7 Years for Med School or Year off Before Residency - Which is Better?

[DrMommy]

Here's the deal: I am currently a 4th year and have had 2 children during med school. During this time I extended twice, so instead of graduating in 2008 I will be graduating in 2010. I decided at the end of the summer that I wanted to do surgery, so I have had to rearrange my schedule to try to fit in 2 surgery sub-Is in October and November.

The scheduling issue is just the tip of the iceberg...my youngest, 1 years old, has been really sick this past year (and by sick Im not talking colds, but recurrent pneumonia, bacteremia, etc) and he's starting to be worked up by a pulmonologist and immunologist. Im thinking that if this continues to occur or if he's found to have a serious disease that I won't be able to fulfill all my responsibilities as an intern. 9 months isn't very long to get this under control.

Im not a strong candidate as it is and I have already taken 2 extra years to complete my MD. I haven't even taken Step 1 yet...I put it off after 2nd year for what I thought was a couple months and then unexpectedly became pregnant a month into 3rd year. I never would have done well on Step 1 with the exhaustion of pregnancy combined with the demands of clinical duties totally draining me. I figured I would take it February or Spring 2009 at the latest when I had some free time, but then the baby started getting sick and never really got better. I had the exam scheduled for July, but he had a febrile seizure the night before. I then rescheduled for August, and he was hospitalized with pneumonia. I scheduled it again for the beginning of this month and he was again hospitalized with Croup. So, now I have no idea what the heck to do about that...

I have been thinking that I really should do a research year before applying for several reasons - I can take Step 1 and Step 2, make myself more competitive with publications in a surgical journal, and focus on getting my son healthy (hopefully he just has a poor immune response exacerbated by 10 hours a day in a large daycare center).

However, I have been led to believe that not entering a program right after med school can look horrible. The dean of students at my school thinks that it would look better than extending another year.

Im up you-know-what creek without a paddle right now and am so hoping that you guys would be able to give me some good advice about my boards and about extending vs graduating without immediately entering a surgery program and how this would affect my chances of matching in the future.

Thanks

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[skiz knot]

Here's the deal:... matching in the future.

Thanks

Sounds like a rough situation. I am not usually one to discourage people from doing what they love, but you may wish to reconsider surgery as a career. It sounds like you have had a difficult time managing your personal life (understandably) and your training. It does NOT get easier in residency, especially a surgical residency. Best of luck in whatever you do.

 

[Winged Scapula]

I'm sorry to hear about your troubles with your child. Medical school is challenging enough without the added pressures of a chronically sick child.

It is true that the match rate for physicians (ie, already graduated) is lower than it is for students. The reasons for this are myriad and it may reflect physicians who were less competitive to begin with, who took a LOT of time off from clinical duties or are switching from another field. Whatever the reason, the ability to match as a graduated physician will vary on a case to case basis. In addition, many will find it more difficult simply because they do not have as much school support and access to resources as they did when they were students.

So the question is whether or not it makes a difference for YOU in terms of taking 7 years to finish medical school (with a research year) or 6 years plus a year off. I don't think it makes a significant difference either way, because...let's be blunt...you have a significantly steep road ahead of you.

If I were reviewing your application, I would be less concerned that it took 6 or 7 years for you to finish medical school than I would be with the reason. What's to guarantee me that you won't leave or try and take a lot of time off during residency? Even family friendly surgery residencies are not nearly as family friendly as other specialties and they have to draw the line. You have a chronically ill child and there is no evidence. when reviewing your application, that that has changed. I can't comfortably ask you about it, but believe me, faculty are going to wonder about your ability to handle a challenging, time intensive and UNPREDICTABLE residency like surgery while having a sick child. Most surgery programs, even those with good adherence to work hour rules, do not have a predictable time at which you are in and leave every day. This is one of the hardest parts for family and childcare givers to understand and work with. What are your plans for child care? If the child gets sick, are you going to call in because you need to be at home/hospital with him?

These may seem unfair questions but I guarantee you that if they occured to me, they will occur to other faculty members. So IMHO taking 6 or 7 years to finish medical school is not the big deal; the appearance of having a chronically ill child without significant resources to manage that and keep you at work is.

Whether or not you continue to try for a general surgery residency or choose something else is up to you, but you have to understand the mindset about women in surgery. You are every male faculty's nightmare - a woman with children who will not be reliable to show up for work, stay at work and not impose on her fellow residents to leave early, take time off. You will spend more time thinking about your child than about surgery. Hopefully, your child will get better and this point will be moot, but it doesn't matter...past is prologue and faculty will worry about it being repeated.

So if you do decide to apply for surgery, my suggestions are (and these are valid for any specialty):

- you need to crush Step 1 to overcome the above biases
- a year off for research may allow the above, but do not expect it to get you published (it takes a long time to collect date, write it up, get it accepted and published...a year is not enough time)
- have a good plan for the inevitable questions - some faculty may flat out ask you what are you going to do if your child gets sick? Do you have family or a husband who can take off work to be with the child? They do NOT want to hear that you have no plan or expect that you are taking off time from residency.
- get good letters of support from faculty working with you now
- you need to spin this - ie, hopefully your child gets diagnosed, treated and the problems are in the past but you will need to find someway to assure faculty that it is

I wish you the best of luck.

 

[surg]

Agree with what WS said in general. Also my sympathies for your troubles. As to your question:

You need to knock step 1 and step 2 out at this stage if you want to graduate. For anyone who is already graduated or has had the time to do so, I'd expect those scores. Without them, it's doubtful you'd even pass the screens to be considered for an interview. I need to know that despite the rest of your academic record, that you can do the work when given the right opportunities.

Get your story together. Be prepared to address the situation in every interview as I would certainly ask you why you went 6 years anyway. I want to hear that you had a problem, but now you have either resolved it or found a way to cope with it.

One consideration in the graduation decision. Is there tuition cost if you stay in school? If so, that may be a deterrent right there. However, remember that when you graduate the clock will start ticking on loan repayment and you may have to start repaying loans. If you don't have a paying job, you may have trouble keeping up financially without being enrolled in school.

As to which is going to look worse, I'd say it depends on what you can do with the extra year. If it's going to improve your grades and get you better LORs to stay enrolled, might be a plus, but a good research experience is also a plus. It's not going to be a huge factor in my decision making on your file which you choose. It's going to be how you convince me that the extra time you took will make you a better resident.

Good luck.

 

[DrMommy]

Thanks guys! I love surgery and everything related to it - at this point I can't imagine specializing in anything else and can't see myself happy doing so. During my surgery rotation a couple of the attendings attempted to recruit me into the field but I always shrugged it off thinking how can I do that and be a good mom, too? When surgery was over I didn't feel happy or relieved like I usually do after I finish a rotation, but sad that I was through and couldn't go back and experience it again. Every morning I woke up excited and refreshed and looked forward to another long day. Even the floor work seemed wonderful.

After much thought I realized that one day my babies will be all grown up and at that point I will be stuck doing something that I really didn't want to do. Plus, what am I teaching my kids - to put aside a promising career in something wonderful for parenthood? My own mom drilled it into me early on that I can be both successful and raise good, happy children and not to sacrifice my intelligence or talents to raise a family (my mom barely graduated high school and married at a very young age).

You guys pretty much validated everything that I was thinking. Honestly, at this moment and likely 9 months from now I wouldn't be able to dedicate myself fully as a surgical resident and my training will suffer for it. In addition, it wouldn't be fair to my attendings and co-residents, patients, or anyone who missed out on my spot. I'm hoping that this explanation will help any program directors to realize that I know where my priorities lay...I need to focus on training to be a surgeon, but I needed to attend to and straighten out motherhood before that would be possible.

Currently, I live 60 miles from my med school so that we can be close to family who do help a ton with childcare. Thankfully we live 2 miles outside a major city with 5 surgery residencies. The kids also go to daycare 10 hours a day. In 2011 my mom, who lives a couple blocks away, will be retired and Im thinking of getting a nanny for backup. I have a husband, too, but he works hellish hours too. My hopes are that the baby's health will either be nothing concerning or we will have a definite diagnosis with management of it in place soon.

I feel reassured by your great feedback that I am thinking along the right lines here. I would much rather extend another year so that I won't have to go a full year without any clinical duties. I would do research in between clinical rotations. Thankfully my tuition is waived after 4 years and I would see if I could get a gradplus loan for fees and expenses.

Again, you have been a wonderful resource and I sincerely appreciate it.

 

[Raidergate]

Thanks guys! I love surgery and everything related to it - at this point I can't imagine specializing in anything else and can't see myself happy doing so. During my surgery rotation a couple of the attendings attempted to recruit me into the field but I always shrugged it off thinking how can I do that and be a good mom, too? When surgery was over I didn't feel happy or relieved like I usually do after I finish a rotation, but sad that I was through and couldn't go back and experience it again. Every morning I woke up excited and refreshed and looked forward to another long day. Even the floor work seemed wonderful.
After much thought I realized that one day my babies will be all grown up and at that point I will be stuck doing something that I really didn't want to do. Plus, what am I teaching my kids - to put aside a promising career in something wonderful for parenthood? My own mom drilled it into me early on that I can be both successful and raise good, happy children and not to sacrifice my intelligence or talents to raise a family (my mom barely graduated high school and married at a very young age).

You guys pretty much validated everything that I was thinking. Honestly, at this moment and likely 9 months from now I wouldn't be able to dedicate myself fully as a surgical resident and my training will suffer for it. In addition, it wouldn't be fair to my attendings and co-residents, patients, or anyone who missed out on my spot. I'm hoping that this explanation will help any program directors to realize that I know where my priorities lay...I need to focus on training to be a surgeon, but I needed to attend to and straighten out motherhood before that would be possible.

Currently, I live 60 miles from my med school so that we can be close to family who do help a ton with childcare. Thankfully we live 2 miles outside a major city with 5 surgery residencies. The kids also go to daycare 10 hours a day. In 2011 my mom, who lives a couple blocks away, will be retired and Im thinking of getting a nanny for backup. I have a husband, too, but he works hellish hours too. My hopes are that the baby's health will either be nothing concerning or we will have a definite diagnosis with management of it in place soon.

I feel reassured by your great feedback that I am thinking along the right lines here. I would much rather extend another year so that I won't have to go a full year without any clinical duties. I would do research in between clinical rotations. Thankfully my tuition is waived after 4 years and I would see if I could get a gradplus loan for fees and expenses.

Again, you have been a wonderful resource and I sincerely appreciate it.

That feeling will soon pass.

 

[filter07]

Floor work is not wonderful.

If I were in your shoes I would do something like psychiatry. It seems like you always put family first, which is admirable, but probably not right for surgery. I don't care what society tells us these days... we cannot have it all.

 

[michaelrack]

Plus, what am I teaching my kids - to put aside a promising career in something wonderful for parenthood? .

There would be nothing wrong in teaching them that.