How to Become a Doctor: Part 3

The conclusion to my journey becoming a doctor.

As with every good story, there needs to be a trilogy.  So this is the third installment of my story and how to become a doctor.  You can get caught up on the first two posts here: Part 1 and Part 2.  Last post ended as I graduated medical school, but this one starts before that.  At the end of the 3rd year of medical school, every medical student sets up an ERAS account. ERAS stands for Electronic Residency Application Service.  This is where we were able to start the application process for residency.

Prior to applying for any residencies, I had to decide on a specialty.  I decided to become a family physician and applied to only Family Medicine Residencies.  The experiences of other students applying to surgical specialties or the most competitive residencies such as dermatology, ENT or ophthalmology were much different than mine.  I can only relay my experience.  Family Medicine is traditionally considered a less competitive specialty, but I chose it because it was what I wanted to pursue, not because it was easy.

In September through December of the 4th year of medical school, I traveled to the residencies which had offered an interview based on my application.  Having grown up in Northern California I knew I wanted to move back. So I interviewed at the UC Davis Family Medicine Residency Network (a network of 7 family medicine residencies from as far north as Redding down to Merced in the central valley), Loma Linda (mostly as practice as I knew I didn’t want to stay is So Cal), Reno and a few others in the Bay Area and Sacramento.

In January after all of the interviews are completed, all students make a ranked list through ERAS of the residencies they would like to attend.  The Residencies all make a similar list on their end.  The ERAS program then takes all of this data and matches up students to residencies using a complex algorithm.  In March, the results of this program are revealed on Match Day.  If a student didn’t match (which does happen, especially in the more competitive residencies), they find out 2 days before Match Day. The next day is then spent literally calling residencies looking a position (sometimes out of the residency of their choice) in a process called scramble day.  This is a complex process which is extremely stressful that I thankfully avoided and do not have insight into.

My match day was an exciting and nerve racking day.  The results of the match are released to every medical student across the country at the same time.  At Loma Linda there is a banquet where they pass out the results.  Waiting my turn felt like forever. Finally, my name was called and I went up and got my envelope.  I went back to my seat, sat next to my wife and slowly opened the envelope.  In small 12 point font were the words, “Mercy Medical Center, Redding.” This was second on my list. I was excited. We were moving back north but had overshot Sacramento! The next few months were spent setting up some housing and getting settled in before residency officially started on July 1.

Residency for family practice is a 3 year program. The first year, or intern year is the most grueling but it improves through years 2 and 3.  For family practice I wanted want to go to an “unopposed” program to get the best education.  This means that there were no residents from other specialties at the hospital.  This was ideal because I was not competing with the other specialties for procedures or patient contact.  Mercy Redding is an unopposed program where we residents had full reign and could do just about anything as long as we could find an attending to follow.

Residency was similar to the 3rd and 4th year in medical school in that I had rotations through different specialties to gain experience.  Since family practice is a specialty that encompasses so many different areas of medicine, we rotated through just about every specialty.  There was a focus on internal medicine, pediatrics and Obstetrics-Gynecolgy.  

Learning through residency was mostly done while treating patients under the supervision of an attending.  “Pimping” was still prevalent during rounding. Every lunch time was also a didactic period spent listening to a lecture on different topics.  Repetition was the key so we were exposed to patients as much as possible.  This included taking call and working long hours.  Luckily, we had a “night float” for internal medicine.  Night float is where one resident works nights for a week or two to cover the overnight shift.  Unfortunately, we did not have night float for pediatrics and OB-GYN so we took call about every 4th night.  I was again blessed to be a “white cloud” but still had a few rough nights.  

At the time I was in residency, laws were in place to make sure residents were not overworked.  When on call we could only work for 30 continuous hours.  So typically we would show up at 7 AM the day we were on call and work through the night until 1 PM the next day. There was also a law that residents could “only” work a max of 80 hours.  Fortunately it was very rare that I hit that number.  It was not unusual to work 60 or more hours though when on an inpatient rotation.

At a point in the intern year every intern takes the last test in the USMLE (United States Medical Licensing Exam) series called “Step 3.”  This one allows a resident to get his or her state license.  Once this and a year of residency were completed, I was able to apply for my state licence after completing a bunch of paperwork. I did this and halfway into my second year I got my license.  Once this was obtained, I was able to “moonlight.”  This is where a resident can work at local clinics or urgent cares under his or her licence and make some extra money.  I took advantage of this a few times a week at about two and a half to four hours at a time.  The extra cash was nice because I really didn’t get paid much while I was a resident.

Things got easier as I became a second and third year resident.  Call became less frequent and rotations moved more into the outpatient setting with a typical 8 to 5 schedule. As a family practice resident I had my own patient panel in our resident clinic.  This was what I enjoyed the most because I was able to form relationships over the course of 3 years.  I was also required to follow at least 10 pregnant women through their pregnancies and deliver the babies.  I then followed the babies as they grew.  This was such a rewarding experience.  The only downside was that I had to be on call essentially all the time to be able to attend these deliveries. (You probably get the notion that I don’t like taking call.  You would be correct.  That is why I am so blessed to only have to take phone call at my current job.)

Late in my second year of residency I was encouraged to place my name on the ballot for one of the two chief resident positions.  I agreed and was voted the first chief resident of my class.  This came with many responsibilities and a few perks.  I had the onerous task of managing the residents with any interpersonal problems that arose.  Unfortunately, these did come up and I had to mediate a few conflicts.  I also made the rotation and call schedule.  By doing this I was able to create the schedule  with all the days I wanted off and make sure my rotations were exactly what I wanted.  

After three years I had my last graduation.  This was another amazing experience. I had the honor of receiving a plaque for being chief resident and I was also voted resident teacher of the year.  This was an award for the best teacher as voted by my fellow residents.  Again, my family, close friends and mentor, my uncle were present.  Each resident was given time to speak and I thanked all who had helped me get to where I was.  I also had a message for my son, who was just 7 months old at the time.

That’s where I want to leave this post and this series.  Shortly after this I took my boards and passed, becoming a board certified family physician.  I landed a job locally where I had been moonlightling and worked there for the next 2 years before moving to where I am now.  I have had an amazing experience leading me in my current position.  I look back and see that after inspiration struck from my uncle, I locked onto my dreams and pursued them vigilantly.  There were a few times where it almost didn’t happen including almost not being able to afford going to college and going down to the wire before getting accepted to Medical School.

So I’ll end this with the same thing I told my son.  “You can do anything you put your mind to.  Don’t let anything stand in your way.  In the future you will have dreams.  Grab on to these and don’t let go.  Shoot for the stars and when life gets in the way or puts up an obstacle, look for a way through or around because it will be there.”  I wish this for you as well.

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