with less patience than you. Sometimes you get spit on too.
You will also require at least 2 photographs of yourself, which, while not hard to get, are still a pain. Plus, you must pay for these things with either a cashier’s check or money order, because if anyone knows who it is that has bad credit, it is the future doctors of your state. Not that you didn’t already check them through NCIC with the whole fingerprinting thing. You also have to explain any and all criminal procedings, including but not limited to speeding tickets in excess of $100 (I’ve never had a ticket that cheap, who out there has?) Then you will need a state tax form (if you have state taxes), a federal tax form, a hospital code of conduct, a school of medicine (if so affiliated) code of conduct, a hospital confidentiality statement (HIPAA), employment eligibility verification form, a licensure policy, a Controlled Substances Act form, a USMLE/COMLEX policy (must take Step III by certain date), signing up for PALS, NALS, ACLS, ATLS, and last but not least, a hospital health screening form.
The screening form cracks me up, because it is the same form they use for the janitor apparently. One of the questions asks if you have or ever have had diabetes, then has in parentheses “sugar disease”. The really bad places don’t even give you envelopes for this stuff, and the extremely bad ones make you print out everything from an online site, but don’t tell you about it until an email shows up 2 weeks after the match. Not that I’m bitter or anything.
Last but not least of these is your “contract”. I put it in quotations so that you know that it really isn’t a mutual agreement as much as it is a mandate. You can either do what this piece of paper says, or you can not have a job and not apply for the match for the next 3 years. Seems about fair. Thankfully Congress prevented us from suing the NRMP over anti-trust issues by giving them a special exemption.
Not to dissuade anybody though, because it isn’t any different anywhere else you go. The biggest pain is that you will get to fill out all of this paperwork each and every time you start working at a new hospital. However, you can negotiate the terms of the contract after you are out of residency.
Anti-Social Breeding Ground
From MDAlien
Greetings from the glorious time of life referred to as the third year of medical school/the breeding ground of antisocial personalities. I’m presently in the midst of my surgery rotation after having done IM, neurology, EM, family med, psych, and OB/GYN.
The following is exactly how I felt during an evening at the end of my day. Don’t try to say you will never sound as angry, cynical, or crazy as this. I didn’t think I would either, but trust me, it happens.
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There was a time when I was a nice person. I vaguely remembered that time, but after the 14th hour of being at the hospital, I’m sitting in the ICU – waiting for the attending to finish his stupid story about the fish he caught that one time that was ‘this big’ – and a horrible thought crosses my mind. “We still have 4 more patients to round on . . . “
I drop my eyes to our patient census and skim the list. There is Mrs. Smith, 85 YO WF w/COPD, CAD, CHF, past MI, recent ileostomy. Look she has pneumonia and she’s on a vent. Even better, she hasn’t been conscious for a week, lived in an ECF, and her family left her full code. Mrs. Smith is on three different antibiotics, which aren’t doing anything to budge her raging sepsis and she’s on the dobutamine drip that seem to not be raising her BP the least bit. Our other three patients are in pretty similar sad shapes. They are all going to die.
Then the next horrible though crosses my mind, ‘can’t these fricking people just die so I can go home already?” Yes, I did just wish some innocent grandma to die because her terminal illness is ruining my day. All of our efforts are completely futile in her case, but when she starts coding tomorrow, I’ll have to go with the team to attempt to save her. Which will put us even further behind on our ever growing census. Thanks dumb grieving family for putting ME through this.
Now I glance at my resident who is still nodding at the stupid story. I’m so annoyed with you that if I had an uzi I’d be gunning for you. Why the hell haven’t you let me go home? The med students don’t even see the ICU patients because this is our surgery rotation. I’ve been here doing nothing for two hours. I can’t write orders, I can’t see patients by myself, and the patients we are seeing I don’t even round on. You aren’t teaching me – no, pimping isn’t teaching – and since you’ve ignored my existence except when I failed to give you that imaginary crucial bit of info the attending scooped you on, why am I still here?
Attending, if I shot the resident, you’re next. Stop telling the fucking story and let me leave. You didn’t bother to show up here until after 7pm to round on your patients, and I know your last surgery ended at 4pm because I was there. I was that med student who held the retractor for two hours that you periodically yelled at for not being able to identify random things in a body cavity that I was too far away to even see beyond my retractor. Don’t you dare start whining about how much harder you worked in residency before the 80 hour work week. In case you haven’t noticed, the 80 work week is a joke and I was here 100 hours last week. So fuck you and shut the hell up.
You know, the hospital doesn’t have metal detectors to use on the staff. I look around at the members of my team and try to figure out which one of us are going to snap, go postal, and start mowing down the patients and the oh-so annoying nurses. Who has been abused the most? The other med student who is getting treated like shit for stating he wanted to go into peds? Or maybe the intern that was left in charge of 50 patients alone while the residents went to the OR and is about to getting it for not knowing Mr. L’s latest potassium. What the hell, it’s totally going to be me, the sweet innocent seeming seething ball of rage that I am.
One hour later, we are sent home and reminded to be back before 5am tomorrow. Thanks, like I’m going to forget that since it means I’ll be heading to bed immediately upon getting home. I see people coming out from dinner at the local resturaunts and I hate them for having real lives. I debate briefly about whether I can hit some of them in the crosswalk and get away with it. Probably not, but prison seems like a good alternative to going back to the hospital tomorrow.
As I finally get ready for bed, I think back about how much I hate the hospital and how awesome it would be if it got hit by an asteroid or something between now and when I’m supposed to be there. Then I have the horrible thought – in the event of a natural disaster, I would have to stay at the hospital even longer.
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**MDAlien would like to point out that most of the anti-social feelings went away after she got off the service – except those toward the attending. No patients were harmed or mishandled in the survival of that rotation. **
The Show
The following is a guest contribution from GeekDoc.
It’s a bitter sweet time of year for med school hopefuls. Those who are applying find out whether or not they’ll be going to medical school in the fall. Tears of happiness, tears of joy, tears caused by your disappointed mother throwing her shoe at you for getting a 29O instead of a 45T on your MCAT., become a normal part of your everyday life. I just wanted to reach out to my friends and say, I know what you’re going through; I feel your pain. I wish someone had explained the process in terms that I’d understand. Hopefully this will act as a beacon of “truthiness” for future pre-meds.
For Future Applicants:
The application process is every bit the dog-and-pony show that you imagine it to be. It starts with a four year struggle to out pace every hardcore science geek on their own turf. You spend every waking minute trying to distinguish between Cys and Trans, E and Z, Cocci and Baccili, only to realize that 100 of your peers will probably know this better than you come test day.
The lucky few who do manage to maintain their sanity while spending every waking minute studying, lose it when they realize that they have to write several essays demonstrating how they did not spend every waking minute of the last few years studying, but rather took the time to “help people”
And isn’t that why we all wanted to become physicians in the first place? To help people? And by people, I mean people other than your mom and dad who will probably spend the next few years introducing you to their friends as “this is my Son (or daughter)….the doctor”.
For the few who manage to be talented enough to strike a balance between spending every waking minute studying, and delivering children in a refugee camp in sub-Saharan Africa to compensate for that A- you got in Organic Chemistry, may be lucky enough to be invited to an interview. It’s the interview that people long for, a chance to set themselves apart by professing their undying love for the school, medicine, and if need be, their interviewer.
If your act strikes the right chord with the right people, you may be part of the small group who receive a big matte yellow envelope in the mail, screaming “Congratulations, You’ve Been Accepted!!!”.
So, my friends, don’t worry to much about the application process, we all go through it. Think of it as a right of passage, a chance to become part of the medical brotherhood. It’s a necessary evil, a show that we all take part in.