Just hoping there is going to be a place in residency for me. Am going to do my best. We'll have to see I guess.
Ok so while my previous post referencing one of your Tweets is hilarious (if I do say so myself), I figured maybe I'd do more than crack jokes.
I absolutely couldn't care less about "this" topic, and by that I mean anything about the pandemic. That's not to say I don't have my own experiences and opinions, but I would rather shove toothpicks under my toenails than talk about masks,
especially on the internet.
But I am deeply interested in discussion medicine as a career in America, and all the meta-topics around it.
Like yourself, I am also MD-PhD. My PhD is in RadOnc, so I have been "in" the culture for a sadly long time now. I got caught in the vortex in the mid-to-late 2000s.
I have a lot of strong opinions regarding...literally anything even loosely connected to Radiation Oncology. And I've had many of these opinions since I started looking at y-H2AX foci under a microscope when George W was still president.
But I planned I completing the "traditional" path of going to residency and practicing medicine, board certified in my specialty. And I quickly learned there was a high price to pay for that. Namely, if my opinions or actions were not perceived to be "in line" with the people "above" me in the hierarchy, my entire world could be crushed seemingly without much effort. My training was done during the "bubble" era of hyper-competitive RadOnc, before the burst, so this was amplified for me.
I don't agree with the current structure of medicine. Hierarchy for the sake of hierarchy when "evidence based" is a phrase more or less uttered by a burning bush is outright contradictory. But...that's our reality.
So I made the choice to bend the knee/kiss the ring. And it worked, I got everything I wanted (though whether I SHOULD have wanted ANY of this is a debate for another day). I created this SDN account when I knees were breaking from bending so hard and I needed an outlet. Having a pseudo-anonymous avatar to spew my thoughts into the void as I finished jumping hoops was very cathartic.
Why am I saying any of this? Because I finally went to your Twitter profile and saw how many followers you have and read some of your stuff. I can at least tell you that while going on Tucker Carlson to talk about masks certainly wasn't a career booster for you, the cat was already somewhat out of the bag.
We should all remember the changes that have taken place over the last few years. USMLE Step 1 went pass/fail. Schools are pulling out of rankings. There already was a huge push to not have grades or class ranks. Blah blah blah.
Each change is ratcheting up subjectivity. I can already promise you that you could be a GENIUS in the actual practice of medicine, but if you made the active choice to take up the mask debate 3 years into the pandemic, on Twitter, and go on Tucker Carlson - you're going to rub a few folks the wrong way in the clinical years. I'm not saying that's fair or warranted, just that it will happen. Which means some less-than-stellar written words about you. It happened to me, it happens to almost everyone. 98% of my clinical evals were good-to-neutral in M3 and M4. The negative 2% were purely personality-based. Once was a "guilt by association" thing which the program director erased for me. Once was a Fellow who thought I was Satan. To this day I don't know why. But that Fellow's review was definitely in my residency application, and that was with me trying to always kiss the ring.
But even more importantly: when you, or anyone, submits your residency application...people will Google you. At least one person reviewing either your app or during/after the interview. These days, probably several people.
And your Twitter profile will pop up. And it will be immediately apparent that you have a long track history of growing a large following by being openly critical of things. The fact that Tucker Carlson now pops up is essentially just icing.
So ask yourself: in a sea of hundreds of applicants at a particular school/program, are you really THAT special? Assuming a Bell curve of scores/achievements - are you going to be a tremendous superstar outlier? Or are you "just" going to be in the top 5%?
Because you're a potential liability. Why would a program want to take on someone who has, for years, leveraged platforms to be openly critical of claims in science and medicine? I'm making zero assumptions about the validity of those claims, I suspect I probably agree with a lot of them.
But how likely are you to be critical of my program, to your large base of followers, if I Match you and something happens that you don't like? What repercussions will that have on my program for years to come? Anyone on SDN knows how damaging a bad online reputation can be for a program. And SDN is an anonymous message board! I shudder to think about a 100k-follower Twitter account saying "so-and-so residency program hates trainees and discriminates against certain groups!"
Not saying you'd do that. This post isn't even about you, personally. This is the math people need to be doing if they want a career in medicine. Everyone needs to ask themselves what is more important, openly sharing and sticking to principled opinions while still in training, or trying to keep their head somewhat down until they get through "the crucible" and are out in independent practice?
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