A New Washington Chapter

Last week Scott signed a contract for his first full time job following medical training!

What a monumental event for us, because we've been building up to this new chapter for so many years - pre-med training, applying to medical school, medical school rotations, interviewing then SOAPing into residency, residency, interviewing then matching into fellowship. Now mid-fellowship year, Scott was offered two different jobs in two different parts of Washington state!

We had long talks about what was most important to us in this first job. We considered location, medical practice preferences, large organizations v. private practices, pay and benefits, potential life balance, opinions of current and former employees. We found that its difficult to look at this decision by logic alone and that everyone seemed to have opinions on what we should do. In the end, the decision came down to prayer and what felt best. Both offers were good, but after evaluating how we feel, one organization stood out to us as the better choice for us now.

So in August, after Scott's fellowship graduation, we will be moving to Kitsap County in the Seattle area for this next chapter in our life, and we're extremely excited! There are A LOT of loans to pay off before we will probably feel like we've moved on to a new chapter, but the thought of settling down in an area for awhile just feels so invigorating.

Family Medicine Residency Recap

When Scott graduated from medical school, I had every intention of documenting residency similar to how we documented medical school - by rotations or milestones. While I started following that schedule of posts, I quickly discovered that a milestone check would be pointless. Primarily because every residency is different and our experience making it through one or more in-patient months or surgery rotations would not likely be similar to another resident's experience, even across family medicine, much less in another specialty. So while it might have been interesting to my parents, it likely wouldn't have been helpful to any medical students or their significant others.

Before my husband entered medical school I was so concerned about how to become embedded in that new community and support my student husband. That concern didn't translate over to residency, which makes sense. Going into residency, I already had four years of experience supporting my husband on this medical journey. I didn't have any reservations about how that might change in residency, because even if there were changes (and life was different, for sure), I knew from experience that I could roll with it.

Residency, for us, was better than medical school in many ways. The biggest change was that compared to third and fourth year of medical school, I saw Scott so much more in residency. Sure, he was working long hours and nights, but every day he was home for some portion of the day and he was usually in the same city. I can't say the same for medical school. In residency, Scott still studied, but it wasn't as much and there was much less pressure for boards. We made great friends in residency, as well as in the community, and we had so much fun exploring a part of the country that we probably wouldn't have lived in otherwise.

Intern year (the first year of any residency) took some getting used to because we were in a new city, with new friends, in a new job that was demanding for someone who'd never really practiced medicine before. But at the end of first year, everyone said to me, "Don't worry! Second and third year are so much better." And they were! Most likely better because I knew what to expect as far as time commitment at work and at home, but also because even in the hardest rotations it seemed like Scott was better prepared to handle them and made more time for life balance.

Our biggest piece of advice that we pass on to anyone entering the residency phase, or for that matter, any phase of a medical journey is this -

Expect that this journey will be hard and that you'll rarely see your spouse. If you and your student/resident/fellow both start the program with the expectation that s/he is going to work hard and commit to get the most out of this training experience, while trying to balance home life, then you'll always be pleasantly surprised when it isn't as hard as you expected.

And now, a video containing some highlights. Enjoy!

Hello from Vancouver!

Let's be clear, because we've been questioned several times - we didn't move to Canada. We're writing to you from Vancouver, Washington where we're living for a year while Scott completes a Sports Medicine Fellowship.

Backing up to Match Day (1.3.18)... We were on pins and needles to learn our match to one of the 10 Primary Care Sports Medicine fellowship programs where Scott interviewed. I was sitting at my work desk, yoga breathing, stressing out that we would experience something similar to the last match we went through for residency. DrH was cool as a cucumber waiting for match results and was elated when at Noon Eastern Time he received an email that he would be working with one of his favorite program directors at PeaceHealth in Vancouver, Washington. We love us some PNW!

I didn't as much about the fellowship application, interviews, and match process, but please send me a message if you are ever in the same position and would like some details and moral support. We're already advising medical school friends who are a year behind but going through the fellowship application process. We feel so much satisfaction when we can use our trials and experience to help someone have smoother transitions in their medical training.

After the match, DrH still had to finish up his last year of residency. Back in the day when we were interns and 2nd years, I remember hearing stories about graduating residents that complained and refused to come in for extra shifts. Hearing those stories I would comment to my husband, "Why are they being so difficult with staffing at the end of the year?" Now I know. Once a resident has their contract for a future job or fellowship, their mind is already in summer vacation mode. All of a sudden, staffing with your attendings seems so tedious! I know this, because DrH did the same thing. He's always been a little passive aggressive, but snark was coming out of his ears by the end of residency when Medical Assistants were giving him extra drop-in patients. EVERYONE could tell that he was looking forward to (read: needed) a month long break before fellowship began.

The "Brother Friendly" jacket strikes again.
Aurora Family Medicine Graduation June 2018

As graduation came closer, though, the realty of our move began to hit. We hadn't even left, and we were already missing the friends and the cheese curds that we would be leaving behind. It was really poor planning on our part to schedule two vacations in the last two months of residency, because every week we had friends that wanted to hang out with us before we moved and there was so little time to fit everyone we loved in. Milwaukee was SO good to us! Aurora Healthcare was so good for DrH. We've said it before, but the SOAP was the best thing that could have happened to our medical journey.

The day after graduation, we struck out in our moving van to make the 33 hour drive, just DrH and I. This move went much better than expected (minus one Honda window fiasco and the fact that the Vancouver/Portland housing market is crazy). We're now settled into a really comfortable apartment overlooking the Columbia Rive. It's only fellowship orientation week, but we're crossing our fingers  that this will be a perfect location for us over the next year.

Also, here's hoping that I do a better job of documenting our adventures here!

Hello, Match Week... I mean 2018!

I'd like to say that we're excited for the possibilities of this new year, but at the moment we're trying to distract ourselves from nervousness.

2018 is the year that Scott will graduate from residency. Yay! This year I'll turn 35. Is another cruise calling my name? Apparently this year we're going to Hawaii twice... that we know of. *wink wink All good things.

But the big piece of news that we're waiting for with bated breath is the Primary Care Sports Medicine Fellowship Match that happens THIS WEEK.

Let's back up a second. Last you heard from us on this subject, Scott had just completed some interviews in Texas. In total, he applied to 17 programs, was invited to interview at 10, and attended all 10 interviews (can we say expensive Q4?).

Side Note: If you want to hear a great story, ask me (not Scott, it's not as funny when he tells it) about his final interview with a program that partners with his alma mater's athletic teams.

His final interview offer came mid-October, most interviews happened in October, and his final interview was mid-November. In the end of November, we discovered this incredibly informative video on how the match algorithm works to match perspective residents or fellows to programs. I'd like to give a raise to whoever proposed this video idea and/or produced it. This video completely eased our minds on what would happen after Scott submitted his rank order list, because before we viewed this video I was under the assumption that the program rank order list had some weight or even drove the match. If anyone is going through the Match, I feel like this video should be a mandatory watch.

In December, Scott's rank order list was due. We submitted a list of all 10 programs where Scott had an interview in the order of favorite to we'd still throw a party if we match to this program. Then we sat back and put up our feet, and I made a three week long countdown chain. Yep, I'm still a child. On each ring of the chain I had written the reference to a patience/trust scripture with the intention of easing our minds as we waited, but it totally backfired on me when most of the scriptures said, to the effect, "Don't be depressed, God will support you in your tribulations." To which Scott replied, "What in the world do you think is going to happen to me on Match Day?!"

Maybe some day, after the match, I'll talk about our experience keeping touch with programs after interviews were over. It's a complicated game where you have to let programs know that you're interested in attending their program, without saying specifically where you intend to rank those programs. This is a subject that I wish we had had some helpful advice on from current fellows, but at the moment, we're not exactly qualified to give that advice ourselves. Maybe next week.

So in an effort to fake it ‘till I make it, I'll say we're optimistic that 2018 will be our best year yet. 

A Thanksgiving Surprise

Leading up to the Thanksgiving holiday last week, I knew that Scott would be working nights at the hospital all week long. One of our good friends that is in the same residency program as Scott knew that he would be working nights. He and his wife suggested that together we surprise Scott at the hospital with a full Thanksgiving meal. Best. Friends. Ever!

Thanksgiving is Scott's favorite holiday, so I knew he would be bummed if he didn't get to celebrate it the way he loves - with football, food, and family. We can't do much about the family part when we are at the end of his medical residency over 2,000 miles away from where all his family was getting together. But we could make sure he got football and food!

As the day approached, Scott asked me what my plans were for his favorite day of the year. I bluffed. I told him that I was going to spend the day at a friends house. This particular friend really did invite me to spend the day, but I already knew at that point that we would be surprising Scott at the hospital so I had declined. Scott took the lie, and with a pathetic frown told me he was happy that I would be eating with friends on HIS favorite holiday. What a sucker! Really, I'm surprised that Scott believed me at all, but I guess I was pretty convincing.

All week Scott went to work around 5:00 Pm and returned home around 7:30 Am to sleep. Most days he slept until just before he needed to go into work again. Some days he would wake up a little earlier, because he had found some sleep time between admissions at the hospital. He would use that time to work out or get caught up on emails and notes.

On Thursday, I was in full cooking mode. I made pie, cranberry sauce, rolls, turkey breast on the bone, and stuffing. Our most excellent friends made potatoes, sweet potatoes, and pie too.

Meanwhile on Thursday morning, Scott went from the in-patient service, to the OB floor to induce a pregnant patient, and then... to a turkey bowl football game. Priorities, of course. When he came home, he laid on the couch and said he was going to watch football and if he "happened to fall asleep" that was okay. Yeah, right! He was exhausted but it's not like he's capable of falling asleep during football on Thanksgiving. He didn't say anything as I was busy in the kitchen, but later he mentioned that he was thinking to himself - "Why is Katie cooking everything when she was invited to someone else's Thanksgiving dinner?"

When the time came, Scott left home to deliver a Thanksgiving baby. Our friends and I went over to the hospital to set up the Thanksgiving feast in the in-patient residency room. When Scott arrived, with his cafeteria take-out container, he was legit surprised! The table spread was pretty impressive, and we had even turned on the residency room TV to a football game before he came in.

He kept saying all night how grateful he was for friends and me, that we would take the time to do this special treat for him. We all shared how grateful we were to have been directed to this residency and each other. For hours, we stuffed our faces with the most fantastic food until we couldn't possibly eat any more. Then after a brief pause for digesting, and some dessert, we left Scott to watch football and take care of his admissions for the night.

Like my friends reflected that night - feasting in the hospital was the best possible way we could have spent our last Thanksgiving during residency in Wisconsin! It was a Thanksgiving to remember.

4 Tips for Your DrH Sports Medicine (FM) Fellowship Application

I am crossing my fingers that we never have to go through another match process after this fellowship match! This match game creates anxiety for both me and DrH. Luckily for you, you can learn from our mistakes and hopefully have a smoother experience applying for Sports Medicine Fellowships.

Here are four tips you need to know before starting your fellowship application. Keep in mind that the process may change from year to year, and that my DrH applied to the primary care fellowship which may have different requirements from other specialties. 

Tip #1: Know The Timeline

Assuming your DrH will be participating in the ERAS Fellowship Application and NRMP match, you'll want to understand the timeline for applications. This year, the application opened up in June. This means that in June, DrH can start sending Letter of Recommendation requests and inputting CV information, but the application cannot be submitted until July.

Another note from this year, is that while an applicant could technically press the submit button on July 6, 2017, applications aren't actually sent to programs until July 15. In other words, all applications submitted between July 6-15 arrive in the hands of fellowship coordinators and directors at the same time. Programs interview only 10-12 applicants out of the 100 or so applications they receive. So while the deadline for application submission is in the fall (Sept/Oct), It seems like it's in your DrH best interest to plan to submit the application in early July.

UPDATE 9/14/17: From our experience so far, most programs review applications in September/October and interview in October/November, though DrH did get a few early interview offers that were scheduled in August/September/October. This year the rank order list deadline is December 13, so interviews must be over by that point. 

Tip#2: Request More than 3 Letters of Recommendation (LoR)

Many programs ask that you submit at least three LoRs, and some programs want those LoRs to be from specific individuals (like program director, two physicians who have supervised DrH in clinic, or an orthopedic surgeon). You'll want to look at individual program application requirements which can either be found on the program's website or in the program information when you search for programs (some programs don't list requirements at all). Note that after LoR are uploaded by the author, the system takes some time to process those letters (up to 5 business days). While letters can not be included in the initial application submission unless they are uploaded and processed, you can "apply" them to previously submitted applications once the LoR is finally complete. 

Because our LoR authors experienced some technical difficulty in uploading their letters, DrH had to choose between submitting incomplete applications on-time or submitting a full application to programs late. He chose to submit on-time and email programs about the forthcoming documents. 

That being said, I would recommend asking for more letters than needed in the event that something like this technical delay occurs. Talk to those LoR authors in the end of May/beginning of June to confirm that they have enough experience with you to feel comfortable writing a positive recommendation. Then, send out the LoR requests as soon as the application opens in June, and send reminders if the LOR isn't uploaded by the end of June/first days of July.

Tip #3: Include Conferences, Event Coverage, and Elective Rotations as "Experience"

Instead of uploading your DrH's curriculum vitae (CV) as an attachment to your application, ERAS has you create a CV type document that will become the application. This includes filling out sections on personal information, education, experience, among other fields. While the ERAS instructions don't explicitly say to do this, based on AMSSM recommendations, sports medicine fellow applicants should include conference attendance, event coverage information, and related elective rotations in the experience section on the application. More up to date recommendations about what to include in sections of the ERAS application are listed on the AMSSM Fellow website. 

Tip #4: Provide Signed Code of Ethics Form

Many programs may consider the application incomplete until they have received a signed AMSSM Fellowship Code of Ethics form, which is odd really, because there's no place that we found to include it in the ERAS application. We recommend being proactive and sending that signed form by email to program coordinators after the application is submitted in early July. That way there's nothing holding them back from reviewing your application and offering your DrH an interview.

Not a tip, but so you're aware here is a list of fees we had to pay for the application alone:

- The application "token", which allows your DrH to start inputting information into the ERAS/EFDO application tools, will cost around $115. 

- Requested transcript and MPSE from DrH's medical school, which cost DrH $12

- When you finally submit to programs, the fee total will be based on how many programs applied to and there will also be one time fees for transcripts. You can see the breakdown of fees here. If you happen to submit to a second set of applications after already applying once, you do not have to pay the transcript fees again, AND the system will take into account the number of applications previously submitted.
Total, we spent close to $350.

We're planning on this being an expensive year with visiting rotations and interviews: airfare, transportation, and lodging all over the country. Another reason why I'm not eager to do this match process again anytime soon. 

Residency Update: Preparing for Fellowship

Years ago I wrote a post about prepping for a career in Sports Medicine, and I admitted in the post that it was likely too early to be writing a "how to" post considering that at the time DrH was only in his second year of med school. This post is it's sequel, and writing this is making me rethink my post titles. Instead of Part 1 being "How To Pursue a Career in Sports Medicine," a more apt title would be "Path from Medical School to Sports Medicine" or "How to Distinguish Yourself as a Sports Medicine Candidate in Medical School." Then Part 2 could be "Path from Residency to Sports Medicine Fellowship," with maybe a subtitle of "How to Speed Date at the Fellowship Fair." Anyone is welcome to submit other suggested titles for consideration.

I should say that the longer I've followed Scott on this journey and listened to the stories of others, the more I realize that our path has not been a standard one. In fact, I'm not sure that there is a standard path to sports medicine. It all depends on what direction or specialization you want for your career and how ambitious you are to get there if you don't have someone providing a schedule of opportunities for you.

That being said, I still feel like the Part 1 post is accurate and includes helpful links. If you or your DrH is interested in pursuing a Sports Medicine fellowship, the ticket is demonstrating early on that the student/resident is interested in a fellowship by participating in sideline experience, research, clubs, and electives.

AMSSM 2017 Fellowship Fair

Now that my DrH is ending his second year of residency, he finally got the chance to attend the annual conference of the American Medical Society for Sports Medicine. As a side note, I asked DrH if he wished he had gone to the conference and fair during his first year as a resident (PGY1) and he gave a resounding yes! It would have provided him with extra motivation and direction on how to approach applying for fellowship. It also would have meant more time to casually talk to a variety of fellowships long before he would have felt the need to have his opinions finalized for the approaching fellowship application period.

For six years now, the AMSSM annual conference has included a fellowship fair where programs from across the United States are invited to have a booth for a VERY LIMITED amount of time on one of the final days of the conference to answer questions about their program. At this fair in 2017 there were over 100 programs represented in a large hotel conference room. Each program manned a booth (seen to the left) for one hour in the morning, 30 minutes around lunch, and 30 minutes before the close of the day. Don't be fooled into thinking that those are misprinted times. Conference staff will shew anyone out of the room when the allotted time for program mingling is up. *My fingers are crossed for you that this changes in the future, and they instead give you a half day or full day to meet the programs.

To add to DrH's tight schedule of program speed-dating, he had signed up for the conference's student and resident specific workshop on "How to Apply, Interview and Match Well" which happened to be scheduled at the same time as the first hour of the fellowship fair. Seriously, conference organizers?! During the first entire half of the fair, many of the potential fellows were tied up in a different room getting advice on the impending application.

Still, DrH was determined to talk to all of his favorite programs. The night before the fair, he prioritized a list of program visits to maximize time in getting his face in front of those representatives. He got up early the day of the fair so he could try to catch programs before and after the application workshop (which he said was helpful, but nothing that was said was surprising), and tried to get into the fair early and stay late, when possible, for the shorter afternoon sessions.

All in all, he talked to 17 programs. SEVENTEEN! I honestly don't know how he did that. The night before I was thinking, "how many programs can you have a conversation with in one hours total time? Five to ten, maybe." I wasn't physically watching him, so I don't know if all 17 conversations were meaningful or seemed to leave a positive impression on the programs; but knowing DrH's personality I would imagine that they were fun, casual visits. Slow clap for DrH!

So now DrH is fine tuning his CV, writing his personal statement (several different versions, because apparently the workshop recommended to make it less of a letter of intent and use less cliche stories), and requesting letters of recommendation from AMSSM physicians that he has worked with during residency. He's also scheduling two-week visit rotations with two top fellowship programs for this fall. Fellowship applications open up in June but aren't submitted until July. Then after the application period closes in September he will (fingers crossed) start to receive many, many interview offers. The fellowship match (yep, another one of those algorithm love connections) happens in January 2018.

We'll keep you posted.

Residency Update: Night Shifts in PGY2

Dr. Chandler (here out referred to in true doctor's wife text as DrH, for Dr. Hubby) just finished five weeks of night shifts, a couple weeks delivering babies on his OB rotation and then moving to an in-patient care rotation on Purple/Yellow team (known among residents as PYT). Whenever he is on nights I end up getting very little sleep, because I prefer to distract myself with books and movies until I'm so exhausted I can't keep my eyes open.

When he was on PYT, DrH would typically arrive home around 8:00 AM, which is normally a time that I would have already been up and at 'em. But with the shift in Wisconsin's temperatures to somewhere in the neighborhood of 0 degrees with wind chill, I've opted to stay warm in bed until that time when he gets home and is doctor popsicle, so that he can cuddle and warm up as he drifts off to sleep.

On night shifts, DrH will sleep during the day and wake up in the afternoon to work out, shower, and look at which patients are in the hospital before heading off to work. He's one of those lucky people who can fall asleep any time, any where he wants and it doesn't take long for him to be fast asleep. It especially doesn't take long when he's exhausted from the previous night. Some nights at the hospital he's able to get anywhere between 2-4 hours of sleep, depending on how much help is on the floor and what cases need to be admitted. As a second year resident (PGY2, which stands for post-grad year two), I find that DrH prefers to ease the pain of interns (PGY1) a little by taking extra patients, letting the interns sleep if the floor is quiet, or helping to finish notes. He talks a lot about how he remembers how awful intern year was and that he wants to make it less stressful for the newbies. He mentioned having some good senior resident examples when he was an intern that made the journey more bearable.

I asked him this morning if he didn't think that put the new interns at a bit of a disadvantage, because he had to learn as an intern to be more efficient with his notes. His intern year also comprised of more case exposure from in-patient and ICU, which he commented at the time made a huge difference in recognizing what disease looks like when he saw it in the clinic.In answering my question, DrH thought that he wasn't crippling the interns by making one shift a little easier and having an ally on the floor to watch out for them, when he knew he could take the extra workload. It appears that he's also biased to giving the extra help to interns that demonstrate good knowledge and are enjoyable to work with, and he is less likely to help out the first years that show up late and don't contribute much to the team.

So far this year, I'd say there have been some better moments than intern year and some that are just as disgusting. Night shifts are near the top of my disgusting residency bits list. Taking pages at night makes me want to throw his pager against the wall, either that or kick him out to sleep in the living room. There have been several relaxed rotations though, where he has more time at home and is less stressed. It's that halo effect from the more relaxed rotations that I think had senior residents affirming to us at graduation that PGY2 would be much better than PGY1.

More thoughts coming soon on what we've learned in residency about the process for becoming a sports medicine fellow.

Making Christmas Wishes Come True

I know it was your secret Christmas wish to celebrate my birthday with me!

My brother asked me what kind of special plans I had going for my birthday, and I told him I've kind of gotten used to celebrating holidays and birthdays on unofficial days or over a span of time because of medical school. Residency is apparently no different, because Scott was on nights this week, which hindered our normal dinner and a show birthday plans. But he sweetly gave up an hour of his morning to take me to breakfast before I started work!



Happy birthday to me!

Life Snapshot: August 15

Catch 22 Escape Rooms in Brookfield, WI

Wisconsin Tidbits: I intend for this section to include information about places we've discovered in Wisconsin, but today I'm posting this linked story about the riots that have been going on the last two nights north of downtown Milwaukee. We live 20 minutes southwest of the city, so we haven't seen any of the violence first hand, only heard about these events from friends at church and in the news. Sad and a little too close for comfort.

What I'm Reading: Amy Snow by TracyRees

Part of My Spiritual Study: I realized this week that meekness may be my weakest link. I was in a meeting and was way too stubborn with my expectations. So now I'm studying how to be more meek. Reading suggestions are welcome!

Church Calling: I was just released from my other two callings, so I am now only the Relief Society Secretary for our ward.

On the Telly: Gilmore Girls Season 6, Episode 9 - the omega and alpha of awkward episodes. I remember enough about the immature mistakes that Rory made from watching this series the first time to fast forward through the silent treatment and life mistakes of this season. Episode 9 brings back the happy, witty banter of Gilmore Girls, though I know more awkward episodes are around the corner. 

Dr. Hubs: This last week was the first time that Scott spent the night in the hospital because it wouldn't be worth driving home and then driving back again for his next shift. He texted me in the afternoon that he felt like he would be lucky if he could get out of there before midnight, and I thought he was exaggerating per his usual. I expected him home around 8:00 Pm. He called me at 11:00 Pm, waking me up, to tell me that he had just finished and had decided to spend the night at the hospital since he had to work again at 7:00 Am. I felt so bad for him. This rotation has been rough, schedule and patient-load wise. 

My favorite moment from this last week: Okay, not quite this last week, but a couple Saturdays ago we went with friends to an escape room. When Scott has a free weekend, we like to play strategic board games (like Power Grid or The Castles of Burgandy) with a few couples from our stake. Before meeting them, the most similar games we'd ever played were Ticket to Ride and Settlers of Catan. I mention all of this just to say, that this might have been the best group to go with to our first ever escape room. When we came out with 2 minutes and 50 seconds to spare, the company rep could not stop mentioning how smart everyone was. Sure, it was a tad crazy at the end with six different theories and strategies being yelled out (five really, because at that point Scott decided he was confused and let everyone else take over). But we conquered!

Residency Update: PGY2 Begins

Intern year is officially over for Scott and his second year of residency (otherwise known as post-grad year 2 or PGY2) has begun. Intern year ended with a night shift delivering babies (he personally caught 32 babies this last year). Second year began with Scott finishing that night shift, sleeping the morning away, and then waking up at lunch when some of our Western University medical school friends came to visit us on the way back from northern Wisconsin, driving to their residency home in Michigan.

Many have asked me, will second year be better than the first? It's hard to say at this point.

Scott and I had the opportunity to attend the graduation celebration for the outgoing Family Medicine residents leaving his program. While we mixed and mingled through the event, the new third year residents assured me that second year would be better than the first. They said Scott would have fewer drop-in shifts, and more weekends free, with the addition of having some elective rotations throughout the year. But then I reminded them that there would be 28 hour shifts added to second year schedules and more senior responsibilities. That was when those new third year residents told me, "Well, third year for sure will be better than second year."

Our intern year wasn't too bad, in my opinion. I've heard horror stories about residents being on their own with no seniors or attending physicians to run hospitals or weeks of work without the resident being given a day off to recuperate. Other than my dislike of Scott's night shifts and the obvious fatigue that Scott was feeling by the end of the year, I feel like I can't complain. At least Scott is in the same city as me and is home every day, even if I only see him for a couple hours.

As for whether second year will be better, I will wait to be the judge of that. Scott already came home from his first day in the clinic as a second year and said that he had to see double the number of patients in the clinic that day as opposed to the number scheduled for a first year resident. I'm crossing my fingers for some restful weekends for that boy!

If you want to learn more about the residency that Scott is in, or the residents that are in this program, you can watch some of the videos on the residency website. They asked Scott to answer some questions for the "Coffee with the Residents" section of the website. Of course, it's pretty clear from the video that Scott doesn't drink coffee, because he looks exhausted. Cute, yes, but completely spent!


And as for that line about wanting to be an obstetrician, I think that thought may have crossed his mind at some point during his third year of medical school. But if it did, it probably only lasted a minute. Ha!

Residency Update: Discovering Efficiencies

Updates are sparse of late, in part because when one works at home there isn't a lot of mischief to write about and in part because I haven't felt inspired to write. But that certainly doesn't mean that an update isn't called for. Occasionally I think to myself, "I really should vlog." It seems simpler to turn a camera on and start talking about life, which could lead to more frequent updates, and then a video would be much more fun to edit. But then I remember that I started my blog because I love to write. By far the easiest and most exciting life event to write about right now is Dr. Chandler's residency.

Since December, Scott has had rotations in the hospital and in the NICU (Newborn Intensive Care Unit). Both of these rotations were designed to be a little less demanding on interns - the rotation in the hospital involved only seeing family medicine clinic patients who are admitted to the hospital. So in theory if the doctors in the clinic are doing their jobs right, they won't have many patients admitted. The NICU rotation is more observation than responsibility, to allow doctors to see what conditions would require intensive care and how those babies would be treated.

Even though these rotations were touted as low-key, Scott has felt pretty overwhelmed over the last three months. In addition to learning about and having pop-quizzes on new conditions for each rotation, he still see patients weekly in the family medicine clinic. Scott described a day for me, where he wakes up at 5:30 Am, gets to the hospital by 6:30 Am, looks over the charts of patients he knows he will see that day to prepare for rounds, rounds with attending physician, returns to take care of patients, triages care for any new patients assigned to him, calls in orders, writes notes; and then rushes over to the clinic to see his afternoon patients, which calls for more orders, prescriptions, follow-up with previous days labs, and notes from today's clinic visits. This full day of work is a lot to juggle, and he still has administrative responsibilities - keeping up with emails, residency training sessions, meetings, studying, trying to be ahead of the fellowship game, etc. Occasionally Scott needs to bring his work home in order for him to feel like he is home that day. He writes notes while he watches a basketball game, records his work hours online, completes evaluations.

That one time Dr. Chandler had to respond to a
page while we were on a date.

The other day Scott said that some of his colleagues had recommended him to be a junior chief during second year. Nominations are considered and then the potential candidates are interviewed and some number of junior chiefs (no idea) are selected for year two. It is certainly an honor to be considered, but Scott felt overwhelmed by the idea. Chief residents, in addition to having all of the above responsibilities that any other resident would have, also administrative responsibilities that would take up time during the work day and outside. Scott has a great personality for that, and being a junior chief would look great on his resume for fellowship applications. But how can you approach thinking about an opportunity like that when work hours are maxed out as it is.

I'm not pushing Scott to take on any more responsibility, though when he initially told me about the nominations I said I thought he would be successful as a junior chief if he chose to go that route and was selected. I'm not worrying about Scott's resume either. Sure, there's a lot more he could do to put himself at the top of the pack and match into a coveted fellowship spot, but at what cost? He knows how much he can handle, and I don't think he's so overwhelmed that he would ignore a clear impression to move forward.

So that's what residency life is looking like at the moment. Luckily Scott has some Fridays off this month, which helps him to feel like he has a work/life balance again. He can sleep in at least one day a week and commit a whole day to studying at leisure, if that's his choice. Whatever floats his boat.

Residency Update: Intern Year Rotations

Scott has a new rotation scheduled every month of his intern year. So far he has done internal medicine, Ob/gyn, and community medicine. This month he will be in surgery. Each new rotation comes with a different type of schedule and new attending physicians.

Internal medicine, working in the hospital to admit patients primarily from the emergency room to stay in the hospital for monitoring, meant shift work for Scott. He worked three or four 10-12 hour day shifts in a row, then three or four 10-12 hour nights. When Scott worked night shifts he would come home between 9:00-11:00 am and sleep until 5:00 pm when he would need to get up for his next shift. Not many sleeping hours! Then he would get a day off in between night shifts and day shifts to adjust. He didn't seem to mind doing this for his first rotation, though he felt like he needed caffeine to stay up during the night. 

In internal medicine, interns are given the task of admitting most of the patients, which takes a bit of time to document symptoms, discuss the patient's medical history, create a treatment plan, and begin administering medications. The hospital here is LARGE, so Scott was admitting 4-5 patients a night, which meant there was no down time to sleep. It was pretty much go-go-go until his shift was over, but then he would need to sit down and write in all the patient charts and give his morning report to the day team before coming home. One day a week, Scott would work in the family medicine clinic too. It was a busy month where I rarely saw him awake. Like I said, though, he didn't mind this as a first rotation. His only complaint was that he rarely attended church over these first two rotations.

His next rotation had him delivering babies. Shift work again, but this time it really did him in. I've never seen him so tired. It was a similar schedule of hours, days, nights, day off, clinic. I'm not sure what made this second rotation so much worse, whether it was the back-to-back months, fewer days off to prepare for family coming in town, or maybe it was labor and delivery. In any case, by the end of the month when family came to visit, he looked pretty haggard. To graduate from this family medicine residency, Scott needs to have delivered 30 babies. He delivered 15 in his first rotation.

Last month was a month where Scott was not on-call, so he could take vacation days. This could not have come at a better time! The schedule for community medicine was 9:00 am to 5:00 pm, or sometimes just a few hours in the morning. He was working in free clinics around town, following physicians to home visits, and completing residency projects. For vacation time, Scott had scheduled to take long weekends all month long, which may have been more restful for him than taking a full week off. He was back to normal again after his first long weekend, which was a relief to me. He also had time to do sports medicine coverage at night for local games.

Last month was a bit more like we would expect his future career would be like - clinic hours, some weekend night game coverage. I could definitely get comfortable with that! 

Residency Update: Intern Year Orientation

Relaxing after working the holiday (July 4, if you can't tell by his outfit)

Dr. Chandler is now part of a family medicine residency with Aurora Healthcare (you can view pictures of each residency class with resident bios that link). For those of you who are only familiar with residents from watching Gray's Anatomy, first year residents are referred to as interns. Internship year is similar to med school, in that the residents have rotations throughout all areas of the hospital and medicine to have a broad foundational training before moving on to focus on the specialty of choice. What makes intern year different from medical school is that residents are no longer students. They now have the responsibilities and challenges of being a full-fledged doctor.

Scott's intern year started mid-June with human resource orientation for the hospital, as well as some testing and certification. July is set apart for orientation of each of the areas where Scott will be doing rotations this year. Each week in July, Dr. Chandler will be spending time in each of the rotations where he will be this coming year. This first month orientation set-up is unique, from what we've heard, to other residencies. Many residencies have the interns jump right in to full-time (80 hr/wk max) clinic responsibilities. This residency has given the interns one week to become familiar with the staff, duties, and timing of each hospital area before the interns take on the year of rotations.

An aside for those with only the TV medical jargon at their disposal or for anyone who's read the Med School Wives perspectives, some doctors do their internship year as a transitional year, transitioning from medical school to residency training. Transitional years are typically at a different hospital/residency for one year before moving on to the full residency training location. A transitional internship is common for surgery specialties, dermatology, some internal medicine specialties, pre-military training, or for yet undecided specialties.

So far in this orientation month Dr. Chandler has worked with internal medicine, newborn, and obstetrics. In addition to those rotations, he spends some afternoons working in the family medicine clinic seeing patients. He has been getting up at 4:45 Am each morning to study before leaving for 6:00 Am work (15 minute drive to main hospital). In June he was often home very early in the afternoon (3:00 Pm), but now that things are going more full swing, Scott is usually home around 5:00 Pm or 6:00 Pm, unless he has an "on call" day where he is at the hospital until 9:00 Pm. He works some weekends, Saturdays and Sundays, though weekend hours are not as predictable.

These longer hours of work are certainly a bit foreign to Scott, who had a more lax schedule in school. He has felt tired when he arrives at home and is eager to take some time to relax before resuming his studies and heading off to sleep. Any down time is cherished. He likes to use this time to go for a run, play Mo-ball at church, sit down to a meal with me, or do a crossword puzzle together. I'm just glad we're in the same city and he gets to come home after each shift.  It will be an adjustment, but we love where we are right now.

I'm still caught up in thinking that Scott is a student. The other day he was going to the hospital and said he was hoping he might deliver his first baby since becoming a doctor. "Surely, you won't be the one actually delivering the baby," I said. "Who else?" was Dr. Chandler's reply. Yep, in this particular hospital, had there been a baby to deliver that day among his patients, Dr. Chandler would have been the one to do it! Note to self: make an effort to avoid any major operations in July (when interns start).

Med School Update: The Match and SOAP

We're going to Milwaukee, Wisconsin for residency!

No need to leave you in suspense. I know you thought you'd have to scroll to the middle of my post to find out. What you didn't know was that the real juice of the story is yet to come.

For those of you who have been following along with our story from the beginning, you may be thinking to yourself right now, "I don't recall seeing any stars in Wisconsin on Katie's application map." You would be right. Scott didn't apply to any programs in Wisconsin... which means we had to scramble.

scram·ble:
1. To move or climb hurriedly, especially on the hands and knees.
2. To struggle or contend frantically in order to get something.
3. Applying and interviewing for unmatched medical residency positions in 48 hour time frame

***
Q: Why did the medical student order eggs for breakfast on Monday, March 16?
A: Because he was told to scramble.

*Ba-dum tssh*


Too soon?

Maybe. But we might as well lighten up the mood. Scrambling after the Match has a terrible connotation. I think medical students unnecessarily attach some of their self-worth to Match results. They apply to residencies, interview and are told from most every program "We hope to see you next year!", try to follow-up frequently with favorite programs, and have no choice but to put their trust in a computer algorithm to determine their future. Then when results roll around, and they are informed that they didn't match, it feels like they were dumped. How could it be that no one liked us as much as we liked them?

Both Scott and I were shocked to see that he had not matched with a residency program. He had excellent board scores, good grades, stellar reviews from rotations, and great letters of recommendation. He had even done audition rotations at sites we applied to and received encouraging feedback. We were sure that he would get into one of his top five choices for residency, especially since we had been told that students choosing to go into family medicine had their pick of residency.

My egg joke, however harmless, would not have been welcomed on Monday or Tuesday of Match week.

As many of you are likely curious how the scrambling process works, I will tell you. But allow me first to preface this process description with a fact - Good students can scramble into great programs. We feel that the residency program we scrambled into is possibly an even better fit for Scott than any of his top five match programs. We are ecstatic! Call it what you want, but we chalk up this happy detour to divine intervention.

There are two different matches, the allopathic match (MD/ACGME/NRMP), featuring residency programs accredited by the ACGME and the osteopathic match (DO/AOA/NMS), featuring residency programs accredited by the AOA. Osteopathic medical students may participate in either Match; and as mentioned before, Scott decided to apply for only programs in the MD match. This year was the largest allopathic match group in history, with a total of 41,334 applicants competing for 30,212 residency positions. More than 8,000 medical students were unmatched and participated in the Supplemental Offer and Acceptance Program (SOAP, a.k.a. "scramble"). Those numbers are for the MD Match only. The  MD scramble currently functions a bit differently than the DO scramble. In the scramble following the DO Match this year, students applied to and were interviewed for unmatched positions on a first come first serve basis. It is the definition of scramble, trying to be the first one to contact open residency positions and receive an offer.  Conversely, the main goal behind MD SOAP is to restrict applicant contact with residency programs through an application process, eliminating the first come first served “scramble”. I can't say how the DO scramble and MD SOAP will function in years to come, but I can describe our experience.

Ground Zero: On the Monday of Match week (MD), the medical students received an email letting them know IF they matched with a residency that they ranked. I was at work on Monday morning and Scott was in Hawaii in the hospital prepping for his sub-internship surgery rotation. He had just finished his early morning rounds when he received an email that he did not match and would need to participate in the SOAP. He forwarded me the email. Of course my heart leapt up into my chest as I imagined what he must be feeling. I immediately requested time off work to be available for him from home. Scott hadn't expected that he would need to take time off at all for the SOAP process, but I encouraged him to request leave from his rotation. Minutes later his school contacted him, knowing that he had not matched, and suggested the same, saying that time is of the essence as scramble decisions would be made in the next 72 hours. When Scott asked the surgery chief resident for an excused absence, the resident was very understanding, actually empathetic - the chief resident in Hawaii had even scrambled into his residency! He told Scott to take care of his future and not worry about returning to work until he was ready and able.

Scott's school had informed him that he could apply to 32 programs. He could apply to programs in the specialty we had chosen before or new specialties that had open positions. Their main advice was to not be selective, just try to match with any program. Once Scott and I reached computers, we logged into the NRMP match website in order to view available positions. Scott decided he would only apply to family medicine programs, as that was our focus for the past six months. There were 72 family medicine programs available with over 100 positions open between them. We briefly scanned the list and, considering the school's advice, applied to 26 family medicine programs without knowing anything about the programs except the program name and location.

Then we resurrected the spreadsheet. We had applied to what seemed like 80% of the available programs without knowing whether or not their program would prepare Scott for his desired career in sports medicine. Program curriculum became priority over location. Scott and I took the list of 26 programs from top-down and bottom-up, and we researched each program using residency websites and the AMA FREIDA database. We marked on the spreadsheet whether the program had sports medicine curriculum, OMM training, and noted if the program had a focus that did not fit with Scott's ambitions.

I'm not going to lie - day one of the SOAP was painful and an emotional roller coaster. However, working for 10 hours straight on researching gave us focus and determination that made us forget the email we had received that morning. Suddenly we were excited about finding the diamond in the rough. It takes some wading through the desert of programs with open positions to find a program or five that have matching desirable qualities. There were no interviews on day one of the SOAP, so there was less pressure to get the diamond before someone else stole it.

Interview Day: Again, Scott informed his rotation that he wouldn't be coming in to work on day two of the SOAP. I, on the other hand, had to work on Tuesday to distract myself from not being able to help. I made myself available to Scott by keeping my internet chat app up all day so he could type out updates between interview phone calls (I didn't want to tie up his phone line).

Scott was on interview calls all day long! He started receiving calls early in the morning - Eastern time and Hawaii time are not exactly compatible, but it was encouraging to be called. A couple programs had scheduled interviews with Scott on day one, but most of the interview calls came unscheduled. Initially Scott would receive calls from residency coordinators, like a pre-screen interview to see if he would be a good fit for their program. If good vibes were exchanged on the initial call, the program director would call him. Every program director wanted to know how Scott felt about their program, what he already knew about the program (booyah for the spreadsheet!), and whether he interested. Programs that recruited him hard made multiple (Scott says "like 50") phone calls on day two, including connecting him with current residents. It was clear that they were interested.

Not every program was so persistent. Of the 26 programs that he had applied to in the SOAP, Scott received interview calls from ten programs (this is where that "don't be picky" advice starts to sink in).

In EACH of the interviews, Scott was asked why he thought he didn't match. Specifically they asked why he thought he didn't match into PM&R (Physical Medicine and Rehabilitation specialty). Scott asked each of the residencies, what in his application had given them the impression that he was hoping to match into anything but family medicine. He had only applied to one PM&R program in the Match and had long ago decided he wanted to focus on family medicine.  He was told by each program, that there was a letter of recommendation in Scott's application had indicated he would be a great match for PM&R.

Now, we could play the "what if" game until the cows come home (what if we hadn't applied to PM&R, what if we had applied to more programs from the start, what if we hadn't narrowed our scope to the western US, what if he had followed up more frequently or bluntly with his favorites... you get the idea). Whatever it comes down to, there was something in the system that caused Scott to be ranked lower on competitive residency lists, and we didn't match.

Rounds of Offers: Wednesday morning following the initial Match notification brought the first round of offers from SOAP programs. The night before offers were extended online, Scott and I discussed scenarios. There are multiple rounds of offers, so there's always the concern that you might accept an offer in round one when a better program offers in round-two or three. However, the residencies that make you an offer in round one are basically saying "We want you, and we don't think you'll be available in round two." It would be taking a big risk to hope that someone else would decline a first round offer in order for you to receive a second round offer from a better program. Scott could take two hours to consider each round of offers. There were a few programs that Scott felt would make an offer in the first round, and when offers came through online he had two offers, both  good programs with sports medicine in the curriculum. The program in Milwaukee offered Scott a position in the first round. It was a front runner in our SOAP research, possibly a better fit for training than Scott's first pick in the Match. We accepted, of course.

Signing the residency contract in Hawaii

We feel blessed and could not be happier. I hesitated in asking Scott if I could post this story on the internet, because I knew how painful the initial Match results were for him. When I did finally ask, Scott said I could because he is going to a wonderful program and it doesn't matter how he got there. Agreed. There should be no shame in going unmatched and finding your own residency.

Now if you'll excuse me, I'm going to start planning my future. *insert mischievous grin*