Match Day

Yes, after months of preparation, weeks of anticipation, days of dread, and hours of sleeplessness, Match Day finally came on Monday, February 14.  

We had flip-flopped tremendously over the past few weeks.  One day we were sure he would match, the next day I was researching hospitals with transitional year programs.  

Expect the Best, but Prepare for the Worst became our unofficial motto for February.  

We weren't sure what to expect, but knew that an email with match results should be sent in the morning, and results would be posted at 12pm EST.  We wanted to find out the results together (it HAS been a team effort, you know), but weren't sure how the day would go.....He began a new rotation that morning, so he left at 6:30am, agreeing that if at all possible he would come home when he saw an email, or at noon - whichever came first. At about 9:15am I got a call that he had an email, and would be home in a few minutes.  I set up the computer and anxiously waited.    

We looked together, and were THRILLED to find out that he matched to the ER program we wanted in OH.  

This is a small town in Southern Ohio, very near West Virginia.  We are so excited to settle for the next 4 years, especially somewhere with a slightly milder climate.  We'll be near Columbus, Pittsburgh, and Washington DC!  I am not so thrilled that it's a 2 hour drive to the nearest Target, but I guess there are trade-offs for quiet living.  It's going to be a busy summer! 

Medical School, Years 3 & 4

I know, we're already into year 4, but here's an overview anyway.  Hopefully this will help clarify how "the process" works.

Year 3

Hooray, you're out of the classroom!  By now you've passed (or will soon pass) your first Board Exam, and are on your way to being an actual licensed physician.  Start getting comfortable with patient contact because you'll have a lot of it.  And that's good - this is when you'll start to get an idea of what specialty is a good fit for you.  

Year 3

Year 3 consists of clinical time in the hospital or office (clinic).  2- or 4-week rotations in a variety of specialities, to include surgery, OB/GYN, family practice, internal medicine, pediatrics, psychiatry, etc.  There are some specialties which are required, some you do multiple times (in different settings/ with different physicians), and a few electives you can choose from.  You still study, there is required reading, you'll give presentations in some of them, and a few have exams afterwards.  

On top of all this, you should be prepping your residency application, including the dreaded personal statement.  FYI - think of the residency process like a job application/ interview.  The biggest one you'll ever do.  Residencies vary in length from 3 years to 5 years, and while you do get paid, it's a pittance when weighed against the hours you'll be working.  I'm not complaining before the paychecks start rolling in, I'm just saying that $42,000 a year is small recompense when you're spending 3-5 years working 70 hours a week of days, nights, weekends.   

Year 4

Boards, boards, boards:  If you're a DO, you'll take your Step 2 computer-based exam & fly to Philadelphia for the Physical Exam portion.  Oh, and don't forget to budget for the $2,000 this will cost you.  If you're an MD, you take Step 2 of the USMLE, and it's also a 2-part exam similar to the above.  

You will also probably schedule some "away" or "audition" rotations at hospitals with residency programs you think you might want to apply to.  Some students spend months away from their home base.  There are required rotations for the 4th year, but there is also much more flexibility in choosing electives and filling in the weeks needed to graduate.  

In July or September (depending on whether you are applying to DO or MD programs), you will submit your residency application to the programs you've chosen.  And then you'll wait to hear back from them.  You may get no interviews, you may be asked to interview at every program you apply to.  Some programs interview as few as a dozen people, while others go through hundreds.  Interviews usually consist of dinner the night before, then various one-on-one and group interviews the day of.  If you don't have dinner with the residents the night before, you will probably have lunch with them the day of.  If you didn't do a rotation there, this is the only chance you have to show and tell why you'd be a good fit with their team.   Interview season usually ends in mid-January, and at that time the student and the programs submit their Rank Listings for The Match.  Programs accept between 1 and 16+ residents, and some programs participate in separate matches (urology, opthomology, dermatology).

Residency Match:  The student submits a list of programs where they would like to enter into a residency.  This is the Rank List.  The list should be in order of most desirable to least desirable.  BUT if a program is on the list, there is the potential to match into it, so be sure you are OK with going there if you match.  Each residency program also submits a list of students they would like to come to their program, in order of preference.  This is a blind process, so neither the students nor the programs know where they stand.  When The Match occurs (February-DO or March-MD), the ERAS computer system magically cross-references all the lists, and is somehow able to (supposedly) make a 90% match to both the student's and the program's preferred outcome.  Shortly thereafter a work contract is sent to the student, and yes, you are contractually obligated to enter the residency program you matched into.   

The Scramble:  If you don't match, you participate in The Scramble.  The Scramble is a process wherein the schools distribute a list of the programs who did not fill all their spots in The Match.  The student then contacts the programs and essentially throws their hat into the ring to fill that spot.  This may mean you end up in a location you did not interview at, or possibly in a specialty that was not your first choice.  

Worst case scenario:  If you don't match & can't scramble into a spot, you can do an internship year and then either slide into a spot, re-Match, or take your final Board exam and begin practicing medicine without completing a residency.   EDIT: I now know that at least a 1 year internship has to be completed before a full medical license will be issued.  

Whew!  "The end" is in sight, but some days it still looks like a mirage.

Med School Update: End of 2nd Year

It's difficult for me to give emotionally accurate updates on Big Daddy's progression through med school. It's not me doing the work, and I have an outsiders perspective. That being said, here's where we're at.

Everyone told us 2nd year would be easier than first year. That's all a matter of opinion. I think that's the consensus mostly because there's one year down, and the students have a better idea of what to expect. Were the classes easier? I can't answer that. I can say that I think he hit his stride when it came to understanding how to study, when to attend classes, and how much weight/ worry to put into each test, lecture, and lab.

And now it's over! He will never have to endure a full course load of classes again! I'm not sure who's more relieved about that - him or me. Don't get me wrong. Big Daddy is very smart. Smarter than I am, and that's one of the reasons I married him. But classroom learning is not for everyone, and I am a solid believer in that. The last 5 years have been a trial of endurance and fortitude for both of us, and we can now move on. I have absolute and utter confidence that Big Daddy will really find his groove and "blossom" in the next few years.

(Can men blossom? I can't think of a more manly adjective right now)

The next 2 years: We were assigned our first choice of rotation locations in Michigan. We'll be spending our time in Mt. Clemens, at Mt. Clemens Regional Medical Center. We weren't sure what to expect next, as we (Big Daddy) heard multiple horror stories of how difficult it was to solidify the actual schedule of rotations. Not our experience at all. A few weeks ago the coordinator emailed his schedule, which was laid out for the next year. There were two unassigned slots, and he was able to fill them with his first choices of Cardiology and Emergency Medicine. Done and Done. No lottery, no phone calls, no class meetings, no guessing. And he's got 5 days off at Christmas! I'm already plotting for days filled with snowball fights, hot chocolate, movies, and cookie baking.

Full schedule as follows (beginning August 3, ending July 9):

• Family Medicine
• Pathology
• Anesthesiology
• General Surgery
• Pediatrics
• Orthopedics
• OMM
• Internal Medicine
• OB/Gyn
• Family Medicine
• Cardiology
• Psychiatry
• Emergency Medicine

After June of next year, he'll begin a 2nd year of rotations. This will consist of assigned rotations in Mt. Clemens and interview rotations at other locations, all spiced up with applications & interviews with residency programs of our choice. Our understanding of interview rotations is as follows: You find a residency program you're interested in, and you request to do a rotation there in the effort to evaluate whether or not you'd be a good fit with the program, the people, the environment, etc. Details on year 2 (4) are still fuzzy, but will hopefully crystallize as time passes.

That's it for now.

Heal Thyself

One of the super fun aspects of being a part of the Med School experience is the constant self-diagnosis that occurs. With almost every new class comes the declaration of a new condition, syndrome, or state.

We're currently in the midst of Psychiatry.

This has been extra fun, as so many of the signs & symptoms are generic enough that if you reflect long enough, you'll convince yourself you have that particular condition. This week, I've been 'diagnosed' with Obsessive Compulsive Personality Disorder. Not to be confused with Obsessive Compulsive Disorder.

Per Wikipedia: Obsessive–Compulsive Personality Disorder (OCPD) is a personality disorder which involves an obsession with perfection, rules, and organization. A person with OCPD may feel anxious when they perceive that things are not "right." This can lead to routines and "rules" for ways of doing things, whether for themselves or their families.

While that's not an all-encompassing definition of the criteria for OCPD, it's a pretty solid condensed definition.

I laughed when Big Daddy first started 'diagnosing' me. But the more I read, the more I identified with certain parts. These are highlighted in red.

Per Wikipedia: There are five primary areas that cause anxiety for OCPD individuals: time, personal and social relationships, cleanliness, tidiness, and money. Time becomes a problem when they dwell for so long on getting something "right" that they stand the chance of not finishing in time. Personal and social relationships are often under serious strain because the OCPD individual insists on being in charge and the only one who knows what is "right". Uncleanliness is, in the eyes of some OCPD individuals, a form of lack of perfection, as is untidiness. They may spend considerable time each day putting everything in precisely the right place in precisely the right manner. Money is of concern because many OCPD sufferers are anxious about the potential for things to go wrong in their lives. They may hoard items for a 'rainy day'.


I reflect back on my childhood & can see some of these tendencies from a young age. But it's hard to know what is inherent (OCPD can run in families - Dad, I am looking at you), and what was shaped by childhood experiences.

I tend to be preoccupied with the rules, and doing things the right way. If I perceive that someone else is having the rules bent or broken for them & feel like I can't have the same done for me, I OBSESS. I know - unhealthy, right?

I also have an unhealthy desire to do things "right". Right doesn't necessarily mean the best or easiest way - it means the way I want it done. I hate creating presentations at work because I will literally never be done, no matter what the deadline is. There's always the desire to look at it "one more time" and make "one last tweak".

I have control freak tendencies. Again, I think I am learning to ratchet it back, but I definitely like things done my way. Having kids and being married has forced me to re-prioritize, and I think I am getting better. I think we can all agree that no marriage will have both happiness and longevity without compromise. I still have a long road to travel towards learning to lighten up & let go a little more.

If you've seen my house, you'll know that I don't have the clean gene. My house is not disgusting (but please don't look at my kitchen floors), but it's not spotless either. Part of me wishes I were a little more compulsive about cleaning, but with a husband who truly doesn't care & two young kids strewing chaos wherever they go, a part of me has just given up. Am I more at ease in a clean house? Yes. But I know I don't want to be a Molly Maid, and I'd rather go to the park than steam clean the carpets in my rented apartment.

Money. Oh yes. As much as I do like to spend money, and prefer to deny myself nothing which my heart desires, I have TREMENDOUS anxiety over money. This was born from the fires of childhood experience, none of which we need to explore here. Let's just say that to me, money=stability. I don't think I need a million dollars in the bank to feel secure, but I do long for the day when I don't need to fret over whether or not I can buy diapers AND formula in the same week.

Keep it or toss it? Again, I think I'm making progress. My home was never filled with stacks of crumbling newspapers and 5,000 balls of dryer lint, but I do lean towards keeping items of sentimental value long after that sentiment has dissolved. I like nice things, but often talk myself out of using them because that moment isn't 'special' enough. There must be hope for me. I'm starting to feel that every day is a special day. Why shouldn't I wear perfume to the grocery store or my pearl bracelets to church? Stuff is meant to be used, and this year I fully intend to bust out my Christmas china on December 1 and use it the WHOLE MONTH. NOTE: I did not purchase said Christmas china. It was a hand-me-down from my Mother, who has a whole set of her own issues. And an even larger set of china.

I guess the whole point of this post is to say that it's been a fun week around our casa. Whether this condition actually applies to me or not, it's been thought provoking. And the first step towards improvement is acknowledging that there's an issue. Self-awareness is good, and of course: Knowing is Half the Battle.

Did I just date myself with that cartoon slogan? I think I did.....

The Next 2 Years

I have been a nervous wreck since 7pm last night. I checked my email every 5 minutes, hoping Big Daddy would tell me the lottery results were posted. No such luck.

I gave up at 10:30 and went to bed. Big Daddy came to bed around 3, and I made him get up and check again before letting him under the covers. Nothing yet. I tossed and turned all night.

We checked at 8:30 am and again at 10:30.

At 1pm today Big Daddy called to say the results were up.

Drumroll, please............

Starting in June of '09,

we will be in Mt. Clemens, Michigan for 2 years.

It looks cute, no?

Michigan?

Yes, Michigan.

We were set on Des Moines for quite a while, but 4 or 5 days before the lottery opened up, both Big Daddy and I started talking about other options. We did some research, looked at different programs, and came to the conclusion that DSM might not be the best place for us in the long run.

Yes, we will be leaving behind some wonderful friends, great schools, a friendly ward family, a cozy apartment, and a generally comfortable life & routine.

But we couldn't take the chance of selling ourselves short on opportunity. The hospital there has a great rotation program, an ER residency program, and is close to a number of other hospitals with ER residency programs. It's located in a growing suburb of Detroit, but Mt. Clemens appears to still be a relatively small town. I've already picked out which school I want Big Sis to go to.

And if we absolutely hate it? It's only 2 years and then we can move on again.

At least we know now, and I can start making plans.

A Little Background Information

When we were in process of applying to medical school, I often searched the Internet trying to find out information about the process, the details, the options, what happened when, etc. One of my intentions in starting this blog was to share the trials and tribulations of said process, and I have done a poor job of holding up my end of the bargain. So here's a little update:

It's now the end of January 2009, and we are 18 months into the process of going through medical school. (As always, I use 'we' because this is a group effort, folks). Big Daddy has started the 2nd semester of his 2nd year of DO school, and this is the downhill slope of his class time. I can't even tell you how much he is looking forward to getting away from lectures and into some hands-on patient interaction.

This is also the time when thoughts turn towards Boards. For us, "Boards" refers to the COMLEX, part 1. This is taken at the end of the 2nd year of a DO program, and you must pass the test in order to move on to clinical rotations at the beginning of your 3rd year. DMU states it has a 96% pass rate, while the national average is 90%. I am a little fuzzy on the details, but I believe COMLEX, part 1 covers information gleaned from the first 2 years of class time plus a plethora of other medical knowledge. It's a big, bad, super stress-inducing test. And costs $600, so that's an extra sweet little cherry on the top of the testing sundae.

If you're a 2nd year DO student and you haven't started thinking about it, start now.

COMLEX, part 2 happens in school year 4 and requires that the student travel to Pennsylvania to take the test. Finally, there's a COMLEX, part 3, and that is taken in year 1 of residency. Once all tests are passed, state licensure is issued, and you are officially licensed to practice medicine. Amen.

Let's rewind for a moment, shall we?

Good. Stay with me now, it will all be worthwhile.

In addition to thinking about Boards, this is a time when we start thinking about clinical rotations. Rotations are the first chance to get into the field and get some real-life interaction with patients while shadowing health professionals in the field. In the 3rd year, you end up in a core hospital, and rotations are done in 4 week blocks, running through many of the basic fields of medicine: OB/Gyn, Family Practice, Emergency Medicine, Psychiatry, etc. I think there are 6 or 8 in all. A very busy time. Now, although you are assigned a core hospital, that doesn't mean you'll be in that hospital the entire time. You may have to travel somewhere else (locally) to do your family practice rotation, etc. Just gotta keep you on your toes, you know.

And how are rotations chosen? Well, that's what I'm here to tell you about.

DMU utilizes a lottery system. The student is given a list of rotation sites that are spread throughout a number of states. For us, this included sites in IA, MN, MI, OH, MO, and WY. The first lottery determines your general area. Here you can choose from IA/ Midwest (includes MI and MN), OH, MO, or WY. You make a first, second, and third choice, and hope for the best.

FYI - throughout the process, the school states that 90%+ of students end up with their first choice of rotation sites.

The second lottery is the nail-biter. This is the grand decision which will determine where you go for the next 2 years, and will likely also heavily influence the type and location of your residency after graduation. Once you've determined your general area (for us it was Iowa/ Midwest), then you have to choose from the actual hospital locations.

Sidebar: About half the class wants to stay in the Des Moines area. If you are one of those who wants to be in Des Moines, this makes it much more competitive in the lottery process. Thus far, there are 17 students who were granted a special exemption to stay in Des Moines. I found this rather surprising, as from what Big Daddy told me about the exemption process, it was stated that exemptions would not be given for people pleading the case of a 'spouse with a job in the local area', 'home ownership', or 'children enrolled in local schools'. And yet 17 people were granted exemptions. Funny, and I don't mean ha ha. At first I was bitter about this, as I saw those people as cutting into our chances to stay in Des Moines (because of course it's all about us), but I have since made my peace with it.

Back to our regularly scheduled programming.....

2nd round lottery: You finally choose from specific hospitals in the area where you landed from the first round. To my knowledge, beyond a name, city, and number of seats available, there is no information given about these programs. So we opened up our friendly neighborhood Internet browser and started poking around. We put together our list (top 4 choices), and hit submit yesterday evening. Results should post on Friday, and if it's anything like the first round, Big Daddy will be waking me up at 1am Friday morning to tell me where we will be for the next 2 years.

A little more about rotations: 3rd year runs as explained above. You go through your set course of rotations in various fields of medicine. Hopefully this steers you in one direction or another, and helps determine what kind of medicine you want to practice. 4th year is where the pressure is on once again. 4th year is when you do your interview rotations. Hopefully you've decided what kind of medicine you want to practice, and you've done some research about various residency programs that might be a good match for you. You then request to do an "interview rotation" at some or all of the sites where you think you'd like to do a residency. It gives you a chance to size up the staff & program & allows both of you (you and them) to see if you'd be a good fit there. While this is great - sort of like an extended job interview - it can also mean lots of time away from your home base and family. And coupled with the pressure of COMLEX, part 2 at the end of the year, it's sure to an induce an ulcer in someone (probably me).

Anyway, I hope you've enjoyed our trip through the maze of medical school. Please exit the ride now, making sure to collect all your belongings on your way out.

(oh, and if I got something wrong, Big Daddy will let me know, so check back and see if I've made any revisions)