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Beware: Smart People Can Offer Dumb Advice

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Thanksgiving is a time for gratitude and reflection. It’s also a time to consider what will make you happy in the future.

When I was a medical student applying for emergency medicine residency programs, a well-meaning, smart dean gave me foolish advice: I was determining the order of my rank list and was particularly concerned about one program that had an excellent reputation but was in a city I didn’t like. The dean told me, “You’ll be so busy during residency, it won’t matter where you live.” Luckily, the advice rubbed me the wrong way, and I wholeheartedly disregarded it. I would argue that where you live for medical school, residency, or fellowship is as important as the quality of the institution. The reasons are several-fold:

1. Medical education/training is time-consuming, and you want to be in a city you can enjoy fully when you have a few moments to blow off steam.
2. Medical education/training is extremely stressful, and you want to be in a city where you have social support.
3. Medical education/training is not completed in a vacuum. Your personal life continues. If you’re single you may meet someone and end up staying in the city where you’ve trained for the rest of your life. If you’re in a long-term relationship you may decide to have children or may already have them. Down the road you might not want to relocate your family.

Not everyone gets the opportunity to go to medical school or train in a residency and fellowship program in a city she likes. But you can make choices that will increase your chances. Consider these options – and your happiness – as you practice gratitude this week and make professional decisions this coming year.

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Check Yourself Before You Wreck Yourself: How to Create a Match Rank Order List

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As you look toward the NRMP Match rank order list deadline on March 1, you’ll want to avoid simple missteps. Improving written materials and interview skills is critical, but all of that work can go to waste if applicants do not understand basic strategies for the Match. Way back in November 2015, the NRMP published an article called, “Understanding the interview and ranking behaviors of unmatched international medical students and graduates in the 2013 Main Residency Match” in the Journal of Graduate Medical Education. The data is still relevant today.

Sadly, the authors found that some applicants made strategic errors including the below:

  • Declining to rank all programs at which they interviewed or not ranking all programs they would be willing to attend.
  • Not attending all interviews, thus failing to capitalize on every opportunity to market themselves. (I suspect this error is less common now with the advent of virtual interviews.)
  • Misunderstanding the Match and, thus, ranking programs at which applicants did not interview.
  • Failing to rank programs based on true preferences or ranking programs based on the perceived likelihood of matching.

It kills me to read about these mistakes :(. Here is a video explanation of the Match algorithm. If you do not understand how the Match works, it is absolutely critical that you learn about it to avoid destructive errors.

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Being Valued is Undervalued

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I read an interesting JAMA study on burnout recently. We’ve all heard about the problem and its growth over the past few years. But I found the results of this study particularly interesting: The authors found that chaotic workplaces and lack of control of workload were associated with higher burnout (think emergency departments or a poorly run, overscheduled clinic), while efficient teamwork and feeling valued were associated with lower burnout. People sometimes pay lip service to the importance of being appreciated, but this study really proves its significance.

It’s worth considering this study’s results when making decisions about what field to choose, where to train, and what position to take after residency. Here’s the article.

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How to Turn Bad Advice on its Head

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As you get to know different institutions during this interview season, I encourage you to take the opportunity to reflect and consider what will make you happy in the upcoming years.

When I was a medical student applying for emergency medicine residency programs, a well-meaning dean gave me some bad advice: After interviewing at several institutions, I was determining the order of my rank list and was particularly concerned about one program that had an excellent reputation but was in a city I didn’t like. The dean told me, “You’ll be so busy during residency it won’t matter where you live.” Luckily, the advice rubbed me the wrong way, and I wholeheartedly disregarded it. Where you live for your medical training – medical school, residency, or fellowship – is as important as the quality of your training program! The reasons are several-fold:

  1. Medical training is time-consuming, and you want to be in a city you can enjoy fully when you have a few moments to blow off steam.
  2. Medical training is stressful, and you want to be in a city where you have social support.
  3. Medical training is not completed in a vacuum. Your personal life continues. If you’re single you may meet someone and end up staying in the city where you have trained for the rest of your life. If you’re in a long-term relationship you may decide to have children or may already have them. Down the road you may not want to relocate your family.

Not everyone gets the opportunity to go to medical school or train in residency and fellowship programs in a city s/he likes. But you can make choices that will increase your chances. Consider these options – and your happiness – as you make professional decisions this interview season and in the coming year.

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NRMP Match

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Congrats to all those who successfully matched the week before last! The NRMP just published statistics from this year’s Main Match:

Of interest, there were 42,549 applicants who submitted certified rank order lists in this year’s Main Match, and 34,075 of those matched to PGY-1 positions (80.1%). This was a 1.6% increase over last year.

The NRMP also reports that out of 39,205 total positions offered, 36,943 filled (94.2%), and of 36,277 first-year positions offered, 34,075 (93.9%) filled. These rates were similar to last year’s. Of 6,087 total certified programs, 5,367 filled (88.2%), which was a decrease from last year, per the NRMP.

For more numbers, take a look at this NRMP press release.  

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About Dr. Michelle Finkel

Dr. Michelle Finkel

Dr. Finkel is a graduate of Stanford University and Harvard Medical School. On completing her residency at Harvard, she was asked to
stay on as faculty at Harvard Medical School and spent five years teaching at the world-renowned Massachusetts General Hospital.
She was appointed to the Assistant Residency Director position for the Harvard Affiliated
Emergency Medicine Residency where she reviewed countless applications, personal statements and resumes. Read more

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