15 May 2015

Yr 4 Perspective of a Med School Wife: Sierra

Sierra was kind enough to share her perspective from fourth year. The last time we heard from Sierra, we had just finished first year and she had yet to marry her medical student.

How fun is it to have book-end perspective posts!

Residency: Emergency Medicine in Jackson, Michigan

Q: How did you support your med student in year four?

A: Honestly, I don't think I did a great job at this. I took on more responsibilities at work, hoping to distract myself from missing my husband while he was on away rotations, as well as to boost my resume since we knew moving for residency was going to be very likely. Looking back, I think I would have still taken on the extra responsibilities, but I wish I would have learned to balance things better so that I could have been more available to support my husband.

But one thing I made sure to do regardless of my own stress was to listen. Just allowing my husband to process his thoughts out loud about choosing a specialty and applying for residency was probably what he needed most. I also encouraged him to go for his dream specialty, even though it was risky.

Q: Did your family move for fourth year?

A: No, we rented a room from my brother during 3rd and 4th years. We saved money this way, but it probably isn't for every couple. Even though I think the challenges of this living situation actually ended up making us stronger, we are so ready to have our own place again!!!

Q: What did your student consider when selecting residencies for applications and the match?

A: We didn't allow finances to limit his applications. I wanted him to go for his dream, so he applied to all programs in his specialty of interest, knowing that realistically, most programs weren't going to offer him an interview since he didn't audition with them. But you never know unless you try! We had most of our discussions about desired locations as he was applying for audition rotations.

Q: What was the most frustrating part about Yr 4?

A: I am sure that my husband could list several and I could probably come up with a few if I thought about it for a long time, but I am just so thrilled at the way things have turned out that I only have happy thoughts :)

Q: Any advice for medical student significant others who are approaching this stage?

A: YES! And sorry if my honesty offends anyone, but here is goes...Please make sure that you and your spouse are prepared for the possibility of not matching because anything can happen and you must be prepared. Talk prior to Match Day about which specialties your spouse would be happy with if they don't match. Prioritize them and have unique personal statements written and ready to submit on Match Day for each possible speciality, if needed. And do your research. Find out all the programs that offer the specialities your spouse is interested in and if your spouse is considering a traditional year, cross-reference to find out which programs offer multiple specialties that your spouse is interested in so you know which TRIs will be most worthy of your attention if they have openings during the scramble. Do these things with your spouse because it also helps to mentally prepare both of you and creates a clear understanding of what would happen if your spouse does not match.

Also, know that Match Day is about your spouse's future. If you find yourself taking part in the scramble, please don't cry (or at least don't let them see you cry until they have a spot). This really isn't helpful in any way. And this might be different for those with kids, but from my perspective, be willing to go anywhere. Don't sacrifice what could be your spouse's entire career for a few years in a particular location. Residency isn't permanent.

13 May 2015

Yr 4 Perspective of a Med School Wife: Kristy

When Kristy sent me her fourth year perspective, I'd be lying if I said I wasn't the teensiest bit jealous. Her student, Josh, was able to set up great rotations around his family so they were able to spend most of the year together... and they got their first choice residency. What?! AmazAZing! Kirsty's perspective just goes to show that fourth year isn't inherently deadly.

Thanks, Kristy, for sharing again this year (1st year and 2nd year posts)!

Residency: Internal Medicine in Pueblo, CO

Q: How did you support your med student in year four?

A: One thing that I really had to focus on this year was not making him worry that the kids and I were struggling with him gone so much on rotations. I stayed as positive as I could about it all, and kept things running at home the best I could. I helped him with arranging housing options while he was away, and asked him about aspects of the audition sites that he doesn't always think about, but that I knew would affect his experience during residency. As an outside observer, there are things that I could see that he wasn't really seeing which made a difference in the end about where we chose to go for residency.

Q: Did your family move for fourth year?

A: For fourth year, we moved to Idaho to live with Josh's parents. It was a challenge to be sure, but financially it worked out really well. We felt like if we saved money on rent it would make traveling expenses for auditions less of a stress, and that it would ease my burden since I would have some help while he was away. It was a really good thing for us. Josh set up hospital affiliations in Idaho, so for the majority of the year he was able to do his rotations and be with the family. I love that we got a lot of time with him this year since that won't be the case once residency comes.

Q: What did your student consider when selecting residencies for applications and the match?

A: It was a hard decision for Josh on what kind of residency that he wanted because he was torn between a couple of specialties.  I really left that up to him because I wanted him to go into something he would really love in the long run. As far as where we would go, we focused on staying in the western states to not go to far from extended family. We looked at the list of sites available and eliminated places/cities where we didn't want our family to be, hospitals that were not compatible with Josh's long term career goals, or places that we just didn't feel right about. Josh applied for auditions that were the closest fit to his goals, and for interviews at other places that seemed okay as well. In the end, it was a matter of a lot of prayer and deep conversations about the future. The residency Josh matched into was our first choice, so we are really excited.

Q: What was the most frustrating part about Yr 4?

A: Finding a surgical sub-internship was pretty frustrating since we would think it was working out and then it wouldn't. Also, if I'm being totally honest, it was difficult to work with the school with a lot of things. It felt like they were hindering our efforts rather than ever being helpful.

Q: Any advice for medical student significant others who are approaching this stage?

A: Get an early start on planning rotations and always have a plan B, or C, or D... And really, take advantage of all the time you have together whenever it happens. It can be a fun time and is really exciting even though it's pretty nerve racking at the same time. So much of the future is figured out during this year, and that is the fun part!

11 May 2015

Yr 4 Perspective of a Med School Wife: Megan

Even though it has been two years since Megan and Devin have lived in Lebanon, we still were able to see them last year when they were in Medford (links to Megan's 2nd year and 3rd year perspective posts). I have missed Megan and her cutie-pie kids. I would say that Scott missed Devin, but they talk frequently on the phone. So though I've heard about their plans, I hadn't heard Megan's perspective from this year. And I have to say, I'm so glad she was willing to share again this year. Megan's story is honest and detailed. Each of us has had unique paths in medical school, and Megan's story highlights that. I'm just crossing my fingers that we'll get to see them while we're both in the mid-west!

Intern Year/Residency: Internship in Jefferson City, MO

Q: How did you support your med student in year four?

A: Basically I was Devin's sounding board. He changed his mind on what he wanted to do about a million times. (I may be exaggerating, but that's what it felt like!) I was always there to listen to him weigh the pros and cons of different specialties, and (hopefully!) I was able to provide some feedback that was useful to him.

Devin was gone for three months, which may have well been three million months because that's how it felt. I held down the fort with our kids without too much, if any, input from Devin. I knew that he needed to be so mentally focused on what he was doing that I tried my best to not distract him from that.

The first part of fourth year was so much harder than the second half of the year, though. They almost feel like two separate years all together.

Q: Did your family move for fourth year?

A: We moved home and lived in our parents basement for fourth year. All of us, in one room... Yeah... It was a long year, but thankfully we are finally seeing the light at the end of the tunnel! We moved home mainly to save money. Away rotations and interviewing is expensive! And we didn't want to take out any more money than we had to.

Also, with Devin being gone as much as he was, it was incredibly nice to have help with our two small children from time to time. Living with parents gave me a little more adult interaction each day than I would have gotten had we stayed in Oregon. (I have a big family :) Someone is always around!) I was also able to start working at our family business, The Blindman, being their general office manager. It gave me something to do during the day so I didn't go crazy! And it helped financially!

Q: What did your student consider when selecting residencies for applications and the match?

A: First, it took us forever to decide on a specific specialty. We had it narrowed down to: OB, Peds, Derm and Family Practice. He loved the clinic setting, but he also loved delivering little babies. So, his first two away rotations were for OB and he HATED it. With a passion. So, yeah, waste of two months! But, at least one of his rotations counted for one of his required 4th year rotation, so not a completely lost month. He then interviewed for Peds residencies because he realized what he loved the most about OB was at the end when he was with the little baby. He interviewed at a couple of different places and was actually offered two residency spots outside of the match! At this point he did a rotation with a Dermatologist that he used to work with. The whole reason that he had gone to medical school in the first place was because of his interest in Derm, but the field is so dang competitive we hadn't really given it too much thought! But, after doing his rotation with the Dermatologist and having many in depth conversations with him and the other Derms there that he was working with, he decided that we should just go for Derm. In the grand scheme of things, if it doesn't work out we will at least know that we tried. So, Dev turned down the other residency offers and started applying to intern years. (Derm is different than any other specialty, you do an intern year and then match into Derm the next year.)

The specialty was hard for us to decide on, but other than that location was huge for me when it came to residency spots. Safety of the area and cost of living. Being a SAHM with two kids really changes your perspective, especially when you know your husband isn't going to be around a lot.

Long story short, we are headed to Jefferson City, MO so Dev can complete an intern year. Then next year we will be doing this whole audition/application process again as we apply for Derm residencies.

Interestingly enough, though, Dev's last rotation of med school was ER and he LOVED it! So, if Derm doesn't work out, ER is the back up... which wasn't even on our radar until he did the rotation. So, maybe him not accepting any of the previous offers was a blessing in disguise, even if Derm doesn't work out. Who knows :)

Q: What was the most frustrating part about Yr 4?

A: Definitely the away rotations. Though I don't think our marriage or anything suffered because of it, it also didn't do us any favors. We were still able to talk every day but he was so exhausted from his days, and the kids missed him like crazy. I was so relieved when those were over!

Also, just the not knowing where we were going to be the next year, that was crazy hard. Even though we found out in February, I am such a planner, and not being able to play - even though it was months in advance - was incredibly hard. But hey, it's kind of an adventure!

Q: Any advice for medical student significant others who are approaching this stage?

A: Figure out what you want to do early. Sign up for audition rotations EARLY! But, as your significant other is finishing up required rotations for fourth year, don't count anything out because you think it's too late. It's always better to maybe take an extra year, but have them do something that they absolutely love! I would hate to get all the way through all of these years of training and then have Dev not love what he is doing.

Be your medical students #1 fan! Schedule in as much family/couple time as possible, because I hear there's not much during residency ;)

Also, lean on family and friends during the rough months - the away rotations. Find a support group, whether in real life or online, but someone who understands and can commiserate with you when things get hard. Because they will get hard. And then they will get better. And then they will get hard, again. But, that's the life we chose, and I wouldn't trade it for anything! (Though, having a house would be nice :) )

08 May 2015

Yr 4 Perspective of a Med School Wife: Shaila

Shaila and I were some of the lone Lebanon survivors this fourth year, and what a year it was for her family (1st year and 2nd year posts). We go to church together, so Shaila and I saw each other each least once a week. In fact, on Sunday we are going to do one of my favorite musical numbers together in sacrament meeting. Shaila has a beautiful voice, and I'm convinced I'll be crying my way through the song from my place on the piano.

Residency: Family Medicine in Auburn, WA

Q: How did you support your med student in year four?

A: I tried to support Matt by TRYING to remain positive, or to lift him up by trying to see things from a different protective. I tried to give slight nudges with my own opinion, but without trying to "parent" him. Sometimes I was super stressed and anxious about how Matt was going about things, but I would sit back and let it get done on his timeline. He didn't need more added stress with me nagging. 4th year was by far the hardest and most stressful for us. Things didn't always go as planned, but they've all worked out and only a couple days left of Matt's last rotation. Yay!

Q: Did your family move for fourth year?

A: We have stayed in Lebanon all four years of medical school for several reasons. We didn't want to keep moving our four boys around and change school and friends too much. Malcolm is now 11 and in 5th grade, Quinn is 9 and in 3rd grade, and Winston is 7 and in 1st grade. (Sterling boy is still little enough to keep me on my toes at home.) We were especially worried for Malcolm getting into those harder years of school switching.

Another reason we didn't move was the overwhelming feeling of "moving home" to try and save money and bombard our parents with our large family.  But we were blessed to receive section 8 assistance halfway through 3rd year, so living expenses out of pocket were really minimal.

We also thought Matt would have plenty of opportunity to find rotations close to Lebanon, which didn't end up being case, but we didn't have it as bad as some. The longest period of time he was away from home was 12 weeks.

Q: What did your student consider when selecting residencies for applications and the match?

A: Matt and I didn't hash out a lot of things we wanted to consider for residency. Part of the reason is that Matt and I are usually on the same page about what we want for our family. But, I'm also not like some of my fellow medical wives who are super amazing and love to research it out, so I didn't really know how it all worked. Matt's always most concerned for his children's wellbeing, then his career, so I knew he had the right perspective. I supported Matt and told him I just wanted him to be happy. If he enjoys what he's doing, he comes home happy, which keeps me happy, and our children. Matt didn't have a set decision on what he wanted to go into, so he applied for two different things and left it up to our Heavenly Father to take us where he needed our family to be, and where our family could succeed the most and where Matt could continue to become the best doctor he could be. I believe things worked out better than we could've asked for.

Matt will be doing his residency in Auburn, Wa for family medicine. We are super excited to be moving back to our "home" state, 3 hrs from our parents and to have some extended family close by. This residency also serves a Marshallese community and Matt will be able to serve some people he learned to love on his 2 year mission for our church, and possibly use his rather useless language of Marshallese.

Q: What was the most frustrating part about Yr 4?

A: Finding/setting up rotations was definitely the most frustrating part of 4th year. Not only was it difficult to find rotations close by, but also when you think you have a rotation secured, and just a few days prior, they are cancelled. Matt ended up having to take his "vacation" rotation at a totally different time then we anticipated, and in the middle of January no less!

Q: Any advice for medical student significant others who are approaching this stage?

A: Let go of all expectations you thought 4th year to be. I didn't realize I'd be as much of a single mom as I was. I also didn't realize Matt would be setting up all his own core rotations. (Not that Matt communicates these things to me well. I'm learning as we've gone along the way.)

Just love and support your SO along their stressful 4th year. Try and be a positive force and uplift them during the lows. (I know a lot of students confidence wavered 4th year.)

Take advantage of all the moments together, if they're home, spend quality time together, if they're on an away rotation, remember they are on someone else's time schedule, or a different time zone, and you don't always get to talk.

Also find support from somewhere. There were too many times I felt alone and many days when I had no contact without the outside world, or even talked to an adult. Having family so far away and friends move away, and husbands basically out of the picture, our social life basically became non-existent.

06 May 2015

Yr 4 Perspective of a Med School Wife: Maren

Props to Maren, who not only willingly contributed to this crazy blogging experiment of mine EVERY YEAR (1st year2nd year, and 3rd year posts), but also had a baby during the craziness that is fourth year. You are one of the strongest mamas I know, Maren!

Intern Year/Residency: Transitional (internship) year in Chino, CA
Q: How did you support your med student in year four?

A: I supported my student by not complaining about his away rotations and by trying to leave his decision-making (for residencies and last-minute rotations and stuff) up to him after giving my input. I also tried not to freak out and guilt-trip him when things didn't work out ideally.

Q: Did your family move for fourth year?

A: No. After 2nd year, we moved to Portland as a home base for both 3rd and 4th years.

Q: What did your student consider when selecting residencies for applications and the match?

A: We had to first consider military residencies, then civilian transitional years. When considering military residencies, we were going off my student's sense of what he thought he would like the most/have the best chance at/be the best at. When we considered transitional years, we decided based on location.

Q: What was the most frustrating part about Yr 4?

A: Confusing our strategy (due to lack of information) for a military residency and then missing some deadlines for civilian transitional years. I actually think things worked out for the best, but it's always hard to sit by and watch preventable problems arise.

Q: Any advice for medical student significant others who are approaching this stage?

A: Gather all the info you can about the process, strategy, and your options; and then decide with your SO what your priorities are in deciding what you want. There are a lot of different priorities to balance: your SO's sense of fulfillment in the specialty, location, the program director's attitude, salary, hours/type of call, etc.

04 May 2015

Yr 4 Perspective of a Med School Wife: Me

Scott had his last day of medical school in April! I had my last day of work last week! Can you believe I am already writing my fourth year perspective?!

Yeah, neither can I.

I was not quiet about my feelings for this last year. Even with the emotional struggles of first year, this year in medical school would be ranked as my least favorite. Many of my friends had moved away from Oregon to be closer to families. Rotation scheduling, residency applications, and the match were stressful for me and Scott. On top of that, Scott only spent about ten weeks at home during this last year with a few weekends sprinkled throughout the year. But we made it! We're going to enjoy a month off together before graduation, and then on to residency and living in the same city together again!

Family Medicine in Milwaukee, WI

My Responsibilities
While Scott was traveling the country for rotations and board exams, I continued to work full-time in Corvallis. It is pretty incredible that I have been able to work at the same organization for the entire time Scott was in school. Working kept me busy and preoccupied while Scott was studying or out of town.

Since I finished my graduate degree last June, I found myself with more empty, dark apartment time than I would like in the evenings. I used that time to read, watch Downton Abbey, practice playing the organ at church, and continue my investigation on how nutrition plays a part in my autoimmune disease.

Supporting My Husband During Year 4
Internet research is a talent of mine, a talent that was fully utilized for Scott's benefit this year. Since COMP-NW requires that the scheduling of fourth year is done all by the student, I helped Scott walk through the process of applying for audition rotations. The school gave Scott some instructions, but together we created a spreadsheet of possible residencies and gathered the materials needed for the application.

Researching a list of possible residencies was easier after Scott had finished his first audition rotation. It happened to be a great audition site, so the experience gave him a better idea of what kind of residency he would enjoy. Scott knew from the beginning that he would like to go into sports medicine. We had originally assumed that the best residencies for entering sports medicine would be ones with connected sports medicine fellowships. However, we discovered after his first audition rotation that some of the most preparatory experiences were available at unopposed residencies that may not be connected to a fellowship. Searching residency websites for options that met these qualifications and had significant sports med experience as part of the curriculum was my task.

When Scott was on his audition rotations, I would ask him questions every day about how he felt about the site as a potential residency. How did he like the faculty? Did the residents seem happy? Did he think he would like the curriculum? These conversations helped prepare Scott for residency applications and interviews.

My research and organization skills came in handy again when we participated in the SOAP following the allopathic residency match.

In April Scott came home from his last away rotation. The last time he had lived at home (besides a few weekend visits) was September. Looking back, it's pretty incredible that we never felt like our relationship suffered during these away rotations. We talked almost every night on the phone. I asked a lot of questions to get Scott talking about what he had done during the day, even though hospital talk makes me squeamish. I had no problem talking about myself or what I'd been thinking about that day. When Scott's rotations were a little closer to home, we would make an effort to spend weekends together when possible.

Residency Applications
Applications for DO residencies begins in August of your fourth year, and the application for MD residencies typically begins in September. Last fall I wrote in this post about our experience applying to family medicine residencies with sports medicine experience in the curriculum. After a tedious search of residency websites we came up with a list of ten residencies that we felt would provide Scott with enough experience to be a candidate for sports medicine fellowships. Of the ten, we were hopeful that Scott would get an opportunity to interview with his top four favorites.

Residency Interviews
Interviews take place from October to February of fourth year. This time of year was particularly stressful for us, because on top of interview prep, Scott had to worry about scheduling required rotations with his obstinate school.

Scheduling interviews and travel was complicated as Scott had rotations planned through mid-December and only had four weeks of vacation time to play with all year. Scott interviewed with six of the ten programs, with his last interview taking place before Christmas.

COMP-NW provided an online resource for students to prepare mentally to answer residency interview questions.

The Match
Even though securing our residency was not the easiest of tasks, we are incredibly happy with the results. I described our match process in detail in this post.

Advice for Significant Others Beginning Year 3
If you are finishing your third year and your student hasn't already scheduled rotations for Year 4, check out my post about scheduling. I updated that post last fall with tips on what I think we would have done differently if we had had a second chance to schedule fourth year. Scheduling rotations can be incredibly stressful for your student. Scott had an idea for what he wanted his calendar to be, and then it was completely thrown off when each audition program came back with different dates. Encourage your student to be flexible and try to {be better than I was and} refrain from showering your student with questions about what is being calendared. Students have little to no control over the process.

Also, it doesn't hurt to remind your student to get all health records and immunizations up to date during the spring before their fourth year. These are required for audition rotation and residency applications, but it is difficult for your student to schedule a physical and shots when they are on away rotations. Best to do it now.

As for applying for residencies and what to consider for the match, there a couple things that you can learn from our experience. First, don't limit your residency application by location. We had hoped to stay west because both of our families live on the west coast. But when it comes to applications, you want to keep your options as open as possible; because it is more important that your student matches into a residency that will provide the training needed than where you live for three or four years. Travel may be expensive, if you are applying across country, but it's just something to take into account. Second, if your student is focusing his/her application on family medicine residencies, make sure it is clear in the application how committed your student is to the specialty, a priority rather than a back-up plan. Letters of recommendation should be from family physicians and essays should clearly communicate your students commitment. Competitive family medicine residencies want students who are committed to family medicine. We were probably not as clear as we should have been. Lastly, even though you hear that you shouldn't talk about ranking with residency programs, you can and should frequently mention it with favorite residencies. We didn't know that other students talked openly to their residencies about how the student ranked them ("Your program is ranked in my top five," etc.).

Fourth year is the worst, at least it was for us. Plan a vacation after your student's last rotation, before graduation, to celebrate your accomplishments!