Today (Thursday, March 30, 2017) is National Doctors’ Day! Which means… shoutout to my awesome doctor hubby!
He puts in long hours of sometimes thankless work, but I want him to know he is super loved and appreciated! 🙂
In our last four years, as we moved through medical school and now residency, I’ve come to find that there are a lot of misconceptions about this process, so I thought I’d take a little time to explain how you become a doctor these days! 🙂 I’m going to mainly discuss our experience, so there could be schools that do things differently, but this is how it was for us (with a little knowledge of other schools thanks to family and friends!).
It all starts in undergrad…
Most people decide before undergrad that they have a desire to attend medical school. This means even before they think about applying, they have to make awesome grades in all the pre-requisite classes (which are typically heavy in chemistry and biology). Steven’s BS is in Biology. They begin preparing for the MCAT (Medical College Admisson Test- the medical school qualifying exam) typically two years in (sophomore year), because most applicants will actually take the MCAT in their junior year. This allows them to apply and interview for medical school as a senior. Applications typically open around September, and applicants will interview at different schools through the fall. Some schools extend early admission offers, and then the process of admission offers and waitlisting happens through the spring.
Steven attended medical school at Texas Tech (which is where we met). I was in my first year of grad school during his first year of medical school. For me, the first three years of classes/clinic were in Lubbock (Tech’s main campus), and then my fourth year internship could be completed anywhere. For Steven, the first two years of med school were at main campus in Lubbock, and then his class was divided for the last two years of clinical rotations. Tech has 3 rotation campuses- Lubbock, Amarillo, and Permian Basin (Odessa/Midland). Students are allowed to submit their rankings of the campuses with any reasons for needing to be at a particular campus, and then all the students are assigned based on this to a rotation campus before starting the first year (most medical schools have different campuses for rotations in order to accommodate the number of students they have with the hospital size. Some make these assignments early like Tech, and some wait until closer to the actual time they move). So, we already knew when we met that Steven would be in Lubbock for the first two years, and then in Amarillo for the last two years.
The first year was classwork- starting with cadaver anatomy. We had met at this point, but were not dating, so I can’t 100% speak to the difficulty of this, but I know it was NOT easy (I mean, I don’t think anyone can think working with cadavers is easy in any way!). They would take mainly one class at a time, but that class would be much shorter than a semester (like 6-8 weeks at a time). He was on his second class of the fall semester when we started dating, and we knew his schedule would be tough, but decided to give dating a try. He took two (maybe three? I don’t remember that long ago that well!) classes in the spring, and then went home for the summer to work an internship with a local family medicine physician while I stayed in Lubbock for summer classes/ clinic.
The second year is still classwork, but they had some exercises with patient interaction (like simulated patients). Some schools offer actual patient interaction in the 2nd year (he occasionally has 2nd years with him now). The classwork was much more in depth (multiple neuro classes), and on top of the classwork, studying for STEP 1 had begun.
Deciding what type of physician one will be isn’t necessarily all about what they want to do. What type of physician someone is depends on what residency training they received, and what residency they are accepted into depends on how good their grades are, but mostly what scores they make on the US Medical Licensing Exam (USMLE) STEP tests. Specialties with better lifestyles demand better STEP scores. STEP exams test over every area of medicine, including bio-statistics (like how research is conducted). STEP 1 is typically taken between the 2nd and 3rd year of medical school. So, while he was taking classes and tests (typically one every few weeks), he was also studying for STEP 1.
For that summer, I was in Ft. Worth for a summer internship, and he stayed in Lubbock for June to study and then take STEP 1, and then moved to Amarillo to start 3rd year rotations in July.
His 3rd year was broken into 6 8-week rotations: Internal Medicine, Psychiatry, OB/Gyn, Surgery, Family Medicine, and Pediatrics. They rotate through different areas in each roation, so for example, his Internal Medicine rotation was two weeks of wards at the Amarillo VA, two weeks of clinic, two elective weeks (he chose GI), and two weeks of something else (he moved ALL THE TIME so I could barely keep up with where he was supposed to be every day!). The main point being, they cycled through every possible thing to help them better decide what they are interested in. Throughout this time, he was living in Amarillo and I was living in Lubbock, but completing a travel clinic rotation at an ENT in Amarillo so that we could see each other more often (so I was driving to Amarillo every week). That travel position worked into a full 4th year internship for me so I was able to move to Amarillo for our 4th year (I really only looked in Amarillo because we knew we wanted to get married). I moved there in May, and we both started 4th year (me in May, him in July).
In July/ August, he took STEP 2, which involved a written portion- Clinical Knowlege (called CK- like STEP 1), and an interactive portion- Clinical Skills (called CS). CK can be taken at any testing center (he took it in Amarillo), but CS must be taken at a special testing center (only 5 locations in the US), so he went to Houston for that. Once that was over, he began the application and interview process for residency.
He knew he wanted to do internal medicine (with plans at that time to specialize in either cardiology or GI). He sent out somewhere in the ball park of 50 applications, but we knew we mainly wanted to stay in Texas (maybe a neighboring state if we had to). He was mainly interested in Scott & White in Temple and Baylor in Dallas, so he did an acting internship in Temple in October (his brother is finishing up residency at BUMC in Dallas so he had a pretty good idea of what it is like there). He went on 10 (ish- might have been more. I just remember he was gone A LOT!) interviews (and turned down several that required more travel) through October, November, and December.
Once all the interviews were over, he decided his match list. Basically, you take everywhere you interview and rank them in the order you like them, and all the programs take everyone they interviewed and rank them in the order they like them. A computer (probably multiple computers??) takes all the lists and runs them through to find the top match for each candidate/ program. He decided his list by mid January and submitted them to the website (even though I think the deadline was like the first part of February). We were getting married the first part of March, so he got those decisions made and we did wedding showers and such through February. We talked many, many, many a time through that year about where we should go for residency and where we wanted to be and for the longest time I would say “I don’t care”, but I learned at some point that that wasn’t true- I really meant “I don’t have a preference”– I actually cared quite a bit! There were pros and cons to all the choices, particularly our top choices, so I knew we would be fine wherever we ended up. I knew residency would be tough enough (with the crazy schedule and much higher workload) that he needed to be comfortable with the choice and be where he truly wanted to be. I can work anywhere, and at the end of the day, home is wherever I’m with him (and you can live anywhere for 3 years is what I told myself!). He told me later after all the match process that there were times that he actually got pretty frustrated with me because I wouldn’t be more opinionated about the choices. And I truly felt like we would be 100% fine wherever we ended up, and I really (really truly) had no strong preference because there were so many pros and cons and good choices for us. I was ready to let the chips fall where they may!
On Monday, March 14 (the Monday before Match Day), all applicants got an email stating whether or not they matched with a program on their list. Applicants typically interview for one area of medicine (apparently it’s frowned upon to interview hop through specialties), and when they rank their interviews, they can choose to rank all of them, or leave some out (which eliminates the possibility of matching there). This first email basically lets the candidates know if they matched into their desired specialty, or if they need to participate in the SOAP (don’t ask me what SOAP stands for– it was formerly called/ still informally called the Scramble) to get a residency spot. Before they submit their rank list, they must designate whether or not they are willing to participate in the SOAP should they not match on their list. This means they take all the unmatched applicants and all the unfilled residency spots (these are typically less desirable locations, less desirable specialties, or spots that are created for candidates) and the programs interview to fill those spots during that week.
On Friday (for us, it was Friday, March 18!), we went to the Amarillo Country Club for the Match Day Ceremony!
That envelope right there held where we would be for the next three years! No one is allowed to open their envelopes (nationwide!) until 11 AM central time. We were seated at a table and he opened the envelope in front of us (and every one, but we were the only ones watching). We have friends (from another med school) that had to open their envelopes one at a time on the stage in front of a microphone. So everyone there got to watch if you matched at your first choice or further down the list (#nothankyou, #noma’am!). The sheet inside the envelope said…. Scott and White in Temple, his number one choice!
After graduation, we moved to Temple for hubs to start residency. General internal medicine residency will be 3 years, and then he is wanting to do a fellowship in gastroenterology (GI), which will be another 3 years. Right now, he does different rotations through the hospital for 2 to 4 weeks at a time with a clinic week every 5th week. Some clinic weeks he’s had to cover the ER for days or nights, but generally speaking clinic weeks are lighter (7:30 A – 5:00 P) with the weekend off. Otherwise, he is going in generally a little before 7 and gets off between 5-6 when he is working on wards or consults, ER shifts are 12 hours (7-7) and night shifts are 14 hours (5:00 P- 7:00 A) for intern year. He is currently working to apply for fellowship in a few years, which means in the fall of his 3rd year, we’ll be doing interviews and match all over again.
You might say to yourself… “Morie, why do you keep up with all that? Isn’t he the one going to work and doing those hours? Why do you care where he’s at while he’s there?” And my reply would be… One– I care, because he’s my husband which means we’re both invested in this. And two– Where he’s at in the hospital can drastically change when he’ll be home and what time off he’ll get. We already know that it’s safe to make weekend plans when he’s on clinic, but if he’s on wards, he’ll only get one weekend day off, and may or may not have to stay late on the weekend day that he’s there (which has changed some of our plans before). We try our hardest to continue living our lives and not let this dictate what we’re able to do, but it can’t be helped to a certain extent. Even though there are things we’d like to get to do, we just know that we are a little limited in this season and that we’ll miss out sometimes. But we do make the most of the time we have, and that keeps us happy and him from getting burned out. We’ve been blessed in that he still has a little time and space to do hobbies he truly enjoys, which helps keep his morale up because just going back and forth to the hospital can become draining after a fairly short period of time.
Medicine can be a rewarding profession, but it can be a tiring and stressful one. They work long, demanding hours for often little recognition and excessive criticism, and are responsible for so much knowledge in the quest for caring for others. So, if you see a doctor today (or any day, for that matter), tell them thank you because they have no doubt sacrificed time with their families, time to themselves, time to get other things done, time to eat, time to sleep, and time to have fun so that they can provide the best possible health care to their patients. I’m proud of my husband for so many other things besides him being a physician, and honestly, that wouldn’t even be in the top handful of words I would use to describe him. But, the top words I would use- selfless, caring, witty, focused, efficient, motivated, hard working, and kind- are all words that speak to why he is so great at what he does. 🙂