I was diagnosed with a debilitating autoimmune disease in my first trimester of medical school. It would eventually leave me disabled during residency, requiring a medical leave of absence. It was during this time that I met with a Program Director outside of my home institution to inquire about finishing my residency in their program in order to be closer to my family, who was helping to care for me at the time. His response was, “I do not believe you are strong enough to finish emergency medicine residency anywhere.” His words crushed my spirit that day, but have led me to amazing accomplishments today as I have fought everyday to prove him wrong.
He was right. In that moment, at that time, I was not well enough, but that didn’t mean I couldn’t get better. And, I did just that. Ironically, today I am now Program Director myself. And, I have expressed to my residents and those students whom I have mentored that I believe my job is to do for them what I wished had been done for me that day. It is our job to tell them that they can do it. To see past the obstacles that they face, and while being realistic, create paths to success to the career they want.
I have been known to mentor the non-traditional students and/or the rejects of traditional paths to medicine. Many of these less competitive students have taken alternative paths, or have waited to have families then return to medicine. Many have graduated from foreign medical schools, or had careers outside of medicine in their former lives. Some of become ill, or have family members who have become ill, deterring them away from their initial plans, which they hope to return to eventually. I am not sure how I became the person that others often refer to for advice, as many do not know my story, but I have become somewhat of an expert.
So what do you tell a student, who wants to get into medicine, after not getting any medical school interviews. Ask them to articulate why they want to practice medicine and what they want to do with their career? You will find that many have false ideals with what the practice of medicine entails, or they have a limited perspective of careers they can have within medicine, i.e., many other career paths allow you to take care of patients, not just being a doctor. Introduce them to public health, nursing programs, or physician assistant degrees. And, if it is still a practicing physician that they want to be then give them the steps that have led to your success. Yes, many of these are based on numbers, and MCAT scores and GPAs often filter out students for medical school interviews. This is reality, but there are other aspects of one’s application that is also weighted heavily including community service, research, leadership skills, and international experiences. While continuing to work on improving scores, encourage them to participate in clinical shadowing experiences for them to gain a wider exposure to the practice of medicine. Also, look for medical schools that value other aspects of your application (such as your community initiatives). They may look beyond numerical filters.
For the students who are less competitive for emergency medicine. Each year emergency medicine becomes more and more competitive. In fact, those of us in leadership often joke that we wouldn’t likely be selected if we were competing among the newer generation of candidates. But, emergency medicine continues to be a specialty that values accomplishments beyond USMLE scores. While highlighting these initiatives is crucial on your application, rotating at programs you both ideally want to get into and those you have a higher chance of getting into is essential. This allows the residency leadership to assess your clinical performance. Often, if you are a clinical superstar that a program has personally gotten to know, they will be more willing to take a chance on your less than stellar test-taking abilities. It is also important to be realistic. You must have a plan B. If you are applying to a very competitive specialty with a less than competitive application, consider also applying to a less competitive specialty as a back up. This may sound taboo as no specialty wants to be a candidate’s back-up career option, but it is a reality in this day where there are less residency positions than students graduating from medical school.
For those who were MATCHED into another field, or through SOAP took positions outside of their intended specialty. Do well in the program you were matched in. I believe that everything happens for a reason. For emergency medicine, the end outcome of how you practice medicine may be the same even if on a different trajectory during your training. There are fellowship options within family medicine they may lead to the same practice settings that emergency physicians work in; for example, Sports Medicine. Many family medicine and internal medicine physicians work alongside emergency physicians in urgent care centers. And, the career to critical care can now be taken through many training programs. So whatever specialty and program you match into, do well, learn medicine, become an excellent physician. These skills will help you to get to the ultimate outcome of the practice environment or fellowships you envision yourself in for the future.
For older students or residents not on the straight and narrow path. You must come to a much clear conclusion as to why you want to go back to school and training to become a physician than many of your peers. But you must consider the humility aspect that others in your position may take for granted. There still exist a hierarchical structure to medicine, and whether right or wrong, this will dictate much of your success and ease within training. You have to be willing to walk that line that everyone before you had to walk, including the working hours, which often times seem inhumane. This is not likely going to change in medicine, so if a medical career is what you want, it will take you eating a very big slice of humble pie to allow you to get over that 20-something year old chief resident telling you to perform that rectal exam.
The residents or students who took time off for varied reasons. You are not defined by your absences, whether that was because of illness or family obligations. Your commitment to medicine is not defined by these time periods either. You are clearly at a disadvantage as compared to your peers, but do not let this hold you back. You have to prove that you are capable of continuing in your studies and training. You have to show that once you have returned to school or residency, you are all in. Do not let your previous disabilities become a crutch to any deficiencies you may have. You must work to the same standards as your peers, even if this means you must work harder to overcome the obstacles you face.
The caveat to all of this is that it is much easier if you are working in a supportive environment, one that will understand your needs. This is where I must thank my home institution because if it weren’t for them allowing me to return and finish residency, I would have succumb to my disabilities. And now as a Program Director, I encourage all residency leadership to realize that training your residents also means supporting them through those training years. This support may be different for the different types of residents in your program. The resident’s success, especially those with medical, mental, or family difficulties, is directly dependent on the program’s support. This support may come in allowing for regularly scheduled doctor’s appointments, giving short two-week sick leave, special work schedules, or extending residency training. In the end, the encouragement to your resident to maintain their health and their families’ needs is priceless.
I am living proof that anything is possible if you put your mind to it. I have never appreciated the look of pity that comes with being forthcoming about my own illnesses. I would rather be judged based on my merit and my hard work just like everyone else. And, yes, while I am, and many others are formally disabled, if we can accomplish the same achievements as the rest, than perhaps being normal is not the classification we identify with. No, in fact, we are super-normal. When, advising your students and residents who have struggled in some way, remember these tips. Do not be dismissive of their goals because it follows less than traditional plans. Individualize their plans to allow for realistic and attainable achievements. Realize that every road to success is not taken by the straightest path. You may be surprised that these students and residents may have your job one day.
The opinions in this article are based on my own experiences.