A Couple Weeks In...

Well, still at it - doing the whole doctor thing.  It's fun, though I still gotta say I like clinic the most.  Clinic is where I see myself practicing most of the time.  Right now, though, I've got another week of Emergency left.  It's fun, it's interesting - a fair few procedures and such.  Only thing about it though is it's all very short term - essentially putting a bandage on someone's problem.  I would find that very demoralizing after a while.  I guess it has the same appeal as surgery - there's a problem, and you fix what you see in front of you.  Maybe it was my education at an osteopathic school, but I just don't see the appeal.  Or at least it doesn't really feel like being a 'doctor.'  You don't even get to do elaborate labs when you have an interesting case - it's just 'not our problem, they'll work that up later.'  The lifestyle is somewhat appealing, a few long shifts then a few days off, but still - doesn't have the same appeal in terms of feeling fulfilled.  

Right now trying to figure out what I should focus on learning on my own - there's so much stuff to learn more about, and it's hard to know what to focus on.  

Also enjoying being employed - getting paychecks is great.  Once I get used to the schedule of how things work I'll feel better about everything and a little less stressed - scheduling in enough sleep is the biggest challenge.  I want to get more out of my day when I've been gone a long time, and end up cutting into sleep.  Almost August...my how time flies.  Well, I think I'll try to read up on one medical topic and one medication each day.  Or every other day.  Whichever I can accomplish.  I'd really like to at least know what receptors everything acts upon - some of them I know but some I just memorized what you use them for.  The nuances count the most...

As far as my crusade against poor management of mental health in outpatient medicine, I'm still not backing down.  Still using my PHQ-9s, documenting them, discussing it with patients... it would be really hard to manage some patients if I were limited by time the way the real doctors are.  I'm given a lot of time to see patients and hear their stories, and I'm really thankful for that.  It'll be a challenge in the future when I have to boil down a 45 minute psychiatric visit into a 15-20 minute visit that includes their other problems.  Gotta pick the battles where you can...

First Week of Residency Year 1

Well, I've had about a week of being a resident - I have to say, parking in "Doctor's Only" spots, getting all the free cafeteria food I want, introducing myself as a Doctor so-and-so, it's been pretty great!  It's taking a little getting used to, but it's fun!  I'm finally having a part in patient care and I think the confidence that comes from having decent decision making skills is making me better with my patient interactions.  Also, I have electronic medical records down almost like a second language after only a day or two.  I haven't used this system before, but I've always been good with computers so...after two years of gritting my teeth while watching my attendings attempt to chart patient visits, finally I am the one doing that!  

I've started out with clinic and homeless medicine - which is very interesting and it's a pretty easy way to start out.  The hours aren't that long and I get to do a lot of reading and videos.  I like that I get noon conferences - kind of a daily lecture on random stuff.  Also the commute from my place is less than 15 minutes no matter where I have to go so far!  For emergency, which I start next week, it gets a little more tricky - I might end up driving 30 minutes each way.  My first call is this weekend, luckily it's 7pm to 7am, starting on Saturday, so I get to sleep in and get both days to hang out and do stuff.  

Pretty much all moved in up here - our place is all settled, wedding and honeymoon are all done for now, time to get back to work...  I'm trying to start out with good habits - always taking care of things on time, staying organized, you know.  The things everyone says they'll do but usually don't do.  Well, I'm hoping to do them!  Anyhow, time to enjoy my evening... after a long day running around trying to keep a bunch of things straight in my head...

As a PS:  I keep seeing emails from recent medical graduates, international, caribbean and domestic, all sending us their applications hoping we've had a vacancy or to get started for the next round of residency applications.  All I can say is I am sooooo thankful to be done with that and finally I can stay put for three years and get paid money!  MONEY!  It's not much but it's something!  

Next Steps...

The last day of fourth year/rotations was last Friday - my last two rotations were allergy/immunology and forensic pathology.  It was quite neat seeing how they track bullets through people and the various gross findings in freshly deceased persons.  At any rate, I'm finally done and I am looking forward to putting Touro behind me and moving onto better things, with my excessively high 300k debt following behind me.  We have our apartments in Davis and Redding secured, and soon I'll have to do some PALS training, computer training, ACLS, BLS, etc.  That won't be until June 19 though, so until then I get to relax and do some prep work for those things, and the wedding.  The wedding is the last hurdle - I'm half excited and half wishing it would just be over already, since we've been planning it for months and the Bora Bora honeymoon awaits us...  

Wish I had more to say.  I'm sure some of my experiences on the rotations are worth reporting but all I can think about is wanting to get away from Touro and start earning money.  I'm tired of just racking up debt in an overpriced institution (when you look at the national averages...) and standing in rooms while doctors and patients interact.  I'm tired of waiting and watching and want to start DOING.  Yes, it comes with responsibility, stress, and long hours, but I want to start moving forward in my life.  This is a big year in terms of moving forward, and I want to get on with it!  Graduation is June 2, tomorrow I'm picking up my regalia.  Soon...  soon...

Match Day: Redding

Well, the results are in and my match is Redding - specifically the new Shasta Community Health Center program for Family Medicine up in Redding, which shares its first year training curriculum with the Redding Family Medicine program.  Basically I am looking at 3 years of training and I should get a well-rounded family medicine education, considering the community-based nature of the program and the resources available.  

What this means is that now my fiance and I must change our current living arrangement - while we had really hoped to stay in the Sacramento area, in many ways Redding may be a better fit for me.  It emphasizes clinical medicine more than one of the Sacramento programs, UC Davis definitely wasn't a real "fit" for me, and the other Sacramento program would have been a close tie with Redding.  However, the fact that the Shasta program wants me makes them all the more desirable.  Currently we are looking for two bedroom/two bath cat-friendly places in Redding, and tomorrow will investigate a one bedroom/one bath place in Davis.  Hopefully schedules will work out so we can spend maximum amount of time with each other.  The other two residents in my program so far (they are still interviewing for a second PGY-2 spot) are both married with children, as are most of the previous years' Redding residents, which hopefully will foster a supportive environment for married individuals.  

I am starting to get excited about checking out the Redding area - see what the local area has in store for us. Our current landlord let us out of our lease agreement, since we signed without knowing we would be moving.  Didn't even charge us for backing out of the lease, which I definitely appreciated.  Hopefully we can sign a lease tomorrow and get that element squared away.  Heading to Monterey for a bit then going to start an Allergy/Immunology rotation.  

Interviews: Done

Well, all is complete.  Finished all my interviews, am one week into vacation, and it has been a busy vacation indeed!  After getting my thank you notes all figured out, had a weekend in Monterey to take care of wedding vendor business (Florist, Cake, and Hair/Makeup).  We also have a guest for the month, and another guest coming next week.  It's nice to be busy with only fun things.  Ordered the Save-the-Dates, got the guest list finalized... just riding out the end of the month.  Things are pretty much going awesome, and I feel very confident that I will match at my top choice, and if not then my second choice, both in Sacramento.  I doubt Davis will rank me particularly high, and after that one then Redding and Modesto are perfectly feasible options.  

Not too sure what else to update - I feel very fortunate compared to some of my classmates.  I know what I want, I'm competitive in the field that I want, I'm compatible with the field I want...  Compared to others who don't know what they want or aren't competitive for what they think they want.  I'll probably hold off on any more updates to this blog until I start my Neurology rotation in January, and then the Emergency Department rotation mid-January.

Change in Reception...

Well, this was certainly a little different than the previous places I went to. Today's interview day went okay. It was mostly negative, though. First off, none of the residents who were showing us around seemed to know what they were doing. The day started off with a tour, instead of an orientation like all my previous days had started, so we didn't even have an agenda. The person giving the tour was an intern resident, who has only been with the program since July and hasn't even worked in all the hospital departments yet. Usually it's a 2nd or 3rd year resident who does the tours. They also were frank about telling us some of the negatives about the program. When we got back, first I was with a faculty member and she seemed to start off a little colder but she warmed up gradually. Went over my application, I got a bit of a skeptical vibe from her, but I kinda shrugged it off, it didn't seem to be a big deal. After that interview, I was with a current resident who was pretty nice and seemed to like me fine. He even told me a little about the criteria for ranking people, which he probably shouldn't have, and said that being a Spanish speaker, interested in OB/GYN, underserved and rural medicine, etc. are all part of their checklist for whether to rank someone or not. 

After that came the program director (PD). I was willing to give him the benefit of the doubt at first, but he didn't seem particularly warm or excited about me. Certainly not like the Sutter had. Sutter probably knew I had genuine interest in them based on me doing the sub-internship, and I had spent a month with them being nothing but nice and pleasant and enthusiastic. I basically felt like the PD here started the interview with the assumption that I was a lying game-player trying to dupe them into thinking I wanted to be in their program so they would rank me highly. For one, he didn't seem enthusiastic or happy at all when I said (TRUE) stuff that matched their mission goals. I DO want to work with Spanish speaking patients, I DO want to have full-spectrum experience and know what resources are available to uninsured patients in California. I don't want to do nothing but OB/GYN but I'd like to be able to handle my primary patients when they get pregnant instead of sending them off to a "specialist".  He basically told me not to rank them unless I really wanted the program, and whenever I said what I liked about the program he seemed entirely nonplussed and just reiterated his previous statements. He even went so far as to say that it's "better to scramble for a residency than match at a place that is just a backup." 

Also, mid-interview, he asked about my Spanish experience and then proceeded to say (in MEXICAN Spanish) "How about we chat in Spanish for a bit?" At first I was thrown off because he used the Mexican-Spanish word for chat instead of the more common verbs like hablar or charlar. I never use the word he used, but based on the context of the rest of the sentence I figured it out after a second of confusion. I asked what he would like to discuss and he said tell me about a patient I saw in the past year. So I start telling him about a patient, and I wanted go on, since I was starting to get going better, and he basically cut me off and played it off like he just likes hearing peoples' accents. First off, part of me feels like he intentionally used the Mexican parlance to make it more challenging. Second, he didn't even let me talk long enough to hear much of an accent, OR let me get in the rhythm of it. He knows it's not my native language, and interviews are somewhat stressful even when you're a competitive semi-confident applicant. Obviously he was checking to make sure I didn't just lie all over my application.  I was expecting to run into someone who would want to speak Spanish with me as a subtle 'test', after all, they always say never to overestimate your language skills unless you can conduct the interview in Spanish.  It wasn't the fact that he tested me, but his skeptical expression and tone. I kind of wonder if it was because my personal statement seemed overly-tailored for their program - I only tailored the very last short paragraph, but the rest of the personal statement (the generic family medicine part) just so happens to perfectly suit their mission statement over the other programs a bit. My scores are also pretty competitive.  Maybe on paper it looks a little too good to be true for their program.

Either way, I had been starting to consider that the place might be nice to be at, if it came to it - it would definitely give me my Spanish experience, the residents all seemed pretty chill and nice, and the earlier faculty member I was interviewed by seemed nice and interesting.  Plus its location is pretty nice is near some nice places.  Ultimately, this program director's attitude was a complete turnoff, and the PD plays a pretty significant role in your residency training over the next three years.  I don't want to have to be around someone like him who treats me in such a judgmental manner and isn't even open to hear what I have to say. One of the other faculty members also attacked a 3rd year student from UCSF who was giving a talk about a global non-profit organization she started before medical school that was reducing maternal morbidity and mortality worldwide.  After we finished clapping and it was opened up for comments and questions, the first guy who raised his hand was this faculty member who essentially told her that some of their efforts were a waste of resources and time, and that they were going about it wrong.  Not a single word of encouragement.  A couple other people commended her after that initial commenter, and of course she took the initial criticisms in stride, but...I was upset because her accomplishments were honestly quite impressive.  

Two Interviews Left...

Well, two more days of GI left, and two interviews left.  I decided to cancel my Reno interview.  I've gotten good enough vibes from three of my top four programs, and two of my backup programs, that I don't really want to risk driving my two-wheel drive car into Reno in January when it would be at the bottom of my rank list anyway.  I am almost tempted to cancel the next two interviews, because I'm getting tired of interviews, the novelty has worn off, and these last two places are also at the bottom of my list.  However, one of the interviews is Thursday, and the next one is a week from Thursday.  They are coming up so soon that I might as well just do them.  

Currently on my GI rotation - mostly just trying to get through it.  I'm already tired of seeing colonoscopies.  They're interesting enough, but ... pretty brutal to watch and most of them are very routine.  Nice preceptor, very glad I'm only spending two weeks doing this.  Really more like one week considering the Thanksgiving vacation and my two interview days.  After this, it's a month off!

On another note, got my wedding dress ordered, got my car repaired (one more expensive repair coming up but I'll do that after I get my next loan disbursement), and have all of December off during which I get to visit my maid of honor in Seattle, have two friends stay over, and celebrate two Christmases.  Oh yeah, and my Birthday.  The guy at the Pinkberry Frozen Yogurt place today guessed that I was turning twenty - off by about 6 years.  Glad I still pass for a college kid in a college town.  I would think it would be even more obvious when you're surrounded by people who actually are younger than you.  Also going down to Monterey soon for a few days to check out wedding venues, and next year Mom's taking us to Hawaii for a few days.  All-in-all, 4th year is winding down to be pretty good, and I feel like when you really set your mind to something, anything can happen...

Probably because today's interview felt like it went really well.  Maybe I was just overconfident or over-comfortable  but I feel like I got really good vibes from them.  Like Kit always says, "Be nice to the administrative people, because they make a big difference and are usually unappreciated."  Very true.  When I did my sub-internship at this place (my number one choice for residency), I tended to go through the back entrance since the front included the waiting room.  The back entrance I had to ring the bell every day and they were always smiling and very happy to get up and open the door for me - I even apologized most of the time, saying I wish there were some easier ways to get through, and started using the other door after a while.  I always chatted with them, smiled a lot, showed my appreciation.  Today I feel like they not only remembered and liked me from before, but I felt like they tried to put the spotlight more on me a few times, and I feel like they even might have talked a little to the program director.  They definitely made an effort to remind her that I had done a sub-internship at the site, and when she came back while I was the only one sitting in the room (others had gone to their scheduled interviews, I was on a scheduled "break") she said she had looked over my application just then and talked to me in a kind of informal interview.  Just the level of comfort from knowing the facility and all the residents was really encouraging and confidence boosting.  

Also, when they're saying to the interview group "We allowed to tell you that you're a shoo-in for the program," I couldn't help but feel like they were half-directing it at me.  I don't know.  They aren't allowed to tell us this stuff because if they do, then students get the wrong idea, and cancel their other interviews and put all their eggs in one basket when there are no guarantees that the program plans to follow through.  It's all part of the game I suppose.  

On another note, we toured the Davis maternity facilities and when I graduate, it would be pretty sweet to deliver my first baby there.  They have one of the lowest C-section rates in the country, have facilities to allow you to be in a pool for labor or for water birth deliveries... it looks pretty dang awesome.  You can also connect your music player up to the sound system in the rooms.  I have 4 years or so to figure it out, so we shall see.  But I've got my eyes set on that location - not to mention it's only 10 minutes from where I live now.  That would be pretty awesome.