Starting to Work on Pictures

It's taking longer than I thought to upload all my pictures onto the computer, then the photo website, but I'm working on it. I'm going to display a few here:

One and a half years ago, my husband and I were married next to this bridge. Obviously, it wasn't snowy then.

View of the valley below while we were climbing on the road to Telluride, CO.
Mountain peaks above Telluride.

All in all, it was a beautiful trip. We're a little sad to be back, which is a place I love but a place where I rarely say "Oh, how lovely!", at least outdoors. We also kind of miss the snow, believe it or not. It's only temporary, though. It is really nice to be back in 65 degree weather, instead of 9.

Cold and Snowy!

It's 10 degrees here. We're on the eastern slopes of the Rockies now, visiting the hubby's aunt and uncle. We're officially under a "winter storm warning" here, which = snow + wind. It's quite cozy inside, with fires lit and baby blankets to crochet--I'm 1/3 through with the first one of the year. I just got news of a fourth baby on the way! Hubby's cousin and her husband are expecting a baby in the summer, so I get to make another blanket. This makes 1 blue, 1 pink, and 2 yellow/green for this baby season. I'm going to be busy!

I have more good news for today. I received a phone message on my cell earlier from an attending at Top Choice Program, just wishing me a happy New Year and saying that they really liked me, please call us if you have any questions! Nothing can be officially said between either of us outside the match, of course, and I don't know how many other people they might have called, but it's a good sign. Or at least that's how I'm taking it. I guess now we can start looking at houses a little more seriously (although we're still not buying anything until I have papers in hand!)

Snow is so pretty! I'm so glad we got to come up here to visit! I cried a little, leaving my mom's house, because I don't get to see them often since they moved up here to the mountains, but it was so nice to spend Christmas with them. I'm going to go eat chili now, since we're being pressed to "come and eat while it's warm", and then I'll crochet some more. It's so nice and domestic and snuggly and cozy!

*This post brought to you by fourth year of medical school, which generously allows time off for such frivolous pursuits. We're very grateful to our sponsors here at WAISH, so thanks!*

Merry Christmas!

We are having a truly white Christmas here on the Western slopes of the Rocky Mountains and San Juan Mountains in western Colorado. It has snowed 11 inches here at my mom's house and it is AWESOME! I have taken tons of pictures, but I don't have the connectors here for my new camera, so I'll have to post them when I get home. Suffice to say, it is totally gorgeous, and we are quite happy to see a white Christmas. I'm sure it's 80 degrees back home, and for right now I don't miss it.

Merry Christmas (or whatever holiday you celebrate)!

...Aaaand I'm Spent

My next post will be from Colorado, if all goes well. I'll answer all your burning questions about Step 2 CS/CK, while cuddled with my sweetie and some warm puppy dogs by a fire, enjoying a white Christmas (that's the plan, anyhow). Stay warm!

Gauderio, check your email!!!! Or let me know if you got the item!

Off to Take the Step 2 CK

When I'm done, I'm going to pack, since we're leaving tomorrow for vacation. I'll try to post about the Step 2 CS later, a test surrounded with mists of uncertainty and legend, but for now thanks for all the good luck wishes!

Not Studying

I have absolutely no study ethic any more. After the first two years of med school, and the marathon of studying that went into the end of second year (end of block 4, then finals, then Step 1--it was like 2.5 months of solid studying), I have just been unable to make myself study much. I take the Step 2 CK on Wednesday, and I'm not studying right now; I'm watching my cat play with a straw on the floor. Yes, a drinking straw. They are his favorite toys; he'll play with them for hours, jumping on and off furniture, flicking them out of his mouth and chasing them, burying them under the rug, or bringing them proudly into bed with us. If I ever figure out how to use my new digital camera (Christmas and birthday gift), I'll try to get a picture or video of this, because it's pretty funny. But now, I'm writing about watching my cat play with a drinking straw, instead of studying. I should probably get dressed, so I can walk the dog instead of study, go to the gym instead of study, go buy more Christmas cards, fill them out, label, and mail them instead of study, etc. It's a good thing Step 2 CK doesn't really matter for my future.

Speaking of that, I had a funny conversation with my father about the Step 2 the other day.

Dad: What are you up to this month? Are you doing another rotation?

Me: No, I'm off this month for interviews and so I can take the Step 2.

Dad: Are you studying hard?

Me: Nah, these scores probably won't even come in before the match. Even if they did, I probably won't share them with a program unless they absolutely rock. Therefore, the score I get on this test really doesn't matter [so long as I pass].

Dad: Well, now, you should always try to do your best.

Me: It really doesn't matter. I'm sure I'll pass.

Dad: Well, you should always aim for the highest, and that way you'll always do well!

I told my husband about it as soon as I saw him: see, honey, there's a REASON I'm like this! My family wanted me to be a type A, compulsive perfectionist! Ha! I have proof now!

Time to go find another way to avoid studying!

An Excellent Question

"TS - are you only interviewing at 5 schools? Do you think that's going to limit your match? ... is it worthwhile to interview at other schools as well, as "safe" backups? (or is that too undergrad application process-y?)"

Thanks for the question, Rach. I chose to answer it here because other people might have a similar question later. The short answer is that it varies widely from specialty to specialty and from person to person.

I am interviewing at 6 schools total. I applied to 10 and canceled/didn't schedule 4 interviews. I'm taking advantage of the fact that psychiatry is a non-competitive specialty. In psychiatry, 6 is kind of an intermediate number. I've had residents tell me they interviewed at only 3 schools, but I met an applicant yesterday who had scheduled 15+ interviews. Since I am "geographically limited", I limited the number of applications and interviews. Also, I need to go where my husband can get a job, so I'm only applying in one state.

I have friends entering psychiatry who wish to move to the East or West Coast, which would require many more applications and interviews (and often an away rotation to seal the deal). They may apply to around 20-30 programs.

I have a friend entering neurology (a low to intermediate-ly competitive specialty) who applied to 30+ programs because she wishes to escape the Gulf Coast and go to the East Coast. Another friend is applying to anesthesia and is applying wherever she can; she applied to 40-50 programs, ranging from state public to East Coast Ivy League.

If you are entering a very competitive specialty, you will be advised by most people to apply widely. When I was entering urology, the AUA said the average candidate applied to ~40 programs. Derm Guy applied to 75 derm programs. Also, many programs require a transitional or preliminary year in medicine or surgery, which often have to be applied to separately (Derm Guy applied to 10+ prelim programs).

So, why did I only apply to 6? I really need to go to a place where my husband can work. I will probably only rank 3 programs, which are all geographically equivalent for me. Yes, that leaves me the chance of going unmatched, but if that happens I will try to scramble for a prelim medicine spot in that area; if THAT doesn't happen, I'll try to get a research position or work at McDonald's for a year. In my situation, my first priority is to go there, and my next priority is to get into psychiatry. Other people's priorities are different.

In other words, I took 3 interviews that were "safe backups", if you will. If I chose to rank those programs, it would be as a backup to protect against going unmatched.

There is nothing wrong with applying widely and whittling down your list as the interviews roll in. Do keep in mind, however, that it will start costing you a great deal of money. My 10 programs cost me $110 for the application ($60 for the programs and $50 to release my USMLE transcript). From the ERAS website:

ERAS processing fees are based on the number of programs to which you apply. ERAS fees are: $60 initial application fee (includes up to 10 programs); $8 each for 11-20 programs; $15 each for 21-30 programs; and $25 each for program(s) over 30.

In other words, applying to 20 programs costs $140, 30 programs costs $290, and 75 programs costs $1415 (I think I did that right). Every interview may require all of the following: flight, hotel, rental car, parking, suit dry cleaning, etc. Some derm applicants can spend around $10,000 applying and interviewing; this cost is NOT included in your student loans for fourth year. Fortunately, you get a break when you rank programs (NRMP website):

There is no charge to programs or applicants for entering their rank order lists for the specialty matches. The registration fee covers registration, submission of rank order lists, and access to Match Results.

The NRMP registration fee is $40 so long as you get it paid on time; late is a $50 fee plus $40 to register. There is no extra fee for ranking a zillion programs (but you can only rank those you have applied with).

So, risks of not applying widely enough: going unmatched, or missing out on a great program you never knew about. Risks of applying too widely: $$$$$$$, interview burnout, time away from electives, family, friends, etc.

After this novella of an answer, it still comes down to this: it varies widely from specialty to specialty and from person to person. Hope this helps.

Hot on the Interview Trail

Actually, it's effing freezing. I drove up here for an interview, and yesterday I was sweating in 80 degree humid weather. Today, it's been in the 30's all day and sleeting/drizzling. Disgusting. I wasn't able to get the wireless router at my aunt's house to work with my computer (although that probably says more about my computer than her router) so I'm at some random coffee shop/chic eatery populated with law students. Just don't sue me.

This will be my fifth interview, and I'm kinda wondering why I'm taking it. After all, I've pretty much decided I won't rank anywhere outside of the geographic area where we need to go, so even if I love this program I probably won't be coming here. It was a nice excuse to come see my aunt, and I got to see a friend from high school today, which was excellent.

Partly, though, I think it's because I like psych interviews. Everyone is excited about psych there, and they get it. No one makes jokes about "oh, you're going into psych, don't analyze me!" or "oh, you're going into psych, I might need your services!" at psych interviews. Instead, you get to talk about what you like about psych, and what the problems are, and what might be done to fix them. Psych people *tend* to be well-read, which I used to be before med school killed my ability to read. Also, the ladies from the program today are apparently big shoppers, which endeared them to my heart; we compared our favorite shoe brands, and discussed the pros and cons of outdoor shopping malls in cold weather. Always a good sign when the residents have time for shoe shopping!

I haven't decided yet how I will discuss my rank choices here. Suffice to say, I have my rank list in order, and Top Choice Program has emerged as the shining winner. It's hard, though, because I feel like I have to be rather hush-hush about the whole thing. One of the programs I interviewed at was rather aggressive about selling the program, but I know that program has some problems, and so I feel that I have to be careful about how I say things, especially since that will be a program I rank, but not highly. Also, since I've thus far kept this blog relatively anonymous, I have to be very careful how I discuss various programs, or it will be extremely obvious what program I'm talking about. It's all very high school, when you had to gossip behind people's backs cautiously, so they didn't figure out who had started what rumor (even in band, we had this problem).

So, without giving you any information at all, I know what my rank list will be. It will likely be 3 programs long; if I don't match, I'll have to scramble into a prelim medicine year. As everyone tells me, though, it's psych, so that won't happen, silly. I agree, but I still have to know my plan B. Yes, I realize how OCD that makes me. Those nearest and dearest to me just know and accept that I am a little crazy that way, and move on with their lives.

31%

According to an article at CNN.com today, that was the rate of cesarean section delivery in the United States in 2005-2006. When I was a second year med student, they told us it was around 25%, and that was still too high.

Interestingly, this number was squeezed in at the end of an article about the teen birth rate rising 3% those same years. While I oppose abstinence-only sex education, I am not too keen to jump on these numbers and say "of course, that's what I expected." After all, the teen birth rate had been dropping every year prior to that one. It will be interesting to see what happens in the next year's data analysis of teen motherhood, as well as what political fodder this will make with the Iowa caucus approaching quickly.

As far as the c-section number, that's 31% of delivering mothers who are exposed to increased risks of bleeding, DVT/PE, wound infection, endometritis, hysterectomy, uterine rupture/placenta accreta in future pregnancies, etc. Of course some of those women required c-section, but many of them did not. How many women would continue to choose c-section if we in the medical community did a better job taking the fear away from labor and delivery? Or if we did a better job of pointing out that the recovery from a c-section takes weeks to months longer than from a vaginal? Or if the lawyers wouldn't ask for millions for a family with a sad outcome by accusing the physician of not doing a cesarean? Even though medical science cannot say when CP happens, even though the rising rate of c-section has not dropped the rate of CP, we continue to do more as we fear the lawsuit. It's a terrible thing.