I get emails all the time asking for residency application advice. A lot of these come from IMGs, which isn’t surprising: applying to residency in the US from the outside is stiffly competitive, and the support/advice from home isn’t always sufficient. Others are those with competitive dreams or particular needs for residency that make fourth year that much more stressful. To profitably fill that void are the “residency consultants” and their ilk, like the folks who wrote The Successful Match who would also love for you to be their client on not one but two (ugly) consulting websites. A lot of these guys are former associate program directors in fields like internal medicine who applied to residency themselves in a different era. In many cases, the nitty-gritty details and current application climate are probably better known by recently matched fourth years and residents in your specialty of choice, not to mention that being involved in interviewing and selecting candidates in one field at one institution doesn’t necessarily make you an expert in the whole process. Great consultants probably exist, but the credentials they spout are a red herring.

I don’t think US allopathic students who are thoughtful and reasonably competitive for their respective fields generally have a significant need for a comprehensive application review. Depending on how supportive and useful your student affairs department and faculty advisors are, many US MDs who are reaching a bit (but flexible) are also likely doing just fine on their own for the most part. But for others, particularly IMGs, a service and all-around helping hand to go over every nook and cranny of your application, help you fix your mistakes and take the right angles, polish your personal statement, and prepare you for interviews is obviously of value. Given how much you have to pour into ERAS, traveling costs, etc–shelling out for a residency consultant may be too much insult to injury, even for those students who are among those who would benefit the most. I’m generally suspicious of a lot of “advice” (and you often get what you pay for), but there’s no doubt that the perspective, experienced editorial services, and advice you get from qualified people who don’t know/like/love you is going to better approximate the things that will help you when the same sorts of strangers review your application or interview on the big day.

Still, I would make sure to exhaust the diverse community of peers and institutional support before hiring a stranger. And I’m sorry, but I don’t have the bandwidth to help one-on-one.

Below are my categorized and annotated book recommendations for psychiatry residents, including book recommendations for the psychiatry boards.Continue Reading

When people talk about the very real gender pay gap, they’re talking about women and men being paid different amounts for doing the same work. There is a pay gap in medicine, and that’s a problem.

What’s so odd then is this discussion of the gender pay gap in the most recent Medscape Resident Salary and Debt Report:

Salaries for women in residency are lower than those for men ($54,000 and $56,000, respectively). The gender disparity in residents, however, is only 4% compared with a disparity of 24% among all physicians, according to the latest Medscape Physician Compensation report. The much smaller difference among residents is most likely due to their work in the hospital setting, where salaries are consistent. But disparity seems to be a continuing problem.

And later:

Over three quarters (76%) of male residents work at least 51 hours per week in the hospital compared with 68% of women. Such a discrepancy might be one reason for the slight income disparity between male and female residents.

But:

• Resident salaries do not actually vary by gender.
• Residents cannot bargain for salary increases on an individual basis.
• Residents are salaried (stipended) workers who do not get paid by the hour as residents (moonlighting aside).

I can think of a few more plausible explanations for the small resident gender pay gap in this totally nonrandom sample of 1279 residents from different fields not accounting for seniority:

1. Out of survey respondents, men were more likely than women to choose specialties with long residencies. This is a general trend which has been demonstrated previously. Resident pay is graded by PGY level. If you are a resident longer, you will eventually get paid more. So a male PGY6 neurosurgery resident gets paid more than a female PGY3 pediatrics resident.
2. Out of survey respondents, the men who answered had a slightly higher PGY level on average than the female respondents, and this wasn’t controlled for. Same logic as above.
3. Out of survey respondents, slightly more men lived in geographically expensive areas with consequent larger salaries thanks to CMS.

I would argue that given the classically terrible methodology of Medscape surveys, that the above explanations or more likely than a nefarious but hitherto unknown hidden systematic gender pay gap among resident physicians. The real problem lies in landing that first job after residency and continues from there.

I’ll leave John Oliver to weigh in more eloquently:

Much of the entire self-help book market is predicated on the idea that copying the habits of successful people will make you successful. This is untrue.1The same can be said any other resource that purports to help you succeed by sharing the secrets of the elite. This isn’t to say that no one benefits from shared wisdom, but while someone else’s methods may work for you, the most important thing to know about other peoples’ success is that it is theirs.Continue Reading

Using the official 2014-15 “USMLE Step 1 Sample Test Questions,” (cached version here) I’ve written explanations and take home points for each of the 138 questions (the “Free 150”). The 2015-16 set has no new questions (a few have actually been removed), so this is still current. I can’t reproduce the questions themselves of course as they’re uber-copyrighted.

An asterisk means it’s a new question (of which there are around 84). The questions and explanations for last year (2013-14) can still be found here.

The new 2016 set is out and has around 50 new questions, which are discussed here.

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QuantiaMD, the “social learning and collaboration platform that helps physicians,” is now temporarily paying people $10 to sign up. I assume with the rapid growth of Sermo (which has been paying doctors to join for a while now), they’re getting a bit more desperate to compete.

Click the link, confirm your “clinician status,”2By confirming the automatically found NPI number associated with your name, for example, followed by clicking a link in an email sent to an institutional email address, a 2 minute process from start to finish. and you earn 10 Q-points, which you can redeem immediately for a $10 Amazon gift card. Finish up your profile (another two minutes), and you’ll have 16 Q-points. Accumulate your Q-points (by referring/harassing your friends and completing the [often pretty good] educational activities), and you can redeem at a higher rate (45 for $50 and 80 for $100).

The short presentations they choose for the Q-point opportunities are usually interesting and often deal with the non-clinical aspects of medicine that most people probably need more exposure to. Also, you can click through them at your own pace (getting the gist and the points in mere moments if you so choose).

I should note that medical students can still join and earn Q-points, they just aren’t able to redeem them for gift cards until graduating and confirming as below.

More information on QuantiaMD, Sermo, and other paying survey opportunities for “clinicians” can be found here.

Update 11/2015: Essentially, things have gotten cheaper (crazy!). New costs reflected below.

Update 1/2016: I wrote a JP exam review book (more info here), which you could buy.

Update 9/2016: DPS numbers are no longer a thing, because Texas finally realized it was stupid to essentially duplicate the DEA number everyone needs to have anyway.

As with most things that really matter, the website, process, and wait for obtaining a medical license in Texas is less than ideal.2This is probably true elsewhere, for that matter, but I wouldn’t know. And then, once you have paid for and subsequently obtained your medical license, you will still have to wait your DEA number (if you don’t already have one) before you can actually do much with it. The whole process from start to finish will likely take you somewhere in the neighborhood of six+ months.

Applying for your license

The application checklist is exhaustive and wordy to the point where a run-of-mill US-trained physician may not be sure if they’re eligible. In Texas, you must have completed your internship (but not your residency) prior to applying for your medical license. As part of the application process, you will need to supply both proof of both your USMLE Step 3 success and a “Form L” from your internship or residency signifying your successful completion of this task. So, if you take Step 3 during your intern year, you can apply for your license on July 1 of your PGY2 year. You also need to pay for, take, and subsequently pass the Texas Medical Jurisprudence exam. Of course, you can’t do that until you fork over the initial application fee.
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