Chapter 36: interview season

 

Chapter 36: interview season

Interview season for residency intermingled with the 4^th year rotations. I had several before the neurology rotation, and even one or two during that rotation.

              My first interview was at the University of Utah in Salt Lake City. It was November. I flew in on a Sunday and had a nearby hotel to stay at. Quickly the trip became disastrous as I realized that I forgot most of my suit, including a shirt and tie. There was nothing nearby open because of it being Sunday, and the pre-interview dinner with residents was in a couple hours. This was usually when you could talk with the residents without administrative staff in order to get a better idea of how the residents liked or disliked the program. Uber and Lyft weren’t running at the time. I found a Target about a two mile walk away. It was hot but I started walking. Eventually I get to Target. There’s an accident right outside and so it takes some time to cross the street. I rush into the store and head straight to the men’s clothing, where I find a white shirt and a red tie that look like they’ll fit well. Target’s “goodfellow” brand, saving me. I buy them and rush out the store and head back to my hotel room. I drop off the shirt and tie with the rest of my stuff. I realize I’ve sweat through most of my clothes at this point. I take a quick shower and put on something semi-casual for the dinner. We had been advised by older classmates and the administration not to try too hard at the dinner because it can give off an uppity and uptight attitude, and that sometimes the dinners came into play for overall interviewee ranking.

              The dinner is at a local brewery. We’re at a big table in the back and have nametags that say where we’re from and our names, as do the residents. The dinner is essentially beer and pizza—not exactly what I was expecting from Utah. They kept ordering pitchers of more beer throughout the night, as though to show that Utah was not as uptight as it’s reputation may suggest. Immediately there are many questions about Mormons and being accepted at the hospital if not religious, and class cohesiveness. There are also questions about research opportunities, and where residents often go after finishing. The residents tell us that the majority of the class is non-Mormon and that it’s never been an issue either way. They add on that fewer than half the people living in Salt Lake are Mormon. Then of course they reassure the research opportunities and tell us that most people go into cardiology or match to whatever fellowship they want. Then they start to tell us about the outdoor activities and fun things that the residents are able to do during residents. One particular resident got 100 ski days in on his intern year, granted many of them were half days. Most of the other residents were also skiers and got many days in the past year. It was certainly a convincing argument. The dinner ended. We thanked the residents and said our goodbyes and they wished us luck for the next day. I walked back to my hotel and set out everything for the next day before heading right to bed.

              The next day I get ready quickly for the interview, review my application to remember what sort of questions to expect and then head over to the hospital. It’s a beautiful campus and immediately impressive. There were plenty of signs to guide us through the hospital into a conference room where there were bagels and coffee (good sign already). We picked up our folders which also had our interview schedules and interviewers. First was a general welcome during the breakfast and a general overview of the program and faculty. This was done by the chief residents. Next was time to mingle and relax while others went for interviews. The rest of us rotated through brief, 1-2 minute, quick sit-down talks with the program director. This short time with the program director was the first interview of any kind I had yet for any of 4^th year. I was mildly terrified. When I entered her office she was warm and friendly. She immediately asked me about my time in Japan and so I told her about my motivations and goals and experiences related. I was happy about this question because it was such a formative time of my life. And then that was it. The first (albeit mini) interview done. I go back to the room. Then we go on what will seem to become the ceremonial tour of the hospital. I have my first full interview right before lunch. It goes overall well—I’m asked about research and explain how I’m open to it but not looking for any career in research. They seem to appreciate my honesty. The interview goes well. Then it’s lunch. I chug more coffee; final interview goes well too. I give myself a little mini-congratulations for getting through my first residency interview day. Overall I decide I like the program but I’m not committed yet. The residents seem happy and there is a lot of things to do outside the hospital.

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              Before submitting applications we all meet with an adviser to discuss which programs to apply to as well as interview techniques and what to expect. Before then, when on an ICU rotation an attending told me that the most important thing to look for when interviewing was if the residents were happy. (Most appeared to be quite happy at Utah). My advisor at UW suggested several academic programs across the entire US. When I told him about considering Utah as well as Spokane, he suggested not applying to these because of poor academic reputation and that he wasn’t particularly fond of the programs, although he did suggest applying to Pittsburgh, which turned out to be a fantastic program. He also suggested several other programs such as Tulane, which would later be caught up in a racism and sexism scandal, as well as several residents coming forward anonymously to warn about malignant conditions in the residency. I’m certainly happy I did not apply to that program. Overall the advisor meetings were a waste of time, and if anything were distracting. It was suggested to me to not talk about wanting to go into nephrology and to take that part out of my personal statement. I was told that programs wanted to produce Cardiology and Gastroenterology fellows and would be less interested in someone looking to go into nephrology. I kept it and would continue to bring it up in interviews. After these meetings I couldn’t help but think back on my inpatient rotations at the Seattle hospitals. The residents seemed miserable. Not only that, but when I was on a pulmonology rotation a resident told me about a plan for residents to walk out for an hour in demand for fairer wages and humane hours and safe transport to and from the hospital (especially after a 24+ hour call shift). This was worrisome, I certainly considered not applying for UW at all after learning these things and after my poor experience with the OBGYN rotation and frustration with administration regarding it, and the overall poor advising sessions. Especially after having done a sub-internship at Spokane, where everyone seemed much happier than at UW.

         …

              I’ll briefly go through many of the other interview experiences. There will be trips and programs that I don’t touch on. I interviewed at Spokane which felt almost like a return to home. It was a wonderful experience and I got to see many of the attending doctors I had worked with previously. I already knew much about the program and how I felt. I wanted to go into some sort of academic program, and so Spokane would be my top community-program choice.

              I interviewed at Emory in Atlanta. My main interest in this program was infectious disease (given its proximity to the CDC) as well as the County hospital, Grady Memorial Hospital. I wanted to work with underserved communities as much as possible and this seemed like a great opportunity. The residents were mostly happy, but did admit concerns of being overworked and the area being too expensive. I had two good interviews there, one with a nephrologist. I really liked the area and was strongly considering it, but was certainly worried about having a life outside of the hospital between work hours and lack of outdoor activities.

One of the best parts of interview season was meeting new people who were all considering their past and future and what it meant to live a good life. One person I met while at Emory, we’ll call her L. After the interview day we agreed to explore a bit of Atlanta together. We went to the park and ended up at a little bar and began discussing what we thought was important in a residency and future goals and even to what it meant to live a good life. She was worried about getting caught in a cycle where one just keeps working hard and long hours—torturing themselves—for some sort of future grace or happiness or freedom. Like, was missing out on all of that life beforehand worth that future glory or goal? We discussed Camus’ myth of Sisyphus briefly, which had become to me like a bible on leading a meaningful life while reading it on the plane. We talked about attendings and where they had ended up and if they were happy. Many attendings were caught up in research and still worked tens and tens of hours every week—the easier schedule did not necessarily seem to be ahead. The conversation went a long way in convincing me that valuing the present time and time in residency would be more important than merit or prestige. Just like the ICU attending had told me: look for where residents are happy.

              Next was Pittsburgh. The residents here seemed very happy, a good sign, and one of my interviewers was a nephrologist who also went to UW for medical schooland who talked about how much he loved being at UPMC. There was a great food scene in the city and overall it felt like there was more to do in the area than in Atlanta for me. The day went well and they moved up my list quite a bit.

Next was Washington university in Saint Louis. It was an impressive academic program and I really enjoyed talking to the residents, who were all very nerdy about some topic outside of medicine, which I appreciated. Unfortunately, they said there was not a lot to do around the city, but some decent shows and music and bars. The interview day went well. One nephrologist who interviewed me also invited me to join the community orchestra given my violin experience. I really appreciated this and thought it to be a good sign. Overall I was pleasantly surprised by the residents and faculty at the program; it seemed more laid back and kinder than I expected for such an academic program.

I happened to see L again there, and we met up briefly after the interview. We had both thought at that point that choosing a place to value the present and time during residency was likely more important than merit. It was comforting knowing that someone came to the same conclusion. She told me she interviewed at University of Washington recently and that the residents brought up possibly striking due to low pay, safety, and long hours. She also told me that faculty did not seem to be receptive to this. I was unsurprised.

The last program I interviewed at was Mount Sinai. I was excited because this program was in New York and right next to Central Park. I had also heard that they offered housing for cheap that was near the hospital as well. I flew in. The dinner was at a cocktail bar somewhat nearby my Airbnb (hotel was too expensive). I talked to several residents, most of whom told me they liked the program, but when I asked what they liked to do in the city since they lived here, they told me they couldn’t think of anything. This seemed like a bad thing. There was so much to do in New York, so much that I wanted to do. It was surprising to hear residents say that there was basically nothing to do. I wondered if they had any free time. Another said about the housing that they called it the Mount Sinai Slums because of the incredibly poor conditions of the apartments, including rats and cockroaches and bad electrical wiring. While I was grateful for their honesty, it made me worry and wonder about a possible New York future. Next day was interview day, which was fairly standard. They showed us a morning report, which was interesting. It was more about reading articles and presenting objective data regarding the case, than refining diagnostic reasoning. While it was impressive and certainly informative, I certainly appreciated the normal morning report format. This program was certainly geared up to make fellows and researchers. My interviews were both just OK. Many asked why I would want to move out the East Coast when having lived my whole life on the west coast. They were quite interrogative.

And so I completed residency interviews (a few others not mentioned) and it was time to make my rank list. Applicants would rank the programs, and programs the applicants, and then a fancy algorithm would match everyone up (which is where the name “The Match” comes from). I ended up ranking Denver first, then Pittsburgh, then Emory, and then got delusional and put Mount Sinai next (turning my back on my decision to value the residency time, but lulled in too much by New York City and the Prestige of the program), then I ranked Utah, then Spokane, and then everything else after.

When match day came around and I learned that I had matched at Utah I was initially disappointed because I felt like by not matching at a higher choice I was basically being told that I wasn’t good enough. It turned out to be an absolute blessing. It was the perfect blend of academics and Enjoying time during residency. Before match day I had gone to salt lake again to ski and it turned into one of my favorite ski trips ever. And with that I became excited to move to Salt Lake. It was a residency program that cared about its residents no matter what and valued wellness greatly. This would turn out to be incredibly fortuitous, and it made the transition into residency easier and more relaxed than it could have been.