Davis: End of the externship

My externship with the Davis combined medicine/psychiatry program ended today. I left the clinic this afternoon with a sense of satisfaction that the experience was all-around positive and that I received encouraging feedback from everyone. I'm sad to be leaving, and I'm eager to return to Davis for the interview; this speaks volumes about my gut-level feeling about the program.

I had two goals when I started this externship. First, I wanted to figure out whether combined medicine/psychiatry is right for me, or whether I might be better served by a pure medicine or pure psychiatry program. Second, I wanted to get a better feel for the UC Davis program, in particular: the leadership, the residents, the strength of the training, and the general environment of Sacramento.

On the first goal:

I am much more certain now than when I started this rotation that I want combined training. I could only feel comfortable coming to this conclusion after gaining first-hand experience in an environment that combines medicine and psychiatry to provide integrated patient care. This rotation leaned heavily toward the psychiatry end of the spectrum, much to my initial disappointment. But this limitation to my experience here at UC Davis provided a contrast that helped me appreciate the satisfaction I feel from treating patients' medical and psychiatric needs together.

Over these past four weeks, I learned why much of my clinic experience was straight psychiatry: MediCal reimbursement rules prevent billing for medical and psychiatric services in one visit. In fact, one of my last patients of this rotation lamented that she would soon have to find a new primary care provider for her medical needs because her insurance was switching over to MediCal. This is a woman with COPD, congestive heart failure, diabetes, and bipolar disorder, all of which my dually-trained attending has been managing well. She would be ill-served being forced to find a new primary care provider who just treats her medical needs. My attending says that changes to MediCal reimbursement rules are in the works to address this problem. This is a poignant lesson, though, of the types of struggles that I will likely face in choosing the combined medicine/psychiatry path.

On the second goal:

Over and over again, I was struck by how friendly and happy people are here at UC Davis. I'm left with the feeling that I would enjoy working with these residents and attendings, an extremely important feeling considering that these would be my colleagues for the next five years. Both the medicine and psychiatry programs, as well as the combined training program, are very strong. And Sacramento itself was a pleasant surprise. It's a small city with not too much going on, which suits my purposes just fine for residency. The heat was not unbearable as I was expecting. And it's close by to many attractions (e.g. San Francisco, Lake Tahoe, the Redwoods). My attending says that Sacramento is a better place to live than visit. I agree.



So, with everything said and done, my mind wanders back to about four years ago when I was visiting different medical schools. I remember walking around Colorado's medical school campus, taking everything in, thinking, "I could see myself happy here." And it turns out that I was. I get that same feeling from Davis. This is a nice starting point to have heading into interview season.

First residency interview offer!

I got my first residency interview invitation this morning! So exciting! The whole thing feels a lot more real, now.

Late Update: My first interview offer was to Iowa's combined medicine/psychiatry program. Exciting!

Residency application: Submitted!

Today is a big day for fourth-year medical students all over the country, the day when we can finally apply for residency programs. This is done through ERAS, the Electronic Residency Application System that aggregates all application materials. The whole process is much simpler than applying for medical school. There are only three parts to ERAS that medical students have any control over: 1) the personal statement, 2) the curriculum vitae, and 3) letters of recommendation.

I did my fair share of freaking out about the personal statement. My perfectionist traits shine brightly when writing an essay that's meant to convey most of who I am and the kind of doctor I want to become, all in less than a page. But beyond that, I've had a surprisingly zen attitude about this new round of applications. It doesn't do to obsess about something that can't be changed. For all the nit-picking over my application this last week, the substance of my application has been settled for quite some time.

Perhaps that's why clicking the "Submit" button this afternoon felt anticlimactic. I celebrated, regardless. How exciting to think about all those program directors out there reading through my application! Nerve-wracking to wait for the interview offers? Yes. But I'm confident in my application and am looking forward to this next step in the long slog of becoming a doctor.

Face time with med/psych residents

Last week, the chief resident took me and a few other med/psych residents out for my first recruitment dinner of the interview season. It's a great opportunity to get to know the people who I may be working with closely over the next five years. Do I like them? Would they be easy to work with? No doubt they are asking those same questions about me. This dinner was all the more important, for all of us. Because I have mostly been working with dually-trained attendings and psychiatry interns, I haven't had the opportunity to get to know my potential future colleagues.

Recruitment dinners in general have an interesting dynamic. On the one hand, it's a social event, and everyone should be having fun. I don't want to come across as boring or rigid or anything else negative, but I also don't want to have too much fun. I've heard many stories from current interns about applicants who drink too much alcohol during these recruitment dinners and end up making asses of themselves. Why anyone would do such a thing with so much in the balance is beyond me. Regardless, I did genuinely enjoy dinner and chatting with the med/psych residents.

Then, this weekend, I took a day trip to San Francisco with one of the med/psych interns and a couple of her friends. The whole day was very relaxed and a ton of fun, a showcase of what my days off could be like if I end up at UC Davis.

Externship at Davis

I have neglected to mention on this blog a major development in my medical education. During fourth year, it is common for students to do clinical rotations at different medical schools. These away rotations are called externships; they serve as a sort of month-long interview for residency, allowing both the student and the program to check each other out before or during the interview season.

I applied for an externship at the University of California Davis in their combined medicine/psychiatry department, and that's where I am right now. In fact, today was my first day! I am looking forward to this coming month to gain first-hand experience in this combined field.

How are medicine and psychiatry combined in practice? What do my attendings' careers look like? What sorts of careers do the medicine/psychiatry residents hope to forge for themselves? Do I want to spend the extra time and money for this dual training, or can I achieve my career goals through another training route?

This coming month promises to be very informative.

Happy ERAS day!

Today the Electronic Residency Application Service (ERAS) opened for the Class of 2013. Thus begins yet another epic application process, this time for residency.

ERAS has five main components:

• Curriculum vitae: General information, education and training, publications, awards and honors, extracurricular and volunteer activities.
• USMLE transcripts: Step 1 and Step 2.
• Personal statements: There aren't any limits to how many personal statements can be written and uploaded, but only one personal statement can be assigned to each program.
• Letters of recommendation: There aren't any limits to how many letters of recommendation can be uploaded, but a maximum of four letters of recommendation can be assigned to each program.
• Program selection: There aren't any limits to how many programs can be selected. Also, multiple specialties can be selected. Then, for each program, the specific personal statement and letters of recommendation are assigned.

I spent an hour or so this morning transferring the information from my CV into the ERAS system. Having maintained my CV on a regular basis over the last few years made this a very simple process.

ERAS is open only to medical students until September 15th, at which point applicants are allowed to submit their application. The few residency program directors I talked with strongly encouraged me to submit my ERAS application on September 15th, rather than waiting, because they like to start sifting through the applicants and offering interview immediately.