Friday, September 28, 2012

How can an applicant really tell what a surgical program is like?

Dear Sir,

I am a 4th year medical student currently in the process of applying for residency training in general surgery. I am sure this is a perennially impossible question to address adequately; do you have any advice on how to begin to discern the true quality of various programs at which one interviews? As interview offers begin to come in, I've spoken with my own chairman and various faculty of differing age groups. I have spoken with our program's residents about other places they interviewed. I've read the reviews written on online forums like and SDN. I've looked at the ACS board pass rate data and the program's individual websites. I suppose I am asking if there are any generalizable factors that you would consider either positive or negative when considering a program. If it matters, my current long-term goals are to practice some type of general surgery or one of its specialties in a small-medium sized academic medical center...of course, that's open to change.

Name withheld by request

Great question. You have done an excellent job of investigating already.

It is very difficult for an applicant to gain insight into a program’s real nature in a half-day interview. Obviously programs try to spin things in the best light possible. Unless they have a death wish of their own, even the residents who show you around may not tell you the unvarnished truth. The down side would be that they will hurt themselves by denigrating their program because fewer good candidates might rank it highly.

Ask more than one resident some of these questions when the faculty is not present.

Are most of the residents happy?
Are residents or attendings doing the most of the cases?
Do PGY-1 and 2 residents get to do any cases as the operating surgeon or are the first two years spent covering floors and/or admitting patients?
Are any residents finishing the program not having performed enough complex procedures?
Are the busiest attending surgeons letting the residents do meaningful portions of their cases?
How much autonomy do the residents have regarding postop care?
Every year, the RRC for Surgery sends an on line confidential questionnaire to all the residents in every program. What were the issues raised on the last RRC questionnaire? Have they been addressed?
How good are the important support services like anesthesia, radiology, laboratory, pathology, ED and nursing?
Is the main hospital in good financial shape? Are they laying off personnel or cutting back services?
If you were sick, would you want to be treated at this hospital?
Are there any scut-heavy rotations and how many are there?
Are the outside rotations good? Are there problems with their locations? How’s the teaching?
Are the program director and the chairman of surgery supportive of the residents?
If you had to do it over, would you still choose this program?

If you are still interested in a program after your interview day, I suggest you call a couple of random residents who are on call at night or on a weekend. You are more likely to find candid responses to the above questions in that setting.

You need to have some questions ready for the faculty who interview you and the PD and chairman too. You need to review the program’s website and be careful not to ask a question that you could have learned the answer to on line. I used to hate that. Clarifications are OK, but don’t ask about factual information that is available on line. Below are some questions for the faculty. You can use some of the ones you asked the residents but exercise good judgment. Some of these questions can be a little edgy. You don’t want to provoke the interviewers.

When was the last RRC site visit? Were there any concerns or citations? If yes, what were they and have they been corrected?
Is the main hospital in good financial shape? Are they laying off personnel or cutting back services?
Are any residents finishing the program not having performed enough complex procedures?

Take notes. Compare resident and faculty answers. Good luck.

Thursday, September 13, 2012

A college student has second thoughts about med school

[The content of this email was edited for length and clarity.]

I'm a junior in college. I was on the path to medical school since sixth-grade. The problem is now I'm not so sure.

Lately, I've been going to sleep at night and waking up with an uneasy feeling in the pit of my stomach. For the first time since grade-school I'm having second thoughts on this career path. Before I studied abroad, I was hard-wired for medical school. But after experiencing so much life after studying abroad, I'm not handling the pre-stress of a medical school education that well anymore. I know there are realities, such as finishing at a relatively late age in life, the large amounts of accumulated debt, and the inability to set time aside for relationships (family, friends, significant other, etc). My alternate goal from here is to finish up my bachelor's in chemistry with a minor in computer science, then pursuing a master's in computer science.

So with this new plan in mind, I decided to call my parents. My mother took it exactly as I expected her to—delighted that I had found a new goal. "We're behind you all the way," said my father, "but remember that the choices you make now affect how happy you are in the future." Then he brought up the income issue and that I wouldn't want to have second thoughts later about sticking with medical school.

Leaving this path after seven or eight years of planning is a huge deal. Maybe this would be different if I were already in a committed relationship that could endure during medical school. But I'm not at the moment, and suddenly the idea starting a family in my 30s with ~300k debt looming over my head is almost unreasonable to me now. Not to mention the social distance I'd put between myself and my family and friends throughout the process of studying and clinical rotations.

I feel guilty. I feel like a disappointment. Not in my parent's eyes, but my own. I'm not sure whether I'll regret this decision or not, and I know that's not something you can answer for me either. I guess I'm just seeking some advice about all of this. What were your feelings before entering medical school? Do you think I'm insane for jumping ship?

Consider yourself lucky that your epiphany occurred now and not after you were in med school or even worse, in a residency. Your email says to me, no, shouts to me, that your heart isn't in it.

I went to med school because I relished the challenge. I had no doubts. I thought I wanted to be a psychiatrist and explore people’s minds. Obviously, that notion didn’t last. I opted for surgery because of the reward of seeing patients get better immediately.

Regarding income, I can't remember where I read it, but last year someone did the math. The loss of earning potential during med school and residency can’t be recouped. You will likely never be debt free if you owe $300K after med school. Don't forget, you will need to do 3 or 4 years of residency during which time you will earn $50-60K per year. The interest on your loans will pile up. I fully expect doctors' incomes to fall over the next few years too. Most of all, money is a terrible reason to choose a career. You should do what makes you happy. I know many MDs who have lots of money and are miserable.

My tuition at a private medical school was $1200 per year to start. Even in late 1960s dollars, my father paid for it with a check. I graduated with no debt.

And of course, medicine has changed dramatically over the years. I'm not sure that I would do it again if I had the chance.

By the way, I wouldn’t assume that being in a relationship before going to medical school would be a lasting solution either. The stress of med school and residency can be difficult for even the best of relationships.

I applaud your parents for supporting you. The second worst reason to choose a career after money is because you don't want to disappoint your parents.

I hope this helps. Good luck.