How to thrive medical residency

I'm a third year internal medical resident thriving in an underrated city sharing my practical tips for thriving (and surviving!) in good health and peace of mind during an otherwise arduous training period for all those involved.

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Before you know kindness as the deepest thing inside, you must know sorrow as the other deepest thing. Naomi Shihab Nye When most people consider the grief endured by physicians in training, they look first to the devastating narratives of patient care—sudden illness, agonizing decline, putrid...

What a powerful piece for those in or entering your journey through residency. Or even for those close to medical trainees. I promise you will never be the same. 

[howtothriveduringresidency]

First Job After Residency

I just started my first job as a hospital medicine doctor working a 7 on 7 off work week. This was after four months of vacationing, studying for board exams, and catching up family and friends. It's amazing time to say the least and I love my work 2 months in. I'm finally getting paid enough to make a dent in my student loans, pursue interests and hobbies I've put on the back burner for several years now, all while living in a fabulous city with a stable job. 

What more can you ask for?!

I decided not to pursue an academic hospital position for my first job. One being I’m too close to the residency experience. I would hate to be the physician who is unable to provide the full medical and clinical education because I was busy managing the learning cure of being a new attending,  the pressures of the HCAP scores and administrative duties. I see more and more reasons why resident well being during this learning process is becoming an afterthought both on a attending-residency level all the way up the the ACGME with the recent letter regarding the work duty hours. I just didn’t want to be apart of that right now.  

So my academic home is not my hospital. My academic home is collaborations with other researchers outside of my hospital that I developed prior to signing my contract. Interest I can pursue on my own time - fixed, and guaranteed.  Things to weigh when you consider your first job. 

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How to Move after Residency

So... I’m moving from Ohio because I found a job, signed, and am moving. How does one move on a resident salary of $50K you ask after paying in the last 1 year $1100 for ABIM examinations, $7,000 interview for fellowship/jobs, and credentialing costs upward of (DEA $741 and licensing $500)?

1. Your new job pays for it (moving and credentialing)

2. You saved and moonlit for the last 12 months

3. You borrowed money from the bank or from family members. 

The expenses creep up on you the last 9 months of internal medicine residency and that doesn’t even include the move!!!

So here are the options and tips on moving. 

1. Movers and Packers: Early bird gets the cheapest moving rates. Start moving company quotes 3 months before your move to get a cheaper quote. Weekdays are cheaper than weekends. Cost: a few thousand which can double if you quote June (high high moving season)

2. Movers only: you do the packing and a few movers come to load into the truck you rented. Lists are available with truck rental companies. Cost: a few hundred dollars

3. You. You are the mover and the packer and the truck. Cost: time which your program (fellowship or residency) may not allow.

Lastly, all trips to your new digs and new city are tax deductible so save receipts and account accordingly!!

Safe travels and move!!

[howtothriveduringresidency]

Another presentation and poster to top off the other 100 item residency program completion checklist?

So I’m wrapping up research time which means poster, presentation, papers, and REPORTS. I’ve never written a report before and thought if I can’t get the content right on the first go, why not at least get the layout right. 

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How to survive 30-hour call

For all the interns who are taking part in the intervention arm of the iCompare study which relaxes ACGME work duty hours or for residents who have to  violate duty hours for reasons take your pick (poor staffing, attendings and fellows who don’t care, sick patients, required meetings), here are my favorite things to pack while on 30-hour call!

Photo (top clockwise)

1. Sweater. Call gets chilly at 3 am.

2. Cooler bag filled with heart healthy dinner and breakfast options. I don’t need to subject my coronaries to the cafeteria all day AND night!

3. Socks. Toes also get cold at night

4. Eye mask for the lucky who are granted a few hours to shut eye. This is a must! As are ear plugs (not shown)

5. Hair tie - hair gets gross overnight

6. iPhone charger because they don’t make phone batteries like they use to and certainly not for 30 hours of use

7. Badge to get into high security parts of the hospital. 

8. Stethoscope. Self-explanatory

9. ACLS cards: chaos happens at night

10. Pager(s) as the case may be.

11. Personal hygiene for those that personally like to practice: Mouthwash, toothpaste, toothbrush, comb, floss. 

It all goes into an overnight bag and I guarantee you’ll feel thankful you didn’t succumb to that greesy pizza or dry stale turkey sandwich.  You may even feel refreshed come morning?

xoxox

[howtothriveduringresidency]

How to conduct your first clinical job search and resources for non-clinical jobs

Finally, I am here at the year three of medical training. The final year. After 13 years of training, I am about to find my real training job as a hospitalist. I started my process briefly during spring of my second to last year and now am full interview and application swing this October, November and December. Here are the great resources I came across.

1. Real people: I contacted recruiters in the location in the 2nd year I wanted to work along with my home institution where I don’t want to work to work with my CV, letter of interest, and introduction emails for cold emails to hospitals

2. Recruitment websites: you’ll get tons of emails from recruiters that don’t necessarily fit your job description. Here is a list of profiles I am using that tailor to my location needs. 

Glass door USA jobs practice link practice match

3. Adventures in Medicine resources book: I have absolutely know idea why this special workbook showed up in my mailbox, but it has been proven to be most beneficial! I love it because it provides step-by-step guidance and exercise to walk you through the whole job process including contract negotiation. It is even available online!! NEJM does one similar on CV and letter of intent as well though more in article form, but I find Adventures to be much more thorough.

http://adventuresinmedicine.com  

http://www.nejmcareercenter.org/article/physician-job-search-timeline-delayed-approach-not-advised/

4. Non-Clinical jobs: the same Adventures in Medicine has a great section on non-clinical jobs blurb and practical resources to look as well. I was quite intrigued to look at dropout club.org and http://www.prnresource.com at the jobs that need a physician eyes but were not necessarily clinical. 

Question: What are your tips for job hunting clinical and non-clinical hmmm?

TIP: save those receipts and travel expenses as they are tax deductible folks!

[howtothriveduringresidency]

Thrive in residency by making your voice heard MDs! Vote!

Best part about living in a swing state?

My Vote Finally Counts!! Again!

With new market economy factors including ACA, malpractice, ACOs, there is going to be more push for physician leaders in this wacky time. Practice by getting involved, have your voice heard, get an “I voted” sticker!

Tip:  If you don’t have time this year as busy residents, watch for the mail-in-ballot deadline date for next year. But first make sure you’ve registered as a voter in the state you are living in

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What to Pack During Interview Season

It is interview season applicants!

I was giving a tour to internal medicine applicants today and a few things came to my mind. I want to put your mind at ease for those who are applying this interview season.

Cleveland is not my home, home. It's not, but that is ok!  I'm a better doctor, culinary cook with all my le creuset cookware instead of gear.  I'm fitter even (just had my annual employee measurements and I’ve lost a few inches of the waist ya!). And I have a better appreciation of the geopolitical issues in this country especially related to health. The list goes on and on. 

With this in mind go for it have fun meet people! Find a place to yourself to thrive and do so in comfort!

Here is a list of my must-have items to pack when I travel for interviews:

1. extra pair of hose and my favorite comfortable heels

2. socks, eye mask, chapstick and hand lotion (air is so dry!) for the comfy time on the airplane

3. kleenex and hand sanitizer because its flu season!

4. thank you notes and a list of first impressions

5. nice jacket for the chilly airport

6. downloaded podcasts and earphones

7. glasses and extra set of contact lenses if you wear them

8. running shoes to work off those high calorie dinners

Helpful? Good luck applicants!

xoxoxo

[howtothriveduringresidency]

How to Thrive During Residency - Bulk cooking for the resident

For the resident who needs to eat to thrive. To make my life easier and always have tasty meals, my freezer is stocked with  frozen food I made from my bulk recipes and meats I picked up from the Virginia farms and D.C area en route back to Cleveland. 

Here are my 3 favorite bulk recipes that can be frozen and stored for times when I don't have time to cook. Kuddos for if you can make the Vietnamese chicken curry which requires some prep time. Bon ap!

1. Vegetarian black bean chili 

http://www.epicurious.com/recipes/food/views/Vegetarian-Black-Bean-Chili-230632

Ta da! Tuesday night dinner vegetarian black bean chili with greek yogurt, aged parmesan, and sliced green onion. Whole grain bread courtesy of On the Rise Bakery 

2. French lentil soup

http://www.epicurious.com/recipes/food/views/French-Lentil-Soup-236772

3. Vietnamese curry with french baguette (make sure to dip baguette in the delicious broth!)

https://www.youtube.com/watch?v=G_t5GlTeOW4

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How to Thrive During Residency - Advice for MD students on Match Day and taxes

Oh man. It's been a while since I've posted. Hasn't been too chaotic this winter. I've had actually a chance to help with the recruitment of bright fourth-year medical students into our program.

Questions like "are residents happy?" remind me  how hard it was as a MD student to choose which program was the best for me. I reached for everything and for anything ANYTHING that would give me some solace in the rank list which would yield a training program so that I might have a doctor job in 3 years after a decade of training, but didn't leave absolutely obliterated by the process.  Retrospectively, the process isn't exactly conducive for a resident's happiness for obvious reasons - overworked, underpaid though we are seen as employees in the eyes of the government (here's that supreme court ruling piece on this issue http://www.supremecourt.gov/opinions/10pdf/09-837.pdf), but as trainees/apprentices without many of the full employee benefits in the eyes of the training institution. We haven't even talked about if you don't get to the place of your choice after The Match!

Folks, yes, the system is less than ideal to say it politely, but I'm here to tell you it's going to be okay because (a) you are resilient (b) you always have a choice. If that residency spot doesn't work you can always change and that path may not be obvious. Please don't despair come Match Day!  

"Happiness is not something ready made. It comes from your own actions."

Thanks, Dalai Lama - we're working on it. 

Otherwise, I offer a practical, important bit of advice for those who interviewed this year as fourth year medical students. SAVE all of your travel and hotel receipts. These are all tax-deductible. So when you file taxes as a first year resident at wherever from you match you can list these items as tax-deductible.

Mo' money in the bank never hurt.

[howtothriveduringresidency]

How to thrive during residency -Surprise shifts and resiliency

Getting pulled to cover someone can feel like THE WORST thing in the world, but after getting pulled to cover a 24 hour shift with 20 new patients before vacation and then getting pulled again after vacation, here is a positive twist I learned about how to approach surprise shifts. 

Let these surprise shifts and coverage allow you to become more resilient and you might learn something of yourself. These can be the more exhilarating parts of medicine that doctors expound upon no end. But there are the opportunity costs of participating in this exclusive world of second-by-second high intensity decision making medicine. You may decide that this isn’t for you.  

If it is defining how much you are willing to pay (in experiences, time, money, relationships) for these experiences can be achieved rapidly through the roughest days in medicine.

After all, there are so many things a person can do in a 24 hour period. How do would you ideally want to split up your 24 hours? 

Surprise shifts might reinforce what really is important to you!

[howtothriveduringresidency]

How to Thrive During Residency - Choosing a vacation destination for the resident

Now I am totally thriving especially since vacation is here. You've got the time and a limited budget. Here are some basic questions that you might want to ask yourself on choosing a vacation destination. My personal responses follow.

What are the things you might need during your period of rest?  I dunno!

Family? maybe now or later?

Epic vista necessary? yes!

What activities do you need? sitting around and adventure

Sun or Snow? In November probably not snow. 

City or nature? um, both

I learned from last year not to cram too many things in the little time I had. I actually ended up doing too much and was not completely rested by the end. Naturally from my response above, I was baffled on how to spend free time. My boyfriend ended up with the decision making and somehow managed to satisfy all of the above. 

The destination winner? California for family time and for Big Sur mountain biking fun!

So here it is folks! Epic vistas, family, sitting around and adventure, city and nature in November. 

[howtothriveduringresidency]

How to Thrive During Residency - Good Conversation

I am going to start easy on my first post - what to do if you have extra time off. 

Congrats to you, resident, if this is you, and to me since I am now on outpatient medicine and vacation is close by. 

As a general rule, residents feel restless in the first week after physical recovery from crazy calls or crazy hours. During this time of restlessness, I've certainly asked myself "how I could possibly be a productive human being if I am not reading, studying or researching?" Socializing and playing sometimes can be lost on a hard-working resident who may feel dehumanized by the training process.  After two days of full sleep and proper meals, it was time to re-hone those skills and connect with people beyond the H and P.  

I turned off the self-imposed demands to study and research and as a Clevelander medicine resident I went to Chicago for my very own special golden weekend (Saturday and Sunday with no clinical obligations). Yay!

The winter storm shutting down Chicago O'Hare airport was not the highlight of my trip, but an eclectic, impromptu Dia de los Muertos party was. The party was filled with professionals in their thirties working for the likes of Google, McDonalds, Baxter, Bill and Melinda Gates Foundation from backgrounds including business, psychology, biology,  ancient DNA, and cacao beans. We compared and contrasted stories of what it was like in our respective fields like the difficulties of sequencing DNA from mummies. I spoke of what it was like to be a resident and the reason for my visit - a golden weekend which in these busy people's worlds turns out to be every weekend more often than not. We ooohed and aahhhed over each other's professional lives even the day-to-day details of what we residents might find the norm. It was a collision of fascinating worlds over home-made enchiladas, Ottolenghi butternut squash dip, and cupcakes.

I flew away back to the other flatland feeling uplifted and full of life, like a human being. I'd like to think everyone went back to their jobs on Monday feeling just as uplifted and incredible about their little world as I felt about mine. 

To thrive in residency, real time off is essential and so is connecting with people.  Share what its like to be a doctor. People are just as fascinated with your world as you are of theirs.

See you next week folks!

Flatland skibunny 

[howtothriveduringresidency]

About me

I am a second year internal medical resident thriving in Cleveland, Ohio sharing my process for thriving (not just surviving!) during an otherwise arduous and intense training period in an underrated city.

As a disclaimer:

I am NOT

driven to specialize in a clinical fellowship  

afraid of hard work 

ecstatic to live in a mountain-less town

a parent

I am

driven to live life to the fullest 

a mountain lover

passionate about ensuring the best care for my patients  

So I don't necessarily fit Osler's mold of the ideal physician, but hey! finding positives during this period of life is training for finding happiness and fulfillment in life too. First year was rough, but I emerged. Still overworked and underpaid (yes, sorry to break it to people, residents are underpaid) with a high debt burden, rather than sharing the dredges of residency,  here's my quirky process on how to live more happy days. Cleveland is feeling like home. 

xoxo

Flatland ski bunny

Bye bye mountains! And sun!