REPLAY: Failures on the Path to Becoming a Doctor #399

Dr Ne may or may not be joining us a little bit later , but today we do have a very special episode for you all and we're really excited to continue on with the kind of partnership that we have going with the Student National Medical Association , otherwise known as the SNMA , which is an organization that is near and very dear to my heart , that I've been a

part of since I was a student and continue as an attending , being a part of , and we are doing this particular episode , or these series of episodes , to really commemorate the 60th anniversary of the Student National Medical Association , which started in 1964 at Howard University School of Medicine , as well as Morehouse School of Medicine or , excuse me , yeah , no ,

meharry .

And the reason that you can if you're watching on YouTube that our guests were smiling is because we have two guests with us today that went to the Howard School of Medicine , right , howard University School of Medicine , and today we have back Dr Love Anani , who was on our previous episode , I believe is 397 .

And we are joined by his lovely wife , dr Uche Anani . Anani , correct , yes , yes , okay , that was the one thing I didn't check before we got on here . No worries , dr Uche Anani as well . Dr Love Anani if you guys listened to the last episode , you'll know that Dr Love is an ER doc and Dr Uche is actually a neonatologist .

However , she is the assistant program director in a pediatric residency program . So I want to welcome you both here , because today we are going to talk about career paths .

I know we all three have been through career paths and you know here on Docs Outside the Box , we often talk about , we talk about money , we talk about pop culture , but when we do talk about medicine , it often is about the career path of medicine and just how we navigate that , and so that's why we're talking with both of you today .

So , dr Uche , you see a lot of residents come through your residency program . Obviously , as an assistant program director , you know what are some of the challenges that you would say that you see with applicants . So , before we get to the actual residents , what are some challenges that you see with applicants coming through ?

You know , coming through that path and trying to navigate whether or not they're even going to even get matched to a residency program .

You know , I'm sure we'll talk a little bit more about decisions of like training program versus not program you're like . Okay , we'll say for example , I think I'm landing on P's . How do I know that I will do well in the specialty ? How do I know if I'll be considered a competitive candidate , all the things right .

I think it's never too late to always have like a mentor , Like . So I think it's easy . It's very important to have a mentor early on or people that you feel that you can trust to just talk it through right .

So I think it's important to be able to say , like I'm thinking about this and these are the reasons why I'm interested in this specialty , versus not , but also , how do I align that with you ?

Know , what is my kind of like goal as a person in terms of my future Like , what's the lifestyle I want to live Like , what are the things that are important for me outside of my career that I also want to make sure I'm able to align my career with that , and so I think it's important to be able to talk to those , have those conversations at a time .

So that's I think that's one thing that I think um students will struggle with and , I think , really being able to assess their like . Am I competitive or not ? oh , yeah , yeah , right and I definitely have a conversation , or definitely have a lot of conversations , a lot of discussions with students who are really trying to like get a sense of that .

And that's where , again , I'm going to emphasize this probably throughout an entire conversation is mentorship is important Having people you can rely on to be able to have those conversations and kind of work through the kind of mental process of like what is this really going to be like for me ?

How do you even know you're competitive ? Do you even have a mentor ? You know what are the kind of the what's the pre-work that you have to do before you get to the point of even thinking about what specialty you're going to apply to if you're competitive to that specialty , and then forget about , like , where exactly you're going to be .

You know applying to . Right Because that's a whole different .

. Unfortunately , a lot of students try to get in the minds of program directors and assistant program directors and they try to assume what these program directors want . And everyone starts with the same thing Scores , scores , scores . And we used to have an easier one , step one . You take that after your sophomore year . You know exactly where you landed .

That's pass , fail now , right . So now everyone has shifted their desire to be competitive , or thought to be competitive , from step one to step two . We're seeing students take that earlier and there's a lot more focus on that . All the while , more students are failing step one now than were before .

But at the same time , if you don't pass that first time , that's still a bad knock on you , right ? I don't know if you got a 250 on step two . You didn't pass the one the first go .

The problem with that , I think and Love you can speak to this is that oftentimes students are grinding for the score . Students are grinding for the score , but are they thinking about all the other things ? Right , that pre-work that I talked about ? What is that pre-work besides just the score that is going to make you competitive for a residency program ?

You know are ? Are students doing that and what is that pre-work ?

So now when people get applications it's not just scrolling through the list . They can say , all right , what 10 things now did you do throughout men's school and which of these top three are the most important to you and why ? Yes , and if that section is one sentence you played yourself , we know you didn't really do nothing , right ? So start .

So , like some people may thrive in terms of doing like extracurricular activities that align with their like passion , their goals , others might be like , listen , I'm focused on just trying to get through class because I have all these other needs I have to do that are priority Right , whether it be family or support , whatever , and I think that's also important too

and that can still come across very positively in your application . But that's where I feel like you need that advisor or that mentor early on to be like okay , this is what I'm interested in doing . How do I make sure I'm doing aligning my pre-work or what I've done thus far to really showcase .

This is why I would be a strong candidate in whatever specialty that may be . So you don't have to be someone because I was not SMA anything , whatever she wasn't , but let me add her up for a second .

Focus on pediatrics , or what have you ?

You're looking at applications saying , okay , well , what is actually here , what's of substance here ? And sometimes students can really portray their stories very , very well .

Other times it's kind of like , well , this chronological timeline of just all of the academic things that they did , essentially repeating their CV almost verbatim , but just in a story which really doesn't necessarily bode well , and I but it's tough though , like if you don't have any experience , kind of showcasing yourself , right , if you're just , I work hard , I

study hard .

That's a really tough thing , particularly like someone where we came from right , like you know , where you like , like we don't get taught those type of things , so it can be a really tough thing to not just like have verbal spaghetti and regurgitate your CV .

Yeah , and I will say honestly , I think to give a plug to SNMA and Tour for Diversity , I was just going to say that those are avenues for students , particularly those who are of us who are underrepresented , considered like historically marginalized , whatever , that you can access the programs through those organizations to really get access to mentors , advisors and ask

those questions early on too and just get the guide of just , or even to just understand the process as a whole , right Cause you don't know what you know . You know you don't know what you don't know .

Right , so I think it's important to like be able to just have that plug in early , because then you can like get the exposure and be like oh , okay , I didn't know , I need to like phrase my application in this way . Or you know , this is how I should like think about my personal statement .

Or , oh , I didn't realize that something that was a strength of mine , oh , I can . I can actually put that on my application . Like I do that , yes , right , and that's where I feel like it's important to like just have people you know and trust that you can just rely on . I mean like hey , do you mind ? Um , not just me and my mentor , but just I .

Just I want , I want to seek advice . I talk to you from time to time and just check in .

Because , I'll be really honest with you , I didn't tell anybody this , but my medical school essay and my residency essay was basically a version of my high school essay that I used to get into college , and I had a mentor who helped me get into a summer program while I was in high school who said , no , you need to rewrite your essay so that you can get

into this program . And then what I did is I used that format to change into a college admission essay , and then I was doing the same thing , not talking to anybody , and so in four years , I just never updated it , and then another four years I . So for me , I was just working with this outdated essay , but it worked once will not work again .

And I felt a little embarrassed to kind of talk to people and say , hey , can you help me with my writing ? Like I don't know if I'm writing something . Okay , that's what I'm talking about you know , just to have someone say okay , let me take a look . You know , maybe we should change this .

Maybe you need to talk more about this extracurricular activity or maybe tell us more about your story . Those are the type of things the reps that I think a mentor could really help out at , because there's a lot of people floating around with those types of stories .

For us it was open the envelope .

Now I want to tell you that there was a very weird trend going on at that time that I figured out Because everyone was saying , well , I don't know , maybe I should do an extra year at my school and do a research program and then reapply . And I was like , why is every single one of you telling me , every single one the extra year of med school ?

But the theory on this side of the door in uh , reddit and on all the mentor applications or mentor spaces , is that when you apply to residency , you look better when you are not a graduate of medical school versus a graduate reapplying because you already have an MDDO degree .

There are some schools theoretically I don't know , I can't say they have filters on people who have their degree already . So , when you're a student , they look at you as a student still . So , even though you could have graduated , you say no , I'm going to take this research year . Your school does not confer on you that MD degree or DO degree .

You go back and you reapply in the match again as a student . Therefore , you're not reapplying as a graduate and it's thought that you look better when you're applying as a student . Now I'll kick it to someone on that .

So the stats show that Part of that is it's large population data , right , but it doesn't necessarily mean that that's like the best fit for you as an individual . So I think that's again I'm going to say it again mentorship , like that's where you connect with those people to talk about okay , this is what's happened .

Let me talk about , from a personalized standpoint , what's going to be best for me in terms of like reapplying next year , if that's what I want to do , et cetera . And do I , you know , stay on another year , knowing the pros and cons of like extending your medical career and more loans and you know , et cetera ?

I think the other thing to take into account is for and I'll just speak from my personal lens Like I think it's important to know that when you're transitioning into a residency program , that you haven't had a lot of long time away from clinical medicine , right .

So I think your letters whether you are , you know you didn't match this year you're reapplying this year you still want to have letters that speak to your clinical acumen , like how skillful you are in that regard and knowing that you can transition well . So it's it's .

It is important to keep that in mind too if you are planning to reapply , like I think , whether you decide to do a research year , whether you decide to do whatever that gap may consist of , like knowing that you still have some connection to clinical activity , observation , participation , so that you can have letters , whether it be from your prior letter writers or

, more than likely , you need at least one from like during that gap year as well . Yeah , that hopefully can reflect on you as an individual growth potential , et cetera . So that's kind of the . That's my understanding .

I think , there's actually data that kind of shows like oh , it's probably a higher likelihood for me to match if I'm still a graduating student as opposed to graduated .

So my recommendation was you need to grind for two months doing nothing . So if you stay a student , you can get those student loans up front . You know your rent is covered , your food is covered , you can graduate later on . And that was my advice to him . Even though that price tag adds on a year , you don't have to worry about it .

Even though that price tag adds on a year , you don't have to worry about it . You can do nothing , you're fine . Another student I worked with in the past just didn't match . So I was like all right , do you know anything else you can do ? Yeah , a buddy of mine says he can get me a research position . All right , well , graduate , stop taking those loans .

Go earn money as a physician , technically , do that research and then reapply . So it just depends . Like Uche said , what do you need to do ?

They weren't even applying all to the same type of residency programs , right , Social media could be dangerous right , oh yeah , In one way you want social media to inform people as many people as possible about all the opportunities .

The other part of it , when we're talking about the money , is even applying to residency , because you know that's hella expensive , hella expensive , right ? And we did a presentation for NRMP a couple of years ago and one of the parts of our presentation oh , you'll appreciate this , dr Uche it was in pediatrics .

There were some stats that showed that people who applied to pediatric programs , if they applied to 13 or more programs or , excuse me , if they apply to more than 13 programs , that their chances of getting into a residency program did not improve significantly at all .

And which is really interesting , because I will tell you the number of people , including myself and this man standing right next to me , who applied to like 40 plus programs . I mean that's a lot of money to you know , throw into your , throw into your education .

And my thing is , my question is especially on your side , dr Uche is you're getting so many applications ? What would you say is the percentage of applicants that you're even offering interviews to right , because I don't necessarily think people are thinking about that Like , yeah , I'm going to put out 40 applications , 50 , 70 applications , but how many people ?

Or what's the percentage of people that these residency programs are even offering interviews to , because you ain't got room for everybody ?

So I want to say the ratio and this is just me guesstimating , but I want to say it's like one , like for every residency slot that you have , you want to interview X amount of number to ensure the probability is high that you fill all your slots Right .

And so say , if you have 20 programs or 20 slots , you want to interview at least I want to say at least eight applicants per slot .

So , yeah , so if you but you're in a program , take , for example , internal medicine , right , internal medicine programs see a lot of applicants that come through and so they're in the order of thousands but if you only have 30 slots right and max . You're probably going to be interviewing 300 , 350 .

And so , like you have two , 3000 people who applied , you're only getting like a fraction of those who are going to interview . So it's yeah , I mean it can be challenging .

Now there are a lot of changes with ERAS , with program signaling which basically says that like I'm kind of designating you as a program that I'm interested in , would like to go to , Is that the token ? Every specialty rather , it's not the token the ERAS token is to be able to apply into ERAS , which I don't really understand .

It should be like this register . It's like a token , like a registration token , but like . Signaling is like when I apply to say I'm applying to 20 programs , but in pediatrics you're allowed to signal up to five programs that are your top priority programs . So you signal them and that gives them an indication .

They're like oh no , I really am Out of all the programs I'm applying . I'm considering you one of my top five and I want you to know that . And then programs can utilize that information if they wish to kind of help prioritize how they want those they want to

interview . Yeah , the theory was signaling was supposed to take that old .

I think programs are taking it serious because I think , again because of the changes with like , step one and like and I'll be very honest , like I'm a huge proponent of holistic application review , like looking at more of the holistic picture of an applicant as opposed to like just certain numbers and metrics , it's another data point to signal whether or not someone

may be interested in coming right . It's not the only thing , right that was going to designate whether or not you come for an interview or not , but it's just an additional data point . It shows the interest and engagement and , depending on the program , the specialty , the location , things like that , that can carry a lot of weight .

I don't know what the stats are on that . I guess NRMP will kind of figure that out . You know , do like the five year and then the 10 year and the 15 year .

I'm going to use the state I used in my last episode , even though I like that state If you're in Idaho and you get one six . So yeah , it matters there . Yes , harvard probably wonders why you didn't signal them Like you didn't signal us when you at .

If you don't get an interview from us on one of these two dates , you probably ain't coming Exactly . I think that has allowed some students to realize oh , I have two OB interviews by the end of the season . I might need to check that family route right quick .

And then maybe they go several years not matching and they're just struggling in silence . Nobody knows , right , right , and I just think that is one of the saddest thing to have this type of professional degree and not either be able to train or not be able to use your degree , but you have hella debt .

No , right , yeah , I just I never understood that right like there's to be another way . There's got to be multiple layers to make sure that whoever graduates with either MD or DO , that they can do something productive in the healthcare system , whether they match or not . And I struggle with that because we know somebody who's gone . Now what ? Seven years ?

But also , at the same time , we've seen the opposite , too , where people are like yeah , I'm going to consider something that's a little bit more realistic from a specialty standpoint , a residency standpoint , and they still can't get in .

And then there's the involuntary change , meaning you either didn't match or you matched but you got kicked out . And those things can be one very differently navigated because they hit you differently .

But two , like like me , was talking about if , if there is , if there is a an issue with trying to figure out how to get back into or how to even enter training , then you're stuck in this conundrum because oftentimes people don't tell other people that they are stuck there .

And that goes back to the mentoring that you were talking about again , dr Uche , with you know , talking to your mentors , identifying a mentor , but also being very realistic about what the mentor is telling you . You know so , if you want to get into a very competitive program , but you've been out eight years . Let's kind of talk telling you you know .

So , if you want to get into a very competitive program , but you've been out eight years , let's kind of talk about . You know what's going on .

Do you have you seen , dr uj , because you are the assistant program director how , what is the approach to those residents or those medical grads who may either have matched or left their programs or the non-traditional one , or got kicked out , right , and the reason I'm not using non-traditional is only because the non-traditional is so different in each one of those

cases , you know . So I mean what ? What's your approach ? Or are you even seeing a lot of that ?

If I do want to go back , what are what ? What does that process look like ? Do I find an open spot elsewhere ? Do I reapply , depending on what level you know year you're in in the training ? Do I consider another career path altogether ?

And I think it's also complicated by the fact of , like where you are in life , like what are , what are the other things that are going on that you need to be mindful of and take into that equation when making that decision . Um , like , what opportunities are available ? Right like it might be , you know if we're talking about .

We'll say , in turn , I just I use internal medicine because there's so many number of programs and lots available yeah it may be available to do that right To transition to another place elsewhere , but for a more competitive , limited number of slot specialty that may not be the case . So then I don't know . I think it takes a lot of soul searching .

I think it takes a lot of introspection . I think it is a very challenging decision and for those who I know have gone through that pathway I know those who've been able to get back in . I know those who have not and have decided upon a different path and are completely happy and living their best life .

So it just depends on what you feel passionate about and what you're willing to , kind of like , commit to and do , Because I feel like you usually have like your three big reasons , right . Yeah .

If they can pass it now , somebody else should take them . That's real easy . Number two you didn't pass rotations within your program . That's a little harder , that's a little different . Right , that means you didn't pass and someone failed you on purpose within that program . So now you get to ask for letters from that program to go somewhere else and you failed .

So those when it's like that sometimes , it's usually like you really may want to switch specialties . And then number three is like you get moved out because you harmed a patient , right Like if it's a serious harm in the program that lets you go .

That again can be a little difficult to navigate because if they have to report that that's going to follow you no matter what you do as a physician . So those are the three big categories I've kind of encountered in you know .

Not remediation , but maybe you guys understand what I'm saying like where you encountered some type of like process in the kind of matriculation process through , through training , Right , Like some interruption where you didn't meet the marker or didn't meet the score or whatever that may be .

But there are situations where life outside of you know , residency changes and you're like , well , I can't continue because now this life thing has changed and I need to either pivot , like step away , maybe come back .

And for me , you know I interact with a lot of people who are starting families so like , sometimes obviously residency should accommodate for parental leave and et cetera for having children . But I know of people because around like family planning or whatever that may be , around family , close family , that they had to stop , they had to step away .

And so the question is obviously , like you know , jobs , institutions , programs should be able to allow for you to take that FMLA , that stop , and then come back , but if it's something that's gonna be more permanent , prolonged or like I need to like move you know like I can't stay here , what does that look like , you know , and so making that decision , you

know , is also very equally hard .

And so you know you feel the financial burden of that as well . And you talked about introspection and that made me think of that , made me think of a colleague of mine years ago who spent seven years trying to get into a residency program he had never actually matched .

He was interested in a program in a specialty that was , I would say , semi competitive I mean it was , you know , one of the top competitive ones but then kind of went , you know , went his way like , navigated through different specialties , um , in terms of applying every single year for about seven years and about year six , year six .

He contacted me because he had graduated only the year after I did . I didn't realize that he was not in residency , and so when I found out he wasn't in residency I was like , oh my gosh , like who's helping you do this ?

He was like I was doing this on my own , contacted my mentor and was like listen , I need you to help me navigate this , because I I don't even know . You know , I don't even know anything about this now one of the things that we talked about about this .

Now , one of the things that we talked about was when you go to an interview because he was getting interviews , he was getting interviews . Yeah , you see how your face just went , yeah .

I won't put the whole story out there , but long story short , the conclusion that I came to , and that my mentor came to listen to this same story , was that you are cocky , you're cocky and this is why you're not getting into residency . Now his response to me was you're reaching , you're reaching , and I'm like I'm not reaching .

And I had to tell him I went through residency . You didn't . And I know that if you approached my residency program , the residents in my program , in the way that you approach those residents , we would annihilate you and just be like done , go to the program director and be like we don't want to work with this person .

So , introspection , what are you doing , especially if you're getting interviews ? What are you doing , especially if you're getting interviews ? How are you navigating ? Your own personality , I guess , is kind of the way to think about it , right , like , how are you navigating through this process beyond just the ? You know , I check this box and I pass the step three .

I check this box and I still have clinical experience . It's like listen , check boxes ain't going to get you everywhere . You have to . You got to learn how to relate to people and sometimes , I think , sometimes I think we're a little bit reserved , even as mentors , and telling people like , dude , your personality kind of sucks .

And if that's the problem , then I think and I think I don't think that that's the problem for most people , but I think if that is the problem , especially if you have a very extended gap , I think that's something that needs to be explored and it needs to be approached very directly , you know .

So I just thought that that was interesting because you talked about introspection , but I wanted people to know it goes beyond . Just well , what steps did I take ?

.

I don't want no program that don't want me . I get that , I understand that , but they're also making one of these decisions and you need to treat all of these like first dates . You know you don't show up to first dates in sweats . You know you're more comfortable like that , right , like you dress up .

Now , for those of you who are not watching , dr knee stepped away again . You already know who it is it's your boy .

So I have hijacked the show again , um , but no , I I really enjoyed this , this discussion , um , because , like I said in the beginning , we talk a lot about careers in this , you know , in this podcast , and I think it's important for people who are listening , who are either , you know , medical students getting ready to graduate or residents , to understand that

the end of the road doesn't stop because you don't match . The end of the road doesn't stop because you might have to have a career change , because you had to change to another specialty or go to another program , like .

These are not ends of the world or ends of the road for you , but I think the most important thing that you can leave with here today is to understand that you need to get some mentoring . You know , you really need to get some mentoring and again , you need to do that introspection to figure out how are you potentially anyway contributing ?

How is you know , maybe the stars didn't align , but if your gap is getting way bigger , you know , then you have to start thinking about what potentially could you be contributing to make your situation not as desirable as you want it to be . So please understand that . The other thing is your resources .

We talked a lot here about the Student National Medical Association and one of the things I will tell you all that if I have a student who doesn't match or who's afraid that they might not match , that's another thing . Preempt , you know . Or who's afraid that they might not match , that's another thing .

You know , and I tell every student I'm like , listen , if you think this is going to be a problem , you need to go to every single booth at the S&MA conference which , by the way , this year is going to be in New Orleans . Do you know ?

Issue Even if you are not yet graduating preemptively , start talking with people and figuring out what kinds of programs will look at you , and don't go up there and just get information on their program . They don't know you . You got to get them to know you . Right , people always who you know . It's like no , it's who knows you .

There are programs on a wait list . Coming to talk to students at our conference For those in med school thinking they want to get into residency . We are sold out , right ? Schools are having to coalesce into one just to have enough space , right , certain people have a lot of space Shout out to Northwestern .

You know , diamond , you know I'm going to have a person there , but that is what I'm saying . So , like Dr Renee said , if you even think , man , I may need someone on the inside to help my application across the finish line . This is where you meet that person . You get them . Your business card , your LinkedIn website , get across that finish line .

So that means that you need to get on down to new orleans and figure out how you're going to get through every single one of those schools and prepare your spiel . You know , talk to your mentors before you go so that you know exactly what you're going to do , exactly what you're going to say .

Um , we're going to be out there also , docs outside the box , we're going to be out there also , docs Outside the Box . We're going to be out there as well doing a couple of episodes , maybe some carpet interviews . So if you want to chat with us , we'll be there .

But I definitely encourage all of you again , because we're so focused on careers on this podcast , to get out there and do what you possibly can to move your career in the direction that you want it to go .

Actress , whatever sub speciality you want , you're probably going to get it because the numbers are in

your favor . You want to do child immunology ? Go ahead . You want to come down to Nashville ? There are whole PEDS fellowships waiting for you . Child Neurology wants you . So just when you get to the other side , you are the highlight . So just make it through people .

So we will see you at the SMA conference Easter weekend . People , we're going gonna say peace , peace .