You-Know-What

Okay, the topic of the post might sound misleading to most, but those who are aware of it, might agree.

I am taking about the San Francisco Match (or the SF Match, as we call it affectionately). There seems to be a surprising lack of resources for more information about this match and how it works. I have yet to see another website besides the official site (which is quite informative for a beginner) that has some information on the system.

First things first, this is NOT a match for match in California! In fact, it has absolutely nothing to do with location whatsoever. A lot of people ask about whether you need a SSN or PTAL for this match. And the answer is NO.

This is just the same as the NRMP/ERAS match, except for the fact that its for certain fixed sub-specialties, and takes place earlier in the year.
Now since I matched for Child Neurology, that is what I'll talk about (even though the SF match also caters to other sub-specialties like NDD, Ophthalmology, Plastic Surgery etc)

Three Years of Child Neuro include one year of Adult.

What is Child Neurology and why am I talking about  it here?
Well to answer the latter first. I MATCHED! And want to spread the love! (Especially for IMGs who don't have a med school advisor, and rely on seniors and forums for all information!)

To answer the former, read on..

When can you get into it?
WHENEVER YOU WANT! (..Well almost!) There are a couple of separate pathways to get into Pedi Neuro. To make sure I don't give a wrong message, let me quote from the website:

"Prerequisite Training: The training can be initiated following one of three options:
(1) 2 years of residency training in pediatrics in the United States or Canada;  

(2) one PG-1 year (as described in the Program Requirements for Residency Education in Neurology**) and 1 year of residency training in pediatrics; or 

(3) 1 year of pediatrics plus 1 year of basic neuroscience training.

The program director must review and determine the acceptability of these initial two years of training."

** (Excerpt from the Neurology RRC Program Requirements (ACGME): 'Those that provide 4 years of residency training, the first year of which training (accredited in the United States or Canada) must include a broad clinical experience in general internal medicine. This year must include at least one of the following: (a) 8 months in internal medicine with primary responsibility in patient care or (b) 6 months in internal medicine with primary responsibility in patient care and a period of at least 2 months total time in pediatrics or emergency medicine or both. Residents must spend no more than 2 months in neurology during this year.'  

I am taking the first pathway, by entering Child Neurology as PGY-3 in 2013. (Does that clear it up a little?)

So, wait, its a Residency after residency, or a Fellowship ..or what? Huh?

Child Neurology, while technically is a fellowship level thing since you do it after a Peds Residency; it is considered a Residency by the Board. So basically, if you do Peds  then Child Neurology-- and end up taking both Boards-- you can be 'Double Board Certified' with 'Certification in Pediatrics' and 'Certification in Neurology with Special interest in Child Neurology'.
The Neurology Certification means you can practice adult neurology too (since you do have to spend one-third of your Child Neurology Residency in the Adult Year)
Then there's the opportunity to pursue a fellowship, in one of the many fields of interest like Epileptology, Neuromuscular disorders, Sleep medicine etc.


The Timeline:
Its an early match.
How early? Well, the process of submission of documents starts in June (as opposed to September, for ERAS).
- You mostly have interviews ranging from late-October and should finish by late-December (though I met someone who was finishing in mid-Jan, so that's how far it can go!)
- Then you submit the rank list by mid-Jan.
- And Match Day is usually in the last week of Jan. (It was January 27th this year!)


How many programs? 
There are not as many programs for Child Neurology as are for Pediatrics (doh!!). There are about 70 odd programs (--they give you the comprehensive list once you register for the match) . I applied to twenty five programs, and received interviews from thirteen places.

Most of the programs via the SF Match are for the three year Child Neurology i.e. beginning as a PGY-3. But programs prefer if their residents do both- Peds as well as Peds Neuro-- from their place, so they *usually* try to co-ordinate with the Peds Department. This means while they might try to interview you for Pediatrics as well (if you apply there via ERAS), it is NOT an obligation.
Now some places like Cleveland Clinic, Rainbow Babies etc have a dedicated five year track. Which means, if you get in the Child Neurology part of the track, you mostly get in for Pediatrics as well (again, through NRMP!)


Match Data:
While people might think that the competition is less in Pedi Neuro, let me assure you-- its a MYTH! There are about 1-3 spots per year per program. So the ratio for candidates per spot boils down to the same thing. Here is a link to last year's match data from the SF Match. So last year 69% IMGs matched, which is more than the average NRMP match percent, but definitely involves more of a commitment!

I know some IMGs might be tempted to apply just for the heck of it.

If that is your plan, then DON'T!

Here's a scenario:
Assuming, you apply for about 30 Child Neuro programs and a hundred-ish Peds programs. (I did.. since I wasn't sure I would be able to make it in Pedi Neuro this year). If you end up getting interviews in Pedi Neuro, then quite possibly your credentials are good enough and therefore you will get interviews for 'just-Pediatrics' as well.
Now, if you aren't sure if you want to go for Peds Neuro, then you might be in a fix since the match date is earlier. Your rank list is divided between the programs that invited you for both Peds/CN and the ones that have only Peds!
You might end up going to a specialty you aren't sure about (Pedi/Neuro) without giving a specialty you might love (eg Peds or IM) a chance!
[Basically what I'm trying to say is, applying to Peds Neuro is not like applying to say Family Med or Peds as a back up that I've seen a lot of Internal Medicine people do! Its a different ball game altogether]

Apply to the field only if you LOVE it! Since if more than just five years of your life.

_________________________________
I tried to cover everything that sporadically kept coming up in my head. More questions are welcome. I'll try to write another post if I have some common queries, or answer questions in comments.

Good luck!
_________________________________

PS: Hugs to one absolutely fantastic CN intern I met during my away rotations. She patiently helped me out a lot through the whole process, when I didn't know squat about You-Know-What! Thanks, S. x

The Brain Doctor

Hello people!

If you're a person who doesn't know me in real life or on Twitter, then, hey thanks for checking in! A lot has happened since I last wrote.

BRAAAAAIN!

One of the biggest decisions of my professional life has been made. I know where I'll end up for the next five years, and how I'll come out of it. Yes, I now have a Residency position at one of my top choices! And that too, exactly in the specialty that I wanted to go in--- Pediatrics Neurology! :D

This blog played a HUGE part in my choice, since some of my readers here introduced me to the field of Child Neurology in the first place! Then doing an elective in the same furthered hammered the interest in!
In one of those earlier posts I had mentioned how I loved the academic part of Neurology -- the lesions and the localisations *swoon*; but wanted to become a kiddie doctor-- well, safe to say Peds Neuro fulfills both wishes! A dream come true. Yes.

Magical!

Dream, reminds me, I also managed to catch a trip to Disneyworld after the interviews! Had a FANTASTIC time!! All thanks to the family I have here!! :D

Also, I just finished with the USMLE Step3 exam today. And can only hope to pass. (Please pray for me. Thanks.)

As you can see I have loose associations and am in almost a hypomanic state today, I'll end this post here.

Bye bye USMLE! (hopefully!)

But I need to write a couple of pending posts. Those shall happen soon. Just, not right now.
x




PS: Oh, I just realised.. one of my best friends is getting married in a couple of hours! Too bad I can't be there! But I wish K and A the very best for their new life together!! Love you, K! (even though I'm sure neither of them will read the blog in a million years! )


Image Credit for IMG1: Gray's Anatomy for Students: One of the best anatomy books. Ever!

The road less taken.. and how much it'll cost

I’m going to make a list of the moolah spent by an IMG (Indian in this case) if they want to do a Residency in the US of A.

The journey from USMLE to MD ( Yeah! Borrowing term from Digital Doc :D) is a long, and, of course, expensive one. A lot of juniors at college have asked me this question time and again - "How much will it cost me if I decide to work for a Residency in the USA?"

Having been through almost 3/4^th of the process, I’m just listing the basic $s that I have spent on the process till now. By the end of this post you should have a gross idea of how much it’ll cost, and thus you can make a realistic decision of what you want to do next – AIPGEE or USMLE.

(I assume that you have basic idea of what the USMLE and the whole process is like on the whole, and are familiar with the terminology.)

-A lot of costs vary by individual choices. So I’m going to list what I spent as an example where this difference arises.

Exams:

There are a lot of exams that you need to take to be fully ECFMG certified.

TOEFL: An optional exam that is steadily converting into almost a mandatory one if you want to have a competitive CV for electives- Fee $130  Its $165 now.

USMLE Step 1, 2 (CK & CS): A little over $1400 ($700*2) for USMLE Step 1 and 2CK, and $1200 for CS. EDIT: Exam now costs much more than that. USMLE Step1 $880, Step 2CK $895, CS $1295. Check official website for regular increments!

USMLE World: QBank plus the Self Assessments- They’re worth every penny. For Step 1, a two month UW subscription plus UWSA will cost you $195 ($135 + $30*2). And Step 2, will be $165 ($135+$30)

NBME Self Assessment: To assess your prep, you’ll end up taking online NBME practice tests. Since each test costs $45 to take (and $60 for one “special test’ for each exam), the number of tests you take depends on your preparation. There are some who take none while others end up taking all tests. I spent a total of $375 for NBME SAs for both exams.

Electives:

Application: Most Universities have an application fee of $100 or so. Although there are some that are free too. Umar Tariq’s website has a comprehensive list of all information for electives. (I spent about $500 on applications)

Tuition Fee: This totally varies by University where you end up doing electives. Some like Harvard and Tufts have a fee of $2000-3700, while others like Cleveland Clinic and NIH are free. (I paid about  $1400 as tuition)

Malpractice Insurance: This is another thing that is new for us and since there seems to be just one company that provides MI to students on a monthly basis, they have been increasing the premium with every passing year! I ended up spending about $600 for MI.

Travel and Housing: Of course travel to the US will cost another $1000-1500.

Housing will vary from $300 to $500 per month depending on the location. This cost multiplies depending on how long you stay in the US. (I’ll take my expenditure as $500 since I was in luck wrt housing.)

Misc: Add to it other costs like travel insurance, visa fees, immunization titers before going to the US.

Then there’s the whole other set of expenditure on FOOD (major spending if you don’t know how to cook daily meals!), travel within the country and, of course, SHOPPING in the United States. ;-)

Fed Ex:

Giving this a special slot since there is a LOT of paperwork to be sent! There are numerous applications, college documents and Godknowswhat!! Each packet costs about $50, and I’m sure I’ve sent over ten such packets. (= well over $500)

Applying for Residency:

After all this preparation, we come to the main application! It costs a bundle, especially for an IMG!

Registrations: $50 for NRMP and $90 for ERAS token

Application: Come September 1, and a major hole in your pocket is just one click away.

In ERAS, applying to 30 programs in each specialty adds up to $305, and then for each additional program its $25 per program. So, if you are a regular IMG who needs a visa, and is not a big hot shot already in the medical world, you’ll apply to over a hundred programs.

You do the math.

(I ended up spending over $2500, plus another $70 for a USMLE transcript release)

Then there’s more:

Although till now this is the stage I’ve reached in the process, there’s a lot more to come.

Travelling again to the US, expenditure of travel within the US for interviews, USMLE Step 3, living there for about six months… and it goes on.

Bottomline:

Going by this list, USMLEtoMD -till now- has cost about a total of *drumroll* $11,350 *faints*

For those who are planning to start on this journey, this was just a preview for you to have an idea of what the costs are going to be like. Just a thought to keep it realistic.

(And now I won’t have to explain the details individually to anyone who inquires- I can just direct them here! :D)

Note: I’ve tried to keep all figures correct and comprehensive according to my memory. If there is something that you’d like to add or remove, let me know. Hope this post was useful! 

:)


Image credit: Google Images

10 things that show that I've gone into pre-exam mode

10. Sleeping > 15 hours per day. With mornings that happen around noon, and pulling late nighters-- which include lots of random googling, surfing and browsing the web (and no studying, of course!).

9. Watching re-runs of FRIENDS, Full House or even Sarabhai/Sarabhai every chance I get.

8. Then again, going into anxiety mode over time that was wasted watching shows or sleeping!

7. Twitter stream filled with study facts (which ARE sometimes useful btw!) and rants about How I Slept For Another (Hour) (<-apologise for the extremely poor attempt at rhyming with HIMYM!)

6. Breakfast> Brunch>Lunch>Mid-day snack after nap> Pre-dinner>Dinner>Late night coffee. Repeat.

5. Ten different alarms on the phone for waking me up. To be repeated everyday! (First alarm starts at 6.30am. I duly wake up anytime after 10am)

4. Googling up any bit-of-information-about-any-obscure-person-or-thing that I come across. (Ritz pointed this out to me yesterday)

3. Being perpetually online, and knowing about every little update on Facebook/Orkut/Twitter. (Notice how, even at this stage of boredom, I did not resort to extreme measures like taking quizzes or playing farmville or deciding who my 'friend/enemy/lover of the day' was!)

2. Cribbing to anyone who will listen about the upcoming exam and how its making my life miserable.

1. Writing blog posts, like this one.

Annd score!!

Yes. Its been twenty one days since that fateful day in October.
Had been waiting anxiously for my score sice the past two weeks, and it arrived fifteen minutes before the scheduled time.

I got that elusive 99.

Happiness.

Yay! Yay!

The past three weeks have been hell emotionally.

I've cried over wrong answers.

Brooded over the difficuilt questions.

Rationalised some ethics questions.

Decided on alternate career options.

And what not!*

I wish the NBME people would post the scores earlier. Whoever heard of the scores of an online exam delayed by atleast three weeks. (Even the state Pre-PG exams results are faster!- However crappy the quality of questions might be! :p) But seriously, some of the questions were maddening. Have never come across such questions, ever!

And even more frustrating was that I remembered a lot of them post-exam!

And now after the results, I feel I could've done a tad better had I not taken the exam as the 'most-important-exam-of-my-life'.

The exam period was spent in extremes. At one hand I was anxious during the early blocks. Lost confidence in the middle. And became complacent in the end-- just wanted to get over with it.

Anyway,

All that is past now.

With a good score, I can hapily leave Step1 behind and move on.

Bring on the next step!!

*All my apologies to Papa, Ritz, D, Kau, Navy, Avi, AnkC, Dibs and others who have had to deal with my depressed mood the past three weeks. I still blame the NBME for the tough test!

PTSD

The exam I'd been dreading the past few months is over!

Yes. Done with it.

And now I'm scared shit about the results.

So we won't talk about that anymore.

As for my life, well, I've been just relaxing since the past few days. Of course, its difficuilt to have too much fun when all of your friends are studying for one exam or the other. So its been mostly me, watching a lot of movies and just surfing the net. Haven't even started on the TV binge yet.

Which reminds me, why is it that when you have an exam coming up, you make lists of all these wonderful things you'll do once it is over, but as soon as, the beast has passed, you just lose interest!

Before the exam, I had to restrain myself from spending hours reading blogs and articles, but post-exam... ehh...nothing! (In fact today is the first time I returned to even my blog, after four full days of doing nothing. So have a lot of catching up to do here.. esp in terms of reading.)

I had this whole list of things I wanted to watch/read/do planned out, but ...nah..not anymore!

So maybe the things-to-do-post-exam are actually just defence mechanisms to distract me from the scary reality of the upcoming exam and loads of syllabus.

And another thing that I've noticed is that medical students are born to take exams.

We are programmed this way.

We crib, and we crib... starting months before the exam, but the when on the other side, there this feeling of actually being 'too free'. Every now and then I get this jolt in my tummy, reminding me that I've got to study.. and when I realise the fact that no, I really don't have to study at this point of time, I get a weird sense of apprehensiveness over the sheer unnaturality (if that's actually a word!) of the situation.

Ah well, I guess that's what Medicine is all about.

PS: Writing this post, has brought back those shivers over the thoughts of all the questions I got wrong. Sigh. *Do not in any way ask/tell/talk/mention my past exam. You are welcome to talk about yours*

PPS: Apparently I am incapable of writing about anything besides padhai (and cribbing about it!) these days. I'd started off with something else in mind (writing some sort of list maybe), but landed up ranting about the exam. Oh well.

Enough about me.

How have you been the past two months?

Cheers!

Arps