Ask a Graduating 4th Year Med Student Anything

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Great advice. I always wondered how that worked. Thanks a lot!

Sure, no prob. Feel free to post if you think of any other questions.

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Before I enter my first year, I am looking through several specialties as all med students do. It doesnt help I work in a ER with a residency program and several other programs in the hospital. I think I will like surgery but the biggest drawback for me is the terrible hours (80+). Any thoughts on this? As well as the recent repeal of the law limiting the amount of hours an intern can work?
 
Hi! I have a few questions if you don't mind. I am very interested in pursuing GS, do you think the school you attend plays a factor in your residency competiveness or is it mainly your board scores in combination with research and other EC's?
 
Before I enter my first year, I am looking through several specialties as all med students do. It doesnt help I work in a ER with a residency program and several other programs in the hospital. I think I will like surgery but the biggest drawback for me is the terrible hours (80+). Any thoughts on this? As well as the recent repeal of the law limiting the amount of hours an intern can work?

I think most people have these concerns when they start. I used to hear "80 hours" and wonder how anyone could work that much and still enjoy themselves. This is why the 3rd year is so important. You'll have to work that much on your general surgery rotation as an ms3 regardless of what you go in to (with some exceptions, there are people who do their core clerkship at a private hospital or a hospital without residents which is generally a bad idea if you have any interest in surgery because you get to see the light at the end of the tunnel without experiencing any of the tunnel). The majority of people seem to decide what they actually want to do during or shortly after 3rd year, and it's because nothing can replace actually getting your hands dirty and experiencing the specialty with other residents first-hand.

For me, surgery is so appealing that I can justify the hours worked... and for others the hours are a major deterrent. You will probably work harder in a general surgery residency than most other residencies, but you'll work hard regardless. Although there are certainly other specialties where you won't work nearly as much (psych and PM&R come to mind).

The repeal of the "law" you're referring to was actually an ACGME regulation and not a law, and it's kind of misleading. The regulation that was repealed was that interns (first year residents) couldn't work more than 16 hours in a single shift. We will now be able to work up to 28 hours in a shift. This repeal is actually much more favorable, in the opinion of most surgeons. One reason is that you can get things done on a post-call day and it's easier to utilize your time. E.g. if you leave in the morning or around noon from a call shift, you can go home, sleep a few hours, and then get errands done that are difficult to do on your one weekend day off a week. Another reason is that you'll have to work these hours as a second year resident and beyond anyway. Yet another reason is that life after residency has no hour caps, and being shielded from working during a fundamental time of development is probably a bad idea. Additionally, the reason is was repealed is that a study was done which showed no benefit.

We still have the 80 hour cap in place, which is probably for the best and likely won't be going anywhere. This alone makes surgery residency much "easier" than it used to be.
 
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Hi! I have a few questions if you don't mind. I am very interested in pursuing GS, do you think the school you attend plays a factor in your residency competiveness or is it mainly your board scores in combination with research and other EC's?

I think going to a "top" school will always help, in any specialty. But the extent to which it helps is definitely debatable. For big name academic programs it will probably matter more than for other programs (there seems to be quite a lot of inbreeding at the top schools). Keep in mind the programs associated with these top schools are not always "top" programs, which is why it can be a bad idea to look at match lists as a premed.

Ultimately the rest of the application matters quite a lot more (you're right that board scores are really important). You can absolutely match into a great program if you don't go to a top school.
 
I think going to a "top" school will always help, in any specialty. But the extent to which it helps is definitely debatable. For big name academic programs it will probably matter more than for other programs (there seems to be quite a lot of inbreeding at the top schools). Keep in mind the programs associated with these top schools are not always "top" programs, which is why it can be a bad idea to look at match lists as a premed.

Ultimately the rest of the application matters quite a lot more (you're right that board scores are really important). You can absolutely match into a great program if you don't go to a top school.
Perfect! Thank you so much, currently I am looking at NYMC but my end goal is to do GS back in Michigan so I am hoping that being on the east coast shouldn't matter too much in order to do that. Do you have any thoughts on doing an away rotation in Michigan to really show I want to go there?
 
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Perfect! Thank you so much, currently I am looking at NYMC but my end goal is to do GS back in Michigan so I am hoping that being on the east coast shouldn't matter too much in order to do that. Do you have any thoughts on doing an away rotation in Michigan to really show I want to go there?

No, going to school in the northeast won't really matter (it would be different if you were trying to get back to California). Doing away rotations can definitely help, if they go well. I've actually talked about this quite a lot recently... from another thread:

"Also keep in mind that away rotations can be risky. It's a lot easier to look bad than it is to look good when you're surrounded by people that know a lot more than you do. They can pay off though--I did an away rotation at my top choice and matched there. But I did another one where things didn't go as well (because of things that were out of my control)."
 
No, going to school in the northeast won't really matter (it would be different if you were trying to get back to California). Doing away rotations can definitely help, if they go well. I've actually talked about this quite a lot recently... from another thread:

"Also keep in mind that away rotations can be risky. It's a lot easier to look bad than it is to look good when you're surrounded by people that know a lot more than you do. They can pay off though--I did an away rotation at my top choice and matched there. But I did another one where things didn't go as well (because of things that were out of my control)."
Ok that makes sense, yeah I have just seen from their match list the only spots in Michigan they send to are in IM and EM. But you don't think that it would be too crazy to match at hospital in Michigan for GS with appropriate board scores and ECs just based on school location. So even though the school doesn't have a relationship sending student to their GS residency that doesn't matter as much?
 
Ok that makes sense, yeah I have just seen from their match list the only spots in Michigan they send to are in IM and EM. But you don't think that it would be too crazy to match at hospital in Michigan for GS with appropriate board scores and ECs just based on school location. So even though the school doesn't have a relationship sending student to their GS residency that doesn't matter as much?

This is actually exactly why reading match lists can be misleading. Surgery is a relatively small field (most programs probably accept 5 residents per year, although there are certainly larger programs), whereas IM and EM accept many more residents on average. Additionally students from that school probably aren't ending up in Michigan for residency not because they can't, but because they choose not to. Things like away rotations (high-ish risk/high reward) and communicating with the program can make a huge difference in where you end up. Ultimately the match really does favor the applicant (over the program) and most US MD students match at one of their top three programs.

If you were trying to stay in California, which is a uniquely competitive state, or trying to specifically stay at a place like Harvard or Hopkins, it would be a different story.
 
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This is actually exactly why reading match lists can be misleading. Surgery is a relatively small field (most programs probably accept 5 residents per year, although there are certainly larger programs), whereas IM and EM accept many more residents on average. Additionally students from that school probably aren't ending up in Detroit for residency not because they can't, but because they choose not to. Things like away rotations (high-ish risk/high reward) and communicating with the program can make a huge difference in where you end up. Ultimately the match really does favor the applicant (over the program) and most US MD students match at one of their top three programs.

If you were trying to stay in California, which is a uniquely competitive state, or trying to specifically stay at a place like Harvard or Hopkins, it would be a different story.
Thank you so much! Extremely informative!
 
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Im not sure if its rude to ask this question, so please don't answer if you would rather not, but what did you score on your step 1?
 
Now that I'm done with all of my ms4 requirements and have already matched, I'm pretty much just sailing until graduation. I found these AMA threads really helpful as a premed so I figured I'd make a new thread and see if I can answer any questions.

Super brief background: I was an average med student and matched into my top choice in general surgery

Maybe @Doctor Strange and/or any other ms4s who post here can chime in as well.
Congratulations! Are you still powerlifting?
 
Im not sure if its rude to ask this question, so please don't answer if you would rather not, but what did you score on your step 1?

I don't really want to post numbers, but I was below the average matched applicant. Because of that I felt like the second half of med school was a huge uphill battle, but I did really well during 3rd year, did research, got strong LORs (which were commented on during my interviews), and increased my step 2 by 30 points which absolutely helped in my situation.
 
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You mentioned one reason you chose GS was for the multitude of fellowship options, which I find extremely appealing as well. What are you thinking, at least now, in terms of subspecialty?
 
You mentioned one reason you chose GS was for the multitude of fellowship options, which I find extremely appealing as well. What are you thinking, at least now, in terms of subspecialty?

It is a huge plus for me. I honestly have no idea, partially because of all of the nuanced differences between specialties (that are difficult to become aware of or appreciate until residency). Just about everything sounds interesting to me at this point in theory. I've done rotations in plastics, vascular, transplant, and trauma/critical care (as well as general surgery) and enjoyed all of them. I have a lot to learn and a lot I haven't experienced yet.
 
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This is actually exactly why reading match lists can be misleading. Surgery is a relatively small field (most programs probably accept 5 residents per year, although there are certainly larger programs), whereas IM and EM accept many more residents on average. Additionally students from that school probably aren't ending up in Michigan for residency not because they can't, but because they choose not to. Things like away rotations (high-ish risk/high reward) and communicating with the program can make a huge difference in where you end up. Ultimately the match really does favor the applicant (over the program) and most US MD students match at one of their top three programs.

If you were trying to stay in California, which is a uniquely competitive state, or trying to specifically stay at a place like Harvard or Hopkins, it would be a different story.

Could you elaborate on "trying to stay in California". Should med students be enrolled in medical school in Cali to land a Cali residency?
How hard is it to get a Cali residency coming from an out of state program?
 
I read your response earlier about repaying your student debt. Many of my family members say that the debt "doesn't matter" because "you'll be a doctor". They're assuming a physician's income is essentially infinite. Can you comment on this line of thinking? I just want to know your perspective.
 
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It is a huge plus for me. I honestly have no idea, partially because of all of the nuanced differences between specialties (that are difficult to become aware of or appreciate until residency). Just about everything sounds interesting to me at this point in theory. I've done rotations in plastics, vascular, transplant, and trauma/critical care (as well as general surgery) and enjoyed all of them. I have a lot to learn and a lot I haven't experienced yet.

That's true, I'm sure as a resident you will be able to really find what you love. Vascular or transplant would be so interesting!
 
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So I am curious during the match if you have a GS residency as your #1, and lets say a thoracic program as your #2, could you get offers from both programs and then make a decision? Like during the match do you field multiple offers and then just choose one or are you committed to your highest ranked choice?
 
So I am curious during the match if you have a GS residency as your #1, and lets say a thoracic program as your #2, could you get offers from both programs and then make a decision? Like during the match do you field multiple offers and then just choose one or are you committed to your highest ranked choice?

I know @sinombre will probably be able to answer more clearly since he just went through the Match but my understanding is that the applicants submit a ranked list as well as the programs and a computer algorithm "matches" the applicants to their program. In the end you only match into one program.
 
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Could you elaborate on "trying to stay in California". Should med students be enrolled in medical school in Cali to land a Cali residency?
How hard is it to get a Cali residency coming from an out of state program?

California is uniquely competitive because so many people from California leave for medical school (I think the statistic is ~75% of successful med school applicants matriculate out of state). A huge chunk of those people try and return for residency, which is what makes it uniquely competitive. I'm not sure if leaving the state makes it more difficult to return, but I suspect it does. I know that a lot of California med students end up matching in California. I think if your goal is to do residency in California it probably makes sense to go to school there, unless you get in to a top school somewhere else.
 
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I read your response earlier about repaying your student debt. Many of my family members say that the debt "doesn't matter" because "you'll be a doctor". They're assuming a physician's income is essentially infinite. Can you comment on this line of thinking? I just want to know your perspective.

I think racking up debt for medical school is worth it, because you have essentially a guaranteed return on investment (compared to something like law or business school where the return on investment is more uncertain). The debt absolutely matters though. Federal loans have absurdly high interest rates, and the interest accumulates during school while you're not paying it off. Fortunately loan forgiveness programs exist, but like I mentioned earlier, there is no legal guarantee that it will exist by the time any of us would theoretically qualify (10 years after graduating med school). Which makes me nervous, and is why I'm most likely going to aggressively pay off my debt since I'm fortunate and have a wife with a solid job.
 
So I am curious during the match if you have a GS residency as your #1, and lets say a thoracic program as your #2, could you get offers from both programs and then make a decision? Like during the match do you field multiple offers and then just choose one or are you committed to your highest ranked choice?
I know @sinombre will probably be able to answer more clearly since he just went through the Match but my understanding is that the applicants submit a ranked list as well as the programs and a computer algorithm "matches" the applicants to their program. In the end you only match into one program.

In this case, whatever program you match at, you match at (you can't get offers from both). If you rank 10 categorical programs in 10 different specialties, you can only match at one. This is different for preliminary positions, which are 1 year long (preliminary positions are not complete residencies). So in a specialty like radiology which requires a prelim year, you would match at a prelim position and a radiology position. But since categorical GS and integrated cardiothoracic residencies are both categorical, you can only match at one.

Typically people applying to integrated programs like cardiothoracic, vascular, or plastics will rank their respective chosen integrated programs first and then gen surg spots as backup (because they are all very competitive).
 
In this case, whatever program you match at, you match at (you can't get offers from both). If you rank 10 categorical programs in 10 different specialties, you can only match at one. This is different for preliminary positions, which are 1 year long (preliminary positions are not complete residencies). So in a specialty like radiology which requires a prelim year, you would match at a prelim position and a radiology position. But since categorical GS and integrated cardiothoracic residencies are both categorical, you can only match at one.

Typically people applying to integrated programs like cardiothoracic, vascular, or plastics will rank their respective chosen integrated programs first and then gen surg spots as backup (because they are all very competitive).
I see that makes sense, what are your thoughts on the trauma fellowship in terms of lifestyle and the surgical lifestyle in general?
 
I see that makes sense, what are your thoughts on the trauma fellowship in terms of lifestyle and the surgical lifestyle in general?

I know a few current chief residents starting a trauma/critical care fellowship this July. In terms of lifestyle during fellowship: fellows don't have hour caps, and are busy in every surgical specialty I know of (there may be exceptions I don't know of, but I doubt it). Lifestyle as an attending is kind of difficult for me to comment on (obviously), but I can comment on their schedules. I've only worked with attendings in academic settings which is probably pretty different than non-academic settings. When they're in the hospital, they're busy. A lot of them would do something like: 1 week rounding on ACS patients, 1 week operating, 1 week managing the SICU, and then 1 week of vacation, or some variation of that. The ability to work and rotate through those different settings was a big reason all of the chiefs I spoke with gave for going in to trauma/critical care. I suspect that being a trauma/cc surgeon at a non-teaching hospital would involve the utilization of more midlevels (PAs/NPs) which might get rid of some of the scut work, but that's just conjecture on my part.

In terms of surgical lifestyle in general, most surgeons work a lot of hours. It is certainly possible to do jobs that are more lifestyle friendly in most subspecialties, but if your main concern is lifestyle, most surgeons would probably tell you to consider other specialties.

I'm looking down the barrel of residency optimistically. I'd rather work twice as many hours doing something I enjoy than half as many hours doing something I don't.
 
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When you were on your trauma rotation, did your attending/fellows do a lot of operating? It seems like it's a lot of management and not a whole lot of time in the OR. That's just from my pre-med perspective working in the OR. I don't work very late either, so I suppose I probably miss a lot of the action...
 
Any particular Advice for us waitlisted candidates to our top school?
 
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When you were on your trauma rotation, did your attending/fellows do a lot of operating? It seems like it's a lot of management and not a whole lot of time in the OR. That's just from my pre-med perspective working in the OR. I don't work very late either, so I suppose I probably miss a lot of the action...

The majority of trauma is managed non-surgically. But in areas with a lot of penetrating trauma (e.g. bad areas with gun violence) they operate a decent amount. It's similar to how the majority of what you see in the emergency room is non-emergent. Acute care surgery involves non-trauma surgical emergencies as well.
 
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I know a few current chief residents starting a trauma/critical care fellowship this July. In terms of lifestyle during fellowship: fellows don't have hour caps, and are busy in every surgical specialty I know of (there may be exceptions I don't know of, but I doubt it). Lifestyle as an attending is kind of difficult for me to comment on (obviously), but I can comment on their schedules. I've only worked with attendings in academic settings which is probably pretty different than non-academic settings. When they're in the hospital, they're busy. A lot of them would do something like: 1 week rounding on ACS patients, 1 week operating, 1 week managing the SICU, and then 1 week of vacation, or some variation of that. The ability to work and rotate through those different settings was a big reason all of the chiefs I spoke with gave for going in to trauma/critical care. I suspect that being a trauma/cc surgeon at a non-teaching hospital would involve the utilization of more midlevels (PAs/NPs) which might get rid of some of the scut work, but that's just conjecture on my part.

In terms of surgical lifestyle in general, most surgeons work a lot of hours. It is certainly possible to do jobs that are more lifestyle friendly in most subspecialties, but if your main concern is lifestyle, most surgeons would probably tell you to consider other specialties.

I'm looking down the barrel of residency optimistically. I'd rather work twice as many hours doing something I enjoy than half as many hours doing something I don't.
yeah I agree doing something you enjoy is important I just would like some time to be able to have a family haha. I have heard that Trauma isn't on call as much which would be a huge plus to me. on average they may still be working 50-60 hours per week but not being on call would be a benefit. Do you see this as being true?
 
The majority of trauma is managed non-surgically. But in areas with a lot of penetrating trauma (e.g. bad areas with gun violence) they operate a decent amount. It's similar to how the majority of what you see in the emergency room is non-emergent. Acute care surgery involves non-trauma surgical emergencies as well.
I have been told this as well, but then the surgeons are able to also do regular GS procedures on the side correct?
 
Any particular Advice for us waitlisted candidates to our top schools (s)?

I'm probably the wrong person to ask about this. I had two acceptances and one waitlist, and I didn't get in off of the waitlist I was on. I think it's probably worth the risk to express interest if you really want to go there. But I have no idea how admissions committees operate, so unfortunately I can't offer any insight into how waitlists work.
 
yeah I agree doing something you enjoy is important I just would like some time to be able to have a family haha. I have heard that Trauma isn't on call as much which would be a huge plus to me. on average they may still be working 50-60 hours per week but not being on call would be a benefit. Do you see this as being true?
I'm not sure. The ACS/trauma surgeons I've worked with were on call a lot when they were there. But like I mentioned above, they took frequent vacations/time off as well.
I have been told this as well, but then the surgeons are able to also do regular GS procedures on the side correct?
Yep.
 
Maybe @Winged Scapula can chime in. I'm kind of just speculating and sharing my observations. Asking me what life is like as an attending is kind of like asking a graduating high school senior what medical school is like. I'm happy to share but also don't have much to offer in that regard.
 
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Maybe @Winged Scapula can chime in. I'm kind of just speculating and sharing my observations. Asking me what life is like as an attending is kind of like asking a graduating high school senior what medical school is like. I'm happy to share but also don't have much to offer in that regard.
That's fair! thank you for your thoughts, any insight is much appreciated.
 
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Thanks! Nope, haven't in probably close to two years. I may start up a 5/3/1 routine since it's easy to keep up with while being busy. Once I got to 1000 total I also started to get busy so I sort of lost motivation.
Ah, take it easy now that you will be a surgeon.

After going through med school, do some nutritional supplements seemed like they are BS? For example, natural test boosters?
 
Ah, take it easy now that you will be a surgeon.

After going through med school, do some nutritional supplements seemed like they are BS? For example, natural test boosters?

For the most part yeah. I think it's extremely easy to sell snake oil to people who don't have at least a basic scientific and medical foundation of knowledge, especially when that snake oil isn't regulated by the FDA.
 
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Who is Archer? Is that another Marvel superhero?
archer.jpg
 
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I know there's the cap of 80 hour work weeks for residents, but I've also heard that in reality that cap doesn't really exist and programs will expect you to report 80 hours but then actually work more than that. Has that been the case for you?
 
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How much operating did the transplant guys do? It seems like it would be very unpredictable OR time
 
This is actually exactly why reading match lists can be misleading. Surgery is a relatively small field (most programs probably accept 5 residents per year, although there are certainly larger programs), whereas IM and EM accept many more residents on average. Additionally students from that school probably aren't ending up in Michigan for residency not because they can't, but because they choose not to. Things like away rotations (high-ish risk/high reward) and communicating with the program can make a huge difference in where you end up. Ultimately the match really does favor the applicant (over the program) and most US MD students match at one of their top three programs.

If you were trying to stay in California, which is a uniquely competitive state, or trying to specifically stay at a place like Harvard or Hopkins, it would be a different story.

What would be your advice for Californians who have to go to the mid West or east coast for medical school, but they want to go back to California for residency?
 
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What would be your advice for Californians who have to go to the mid West or east coast for medical school, but they want to go back to California for residency?
I'm in the same boat. Moving from CA to Colorado this July and plan to come back. Can anyone speak on this?
 
Sorry for the bump. How's the residency going?
 
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Sorry for the bump. How's the residency going?

No worries. Residency is going well so far... it's much more enjoyable than being a student. I didn't realize how little I was actually doing as a student until starting.

I'm finishing up trauma/acute care surgery right now, starting general surgery on Monday. Overall I'm really happy with where I ended up. Surgery is awesome.
 
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I know there's the cap of 80 hour work weeks for residents, but I've also heard that in reality that cap doesn't really exist and programs will expect you to report 80 hours but then actually work more than that. Has that been the case for you?

It's kind of a mixed bag. Sticking to the hour cap is pretty difficult on certain rotations. I'll come back and post more about this later.
 
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