5 Reasons to Meet with a Financial Advisor Before Residency

We are approaching the end of fellowship year, have a signed contract for the first real physician job starting in August, and have only just now met with a financial advisor to talk about what to expect next. If I could go back in time and do this journey all over again, I wouldn't change too much (especially because not a lot of decisions were in our control, Ha!) but I would have met with Justin Berry before we left medical school so that Scott and I could approach these post-school years with a little bit more financial education.

We specifically wanted to meet with a financial advisor who was familiar with physician financial situations - the debt load, training schedule, first job benefits, and physician-specific financial options. I can't recommend Justin more highly for those in the Pacific Northwest, especially within the Portland, Oregon area. We arranged for some educational visits with Justin, at no cost to us, to learn about: loan repayment recommendations tailored to us, the difference between consolidation and refinancing, what types of private insurance outside employment benefits might be advisable, recommendations as we start to move into the adulting world (regular salaries and budgeting, renting vs. buying, first time home buyer tips, prioritizing savings, understanding hospital benefits, etc.), and how to approach future investments.

In an effort to save future doctors (more likely their significant others) the headaches that Scott and I have gone through, here are five reasons you should meet with a financial advisor (preferably one who specializes in physician finances) before you leave medical school and begin training:

1. Either the doctor or the spouse needs financial education.
There should be a mandatory adulting class in high school or college. It is inevitable that between you and your significant other, one is in charge of the finances and the other has no clue what the difference is between checking and savings (not pointing any fingers). According to our financial advisor, among his clients it's the physician who most often doesn't deal with the finances.

Set your marriage and residency up right by getting on the same page finance-wise and meet with a financial advisor who can help you talk through budgeting for your new income levels. Don't make the mistake of overspending because you're finally done with school. It's a long journey to financial independence, you'll get there, but you don't want to make it longer. Be frugal while you're used to being frugal.

2. Medical school loan interest capitalizes when you begin repayment. 
Ugh! Since neither of us had undergrad student loans, capitalization came as an unexpected shock. Throughout school we made modest efforts to keep our total loans at a low amount (namely: only taking loans to cover tuition, I worked full- time to cover living expenses, and an occasional loan payment when extra funds were available). That total practically doubled overnight after residency began and we made plans for repayment, when the accrued interest during medical school became principal (a.k.a capitalization... Google it!). If we had met with a financial advisor during 4th year, s/he could have helped us understand capitalization and our options for deferring or paying off loans, which likely could have saved us some money.

3. An amount of student loan interest is tax deductible.
Again, a helpful financial tidbit that I found out through experience after the fact, when we did our first tax return after graduation. Depending on current tax laws, a portion of your paid student loan interest might be deductible, which in essence is like getting that money right back in the form of a tax refund. When we graduated from medical school, $2500 in student loan interest payment could be counted as a deductible on your tax return. In December of that year we had only just decided on our loan repayment options and paid a very minimal amount back thinking we would save money. Had I known that I could have paid off $2500 in interest, before it capitalized (!), and seen a $2500 increase in our tax refund, I absolutely would have cashed in on that. I've tried to remember to share this fact every December to medical school significant others from our school since that mistake.

4. Repayment options are complicated, as are the reasons you might choose them. 
When my husband started his residency and the repayment decision needed to be made, I had no clue why I would choose one option over the other, except to choose based on what we could afford. There are standard repayment options and income-driven repayment options. A financial advisor can walk through why you might choose an income-driven option or when that wouldn't be a good idea. When we met with our financial advisor this Spring he said, "If you weren't taking the job that you were now, that repayment choice would have been a costly decision. Lucky for you, it's a moot point now." *insert big eyes emoji

5. Federal loan interest rates are high!
You would think that of all institutions, the government might be interested in offering market low rates to students. Nope! We elected during residency to make fixed payments to the federal loan servicer, with an average interest rate on our loans of 6.5%. After meeting with our financial advisor this Spring, he recommended a couple of private loan companies where we could refinance for closer to 3%. So I'll swallow the fact that I paid off our loans for four years at the higher interest rate and just tell you, it's absolutely worth your time to talk to an advisor about this.

We ended up refinancing all of our student loans through Earnest and have an aggressive goal to pay them off in 5 years. It means we need to be frugal for a little bit longer, but we think it will be worth it when we can start taking what would have been loan payments and start investing in our future.

Shameless plug: a lot of refinancing or loan consolidation companies offer referral bonuses, and Earnest is no exception. So we're including our referral link here. I'm not saying you have to go through Earnest. Do the research, talk with a financial advisor you trust, and see what's the best option for you. No matter what company you choose, there will probably be an acquaintance who has a referral link you can use.

If you choose to refinance, and Earnest looks like the best option for you, THEN feel free to use our referral link for $200 in savings on your loans.

https://www.earnest.com/invite/scott3034
Hey Physicians and SOs - Any other tips you would add?

Paging Dr. Chandler to Graduation

He did it, folks! Four years and $230k in loans later (yep, really!), and we are now able to call him Dr. Chandler.

Scott graduated from Western University College of Osteopathic Medicine of the Pacific Northwest on June 5, 2015. As the graduate, he had to be at the event center in Lebanon by 7:30 Am. I, the "hooder", in other words, the one who put his fancy graduation cape on after he crossed the stage, had to be at the events center at 9:30 Am. The actually graduation ceremony started at 11:00 Am and was done around 1:15 Pm.

As I mentioned, one of the special things that Western University does during graduation is allows one or two family members to "hood" the graduate after the receive their diploma on stage. So during the ceremony I was escorted back stage with the other family members and was privileged to present Scott with his first official superhero cape. I thought for sure I would tear up during the hooding ceremony. I was crying just watching the graduates walk in to Pomp and Circumstance! But when they announced Dr. Scott Ernest Chandler and he shock the Dean's hand before walking across the stage to me, all I could do was smile from ear to ear.

I'm so proud of all that my man has accomplished, and all of the random but necessary medical facts he has stored in his brain. He will be a great doctor!

We were joined at graduation by Scott's parents, his older sister and brother, some of Scott's nephews and a niece, his grandparents, and my parents. (More family wanted to attend, but we were told we were limited to 10 guests.) It was quite the party!

Sterling, Scott's special buddy and nephew, was probably the most excited to see Scott graduate and the least happy about us moving to Wisconsin. That evening with diploma in hand, Scott and his dad drove off into the sunset, hauling all of our material possessions to the great state of Wisconsin.

Tender Mercies in Medical School

We are active members of the Mormon faith. Our beliefs are so much a part of who we are and what we do, including our time in medical school. So I would be remiss if I did not acknowledge the many tender mercies that we had these last four years. Prepare yourself for a doozy of a post!

1. Being Accepted to Medical School: The process was a minor trial for Scott and I, though we felt the Lord's hand in the entire process. The second time around we spent a lot of time talking about where he may want to go to school and what he could do in the year he had been given to improve his chances. Heavenly Father buoyed us up when we were feeling pretty low. What a blessing it was that Scott was able to improve his grades, MCAT score, and gain more volunteer hours. These improvements spurred two school interviews and acceptances.

2. Oregon: In the application process, we had poured over the application time and again looking for schools to add or making edits in essays. I distinctly remember Scott calling me from a boy scout overnight he was chaperoning to ask if I would finally submit the application. On the phone, I reviewed with him the schools where we had selected to apply. Then, though I had never seen the option before, Western University's brand new Oregon campus appeared on the application list of schools. I asked Scott on the phone if he wanted to add it, and we did, knowing that he had family nearby. Little did we know that shortly after moving to Oregon, my parents would move to the state, as well!

I've talked quite a bit with my fellow med student wives about our choices to come to COMP-NW. To be honest, there were times in the last four years that we were jealous of the customer service, curriculum, resources, or prestige of other schools. However, we all had stories of prayerful consideration and an impression that Oregon was where we needed to be. Education aside, we have most definitely benefited from the supportive community of Lebanon, bountiful resources of Oregon (oh, the berries!), proximity to family, and the amazing circle of friends we made!

3. ISAC and Teaching Assistant: One of the main reasons Scott selected to attend Western University was because of their Intensive Summer Anatomy Course that allowed students to take their first anatomy course in the summer as a stand alone class and prepared them to be Teaching Assistants in the lab. Scott was lucky enough to be accepted into this elite group of students. It allowed him to complete one of the hardest first year courses before he had even begun school. As a TA, he became fast friends with his classmates and had the opportunity to solidify what he'd learned in the months before. This emphasis on anatomy helped Scott to do well in all of his courses during the first two years, not to mention all of the times he was questioned by physicians in the operating room.

4. My Job: Getting a job in Lebanon is no simple task, though with a brand new school opening up in Lebanon, you would think otherwise. The community has grown quite a bit since the medical school campus was built, but there are still very few professional jobs open, much less jobs that might actually progress my career. We decided to move to Lebanon three months before school started, since I otherwise would have had to move to Oregon without Scott since he was attending the summer anatomy course in California. Another reason for the early move was to give me a head start on the job hunt. I spent a couple months hanging out in Lebanon, applying for jobs of interest, and exploring the area.

One month after I was settled, two part-time jobs opened, one each at two different non-profit organizations in the area. I applied and was asked to interview for both. Then my then future employer contacted me and asked me if I would be interested in interviewing for a full-time job instead. After several interviews, I was offered the full-time position.

Since graduating from BYU-Idaho, I have enjoyed the jobs I've worked at and have had wonderful working relationships with colleagues. I have also felt, throughout my career, that something was missing - I needed to find some greater purpose at work. This position that I have held during the last four years of medical school has been the best job I have ever held. I have loved my experience at the foundation and have been supported in my professional development by wonderful supervisors and colleagues. It was an incredible blessing for me to be offered a position with the foundation, and then after demonstrating that I could do great work, I was continually blessed with more learning opportunities. On top of that, the job offered wonderful benefits, and I was able to help other med student wives to find positions at the organization. It was truly a privilege to work with my colleagues at the foundation.

5. My MBA: One of the amazing benefits offered at my job was tuition assistance. Before we began this medical school journey, I had started taking class towards my MBA through UMass Amherst's online program. My job allowed me to take classes, for a very small fee per unit, through Oregon State University. It was initially a tough decision to transfer credits, not knowing if I would be able to stay in Corvallis long enough to complete the OSU MBA program. After transferring credits to OSU, I took night classes while working full-time and finished the OSU program in three years. Going to school kept me very busy while Scott was preoccupied with school and away on rotations.

6. Boards: The pressure was mounting for Scott as he prepared for his boards following Year 2. A competitive score on the COMLEX Level 1 and/or USMLE Step 1 are a key component to securing an interview with competitive residencies. We were blessed to have resources for Scott to orchestrate his intensive studying regiment. I was grateful that Scott could do all of his studying at home so I could see him (though, not talk to him) during that time.  We both fasted and prayed that he would pass his board exams and if it synced with God's plan for us, that Scott could also perform well.

One of the two board scores came back, and while he had passed, it was not the number he was hoping to see. For a few days Scott moped around, saying that he would have to be a penguin doctor in Antarctica. I reassured him that his scores could never be that bad, and we spent some time researching what the average board scores were for various specialties. I found that while his one board score was lower than expected, Scott would still have a chance to interview for dream specialties, knowing that no matter where he interviewed his character and work ethic would help him stand out. Then we received Scott's second score, which was above average, helping to boost his ego back to normal. I most definitely contribute these gains to our fast and tithes, and we've since decided that Heavenly Father wanted to send a little reminder to Scott that he needed to be open to all medical specialties.

7. Third Year Rotation Electives: When we selected our home base and Scott's rotation schedule for Year 3, I asked him to select a rotation schedule that allowed for him to vacation around my birthday, since I planned a fantastic cruise to celebrate. We ignored the timing of electives during his third year, or naively thought that having electives early in the academic year would help Scott to make better, earlier career decisions. We had no idea that because the campus was new and rotations now had to accommodate a larger number of students that Scott's requests for electives would be pushed off. Scott was left to arrange electives outside of the approved system, which required 90 days of paperwork. Scott was extremely fortunate to arrange with a family medicine physician in Medford to rotate as an elective and a family medicine/sports medicine physician in Portland. An extra cool blessing came when Scott was able to negotiate with the school to count one of these rotations as his family medicine rotation in order to have an additional elective later in Year 3, giving him more career options to consider.

8. Audition Rotations: At Western University, the students are required to set up all their rotations for Year 4 and not much instruction or assistance is given to help them accomplish this major feat. Scott and I had started talking about audition rotations and the required school core rotations during March prior to fourth year. Scott made some calls with potential residency programs, but many didn't have their visiting student applications available until later in the spring. Scott was so busy with rotations and board prep, that he dedicated very little time to the scheduling of his fourth year rotations... especially since scheduling had to happen during normal business hours when Scott was likely at the hospital with patients.

So when the summer came, Scott had communicated with many audition sites, but hadn't finalized all the audition rotations that he needed. He was frustrated that residency sites were difficult to schedule and didn't follow the schedule he had in his mind. More than that he was incredibly frustrated that the school was little help during that time.

His first rotation hadn't been scheduled when Scott spoke with one of his classmates about two residency sites in Utah that sounded perfect for Scott. I had researched and provided information on many residencies for Scott to consider, but I had failed to include those two residencies. Scott quickly called both residencies and by miracle and divine intervention, he was able to schedule one for his first audition in a matter of two weeks! Not only was his first audition rotation a miracle, scheduling wise, it became one of his favorite auditions of the year and prepared him to consider what he would like best in a residency.

9. The Match: I've said it before, and I'll say it again - we were incredibly blessed to land the residency we did. When applying for residencies, we prayed that we would be aware of the residencies to which Scott should apply. During audition rotations and interviews, Scott received great feedback on his potential to match. On Match Day I was telling people that I was 98% sure that Scott would match with one of his top choices; but he didn't, and we went through the emotional process of scrambling for his residency. Since residencies haven't started yet, I can't say that we scrambled into the perfect match for Scott, but it sure feels like it - family medicine, sports medicine in the curriculum, dually accredited, OMT training! We feel optimistic about the opportunities awaiting us in Wisconsin; and though we would have preferred to be spared the trial of scrambling, we feel the results were brought to us by divine design.


We are humbled and grateful to have had these experiences. They have reminded Scott and I that we should always prioritize the Lord and put our trust in His plan for us.

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.

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!

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 :) )

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.

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 year, 2nd 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.

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!

Residency
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!

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*

Med School Update: Match Rank Order List

Last year when we were beginning fourth year, I sent out a plea asking for someone to give me the DL on residency applications, interviews, and advice on how, in the world, the match actually works. I got nada in response. That's not true - I received blank stares and well wishes. That should count for something, right?

If you recall, in October Scott applied to ten residencies that he was most interested in, and throughout November and December he occasionally took breaks from his required rotations to interview with the residencies that invited him to visit.

When friends and family asked where we would be for residency next year, I've told them about Scott's list of ten residencies and interviews. Then I described how Scott would rank his list of residencies in order of his preference and the residencies themselves would rank all of the students they would accept into their residency in order of preference. These lists would separately be submitted via the internet. Then magic happens in March, and the computer algorithm would spit out where my husband would receive training for his future career. The National Resident Matching Program (NRMP) website shows pictures of ecstatic models and names this process "the algorithm of happiness." Really?! I think that's taking it a bit far, but whatever makes you feel good.

Now that Scott has officially submitted his rank order list for residencies on the NRMP site, I have a better understanding of what is going to happen during the match process in March. I've read several articles from residents and doctors about the process, but probably the most understandable explanation came from Scott's school in a PowerPoint slide sent to students.

In my words, aka layman's terms, here is a synopsis of the national resident matching program:
The first part I described above is still true. Each student will apply to and interview with residencies. In these interviews, the students and residencies (residents and faculty have a voice in the decision) have a chance to ask questions to form an idea of whether the residency would be a good fit for the student. Fit depends on the student applicant really - how they prefer to learn and work, what types of procedures they want to perform, if they feel a connection with faculty or current residents as future mentors and colleagues, focus of the residency training, the student's bedside manner and interviewing skills, etc.

Pretty much every interview will end in the student saying "I would love to come train with you next year," and each residency coordinator sending you a thank you card to say how much they enjoyed your visit and hope you stay in touch. It is important to stay in touch with the residencies you plan to include in your rank order list, which means email or call residents and faculty with questions you still have about the residency. The students are not allowed to tell the residents the order of their rank list, and the residencies are not to ask.

Students register for the match often before they've even interviewed. Then in February the rank order lists are due for the MD residency match. This is where the algorithm of happiness makes  difference.

This is how the algorithm works, as it was explained to me. The student will list the residencies they wish to match with, in order 1 - 20 (you can add more to the list for a fee) with one being your favorite residency. The student will want to list residencies that are their favorite but also consider the odds for the residency including the student's name on their rank list. So if the student didn't interview with a residency that they applied to, the odds of that residency including the student's name on the rank order list are slim. Something to keep in mind.

The residency then lists all of the students they would accept into their residency in order of their favorites (not sure if there is a limited number).

Between the February rank order list deadline and the match announcements at the end of March, the algorithm tries to put students into their first choice of residency. This happens if the residency has the student listed on their rank order list of students and if there is a resident position open. If the student wasn't on the residency's rank order list or other students also ranked it high and were listed higher on the rank order list, the algorithm would then move on to the students second choice and goes through a similar process. In theory, the algorithm is supposed to connect the most student applicants with their first choice of residency.

Clear as mud?

The long and the short of it, is that we'll announce in the end of March where Scott will be training for the next three years. Booyah!

Med School Update: Residency Interviews

It was only a few days after Scott applied to residencies that he started to receive invitations to interview. Residency interviews take place from October to February of fourth year. Each residency contacts the applicants by email to extend the invitation to interview and offer potential dates. Students will likely have other rotations planned during that time, so they have to take time off from their rotation in order to attend the interview days. Typically, these residency interview schedules will include a dinner (the night before or night of the interviews, often including spouses or significant others), a day of interviews blocks (7:00 or 8:00 Am until around 3:00 Pm) with current residents and faculty, with a lunch in between for casual mingling and Q&A. The student may be interviewing with four or more other applicants on the same day, depending on the size of the residency. Interview questions are similar to job interviews, where they ask the student questions like: "why this specialty", "why this residency", "how do you overcome your weaknesses", etc. COMP-NW provided  its fourth year students with an online resource to prepare mentally to anticipate and answer these residency interview questions.

The requisite pre-interview selfie demanded by crazy blogger wife

Scott has now completed four residency interviews. One of his interviews happened while on an audition rotation with one residency. For that interview, Scott had a one hour discussion with the residency director on the last day of his rotation. All of the other interviews are scheduled for a full day, and Scott has had to take time away from his scheduled rotation in other states to travel to and attend the interviews. He has had to make up any time that he missed for those rotations due to interview travel.

Last month I had the opportunity to travel with him to one of the interviews. I attended a dinner the evening before the interviews. It was very casual event where some first and second year residents talked about their experience with the program and answered students' questions about program curriculum, camaraderie, and faculty. There weren't any resident spouses for me to talk with at that particular dinner, but there were other applicant spouses at the dinner. It was mostly interesting for me to hear how the residents enjoyed their experience. I observed their emotions as they talked about the curriculum and faculty, their home lives during residency, as well as the interactions between residents. I also observed how my husband interacted with this group of residents. That information was invaluable to me, and I would have never learned tidbits like that from the residency website or even from Scott's recount of his day of interviews.

I heard the residents speak somewhat about their satisfaction in residency choice. All of the residents there were extremely satisfied with their choice and talked about school friends who were unhappy elsewhere in the country. Not to say there is A LOT of choice involved when you go to a residency, since in the end students have to go through Match Day; but students do rank their residencies, and we have heard that family medicine residents are likely to get a higher ranked residency choice. At the end of our dinner, one of the residents said that in his experience, there are two types of applicants - the type to make a spreadsheet in preparation for the Match, and the type that base their decision on gut impressions. *insert sheepish grin

I may or may not have created a spreadsheet for Scott prior to his interviews. Let's be honest, we all knew what group I would be in, and thus what group Scott is in. That same resident recommended to our dinner table that the students use their gut instinct to decide how to rank residencies for the match. What does he know? I had a system.

Actually, after my interview day with Scott, I would 100% agree with that resident.

Those who know me are shocked, I know.

Since I wasn't allowed to be a fly on the wall of the hospital during his interviews, Scott and I talked about every detail on the six hour drive back to Oregon following the interviews. Based on his impressions during the interviews, that residency had exceeded his expectations and went higher up on the list. Still, the most insightful question was "can you visualize yourself being happy in this residency?"

In the end, it doesn't matter if one residency had a six in one column of the spreadsheet and another had a nine - I want to know where he feels like he would fit in best, where he can visualize himself being successful. Because if he comes home happy every day and is excited to go back to work, then I'm happy too. *spreadsheet deleted

Med School Update: Applying to Residencies

I would like to say here and now that fourth year is no bueno.

Sure, there is definitely a light at the end of the tunnel.

In general, though, "the tunnel" hasn't been all that bad... except this last stretch. Why?

1) Because the students of COMP-NW (and many osteopathic medical schools, as well as some allopathic schools) spend the first half of their fourth year traveling to all of the various residencies to which they want to apply. These audition rotations are great for Scott, as he shines in person and is able to get a feel for whether the residency would be a good fit. However, Scott will spend approximately five weeks at home between July and December. That part is no bueno.

2) Applying to residencies is almost exactly like applying to medical school back in the beginning, and that was a big no bueno in my book. Hopefully by the beginning of fourth year (if not earlier) your student has decided how they want to spend the rest of their lives. Then they have to look at all the potential residencies in the United States. Even if your student knows what attributes they like best in a residency, it can be tricky figuring out which residencies would be a good fit for your application (there wasn't a search for sports experience on FREIDA). Is there a sweet spot for number of residencies to apply to? I've heard 10. I've heard 20. Some say apply to them all. It probably depends on the specialty your student has chosen to pursue.

Then you have the essays... Describe - in the most entertaining, but profound manner - why you want to be the bestest doctor in the world. Not that again!

Is this the face of someone who loves writing application essays?

The list of application no Buenos goes on: applications fees, the stress of waiting for invitations to residency interviews, the interviews themselves, THE MATCH!

You get the picture.

3) Fourth year is expensive. Students are still paying tuition, not being paid for working hours, paying to travel for rotations, shelling out applications fees, paying for travel to interviews, paying for travel to boards that can only take place in Pennsylvania... It's a good thing Scott has a sugar mama like me.

...

Now that I have sufficiently described for you how fourth year is no bueno, and all med students and med school wives should bask in the glory that is Years 1-3...

You should know that we are doing great! Not sarcastic. All things are copasetic. Despite how not cool this year is formatted to be, we've gotten used to some not cool things and have learned to just keep swimming.

In August applications opened for residencies connected to osteopathic medical schools. Scott decided not to apply to any osteopathic residencies. This is not a reflection on the quality of residencies or osteopathic opportunities. He would love to keep up his OMM training. It just so happens that the majority of the residencies Scott has elected to apply for are connected to allopathic medical schools. Since the osteopathic residency match happens before the allopathic residency match this year (supposedly will change in future years); Scott decided that if his top choices were in the allopathic match, he would be better off only applying there. Allopathic residency applications opened in September.

I did a lot of researching on residencies for Scott. We were lucky to find a list of five residencies that were an über good fit for Scott (great sports medicine integration in the curriculum, some with OMM training too). Since Scott felt fairly confident after completing his first audition that he could be accepted into one of his top five choices, we supplemented that initial list with five more (sweet spot of 10?) residencies in the western United States with decent sports experience included in the curriculum.

Because I know you're curious, and because I love maps, here they are:

D.C. is the capital, not a residency. A residency in Hawaii (yes, ma'am!) is that star in the Pacific Ocean.

Interviews will begin in November. Scott has heard back from the residencies where he has already done audition rotations. We are thinking that in some cases auditions may be given first priority for interviews. One of Scott's audition rotations offered for him to go through the interview process before he left, which is a nice way to save on travel expenses... not to mention the effort of taking time off from the rotation he would have be on during interview season. We are still waiting to hear back from most of the residencies to which he applied.

Like I said, all things copasetic.

A Continuously Growing Campus

West side of COMP-NW campus September 2014

Last month I drove past the opening ceremonies for a veteran's living facility that was built in connection with the Samaritan Health campus. We have been watching that construction for months now, and it is exciting to see the buildings finished.

You can see from my panoramic photo above that the field across from our apartment has had significant construction since we first moved in, back in 2011. The field now contains not only the medical school, but an urgent care facility, events center, bank, a dialysis center, and now across the street by the elementary school is our new veteran's home. Currently under construction on this field is an 84-room hotel, which apparently they will be calling the Boulder Falls Inn.

It has been neat for us to watch the changes in this community. We have felt lucky to be here for four years and to meet so many wonderful friends here.

Med School Update: Clueless Fourth Years Seeking Advice

This was a common occurrence last year during rotations:

Physician, after asking a difficult anatomy question: What year are you?
Scott: Oh, I'm a third year.

There was great comfort in saying those words - he had just finished two years of book work, and even if he was at the end of his third year and had completed many rotations and "pimping sessions" (where the doctor grills the med student with complex questions on disease function or drugs), he still had an excuse for not knowing the answer... or by knowing the answer, he was some how more impressive.

That excuse is gone.

And fourth year can be intimidating. Some audition rotations give their fourth year students great responsibility because the next year they will be doctors charged with the care of patients. On the other hand, some audition rotation sites will have plenty of interns (first year residents), residents, fellows, and faculty who have received their doctor status. Fourth year students are then merely given the opportunity to shadow. No matter what the experience is, in audition rotations the student has a glimpse of what their working life would be like if they were a resident there.

Even though we've begun fourth year, the schedule and process of fourth year medical students is still so mysterious to me. There is little to no direction from the school (Scott may receive emails from the school's rotation office, but that rarely gets relayed to me). The decision of where to do audition rotations and where to fulfill school rotation requirements is all up to the student. Scheduling of those rotations is all up to the residency hospital systems, so your fourth year schedule is at the mercy of every residency coordinator.

When do you start applying to residencies? When are interviews supposed to occur? How does the match really work (in layman terms, please)?

This is about the time when I really wish there was a class ahead of us, and I could have spent the last few years watching them mess up and learning from their mistakes. Alas, we are the first graduating class on this campus.

Using my finely honed research skills, I have found some helpful articles linked below. But truly, if someone out there has gone through this mysterious process and can offer advice, I would be overjoyed to read said advice.

Applying for Residencies
AAMC: The Cost of Applying for Medical Residency
NRMP Match: Tips and Reminders
AAMC: Roadmap to Residency

Residency Interviews
DIT: When Should I Schedule Interviews?
DIT: 6 Tips for Residency Interviews
Chief Resident Interview Tips
Interview Stream (Resource offered to students at COMP-NW)

UPDATE POSTS: Residency applications

Yr 3 Perspective of a Med School Wife: Jenny

I really appreciate that Jenny was willing to share some of her story. Even though Jenny and Terryol are no longer together, she is likely his best cheerleader.

Every time I see Jenny in town she exudes courage, patience, and kindness. I am so impressed with all that she's accomplished, and we are extremely lucky to include her in our medical school journey!

Q: What are your responsibilities this last year while your med student was on rotation?

A: I continue to live my dream job of being a homeschooling mom.

Q: How are you preparing for residencies?

A: I have been decluttering (inside and out), finishing projects/books or passing them along. That way I will not be as intimidated if we end up needing to move.

I have had more exercise opportunities this past year. I always bike but that was about all Lebanon had (for my interests) until the pool opened several classes and opportunities enabling kids to swim while moms workout. We even got coached in masters swimming sessions for about 6 months! Being healthy and happy is the only preparation I think we really have any significant control over.

I have been surprised how tentative 4th year really is and admire all those that have already moved knowing their original homes are the best base camp for them. We are exited graduation will be here momentarily - this whole process really does go by quickly. 

Q: Any advice SOs beginning third year?

A: Make sure you have some worthwhile hobbies/projects going on so that your oil lamp/joy stays full.

Yr 3 Perspective of a Med School Wife: Alyssa

Alyssa is a first time contributor to our little perspectives game, but the more the merrier I say. Everyone's family has unique circumstances, especially during third and fourth year of medical school. Each perspective helps me to see what I can do to better support my student and what I might expect in the future. Thank you for sharing, Alyssa!

Q: What are your responsibilities this last year while your med student was on rotation?

A: We have 4 kids ranging in ages from nine year- old to a one year-old, so my day was pretty much just keeping up with them and all their activities -from soccer practices to guitar lessons, church activities, and homework. Their schedules kept me pretty busy. Then there is all the housework, laundry, planning and cooking meals etc. Because Zach was gone a lot, I am also in charge of financial aid for him, taxes, benefits, and insurance for our family.

Q: What did you do differently in year three to support your med student?

A: The same as the last two years, just let him tell me his schedule and what he has to do. To make it easier on myself I would tell myself he is not going to be able to make it to most things and if he is able to show up it's a bonus. That way he is able to study for shelf exams and keep up with the quizzes and coursework that goes with each rotation.

The BIG extra thing for me was I made cupcakes for each rotation site he was at to say THANK YOU to everyone who helped him. I made enough for his preceptors and office staff at each rotation. It was a way for the preceptors to remember him, and it helped grease the wheels when he asked them to write letters of recommendation. I usually made them in week 3 of the rotation.

Q: What surprised you about clinical rotations?

A: How much he was still gone. You think it's going to be better because EVERYONE says third year is better (which it is to a point) but they still have quizzes and assignments with every rotation.  Depending on the preceptor you get, there is a LOT of on-call weekends and nights. For us it was PEDS, OB and IM that were the rotations that he was gone the most. He also had to leave for two months to do two rotations on the coast (surgery and family medicine).

Then there is didactic week every 12 weeks where there are practical and written exams, so the students are of course cramming for those.

 The biggest change I saw for positive was actually in Zach. He was happier and not so beat down and mentally tired. They are finally actually practicing medicine in a clinical setting. They aren't sitting in a classroom for 8+ hours and then studying to all hours of the night on top of that. 

Q: How are you preparing for residencies?

A: I think our situation is a little bit different because we have 4 kids...and they are older. We have to think about their needs as well as what is best for Zach. Obviously we wanted Zach to have the best residency possible, but with also the best possible situation for our kids as well.

So we looked up all the DO OB/GYN rotations...Zach looked at the programs and what they offered as far as education and training. My job was to look at everything else. I looked at pay, vacation time, benefits, perks (malpractice insurance, paid CE, paid license fees etc), and cost of housing. Housing and pay were a big one. Some of the residencies sounded great...but it was in downtown Detroit and the pay wasn't that great. $42K a year with 4 kids would have us living in the ghetto...that's all we would be able to afford. So we tried to find the balance...where could we afford to live that was safe for our kids, but get Zach a great residency education.

Then Zach ranked them and stating in December started trying to set up auditions. Most don't open up until January, and with most if not all of his residency auditions you HAVE to be persistent and DOUBLE CHECK and DOUBLE confirm EVERYTHING! Often he talked to many different people, and one person would say he was ʺpenciled inʺ for a certain time period...Zach wouldn't get an email, so he would call next week and the department head would not know a thing about it.

Q: Any advice SOs beginning third year?

A: Don't expect a ton of one on one time with your student. They still have lots of work and their schedule depends entirely on their preceptor. Make some sort of treat for the preceptors and staff. It's very much appreciated, and it really helps them remember you. Zach is known as the cupcake guy. Everyone was very excited when they found out he was rotating through their office. :)