Work and Career in that Order: Residency is Just the Next Step in the Life of a Physician

 From the 3/19/2021 newsletter

Director’s Corner

 

Work and Career in that Order: Residency is Just the Next Step in the Life of a Physician

 

By Adina Kalet, MD MPH

 

Dr.Kalet celebrates Match Day 2021 by exploring how residency, as difficult as it can be, offers opportunities for growth and a path to a rewarding career …

 

Later today, more than 48,000 medical students will find out where they will begin residency training in July.

While the numbers vary, about half of students matched to their top choice, and about two-thirds to one of their top three. About 5% of all applicants did not match and have spent the week working with deans and faculty to “scramble” into open slots. There will be disappointments and not everyone will be thrilled.

In normal times, MCW-Milwaukee would be hosting our 200 students, their families, and their friends in an Alumni Center celebration with balloons, short speeches, finger food, intense excitement, and identical “I MATCHED!!!” t-shirts. Even still, today’s celebration and energy will be shared on social media and over the internet when, at 12:00 noon EDT, students open the e-equivalent of an “envelope” and learn for the first time to which program they have matched.

Today is one of the most significant watershed moments in each of their lives. They will, finally, be able to glimpse more clearly the outlines of their future selves.

 

The importance of “place” in residency training

Where a physician trains does matters. Residency takes each young physician to a city or town where they are committed to stay for a while and, although it varies by specialty, over 50% of physicians end up practicing in the state where they complete training. The shared experience of residency builds profound and lifelong friendships forged during long nights-on-call and the intellectual, physical, and emotional challenges inherent with the transition from medical student to practicing physician. Clinical “habits” are formed and imprinted for a lifetime.

I am amazed how intense the experiences I had during my own residency remain. While I have not drawn blood cultures, done a lumbar puncture, or placed central intravenous line in the subclavian vein in three decades, I still recall the rhythm of each procedure, the proper aseptic techniques, the positioning of the patient, the feel of the cannulas and needles, and the proper documentation. My fingers remember the sensation of the needle overcoming resistance, piercing the skin, and finding the proper space. During my residency, I learned to rehearse “delivering bad news,” and still do so as I walk toward a difficult conversation. Facing an emergency, I still summon courage the same way I did when I was wearing the “code beeper” and running toward, rather than away from, the crisis. Always take the stairs. Never wait for the elevator. Hope the nurses are already there with the cart. Will the medical student by my side be ready to do chest compressions? I learned to be ready when I arrived. 

 

Looking for meaning during residency training

Some things have changed about the match since I was in medical school. While many of my classmates in the early 1980’s applied to only one type of residency, a sizable minority listed more than one type of program on their match lists, allowing the algorithm to determine whether they would end up as an internist, pediatrician, dermatologist, or orthopedist. I share this because I now know how this approach worked out. These peripatetic students understood something the rest of us did not, and here is the lesson: It is much more important to choose what kind of career you want to have, than which clinical discipline or “tribe” you seek to join. They understood that there are, for most of us, many paths to a satisfying life as a physician.

Here are some examples. One friend knew she wanted to spend her career in women’s health, so she applied to and ranked OB/Gyn, family medicine, and internal medicine programs. Another close colleague, hoping for a quiet, suburban, “Marcus Welby” type of practice, applied to both family medicine and internal medicine. They let the match decide their specialty, knowing that each path would lead to their goals. Other classmates were so committed to where they wanted to live that they applied to several different specialties in the same city, believing that the type of residency was secondary.

This type of flexibility seems very old fashioned now and there are reasons for this. Over the past decades, for example, the increase in medical school graduates has far outpaced the increase in first-year residency positions, placing an intense “What if I don’t match?” pressure on students that we never experienced. Today, certain clinical fields are so competitive that students feel the need to plan far ahead, take time off to complete specialty-focused research, concentrate on doing things that will make them more attractive for the few spots, and audition extensively. Back when each residency program had its own pen-and-paper application form, we applied to ten or so institutions and ranked five to eight. These days, the number of electronic applications submitted by each applicant continues to climb, and it is not unusual for a medical student to apply to over sixty programs hoping for a handful of interviews. Different times, for sure. But instructive. Life as a physician has always been a journey with many choices, and residency is just the next step after medical school.

 

“Careers are made in retrospect”

Most of us can look back and see the paths we took, the opportunities we seized, and the roads not taken. But discerning the path that still lies ahead of us is impossible. It is rare to meet someone who, in retrospect, knew where they were going from the very beginning. Nearly half of the students who match today are entering different fields than they had envisioned for themselves when they started medical school. As many as 20% of residents switch fields before the end of their training. Mid-career physicians often retrain into new clinical specialties, seek advanced education, or pursue mid-career fellowships in a wide range of areas.

My woman’s health friend, for example, ended up happily doing groundbreaking immigrant health research. “Marcus Welby” is now a professor and urban health services researcher. Even though they did not end up where they might have predicted, their training gave them the flexibility to build satisfying and meaningful careers.

This is really good news. It means we can each feel free to be fully in the present. With reflection, mentorship, and opportunity, we can redirect our work. As the ancient Greeks advised: Know Thyself. Then move in that direction.

The wonder of a career in medicine is its flexibility and ever emerging opportunities. So how do we make good choices?

 

Residency is a learning experience, but it is also a job. Some advice …

Find work that matters. Look for the aspects of your new careers that intrigue you and get you out of bed in the morning. As novice physicians, you will learn about yourselves and your patients as you engage with both the well and the chronically ill. You will learn to prioritize and lead teams as you work through the daily tasks and confront the patients who decompensate in front of you. You will perform procedures that require significant manual dexterity and employ advanced technology. You will engage with colleagues, team members, and communities. You will collect and analyze data, peer through microscopes, study the results of sophisticated analyzers, and seek the truth and beauty hidden in a radiologic image. You will deal with unimaginable ambiguity. Learn to think, to feel, and to engage at various paces and rhythms — optimally, for your entire professional lifetime.

Take time to reflect and grow. Listen to others as they help you discern how your work impacts you. Find ways to stay well even as you do the hardest work in your life.

 

Residency is only one step on the path to a career

Training is extremely hard, and it can become a life of one challenge after another. Yet, as residents touch the lives of patients, learners, colleagues, friends, family, and the community, opportunities for growth, character development, and changemaking present themselves. Some residents will avoid these occasions while others will seek them out. To some, the work of residency will drive them forward into rich careers, dictating their goals and what they work on. For others, the opportunities will fade into the background while they are “busy making other plans.”

This is what continues to astonish me. While residency is an overwhelming experience, there are those who take full advantage of its opportunities. They learn early that training is only one step toward a career that will take unexpected twists along the way. As faculty, we must recognize their sacrifices, yet help them stop and consider: What do you want to be able to say you have done? How will you know you have done it, influenced others, engaged in those conversations, made the world just a little better? How might I help?

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The next group of residents will arrive soon. This week’s Transformational Times celebrates the agility, flexibility, and compromise inherent in recruiting the next cohort of residents during a pandemic. In this issue, you will read about how our MCW community of residency program directors, students, and residents have faced and embraced the special challenges this COVID-19 year. Airports, hotels, and long visit days filled with hospital tours and interviews were replaced with Zoom interviews, “1980’s style” videos, social media blitzes, all produced to give the potential residents a “feel” for the culture of the programs.

And there have been upsides! Programs saw the numbers of applicants increase. There was a more diverse applicant pool. Web pages were spiffy, social media campaigns were buffed, and all hands were on deck as residents showcased their program’s camaraderie and the wonders of living in Milwaukee. In some ways more exhausting (zoom fatigue) and in some ways more intimate, faculty and applicants got to see each other’s home offices and meet the family dog. No cheese curds, brats, and beer; instead, there were suit jackets, a clean shave, and a new house plant along with scrub pants and sneakers.

Creativity overflows. This is an important moment. Let’s take advantage of it.

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.