Days of Daze
I only recently met with the man who will write my Dean's Letter1.
I'm dazed. I'm tired. I'm fighting this fog of exhaustion, and I feel like I've lost my way. Having to think about applying for residency turns my stomach. It means writing personal statements, and exposing your blemishes for all to see. Perhaps it's my perception, but it's always my shortcomings that seem to stand out, muting whatever good things that may be in my portfolio. Instead of comments like "Wow, nice job with the research and publications and clinical performance" I get "Hmmm, well, couldn't you have honored this clerkship? You should schedule some external rotations next year. Are you really happy with that board score?"
I wonder how much of my angst is me just being tired of trying to climb the academic ladder. I've been at this large university medical institution for almost a decade and before that I was at NIH, an even larger medical institution, so I've have quite a level of comfort being at these places. At the same time, I'm kind of sick of the idea, and I'm thinking seriously of just going into primary care and waving goodbye to academia2.
And what, pray tell, am I supposed to say when I start hitting the interview circuit? I spent five years in graduate school, and having to still sell the line about academia is such a tiresome thought. And that strategy about being yourself? I think that's true to an extent, but being too honest at this point can only hurt - can you imagine hearing the following from someone applying for a residency spot in your program?
There's also the possibility that my exhaustian is somehow a manifestation of me being quite lost at the moment. I haven't yet decided what I want to do with myself. I liked pretty much all of the third year clerkships, meaning I haven't chosen yet. Here are the rotations in the order of my third-year schedule:
1 Fourth year of medical school is mainly about getting more clinical experience and applying to medical residency programs. The Dean's Letter is basically an advocacy letter written by a faculty member, who focuses on the student's strengths whether it be academic record, research experience, physique, hairstyle, or manner of dress.
2 For further thoughts on being in academia, see oh, any one of my previous postings on my experiences during graduate school.
I'm dazed. I'm tired. I'm fighting this fog of exhaustion, and I feel like I've lost my way. Having to think about applying for residency turns my stomach. It means writing personal statements, and exposing your blemishes for all to see. Perhaps it's my perception, but it's always my shortcomings that seem to stand out, muting whatever good things that may be in my portfolio. Instead of comments like "Wow, nice job with the research and publications and clinical performance" I get "Hmmm, well, couldn't you have honored this clerkship? You should schedule some external rotations next year. Are you really happy with that board score?"
I wonder how much of my angst is me just being tired of trying to climb the academic ladder. I've been at this large university medical institution for almost a decade and before that I was at NIH, an even larger medical institution, so I've have quite a level of comfort being at these places. At the same time, I'm kind of sick of the idea, and I'm thinking seriously of just going into primary care and waving goodbye to academia2.
And what, pray tell, am I supposed to say when I start hitting the interview circuit? I spent five years in graduate school, and having to still sell the line about academia is such a tiresome thought. And that strategy about being yourself? I think that's true to an extent, but being too honest at this point can only hurt - can you imagine hearing the following from someone applying for a residency spot in your program?
"Nah, screw academics. I'm tired and burnt out - there's nothing worse than the thought of spending the rest of my life hanging around a place like this."See? Refreshingly honest, but not exactly endearing.
There's also the possibility that my exhaustian is somehow a manifestation of me being quite lost at the moment. I haven't yet decided what I want to do with myself. I liked pretty much all of the third year clerkships, meaning I haven't chosen yet. Here are the rotations in the order of my third-year schedule:
- Psychiatry - I enjoyed it, and as much as I enjoyed talking with patients, it just doesn't feel like practicing medicine. Yeah yeah, you can order a couple tests here and there, prescribe some drugs, but in general, I would find it relatively unfulfilling.
- Medicine - aka "Mental Masturbation." Talking to the patient and getting the diagnosis is fun. Treating them can be gratifying, but it can also be infuriating, especially in this day and age of diabetes and heart failure where you're just managing the illness and slowing the progression of whatever disease they have. The endless morning rounds can be really painful, but Medicine offers quite a few options for career choices.
- Family Medicine - Much like medicine, but a little less emphasis on hospital work, more outpatient medicine. Basically, you take care of patients 'From Birth 'til Death'. Not a bad option, although spending so much time in the office could potentially drive me crazy. But I'm weighing that against the fact that apparently I'm really allergic to hospitals.
- Pediatrics - Medicine, except for little people. Loved it. Not certain I want to make a career of it. I's not like there's a shortage of pediatricians out there, and, like family practitioners, it's a tough living salary-wise.
- Surgery - I enjoyed surgery, I could think like these guys. But the early start to the day (surgeons are slicing someone open when the rest of the world is brewing their morning coffee) combined with a diminished relationship with the patient is quite the deterrent for me. You have to love the procedures more than you do the patients.
- OB/GYN - I actually haven't done my OB clerkship yet. I'm anticipating the worst.
1 Fourth year of medical school is mainly about getting more clinical experience and applying to medical residency programs. The Dean's Letter is basically an advocacy letter written by a faculty member, who focuses on the student's strengths whether it be academic record, research experience, physique, hairstyle, or manner of dress.
2 For further thoughts on being in academia, see oh, any one of my previous postings on my experiences during graduate school.
posted by Mikey at 10:38 PM
13 Comments:
hey there Mikey,
I think you should keep in mind that honesty and absolute complete truthfulness are two entirely different animals. If someone asks, “How are you?”, either “Fine, thanks” or “I’m having a bit of a rough day” are both perfectly acceptable and indeed preferable to the complete truth such as: “I’m so constipated, it’s like there’s a family of gophers colonizing my bowels.”
People don’t actually want the whole truth. They understand that on things like reference letters the purpose of the letter is to convey a positive message and neglect to mention the blemishes or put them in a good light. People who write reference letters usually, but not always, understand this. There are tactful code-phrases for saying negative things, particularly in academia, such as, “Works well under supervision.” (This does not mean the person works well. It means the person lacks initiative and that you need to check up on them and scrutinize their work.)
Reference letter writers who complain about your achievements to you are really saying that they don’t you well enough and they’d like it if they could reference some external outstanding score rather than have to put out something that they’re not really sure of. Don’t take it personally. Reference letter writers who know and like you don’t complain about these things. That's why some terrible people look great on paper.
re: Are you really happy with that board score?
Sure, a great score is a great thing to have, but I can’t imagine that re-writing the boards at this point would improve your record on paper or make you a better doctor. The person who asked you that question is a douchebag.
Academic labs are desperate for post-docs. They take foreign MDs with no lab experience for fellowships. And if those foreign MDs manage to get a paper out and if they’re from Japan, they can go back where they came from and they’ll be given a PhD. Free, literally! You could go wherever you wanted to for a post-doc, if you wanted to. But no one really wants to be a post-doc, and I think you should really think about how far you are from writing an R01 and getting funded. If that seems so far away that it’s out of reach, then quit pissing around in academia and go do something you enjoy.
Now I’m really curious as to why you think psychiatry would be unfulfilling. You enjoyed it. Not too many people really like dealing every day with the mentally ill, really, it’s rather challenging in the people-skills department. Why do you think that things that seem easy to you aren’t enough work to be fulfulling? What exactly does "work" mean to you? (Does your career have to be a pain in the ass?) Couldn’t you be one of the rare happy, well-adjusted psychiatrists?
How are you going to get past where you were last week, last year? You don't have to be tjagluum, do you?
Dang, Lia...what did you do with your Saturday?
Well, what I didn't convey effectively in this post (because I actually started writing it about a month ago and didn't finish it until just before posting) was that, yeah, I know that complete honesty wouldn't work. What I really should have said is something to the effect that I'm kinda too tired at the moment to even come up with a more diplomatic answer. I'm too tired to fake not being absolutely exhausted at the moment. I'm hoping that, come interview time, I'll be enthusiastic enough without having to act.
re: Are you really happy with that board score?
Sure, a great score is a great thing to have, but I can’t imagine that re-writing the boards at this point would improve your record on paper or make you a better doctor. The person who asked you that question is a douchebag.
I made that up, actually. My board score is fine, thanks. But is it ever really high enough? But your point is well taken - the faculty member writing the letter is just getting to know me. And he's a Pediatrician himself, so he's so not a douchebag, although you're picking up on the frustration of the application process, that it can be too focused on numbers and not the person. But...that's what the interview is for. Board scores, grades, combined degrees,...they all serve the function of getting one's foot in the door.
Now I’m really curious as to why you think psychiatry would be unfulfilling.
Hmm. Well, the truly mentally ill people aren't as fun. And there's not much you can do for them. Yeah, a little depression there and a little seasonal affective disorder there, that's usually pretty easy stuff. The more complex cases, it seems that you're just rearranging furniture on the deck of the Titanic. And there's so little science (as of yet) to back up what they actually do in Psychiatry, when compared to the other fields.
Are there times that you get a patient to truly feel better about himself? Rarely, I think - it seems that you get the patient to the stage where they are not a threat to themselves or anyone else, and then anything else is pretty much in the realm of behavioral therapists. What I'm basically saying is, that it is my belief that the breakthroughs and happy endings are even more rare in Psychiatry than they are in Medicine.
As far as what I enjoy, I enjoy interacting with patients because I seem to be good at it. It doesn't mean that patient interaction should be my sole focus. I enjoy the 'mental masturbation' part of medicine - figuring out what's wrong, coming up with a strategy to treat the problem - in addition to the social part of the thing. There's less of that in Psychiatry than Medicine. I think Medicine offers the widest range of possibilities, s'all.
Aaaah, what do I know? It's all pyrboerl to me.
re: Dang, Lia...what did you do with your Saturday?
Pissall, actually, but it was pretty nice.
You did say the idea of residency applications turns your stomach, so I was trying for a plop plop fizz fizz effect. Probably I told you things you already know, (does it seem like less of a big deal when I point out the obvious, or an insult?) The way you wrote out your options made it look to me at a glance like you were all for skipping the 'easy' stuff, and that you wouldn't be happy with anything less than complete exhaustion.
re: Aaaah, what do I know? It's all pyrboerl to me.
Who knows more about pyboerl than you do?
Oh man, I hear ya. *sigh*
Lia, your comments on postdocs are a bit inaccurate. Most labs I've been around wouldn't hire foreign MDs with no lab experience. And the comment "no one wants to be a postdoc" should probably be ammended to "I don't want to be a postdoc". Or, "no one wants to be paid like a post doc". But residents don't make much more than postdocs anyway, from what I've been told.
The way you wrote out your options made it look to me at a glance like you were all for skipping the 'easy' stuff, and that you wouldn't be happy with anything less than complete exhaustion.
There's some truth in there. And perhaps if one to take the time and patience to psychoanalyze me, then I'm sure that there is an element of that statement that is manifesting in my decision-making tree.
Although it could also mean that 'easier' stuff can become routine and boring, while 'frustrating' stuff leads to interest and burnout :)
Mikey,
Decisions grow on trees? cool!
I just meant that you might be overlooking your own strengths because you think if something's easy for you, it must be easy for everyone...myself, I've been bored of frustration.
re: "I made that up" -- promise me you won't ever go on Oprah...
Anonymous,
If you're a post-doc and you like being a post-doc, show some keqetk and say so. I've yet to meet a post-doc who really really wanted to be a post-doc, as opposed to having it be something they put up with because they had to do it to do something else.
I saw a big sign outside a McDonald's offering 35K starting salaries for assistant managers, so I don't think these people are really in it just for the money.
A residency is a clearly-defined step. Up. Some post-docs finish their post-docs and then do...another post-doc...as if they're climbing the down escalator.
I don't think that happens for residents. I can think of eight MDs with no previous lab experience that I've seen post-doc-ing (with varying degrees of success) off the top of my head. I think it's a horrible idea, but unfortunately not as uncommon as it should be.
Nobody wants to stay a postdoc forever, that's true. And there are many people who end up doing that. I am a postdoc, and I initially didn't want to do it, but I've found I actually like the work, and my life, quite a bit. I don't have to wake up at 3 am to go into surgery like our buddy Mikey, nor do I have to work 100 hours a week as a medical resident. I certainly don't plan to spend 5 years at this level, either, so to me it is definitely a step up to something. And certain fellowships pay considerably better salaries than assistant managers at McDs. But postdoc'ing isn't about the money, obviously.
Anonymous,
Please do come back and share when you get a name and/or a blog to show us more.
I've come across very few post-doc blogs, though there are quite a few posted by grad students out there, and even the ones who seem happy and well-adjusted manage to come up with names for their blogs along the lines of, "I drink from the toilet!" Hmmm....this could be the start of some fun with the blogger search engine, but just now I've got other shwphtd stuff to do.
Thanks Lia, but I would never post my daily life and thoughts for anyone (potential employers, etc) to dig up some day. Just not in my nature to share that kind of stuff with cyberspace. But I'm not surprised that you find a lot of negative blogs from grad students, seems like there is a lot of unhappiness stemming from the lifestyle, although I think a lot of them are just naturally unhappy anyway. More of a "unhappy, socially inept people tend to gravitate toward science" effect as opposed to science makes them that way. But who knows, I'm just a postdoc, not a social scientist.
re:
Just not in my nature to share that kind of stuff with cyberspace.
I see...well, probably that's a very good thing for cyberspace.
Well, Lia, not everyone feels the need to bitch and moan daily online about their lives as career lab technicians. Get a life.
Please, folks, let's refrain from punching below the belt.
People are free to post comments without being required to divulge their names or keep blogs of their own. And I happen to know many "career lab technicians" who can work and think circles around post-docs, so there is certainly no shame in that.
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