Tag Archives: residency

Podcast Episode 8 – Dr. Jason Eberhardt

Dr. Eberhardt and I were ‘middle management’ at a new institution so shared many struggles and successes. Although we lead sometimes apparently different lives, we feel very similarly about success and how to achieve in veterinary medicine. I hope you enjoy!

Should you Do a 4-Year Residency?

Ridiculous switchbacks at Angel’s Landing in Zion remind me of the path to residency.

Most residencies in veterinary medicine are three years, with a handful of two-year programs out there for some specialties.  In recent years, the four-year residency has become more common. This is typically a residency in a highly competitive specialty, such as surgery.  In effect, the institution is getting you for an extra year for very little pay- they get a reasonably competent specialist for resident pay as opposed to faculty pay.  The advantage for the applicant is that a 4-year residency may be less competitive, because some applicants are not willing to sacrifice another year of their life for low pay and delaying their career.  So the rub is, should you apply for a four year program?

The principle advantage of pursuing a four-year program is that there are fewer applicants for such programs than for three-year programs.  So, you may be more likely to be accepted into one than into a three year program. The consequences are that you have another year as a resident, instead of getting to start your career as a specialist.  You delay moving to your next destination. Maybe you delay finding relationships (romantic and fraternal). You delay earning Real Money. If you are fanatically dedicated to the discipline and don’t care about the consequences to your life and career, a four-year program may be acceptable.

The disadvantage of a four-year program is primarily time.  In a three-year program, you would be done and then earning a decent salary by your ‘fourth’ year.  You would also be considered a specialist, and able to apply for private practice or university positions.  A four year position is adding 33% of your residency time to your life timeline. Another year may not seem like much now, but you will never get that year back.

Ultimately, four-year residencies are designed to take advantage of the competitiveness of some disciplines and take advantage of those applicants who are desperate.  The institutions get a year of low-cost high-skilled labor from your fourth year. You get a residency you may not have otherwise gotten. It’s a difficult balance and exemplifies the principles of capitalism: a balance between supply and demand.  What you need to ask yourself is: Are you willing to be inexpensive labor for a year in order to get a residency?

Internship/Residency Rankings Done Right

After you’ve chosen the programs in which you are interested, sent in your application materials, and done an interview (if applicable), you are now ready to rank the programs.  The rank order list is due in early January. What does it mean and how do you do it?

The mechanics of the match are described in detail elsewhere.  Put simply, you rank the institutions and the institutions rank the applicants.  Then an algorithm runs and matches the applicants with the institutions.

Some people try to over-complicate the match process.  They think, “Well, I doubt I will get into place X, so I won’t ‘waste’ a high level spot for it.”  Don’t assign value to the actual rank spot. Instead, you should rank purely on one criteria: Where do you want to go?  Rank in order from YOUR highest picks to your lowest, without regard for your likelihood of them wanting you. The system is designed to be treated this way; you’ll mess up your chances if you try to second-guess the algorithm.

How many institutions should you rank?  It depends primarily on how happy you can be in a given circumstance.  For example, have you decided that literally the only way you can have professional fulfillment is to be a surgeon?  First, I’m sorry for you. But if so, then you have to rank every single program. On the other hand, if you’ve decided that you would very much like to do surgery, but not at the expense of your physical or mental health, then you should only rank the programs where you would be happy.  That’s difficult to know a priori, but it is possible if you do your research and talk to current or former interns/residents

The second consideration for number of institutions to rank is financial cost.  There is a substantial step up from 10 to 11 institutions ranked ($90 to $250 in 2019).  However, this is your future, the next step in the rest of your life. Even the highest step ($350 in 2019) is not particularly expensive, matched against your entire education to date and your professional future. My advice therefore is to rank more.

The next consideration is how good of an applicant you are.  If you know you will be a top choice at a few schools, you only need to rank a few.  If you are a good candidate but not sure where you stack up, you will want to hedge your bets and rank many more institutions.

The final and most important consideration is how to decide how to order your rankings.  Being an analytical sort, I made a table. It looked something like this:

Program# InternsSalaryElective TimeSpecialists% ER TimeResearch Notes

Your table may have other variables, such as: geographic location, # cases, equipment, license requirements, rounds, or % primary care time.  Some of this information you can get from the position description, some will come from your research on the position. At the end, organize the programs according to the most important variables for you.

My general advice is to rank every institution where you think you could be happy.  The cost is not very significant, it minimizes the risk of not matching and having to do The Scramble, and is fairly efficient.  Rank them in order of where you want to go. That’s it! Tell me what you think and how it goes!

Avoid the Biggest Mistakes Made during The Match

Making your professional life successful is as much about what NOT TO do as it is about what TO do.  The Match is probably the highest-stakes professional selection in academic veterinary medicine- even more so than getting into vet school in the first place.  As a result of this pressure, people make a lot of mistakes which adversely affect their professional future. This is not an exhaustive list, just the most prominent ones I have encountered.

1) Trying to game the matching algorithm.  Please don’t do this.  I know it’s tempting. I did it because I was foolish, didn’t talk to anyone wiser, and the internet was barely a thing.  Rank the place you most want to go #1 and then move on to the next.

2) Not reviewing your application materials.  How is it possible there is a misspelled word in your letter of intent?  You have spell-check on your writing program, don’t you? Run basic diagnostics and read and re-read your materials.  Simple errors like this suggest to me that the applicant isn’t really all that interested in the position. If they were, they would have spent more time on their application.

3) Not sending out your application materials.  You must get others to read your letter of intent and CV.  Preferably veterinary academics who have looked at many such applications.  However, even your friends and family can be helpful. Tell everyone to be brutally honest.  Your goal is to get the best application possible, not to assuage your ego. You don’t have to take everyone’s suggestions.  In fact, if you send it out enough, you will start to get conflicting suggestions. But you must have others review them. You would not believe the poorly written letters I have helped people improve.

4) Not getting your ducks in a row in time.  Hopefully, you strategized your time to maximize your match success.  And you did give those writing letters of recommendation plenty of notice, didn’t you?  And you have gotten all your materials in well before the deadline, right?

5) Not preparing for interviews.  If you apply to institutions which hold interviews, you must do your research and study up on how to do a successful interview.  Failing to plan is planning to fail.

6) Delaying the decision.  I know some students and interns who waffle on whether to apply to the match and then make a decision at the last second.  That is unacceptable. If you THINK you may want to apply, set up everything as if you will. You don’t have to submit your rank list until January.  If you put in applications but don’t rank any institutions, you won’t match anywhere.

It’s not a long list, but you would be surprised at the number of people who continue to make these mistakes- hence this post.  Try to avoid being one of them and let me know if you need help!

Podcast Episode 7 – Dr. Jarred Williams

Dr. Williams and I worked together at an institution and spent many a night doing colic cases together. He has insight into the world of veterinary equine medicine and equine surgery. I hope his insight is helpful to those of you interested in that path!

Vetducator Dr. Waitt Podcast on a Horse

Podcast Episode 6 – Dr. Laura Waitt

Dr. Waitt and I worked together at the same institution and we met when, on her first day on the job, she jumped in to help with the anesthesia OSCE. She is also a WSU grad and a terrific person with whom to work. She has insight into the equine veterinary world which I don’t have which she shares during this episode.

Making the Most of a Residency Interview

The Vetducator - residency interview image.

Your application is compelling enough for a program to spend the time interviewing you- congratulations!  Many residency programs conduct interviews, and it can be a significant variable in the decision making. Sometimes these are by phone, sometimes by video, and sometimes in person.  Obviously, you should follow the general guidelines for each of those interview types as well as prepare so you can present your best self. More specifically, here’s how to make the most of your residency interview experience.

This is not only a chance for them to learn about you but for you to learn about them.  If you get matched for a program but will be miserable, you may not finish. Every year there are residents who drop out of their long-dreamed-of specialty because the program wasn’t a good fit for them.  You need to make sure this is somewhere you can be happy for three or four years. Here are some questions to ask the program directors or existing residents to help you decide:

Both program directors and existing residents:

  • What’s it like to live here?  What do you like about it? What do you dislike about it?
  • What are the students/interns like?  What are the interaction with them and the residents?
  • What are the responsibilities of the residents?  Do they do general ER duties or call or only do specialty emergency duties?
  • What is the interaction with other specialties like?
  • What is the strategy for ensuring residents successfully complete a research project?  Are there opportunities to do more than the required project?
  • Are there opportunities or requirements to teach in lab or classroom or rounds room?  What kind of support is available to help nurture resident teaching skills?
  • If you could change anything about the program, what would it be?

Program directors:

  • What do you do to ensure resident success?
  • What are the plans for program improvements?
  • What have you learned from previous residents that has caused you to change the program?

Existing residents:

  • What have been your challenges with this program?  What did you like about it?
  • Would you have chosen this program if you knew then what you knew now?
  • What would you change about this program?

Asking incisive questions will ensure that the program knows you are serious and engaged.  What else can you do to impress them during your short interview time? Remember, their goal is to determine if you will be successful in their program.  You want to assure them you are competent, dedicated, and enthusiastic.

You need to have examples from your experience that demonstrate your best characteristics.  Are you willing to come in odd hours- tell a story during your clinical year or internship when you did and had a great time.  One of my best days in vet school was 22 hours long and started with a hemilaminectomy and ended with a GDV. The resident on duty said excitedly, “Well, what else would we be doing on a Friday night?” and I was in enthusiastic agreement.  Just saying, “Yes I work hard and I would love to be your resident” is not enough. Demonstrate you have those characteristics with stories.

Each residency program is different, but characteristics that are generally looked for include (in no particular order): curiosity, willingness to work hard and long hours (no laziness or cutting corners), detail oriented, compassionate, humble, teachable and willing to accept and use feedback/criticism, able to handle setbacks, good at managing stress, pleasant to work with/positive, ethical, good critical thinking skills, knowledgeable, effective at communication, enthusiastic, dedicated, and cooperative and helpful.

The residency interview is a difficult experience to navigate.  You need to get information to make sure you would be happy there while assuring them you would be happy there and a great catch for them in a very short amount of time.  Have a plan ahead of time. If you fumble asking questions or coming up with examples of how you’re awesome, you’re sunk. It’s a fairly high stakes experience. You spent undergrad, vet school, and maybe an internship to get here.  You can’t just hope it will work out. You must prepare.

The Vetducator Podcast- Dr. Diehl

Podcast Episode 5 – Dr. Katie Diehl

Dr. Diehl and I worked together at the same institution and enjoyed discussing and engaging in research. Since I left, we have continued to work together and have some great collaborations. Dr. Diehl talks about the unique circumstances of finding and obtaining an ophthalmology residency as well as what she looks for in candidates and how she likes to help students be successful.

Choosing Letters of Recommendation for a Residency

The Vetducator - letters of recommendation series image.

The letters of recommendation for a residency are key.  These people will hopefully not only write you a letter but advocate for you in the residency selection process.  Fortunately, the strategy for this letter is simpler than the strategy for letters of recommendation for an internship.  I really have only two guidelines:

1) All of your letters should be from someone in the specialty to which you are applying unless it violates (2).

2) At least one of your letters MUST be from where you are currently working.  If you are doing an internship, all of your letters can’t be from your student days.  If you are doing a specialty internship, all of your letters can’t be from your student or rotating intern days.

My recommendation is therefore as follows:

At least 1 letter from a specialist in the field at your current institution.  The more the better.

If you do not have a specialist in your field at your current institution, get a recommendation from someone in a core discipline (internal medicine, surgery, emergency/critical care).

The balance of letters can be from specialists not at your current institution.

The reason you need a letter of recommendation from someone at your current institution, even if they are not in your specialty, is to demonstrate that you are not a monster.  If I were to read an application from someone from a private practice internship- which did not have an anesthesiologist- and they had 4 letters of recommendation from anesthesiologists from where they went to school, I would wonder, “Did they peak in vet school?  Is there NO ONE working with them now who can vouch for their medical competence? Anesthesia includes knowledge of information from all kinds of disciplines- if they can’t do basic medicine, will they be a competent anesthesiologist?”

In general, more letters from people in your specialty is good.  If you have your choice of specialists, those more well-known or connected may be slightly preferable.  But a great letter from just any surgeon is probably better than an OK letter from a renowned surgeon. If at all possible, those writing for you should already be boarded and have a lot of experience writing letters of recommendation. If this is not possible, unboarded people in your specialty will have to do.

Dr. Coretta Patterson Vetducator Podcast Image

Podcast Episode 4 – Dr. Coretta Patterson

Dr. Patterson was my supervisor at one of my academic positions, and she was a very inspiring, positive, wonderful boss. She has a massive wealth of experience in academic veterinary medicine and mentoring students and faculty. She is compassionate and will also tell you what you Need To Hear in a positive way to make you a better veterinarian. Dr. Patterson talks about raising a family during training, how to progress successfully through an academic career, and what is great about internal medicine.

Links to topics brought up in this episode:

What to Get Out of Doing Research Work as an Undergrad

There is No Ideal Applicant

Words of Caution for the Aspiring Vet Student