Training License.

So the other day I received a great letter. It was from the Pennsylvania License people telling me that they received my application for my medical license while I am in training.  I could not believe that I am getting information about my medical license. Then I get the email telling me about orientation. I cannot wait.

Only 56 more days to go, but no one is counting. Ah, who am I kidding; I AM COUNTING. This is the greatest feeling in the world. To know that in less than 2 months I will be a doctor. The cool thing is that when I book my trip to Las Vegas for the Old Pre Meds conference (www.oldpremeds.com) I plan to reserve it under Dr. Lerman. Something that I have wanted to do for a very long time.

Right now I am on my Endocrinology rotation. It is still a lot of general medicine, however I am really learning how to manage the diabetic issues in people, which is the reason I took the class anyway.

This week I am going to be going to the Exit Interview, which pretty much drills into your brain that you have to pay your loans back. I have to look into programs that help with loan repayment if you work in an underserved hospital. But I will be earning a paycheck again. I have to kick out the senioritis out of my. I have stuff to read and I even purchased my Step 3 review book. In the meantime, I have been reading non medically related books.

The first book is Mad Money by Jim Cramer. I am reading this because I will be getting back into the stock market after a several year hiatus in order to make some more money. It is a nice diversion from medicine. The other book that I am reading at the same time is Sun Tzu's The Art of War. This book is purported to be read by heads of state as well as corporations. Since I am gunning for that fellowship position, I need to have all of the tools possible for my success. I will let you all know how it turns out. There is something to be said about a book that has been around for 2400 years and is still being published (bible not included).

I am also looking forward to my time off between graduation and start of residency. Getting back to the golf course and fishing.

Till next time.

Relaxing and Motivation

Hello there fellow Non Trads,

Well, since we last spoke I received, signed, and returned my contract for residency. I am so glad that I do not have to worry about that anymore. It is for real and I will soon be getting my orientation schedule and on July 1, I will begin my new career as a doctor. However, until then I still have to be a student.

Recently, I finished my Cardiology rotation and I noticed that I have absolutely no motivation to do anything. I mean, I do not want to read or want to listen to anything. I just cannot seem to get myself to read for more than 5 minutes. When I get to the computer, I play games until it is time to go to sleep. I realize that this can be a problem. Especially since I need to start getting motivated again and prepare for residency.

I downloaded this program back in January to test it out. It is called Life Manager Pro. It is for Mac but I am sure that there is a version out there for PC. Well, it has allowed me to set some goals and organize projects and activities into these goals. Since I am a type A personality (and what medical student is not) and I am OCD, this is perfect. I noticed that with those goals and this program trying to put things into perspective I have been able to accomplish many things. For instance, I have been able to once again organize my family's financial books by getting a program for the computer that is made for Mac and I was able to sync all of the accounts that I need to keep track of. I am able to look at where the money is going and how I can better work things out financially. It will also allow me to ensure that the credit cards are taken care of. In addition, future plans include rolling over 401Ks into IRAs and once I start working again, rolling over my 401K so I can start contributing again. These are the things that sets us non trads apart from the trads.

In addition, I am going to be using the Kelly Howell meditation files to get motivated again and I would like to start meditating in order to clear my mind and remain more calm. Especially with my girls, since I have noticed that I have been a little short lately. 




On the other side, I am sooo ready to be done. We have planned a trip to the Shore for a few days after graduation and then once we get back, my wife and I are flying to Las Vegas where I am going to be presenting a talk at the Old Pre Meds annual conference: 

Then when we get back, I have a few weeks of R and R before starting my new life as a physician. During that time, I plan to go to the pool in the morning, when no one is around. Get in a few shots around the links, and get to the ol' fishing hole. In addition, read, read, read, oh and did I mention read.

Tomorrow, I start a new rotation in Endocrinology and have to be at the hospital at 7am. Until next time dear non trads.

I MATCHED!!!!!

So today was the day, the day that I found out not only what type of doctor I am going to be, but where I am going to be for the next several years.

And the winner is.......Mercy Fitzgerald Hospital in Darby Pennsylvania for Internal Medicine!!!! The goal is to do a fellowship in Pulmonary/Critical Care medicine after that and finally be an Intensivist/Critical Care physician in the ICU.

As promised, I will go through what I did and why I did it.

Let's start at the beginning. When I was making my list of residency choices, I was gung ho about going into Emergency Medicine. I was, after all, a 20 year veteran as an EMT. And it only seemed natural. While was rotating through the emergency department is always felt right. However there were several things that were going against me. First and foremost, Emergency Medicine is very competitive and there are a lot less spots than there are applicants. So, I needed to be realistic. That being said, while looking into the Osteopathic programs that were available, there were only 3 that I could realistically apply to. I forgot to preface that the decision was made not to move from the area, but that I would apply to programs that were within a 1-1.5 hour driving radius of my house.

The other Emergency Medicine programs were all Allopathic and from looking at the residency classes over the years, many had not had a respectful number of Osteopathic physicians within their programs. So that already told me that there would be very little to no chance of getting an interview there let alone match into their program.  So I had to decide what to do about a backup plan and decided on Internal Medicine. I liked seeing patients, especially in the hospital but I was not crazy about taking care of little kids. Then came my fateful rotation in November in the ICU.

From the first time that I started that rotation, I felt like it was right. That was especially true after one of the Intensivists started teaching us and while waiting for a patient to come up we had a very interesting conversation about critical care. The more I spent time in the ICU, the more I realized that I loved it there and so I became very torn. What to do? EM or IM to pulm critical care.

I added a couple of combined EM/IM and EM/FM programs and interviewed at a few. Then came the time to rank my list. I started receiving bad news that I would not be ranked at one location for Emergency Medicine and slowly I was coming to see that EM was probably not going to happen. I then received a phone call from Mercy Fitzgerald telling me that I am going to be ranked very high and they feel that the program and I were a good fit. Three days before submitting my list, I received a phone call from a combined program telling me that they were ranking me high. So there was a chance that I can do both EM and IM and eventually do critical care medicine.

Why did I set my rank list the way that I did (no, I will not post my rank order or the other places that I ranked). There were several things that I looked at:

First, what type of doctor do I see myself. Then I looked at the didactics. How were their teaching? Did the residents like the teaching style? Did I like the teaching style? From one of the places that I rotated at, I knew that I did not like their teaching style so, while I ranked them, I did not rank them high.

Then I looked to see what benefits the program offered. And most of them had very similar benefits so this was not a big deal.

I looked at a time frame. how long until I can finally be done with training. IM=3 years, Fellowship=3 years, EM/IM=5 years fellowship =1 year. So there was no difference there.

Finally I looked at salary. And there were big, big differences. While one program had very high salary compared to the others, I did not like the didactics. If I am not going to be happy, no amount of money will compensate for it. So that did not change. In the end I was torn between my #1 and my #2 but as you know, there can be only 1 and therefor I had to make the decision.

In the end, I matched in a location where it was close to home, had a good salary and benefits, had good didactics, and in the end would train me to be the doctor that I want to be.

Now, my focus will be to graduate from medical school, and enter into residency with my eye on getting that fellowship in 3 years. No holds barred.

Almost there but have Senioritis

So we are less than a week before I find out my fate. Before I get news of whether I matched to my #1, matched at all, or have to scramble. In the meantime, I having a bad case of senioritis. I mean I just do not want to sit and read anymore. After 3 or so years of hard core reading my brain just wants to shut down.

But I need to pucker up and get it done. I am almost done with my infectious diseases rotation and I am glad that I did this rotation. I am really understanding how to give antibiotics but more importantly, which antibiotics I should give. Next I am on Cardiology. Another very important rotation. Then 3 more rotations and I am done!!!!

Now comes the hard part. Since I am on the cusp of the end of my medical school career I am no longer eligible for scholarships or financial aid. Now I have to start earning a paycheck again, which while it will feel great will require tweeking of the budget. I decided that I am going to need a bridge from here until I start getting paid on a regular basis to ensure that the bank accounts do not go dry. There appears to be a limited number of these residency loans. One thing you need to remember is that the more loans you take out the more that you have to pay back, this on top of the mortgage that you already took out for the house. One thing that I did when I moved was that I did not trade up in my house.

We actually stayed the same, or some people may even say that we traded down. The house we bought was cheaper than one that we sold. Albeit we moved from Northern NJ to Southern NJ and the father from NYC you go, the more normal the prices get. When I sat down with the finance guy I pretty much laid it out in front of him: 30 year fixed or I am walking out. But some people may say that a 5 year ARM is better since you will be in school for 4 of those years, when you are paying very little and you may then move depending on where you do residency or you can then refinance to a fixed rate.  To that I say, you are correct but that is also how this housing debacle started too. People buying houses they could not afford with a 5 year ARM and then when the rate readjusted they could not pay. These are things you should think about and do it carefully. Not just how far you should be from school. Another thing to think about would be the chores of the house. Will you have enough time in your day to cut the grass, rake the leaves? We moved to a townhouse complex and I do not have to do those things. They are part of the association fee. So my weekends are free for the family.

You should also think of ways to reduce how much you spend. Before you leave work, it would be beneficial to you to invest in a coffee maker (if you are one person, get those single cut coffee makers and buy the filter so that you can buy coffee in bulk and use the ground coffee), buy a lunch box to make your own lunch, invest in a wholesale club membership. Be a coupon clipper, shop around for textbooks on line and when you are done with a class, sell them back on line. I just sold a bunch of books that were just sitting on my shelf for almost $200.

Well, I am done reading probably for tonight. See you later dear readers

Time to Wait

Hello there dear Readers, 

It has been a few weeks since my last update. Since that time, I not only ranked my match list, but I can no longer make any changes as it has already been submitted. What does this mean? Well basically I have to wring my hands until February 14th to find out where I am going for the next 3-5 years. I took the time to make my list and there is rhyme to my reason of why I ranked my list the way that I did. I do not want to say anything yet as the match process is still going on, but once I match then I will spill everything. 

In the meantime things on the studying end have been hard. I mean I really do not want to sit and read anymore. After spending 3 years reading hours on end, the last thing I want to do is read. But alas, I still have to. In fact during this current rotation, Infectious Diseases, I plan on doing more reading. I am in the library now taking a break from doing such. This rotation is nice because it is not very intensive and at times there are 1/2 days where I can catch up to reading or relaxing. Although it has been the later lately. 

This weekend is my school's annual Medicine Ball. Basically it is a dinner/dance and people get dressed up for it. My wife and I are not going this year for a couple of reasons. For one, we do not have a babysitter available. And for the other, being older to just about everyone we do not really feel like we fit in. We mainly sit around the table talking to ourselves. Why should we pay $100 when we can do that at home for free. But I am glad that we did go the previous 3 years. We are just not in that scene anymore. We have other friends that we have more in common with anyway. Besides, we can use the money for our trip after graduation. 

A question came up in the comments about studying with children in the house and not being guilty about spending time with my wife. This is a question that has come up to me many, many times. And it is one that I will address here and at the Old Pre Meds conference in June (hint hint). In answering the question I need to preface it by saying that until this past June there were only 3 kiddoes. 

While I was a 1st and 2nd year I needed to be very anal with my schedule. I stuck to it like glue and it worked out well. I treated my medical school time as if I were at work. I would not be home during those hours anyway so nothing was lost. When school was done for the day, I would go home where we would have dinner as a family. This would be around 5:30pm. Yeah, I know very early. During dinner, the TV would be off and the radio would play jazz that was barely audible. My wife and I would sit and our girls would each tell us about their day. At about 7pm, after dinner was done and I was settled, I went to the public library that was across the street and studied there until it closed at 9pm. I then went home and studied some more. This wold happen Monday through Friday afternoon. On Friday evening through Sunday afternoon, I would not study as this was our Sabbath and it was family time. On Saturday night, I would go out with my wife if we had a sitter and on Sunday mornings I would make breakfast as the short order cook and the girls would be the waitresses. 

If there was an event at my kids' school then I would study when classes end and then meet everyone at the school to see the event. I made sure that I was at the parent teacher conferences and on Sundays if there was something going on, I would see if I can make it. Or I would go to campus in the morning and get a couple of hours done before going to the event. So to answer the question about guilt, no I never felt guilty because my kids and my wife understood and I made time for them as well. 

During my 3rd year and now my 4th year I had less studying and thus more down time. So I would spend time with each girl on their own. We would either go to the mall or go to the diner for a drink but we would only talk about what they wanted to. Sometimes they did not want to talk at all, just draw with me around.  They know what I am about to become and they are glad that I am doing it. They are also looking forward to when it is done and it soon will be. 

I can tell you that being an older student does have its advantages. For one, many patients feel more comfortable with you because you are older and have a tendency to act more mature. We have a way of the world and since we have been in the workplace, are aware of office politics and how to play the game. We also know how to network with other people. We also have priorities that do not include drinking and partying every week. And we know how to make our money last longer. For example, I found a way to get some new cologne every few months and not have to shell out the high cost for it. Ask the counter people at the stores if they have any samples. Sometimes these samples come in a spray bottle that can last a couple of months depending on how much you use or it comes in a packet that is single use, but you can get a couple of them. In addition, ask for discounts. What is the worse that can be said, no? Then you are no worse than you were before. 

When I saw that my cable bill went up, I called them up and explained the situation. They brought it down to the introductory rate for another 2 years. When I went to buy a suit for interviews, I spoke to the manager and they knocked off 10% of each item. The library is a great resource for magazines and books that you do not need to buy. In addition to borrowing CDs and listening to them. 

Finally, we have restraint. Dear readers, I really want a brand new 40+" TV that is top of the line and has all the bells and whistles on it. But I cannot afford it now. I will be able to in the future. My car is rusting out and I brew my coffee at home. All of these things add up to less in loans. 

I hope that you keep on enjoying to read this and I will update more often as time permits, and baby too. 

Match day is almost here

Well fellow readers what can I say? I received a notice from the match that it is time to put together my list and to rank them in order of preference. In about 1 month I will know where I will be going for my residency, hopefully. For those who do not understand, let me explain.

Back in August, I submitted my application to the Electronic Residency Application Service, or ERAS. It is an application packet that includes your transcript, resume, and personal statement. Then you need to select which programs you are going to apply to. Then you wait for interview invitations. If this is sounding a lot like applying to medical school, it is.

When you get interviews, they usually last about 20 minutes and you then take a tour of the facility. From About September until January it is interview season. Then both you and the programs submit lists of rankings. You submit your list of most to least preference and so do the programs. On match day, the computer compares the lists and the first time there is an agreement between the lists, you match. If there is no agreement, then the next day you scramble. Where you send out applications to who ever has any openings left.

The important thing to remember is that you need to be realistic. If you always wanted to be a neurosurgeon and your grades are below average and your board scores are below average, you will never match into a program. Simply because there are too few programs and too many applicants and they programs only want the best. This is why you should always have a backup plan. I did just that.

However, I am a believer that things happen for a reason. I have been an Emergency Medical Technician for 20 years. I have been involved in emergency medicine this whole time. And when I went into medical school I was sure that I wanted to go into emergency medicine. I also thought that I would be able to make up for not getting honors in any classes by showing my work ethic to programs. Unfortunately, my board scores were not in the competitive range for emergency medicine. But I still applied. However, I also liked Internal Medicine and I applied to those programs as well. Back in November, I did a month in the Intensive Care Unit. Wouldn't you know it, I fell in love with the ICU. And for the first time in my medical school career I felt torn between the ER and the ICU. This past month I was doing a sub-internship in medicine and I just happened to be a part of the pulmonary service. And let me tell you, it solidified my decision. I want to go into Pulmonology/Critical Care.

I was able to see 2 patients from admission to discharge this week and the best part was that as a sub-intern I wrote orders and the resident cosigned them. It was just like being a real physician, but without all the responsibility. I can now see myself running an ICU. Like I said, funny how life works out.

I pretty much made my match list. This I will have to keep to myself until after I match.  Next time, I will  talk about some tricks to living on a very very tight budget.

Could be the end of Interview Season?

So I finished my last scheduled interview earlier this week. In total I had 6 interviews, and while I would like to at least have had 9 or 10, the fact of the matter is that you only need 1 nod and you are in your residency.  This last interview was a little more challenging as I was asked questions that I did not anticipate and therefor did not prepare. So I will talk a little bit about how I prepared for my interviews.

To begin with, I applied to as many places as I could have within a 1-1.5 hour driving radius as the boss (aka the wife) told me that we are not moving. Or at least, that is the DEFCON 1 option. So when I received the invitation I ensured that I was prepared.

I started off by going to the website of each institution and program. I spent at least 1 hour looking around the website. Looking at the community that they tend to serve,  seeing how many patients they see annually, looking to see if the hospital has a special niche. For example, is it a level 1 trauma center, does it have a cancer center, is it known for bone and joints, etc. Then I looked at the services that were offered to the community. What kind of resources were available? Then I looked at the residency program. I wanted to look for the curriculum. How long was each rotation, was there elective time and if so how much and where. Look to see where graduates of the programs went to, what type of specialty did they get and where. What kind of benefits are there, do they give you a stipend for books, meetings, conferences, if I was able to find out who I was interviewing with I did several searches to see if they had published any literature. And I read the papers when I could. And finally, I made sure that I thought about and wrote down at least 7-8 questions.

What I have found with this strategy is that the people that you interview with realize that you took the interview seriously. That you made the effort to research them and you care. I always say that if you do not have any questions, then you did not prepare enough because there is no way to know everything about the program.

So now, as in medicine, comes more waiting. The Osteopathic match is not until February 14th. So until then I have to wait. I need to sit down with all of the information I garnered from the interviews and I need to put together a ranking list for the match. In the meantime, I will be continuing to go on rotations. I will be happy to do something other than emergency medicine. I did some family medicine, I will be doing some internal medicine, infectious diseases, cardiology. I need to set up a surgical subspecialty and I may just do it in plastic surgery. I am so looking forward to being able to spend more time at home and relax before residency starts. I cannot wait,  just over 5 months to go.

Right now I am doing something I have not done in a long time. Read for entertainment.