doc w/ pen

a journalist becomes a doctor before your eyes

Category: Residency

Bright future? Or dark cloud?

You have a bright future in front of you
But a dark cloud over you

So stated a New York City subway ad for a student loan refinancing company. (My paraphrase, but that was the gist.)

I smiled as I read the words, sitting there on an orange plastic seat, the train clattering along. Smiled, because I could relate to the feeling. Smiled genuinely though, not in a sad, resigned way. Because while I could relate to that feeling, I no longer felt that way.

Medical school in the United States is insanely expensive. Each year at Weill Cornell Medical College, I borrow about $90,000 from the government for tuition, living expenses, health insurance, and so on. I also have loans from the two-year pre-medical program I completed — more government loans, and some private bank loans too. At the end of it all, I will owe the equivalent of a hefty mortgage. Heck, depending on where you live, I could’ve bought two houses with all these loans.

Residency is when you start having to pay things back. You’re a doctor, but not making a doctor’s salary. For the government loans, there are income-based repayment plans. But not for the private loans. I’ve had many moments of middle-of-the-night panic about this. How in the world could I afford to start paying back all this money, potentially three loan payments at once, while making around $50,000 a year?

“It will work out. It always does,” I’ve whispered to myself on more than one occasion, to still the panic.

And now I have a better idea of how it will work out.

The fact that I’m graduating in a year has forced the issue. As I’ve scrolled through psychiatry program websites and pondered my personal statement, residency — and the accompanying loan repayment — has shifted from the realm of fantasy to reality.

But I’m no financial expert. And the world of student loans is a quagmire. I’ve felt completely unprepared to figure this out on my own. So I turned to the Internet. I don’t remember my Google search terms. They were probably something desperate like this:

How do you afford medical school loans as a resident?

Bank websites came up, of course, promising special repayment deals for medical residents. I investigated, discovered that it’s possible to refinance private and/or government loans to drastically reduce monthly payments during residency. Interest continues to accumulate, of course. But you can now afford to buy groceries, pay your rent, and avoid default. Seems like a good compromise to me.

I even called one of these refinancing companies, heard their spiel, and learned that there’s really nothing for me to do until after I graduate. I can’t refinance until then, or even apply, until I have my diploma. I was glad to know about the option though, and now have it tucked away for next year.

I kept poking around the Internet though, in search of advice on how to create a more comprehensive repayment plan for myself. Or for the name of someone who could help me do that.

A website called The White Coat Investor popped up. The person who runs the site is an emergency medicine doctor who got sick of “financial professionals ripping me off.” This seemed promising. Specifically, I landed on a page titled Student Loan Advice. The page gave me some information I already knew — how complicated student loan management is. It also gave me information I didn’t have — the names of people who specialize in helping medical residents manage their student loans.

I scheduled a free consultation. A specialized financial advisor and I discussed my options (in broad strokes), what his company could do to help me, and how much they charged for their services.

After the call was over, I felt a sense of relief. More than that: pure peace.

The exact details of my plan are yet to be determined (and can’t be, not fully, until after I graduate next May). But there are doable plans, and people who can help me map them out at a price I can afford.

Rather than that dark cloud, I can now focus on my bright future.

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On this day …

I don’t normally look at the “On this day” posts on Facebook. I don’t normally spend much time on Facebook at all. But today, on a whim, I did. This came up, a 5-year-old memory:

As did another post from a dear friend exactly a year later, which I’ve copied below. If I remember correctly, the first sentence, in quotation marks, is her quoting me; the second sentence is her reaction to my words:

“Holy shit. That is an acceptance letter.”
I LOVE YOU

Discussing the MCAT on this day in 2013, and a medical school acceptance letter on this day in 2014 …

I’ve come a long way since then. I’m now discussing medical school graduation (in 13 months!) and where I will apply for my psychiatry residency (in 5 months!).

Thanks to all of you who have helped make this possible, and to all of you who have followed me on the journey. I couldn’t have done it without you.

Celebrate!

Every day, it gets a little more real. The fact that in just over a year, I’ll be a doctor.

Some moments, that timeline feels more concrete than others. Like today, when I logged in for the first time to my new best friend ERAS, the Electronic Residency Application Service.

I’m sure I will grow to loathe the purple, orange, and green color scheme of my ERAS dashboard, given how much time I will spend on this website. (And really? Purple, orange, and green? That’s a little much, isn’t it?)

But today, the colors seemed festive and celebratory. And so I am celebrating.

That’s right, I’m applying to RESIDENCY. Wow …

 

Picking among disciplines

“What do you want to be when you grow up?” It’s a common question throughout childhood. It comes from teachers and parents. It’s also a question we ask of ourselves. We dream into adulthood, trying on different career costumes, imagining what could be.

My own sense is that the question is in constant evolution. It can’t be definitively answered after high school, college, or even graduate school. Few people in this era complete a career with the same company. Each new promotion, each new employer, provide further clues into our professional identity.

When I decided to go to medical school after a career in journalism and publishing, I turned over a radically new leaf. I handed in my pen for a penlight, political sleuthing for a stethoscope.

Could I have imagined such a change in course when I first thought about my future? No.

As I approach the start of my fourth and final year of medical school, the original childhood question takes a far more specific turn: What kind of doctor do I want to be?

It’s pondered endlessly, ad nauseam, at times to the point of true nausea. As in childhood, my reply to the medical school version of the question has changed over time.

For as long as I can remember, I’ve made things with my hands, from beaded necklaces to stained glass windows to origami flower bouquets. So I initially pictured myself in a procedural specialty, something surgical, making the most of my manual dexterity. But I quickly realized that I much preferred waking patients to those under anesthesia. I also realized that the reporter in me craved stories, conversation.

In the context of my career history, filled with interviews and human contact, my chosen field — psychiatry — makes obvious sense. Admittedly it wasn’t the choice I’d imagined when I began medical school. In fact, it was among the fields I thought I wouldn’t choose.

But in a way, psychiatry chose me.

Before starting my psychiatry rotation, I’d rotated through obstetrics-gynecology and primary care (outpatient adult medicine). I’d loved aspects of each. In the ob-gyn segment, it was my two weeks on the labor and delivery service. Holding the hand of a mother-to-be, counting with her as she pushed out a new life. Talking, in between pushes, with her and whomever was there to support her (husband, partner, mother, sister, friend) about their hopes, dreams, and fears. During primary care, it was sensing the trust that patients put in their internist, who’d known many of them for years, knew their life stories and struggles as well as their medical diagnoses.

Not long into my psychiatry clerkship, I realized that in this one field, I could experience my favorite parts of my time in ob-gyn and primary care. I could talk about a patient’s hopes, dreams, and fears as well as develop ongoing relationships with them.

I could also use many of the skills I’d honed in my decade-long career before medical school. Psychiatry, like journalism, is about stories. It’s about developing quick rapport, asking the right questions, and being an active, empathetic listener. These skills are certainly not unique to psychiatry, but they are especially important in psychiatry, where a detail from the patient’s medical history, past hospitalizations, relationships, or living situation might be crucial to how you manage the person’s care. This background suddenly takes on immense importance because of the way past experiences shape mental health.

There is also an investigative aspect to psychiatry. One of the tasks frequently given to medical students on the psychiatry clerkship is to track down so-called “collateral” on a patient – to talk to a person’s medical doctor, therapist, psychiatrist, case worker, significant other, sibling, parent, or friend – to get a more complete picture of the person’s immediate situation. In psychiatry, as in journalism, you don’t rely on the story you get from one person. You approach information with healthy skepticism. And so you gather evidence from a number of sources and put the pieces together yourself.

Each field of medicine also has a vibe, a unique personality. Part of finding your place, I realized early on during my clerkship year, is finding your tribe. In psychiatry, I did. I found people whose personalities, interests, goals, sense of humor, wardrobe choices, and even favorite eyeliner color meshed with my own.

After completing my psychiatry clerkship, I was almost sure that I wanted to be a psychiatrist. After finishing other rotations, I’m entirely sure. Because the things I liked best about each of them also have a place in psychiatry. In neurology, my favorite patients were those whose illnesses blurred the lines between neurology and psychiatry. In surgery, I thrived under the tutelage of a particular trauma surgeon, one of the best educators I’ve ever met. He inspired me, on a daily basis, to learn and explore, to be curious. I’ve found mentors in psychiatry who do the same, and I find psychiatry’s subject matter inherently interesting in a way surgery concepts were not. In internal medicine, I liked the challenge of using artful communication skills to broach difficult subjects with patients and family members. I also felt at home in the role of being a comforter to those in distress.

While I’ve answered the next iteration in this serial question – “What do you want to be when you grow up?” – my future is by no means fully defined. First of all, where do I want to do my four-year psychiatry residency? And after that, do I want to do a fellowship for more advanced and focused training? Do I want to work with inpatients, outpatients, or a mix? What city do I want to practice in? I’ll find the answers to these questions and others, in time.

For now, I focus on what’s in front of me: finishing medical school, and finding the right place for me to become the best psychiatrist I can be.

 

Note: The original version of this essay appeared on the online magazine “The American.” You can read it here.