Begging for advice: I messed up my application this cycle (very late, missing deadlines, etc.)

Thimble

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May 24, 2010
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To be perfectly honest, I should not have applied this cycle. I didn't have my **** together all summer, and I'm still falling apart now. The gist is that:

* I applied very late in the cycle, submitting my primary at the end of September. Part of this is because I was insanely busy with research, contributing to sleep deprivation. At the same time, I relapsed into self-harm and had to seek counseling for that...

* I got secondaries for all the schools I applied to (a mix of reach, hit, safety), BUT I didn't complete 4 secondaries by the deadline. I'm really kicking myself for that, because I *wanted* to go to those schools, and now it is a black mark against me when the program directors talk to each other / when I need to apply again next cycle.

* I do have 4 interviews at places I like. I'm going to wear clothes that hide my self-harm scars, but I do feel like it is something I need to ethically disclose (because sleep deprivation seems to play a role, and the whole medicine route is rife with sleep deprivation). How do I go about disclosing something like that?

* I'm still waiting to hear back from most schools, however I have a feeling that I'm going to need to apply again next cycle, i.e. this June. Would it still be possible to apply to the schools I missed deadlines for, or just safer not to? Is it okay if I switch to another lab that doesn't demand 18-hour days (weekends included) for weeks at a time, for my mental health? (Unfortunately, we are still paid as 40hrs/wk workers.)

Thanks for reading this! I realize I probably come across as neurotic or something, but I really do want to do translational research and care for patients.
 

BigFatCat

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Disclaimer: I am also applying this cycle, so my advice would be totally anecdotal/speculated.

I would be cautious about disclosing your self-harm situation. It seems risky to tell your interviewers that you resorted to self-harm when you were challenged recently. Unless you can make a positive and convincing story out of it, your interviewers will have no reason to think that the same thing won't happen again when you are under stress in med school and grad school (which will happen quite frequently).

Your mental health is important! You should speak with your PI/supervisor if you are unhappy about your current workload. I personally think it is totally acceptable to switch lab if your current one isn't treating you reasonably.

Most importantly, relax and have a good time :). I know it is hard to see it in the middle of this craziness, but the application process is actually quite fun and rewarding. Especially the interviews! For me they have been a great learning experience. Even if you do decide to reapply in the end, you will be better prepared.
 

OCDOCDOCD

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May 26, 2012
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I don't think that failing to complete an application will count against you aside from being a reapplicant. My experience talking with other applicants is that it's normal for people to never submit secondaries to several schools that they applied to on AMCAS.

The bigger issue is your mental health. I'm no adcom member, but I think it's safe to say that disclosing on-going habitual self-harm would be an instant rejection, and for good reason. IMO you should get these issues taken care of before trying to enroll in medical school. It'll make life better for you and everyone around you.
 

Neuronix

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How do I go about disclosing something like that?
You don't. You just don't go into medicine. If you insist that you're better and you want to go into medicine, you don't tell anyone about this except confidential counseling. You're so high risk for relapsing and then not getting a residency that I'm not sure medical school is right for you.

Nobody is going to create exceptions for you. If your issue is that "If I don't sleep, I start hurting myself", the real world is just going to kick you out of medical school or fire you as a resident. They're not going to change the job requirements because you start hurting yourself if you don't get your sleep. Thus there is no ethical disclosure to anyone. The reality is that you need to get yourself under control or not go to medical school.

Would it still be possible to apply to the schools I missed deadlines for, or just safer not to?
Nobody cares that you missed your deadline. There are plenty of applicants. Yours will simply not be considered at those programs. Move on. If you reapply next year they might notice and care, or they might not. That's not a big deal in the grand scheme of your post.

Is it okay if I switch to another lab that doesn't demand 18-hour days (weekends included) for weeks at a time, for my mental health?
Of course it's ok to switch labs. However, if your former PI writes you a bad letter, it's going to seriously hurt you.

I probably come across as neurotic or something, but I really do want to do translational research and care for patients.
There's two types of neurotic on SDN. One is: "OMG I HAVE A 3.9/39 IS IT BAD THAT I DON'T HAVE A 4.0/40" neurotic. Two is: you should seriously seek help neurotic. You fall in the latter. You're not appropriately caring for youself. You should not be caring for patients. If you can't handle 18 hour days now, you're not going to be able to handle them as a medical student and beyond. I think PhD alone may be a better choice for you.
 
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Thimble

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Neuronix, how much sleep deprivation is there in medical school? I'm okay with 18-hour workdays, but not chronic 18-hour workdays without rest. My situation over the spring/summer was at least one all-nighter a week, without time to catch up. For months. I was doing a mix of physically vigorous work and thinking really hard. I'm not sure how feasible it is for anyone not to feel out of whack in that situation; there are some minimum physical requirements for sleep. To the best of my understanding, the first half medical school is about learning existing knowledge, which should not be as taxing. The mild sleep deprivation associated with schoolwork has not been a problem for me so far. I'm not sure what clerkships are like, but I have heard that residents in some specialties aren't worked to the bone.

I did ask my counselor (of many years) about applying to MD/PhD, and she thought it was fine...

I think my professor would be fair enough to write me a good letter. She has been quite happy with my work so far, and apparently the current letter is pretty good.
 

gutonc

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Neuronix, how much sleep deprivation is there in medical school? I'm okay with 18-hour workdays, but not chronic 18-hour workdays without rest.
In residency it will depend on the specialty but for something like IM, think 6 16h days a week, every week for 3 years (with a couple weeks of vacation each year and maybe a month or two of electives or clinic) with a month of more of nights each year as well. This is doing physically, mentally and emotionally demanding work. As a med student, you will do that kind of schedule for a couple of months, then 4+ months of even worse schedules in Surgery and OB.

I, like Neuronix, feel that you will be putting yourself (and possibly patients in the near future) in danger if you don't get your own stuff worked out first. Not only do I not think you should apply this year, I think you're better off taking another year or 2 to care for yourself and really figure out what you want and what you can handle. You sound very high risk for not only dropping out of med school but doing serious, potentially fatal, self harm as well.
 
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Thimble

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You sound very high risk for... doing serious, potentially fatal, self harm as well.
With all due respect to your experience as a doctor, I would rather trust the assessment of my counselor in this regard. I will ask my counselor again about if I might be at high risk of dropping out of medical school / if this path might be wrong for me. She did not bring up any concerns with my plans. She is a psychiatrist (but she doesn't prescribe me any drugs), so she has gone through medical school. My pre-med adviser also did not seem to think it was a big deal, but I will ask him again as well.

Isn't residency capped at an average of 80 hrs/week? 16*6 is 96 hours. The extra 16 hours is two full nights of sleep...
 

DrCharlemagne

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With all due respect to your experience as a doctor, I would rather trust the assessment of my counselor in this regard. I will ask my counselor again about if I might be at high risk of dropping out of medical school / if this path might be wrong for me. She did not bring up any concerns with my plans. She is a psychiatrist (but she doesn't prescribe me any drugs), so she has gone through medical school. My pre-med adviser also did not seem to think it was a big deal, but I will ask him again as well.

Isn't residency capped at an average of 80 hrs/week? 16*6 is 96 hours. The extra 16 hours is two full nights of sleep...
Yes, there are caps, but if you took the time to review any recent literature you'd know that 1) the caps wind up driving you to cram more work into fewer minutes 2) program directors find ways around it. You're correct to defer to the opinions of your healthcare providers and your counselor, but do some serious research on your own into the lifestyle, particularly for MD/PhDs. I watched those people grind in the lab for hours and hours during their medical education for years, and those experiences put me off the combined degree track. It's really not for the faint of heart, and it happens even before residency.
 
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Thimble

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Yes, there are caps, but if you took the time to review any recent literature you'd know that 1) the caps wind up driving you to cram more work into fewer minutes 2) program directors find ways around it.
Perhaps what I have read is incorrect, but residency programs that force or pressure residents to overwork do so at the risk of losing accreditation and funding, so there is pressure on program directors to follow the law. Stress from cramming more work into a shorter period of time and extreme sleep deprivation are different for me, because I can handle stress a lot better than that much sleep deprivation. To give you a picture of how bad it was, I was stopped a few times that summer on suspicion of being drunk because I had trouble walking straight and avoiding obstacles. From the people I've asked and what I've read, it hasn't been that bad since residency in the "good old days."

I understand there is a lot of 'grinding,' but even the MD/PhD students in their thesis year in the department were commenting that I was in the lab too much, because I was in the lab more than them. The unbalanceable workload was probably a side effect of my professor being in her first year, and I don't anticipate it getting that bad for that long again.
 

DrCharlemagne

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"The survey results suggest several possible explanations for this dissatisfaction. First, residents are working the same number of hours with no change in the amount of rest they receive and with worse schedules than last year, which diminishes their overall quality of life. Second, residents believe that a chief goal of training — preparedness for transitioning from intern to senior resident, then ultimately to attending physician — is being delayed. Third, there has been no ostensible increase in available supervision or in the benefits for safety and education that would accompany this increased attendance. Finally, the frequency of handoffs has increased, reducing continuity of care and thereby negatively affecting the educational and emotional experience associated with a strong doctor–patient relationship."

http://www.nejm.org/doi/full/10.1056/NEJMp1202848
 

mercaptovizadeh

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Your first problem is posting questions on a forum, then rejecting the advice given by people who have experience, people who have completed MD/PhD programs and are either in residency or have gone through residency and are attendings.
Your second problem is being unrealistic about what medicine is like. Work hours or not, these restrictions hold for residency, not fellowship or medical school or attendinghood. If you are stumbling around and look drunk when you've not slept well, you will not be a successful resident, student, fellow, or attending. There are no "joke" residencies, just some with a lighter lifestyle than others. Even the "lifestyle" residencies like PMR, rad/onc, radiology, and dermatology (which is uber competitive, so may be moot anyway) require a medicine intern year (or a transitional year if really lazy). That's not going to be easy if you're collapsing on 4-5 hrs of sleep a night for 6 nights of the week (not to mention overnight call).
I think that given the struggle that you would have bearing the sleeplessness, not to mention the social stressors of not knowing what to do or how to do it, being overwhelmed with a heavy patient load, new admissions, documentation, family discussion, interactions with consultants, teaching, leadership, etc. you would either fail to do what needs to be done, or end up hurting a patient or yourself.
I really think PhD is a much better option for you. The lifestyle is MUCH more controllable (not to say that it's easy), which is what you seem to need.
 

Neuronix

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Neuronix, how much sleep deprivation is there in medical school? I'm okay with 18-hour workdays, but not chronic 18-hour workdays without rest. My situation over the spring/summer was at least one all-nighter a week, without time to catch up. For months. I was doing a mix of physically vigorous work and thinking really hard.
Things will not get easier for you as a physician-scientist in training or practice.

You keep making excuses for your behavior. But at the very least, your posts reflect poor planning and time management. This is how I perceive you based on what you posted, and it is how others will perceive you if you start this mess again in medical school or beyond. My advice to you is to stop making excuses for your own bad behavior. Then do whatever you need to do to stop doing the bad behaviors.

Regardless, you asked initially if you should disclose this information to medical schools. The answer is no, never disclose this information to anybody unless you are seeking help. This issue will never be an acceptable excuse for anything.
 
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Thimble

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May 24, 2010
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Things will not get easier for you as a physician-scientist in training or practice. You keep making excuses for your behavior. But at the very least, your posts reflect poor planning and time management. This is how I perceive you based on what you posted, and it is how others will perceive you if you start this mess again in medical school or beyond. My advice to you is to stop making excuses for your own bad behavior. Then do whatever you need to do to stop doing the bad behaviors.
Well, thanks anyways for the advice. I guess I'll have to think about it, and see what my counselor thinks is reasonable, given the physical reality of the hours needed to be a resident/doctor. I do need to work on time management, and it was a poor decision to join a lab with a culture of putting the thumbscrews on people...

Your first problem is posting questions on a forum, then rejecting the advice given by people who have experience, people who have completed MD/PhD programs and are either in residency or have gone through residency and are attendings.
Your second problem is being unrealistic about what medicine is like. Work hours or not, these restrictions hold for residency, not fellowship or medical school or attendinghood.
I guess I'm surprised, because the people who are doctors (and one resident) I've met in real life have been completely opposite, encouraging me to pursue MD/PhD. I don't remember anyone bringing it up as a serious impediment. In the past, I've had to disclose it, along with any counseling, and I still made it through, so I didn't think it was a huge deal. My pre-med advisor is a doctor, for land's sake, and it was part of the documents I sent to the pre-med committee. It wasn't even brought up during the interview for the committee letter.

Edit to add: I mean, I recognize self-harming is definitely bad, which is why I seek counseling, try to stop it, and haven't done it since May, but I didn't think it was damnable.
 
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Studies have shown that mental illness and substance abuse are present at much higher rates in the medical field than many others. See http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60145-1/fulltext for a decent overview. Anecdotally, I have known several medical professionals who have struggled with these issues. When I was on my psychiatry rotation, a medical student at my school was admitted onto our floor for suicidal ideation. One of my classmates was using cocaine regularly. One girl almost certainly had an eating disorder. Several were alcoholics. A lot of people abused stimulants. Several had to take personal leaves of absences. Other than Ambien, antidepressants were probably the most commonly prescribed medication by our student health; I would guess that maybe a quarter of my classmates were on them or receiving therapy at some point during their medical school. And I went to a school with an incredibly supportive administration with a tremendous amount of access to mental health needs.

Many people who struggle with mental illness manage to survive medical school, residency, fellowship, etc. The reality is that the medical field is very stressful and still suffers from the archaic attitude view that the suffering is part of the training (especially prominent in the surgical specialties).

However, not all schools are the same. There are schools that treat their students and residents relatively well. Seek out those places if you're afraid the stress is going to lead you to self harm. The quoted 16 hour a day 6 day a week for IM residents is not the reality in many programs. I'm a resident currently, and I almost never work those hours for days on end, and my program is probably more malignant than most. There are actually a few that take the work hours very seriously and actively try to give their residents a good quality of life. Nevertheless, there are other severe stressors in just taking care of sick people, filling out endless reams of paperwork, having too little time during the day to do your work, not having enough personal time to relax or exercise, managing your personal life, etc. Those are not trivial, and they alone are enough to push some people over the edge. You should think very carefully about what kind of life you want, and remember that every year of your life is around 1% of your life. Make sure the sacrifices are worth it.

Also, never reveal your problem with cutting to the admission committee. Do they reveal to you that four students dropped out last year because they were unhappy? No. Everyone plays up their strengths and pretends they have no weaknesses. It's just how it works.