I promised this post a while back and I think this topic is fitting for my first post of the new year because it’s all about new beginnings. I was not a traditional applicant to dermatology and because I decided late in the game, the months leading up to the match were the most stressful times of my life. I really want to share my experience with you readers so you know that everyone goes through major ups and downs in this process (even if everything seems perfect and peachy on social media!) and that no matter what happens, everything does work itself out in the end. So here we go.
I went into medical school determined to be an ophthalmologist (for the non med folk, these are doctors who specialize in eyes and eye surgery). A close family friend of mine is a great ophthalmologist and loves his job, which I found very inspiring. I think a part of me also felt pressured to choose early on, because I worried that I couldn’t get into a competitive field unless I started doing research, volunteering, getting to know the faculty, etc. In retrospect, this is silly, because exploring different fields to find out what you like is probably the most important thing you can do as a medical student. But I thought I knew, and so I threw myself into my research on mouse retinas and spending time at the free eye clinic. I really enjoyed working with my amazing mentor and PI (the head of my research lab), but fast forward to the end of third year, after I did two months of ophtho rotations, I realized that I didn’t love the clinical work. Major uh-oh, as I was three months away from residency applications.
I did some quick and frantic soul searching and made many many phone calls and wrote emails to several mentors. One of my early mentors from undergrad suggested that I try a dermatology rotation. Crazy, I thought to myself at the time. I had been interested in dermatology as a first year medical student, but after hearing about the insanely high board scores, the intense type A pre-derm students who were at the top of their medical school classes, and the crazy number of publications you needed to get in, I was completely scared away from the field. I had done a few case reports in dermatology with that mentor as a first year medical student but that was it. How could I possibly compete with all the other amazing derm applicants?! My mentor told me to try anyways, and I listened. This was another great lesson for me, to surround myself with great mentors who inspired and encouraged me even when I didn’t have faith in myself.
I figured I had nothing to lose and in June at the end of third year, one day before my ophthalmology sub-internship was set to start, I dropped out and switched into a four-week dermatology rotation. I think I was actually half hoping that I wouldn’t fall in love with the field, so that I didn’t have to go through the grueling application process. But (as you would expect) I completely fell head over heels for dermatology. One of my favorite clerkships in third year was internal medicine, but I found it really challenging to fully address the large scope of patients’ medical problems under the time pressures of the current medical system. Dermatology combined what I loved about internal medicine (the actual thinking about the medicine!) with super interesting visual diagnoses. I loved the mix of procedures and clinic, the continuity of care I got with patients, and the huge overlap between dermatology and other fields like rheumatology, cancer biology, immunology, etc. In short, I liked it more than any other clerkship I had done and I could really see myself in this field. So I decided to go for it and apply into dermatology, even though the rational side of me was screaming that I couldn’t successfully pull it off.
By the time I decided to apply into dermatology, it was the July of my 4th year of medical school, just two months before residency applications were due. I didn’t know the faculty well and I had very little to show in terms of dermatology research. My board scores were nowhere near the quoted average needed to be a “successful applicant.” At that point I emailed all the faculty to see if anyone had a short term research project, including faculty at neighboring institutions including UC Davis and UCSF (the only other two medical schools in Northern California). I ended up working on and presenting a case report of Graft vs. Host Disease with an amazing young attending named Dr. Kwong in the Stanford dermatology department, and I am so thankful to her still for giving me a chance at that last minute. She ended up writing me one of my letters of recommendation from the derm side. I also met Dr. Maurer, the chief of dermatology at SF General Hospital who is the leader in global health dermatology (another huge interest of mine), who made a special away rotation for me at her hospital in October, a month after I submitted applications. The dermatology residents at Stanford and my Stanford classmates who had matched into derm the years before all helped read my personal statement and application. Writing this out now, I’m again flooded with gratitude for all of these people further along in training than me who took the time to help me when I needed it the most. I remember deciding at that point that I would pay it forward and help out whoever else needed advice from me further down the line (that offer still stands folks!).
Fast forward to November of fourth year. Everyone in my class had gotten interview invitations, but my inbox stayed quiet. Then … the floodgates opened, and not in a good way. I applied to around 85 dermatology programs, and everyday that I opened my inbox I got rejection after rejection after rejection. I remember getting twelve rejections in a day once, and then, the cherry on top, I got rejected from one of my top programs (expected, but hey, I still had dreams). I had just gotten off the Muni (public bus in San Francisco) and it was pouring rain, and I just stood there on the street holding my umbrella and broke into tears. That wasn’t the first time that happened either; breakdowns were pretty common over that period of time (funnily enough, that school actually extended me an interview invite the next week). I had never felt so insecure, so unsure of myself and my accomplishments, and I felt like I had no future in medicine. I started measuring my self worth with each rejection email, and I remember constantly having heart palpitations and a low steady baseline level of stress and feelings of uneasiness. I put an insane amount of pressure on myself, thinking that if I failed at this, I pretty much failed at everything. My fiance at the time (hubby now!) worked in tech in San Francisco, so I thought that if I couldn’t find a way to stay in Silicon Valley, I was letting down our marriage before it even started (none of this pressure came from Matt though; he was supportive and loving every step of the way. He passed me a lot of tissues and gave a lot of hugs – definitely a keeper). It 100% wasn’t a healthy period of time for me, and looking back, I am so thankful to my now-husband Matt, my friends, family, and God for helping me through those moments.
Little things set off anxiety out of proportion to what they should. I remember one day I bumped into someone I knew from undergrad who had recently started as a first year medical student at Stanford. We caught up casually over coffee at LKSC and I shared a little about my application process and what I was experiencing. I will never forget how his friend, another fellow first year medical student who was interested in derm, looked at me incredulously when I explained my late switch. “Well, no offense but…what about you makes you think you can match?” she asked me, cutting me off. “Everyone else has been preparing for years!” Even though she didn’t mean it, this student who was only a few months into first year summed up my fears exactly. I thought about that conversation often, when I was driving or showering or any other time my mind was free to wander. If it seemed that obvious to everyone else that I was fighting an uphill battle, why was I doing it?
Eventually I did get some interviews through December and even January, and most were surprisingly at excellent programs I felt very lucky to be visiting. I felt like I somehow snuck into the interviews, not believing that I really belonged there even on the interview day, kind of like an impostor compared to the other applicants who seemed so confident. Then as I went on more interviews, I found that the interviews themselves were actually not bad at all; I like interacting with and meeting new people and I made a few friends on the interview trail (PS if you missed it before, derm interview tips here and more general residency interview tips here). What I realized throughout the trail was that it didn’t matter that I wasn’t pre-derm from the start or that I didn’t have the highest board scores or number of publications. Every school I visited was really interested in my global health and media background and the gap year I had spent working in medical journalism! I had something different in my application, and even though it was nontraditional, it helped me stand out and gave me another skill set to bring to the department.
NYU Dermatology really stuck out in my mind on interview day; I clicked with the faculty and the residents that I met, and I loved the facilities and specialty clinics there. I never thought that I would actually match there, but I’ll never forget the feeling that shot through me when I opened my red envelope at Stanford Match Day and read “NYU Dermatology.” (More on Match Week drama here, because this is just a freakin’ ridiculous story) I’m halfway through my first year of derm here at NYU and I still pinch myself sometimes because this training program is amazing, and I am so impressed by my co-residents who are not only super smart but also awesome human beings.
Ultimately, one of the main points I want to get across in this post is that the whole application process is an unpredictable free for all. There’s no way to say whether one person or another who will definitely get into dermatology residency because it’s a totally SUBJECTIVE process. If you are passionate about something that can be related to dermatology in some way (and most things can be), that can make you stand out, so show it in your application! Don’t freak out comparing yourself to other applicants because chances are even the most confident appearing ones have moments of insecurity too. You’re all in the same boat. Also, don’t let the fear of failing stop you from trying. If I had let my worries of embarrassing myself stop me, I would not be a derm resident today. What if I had just continued with my previous life plan and went into a field I didn’t love? I would probably end up unhappy and regretting my actions. Most importantly, don’t let the application process define you and affect how you think of yourself. Any medical student has already worked so hard to make it this far, and no matter what happens, you will be more than fine.
I remember right after Match Day, someone online created an open google spreadsheet of every dermatolgy program in the country along with the applicants who matched there, the degrees those applicants have, what medical school they were coming from, and whether or not they had achieved AOA status (a medical school honor society). Yes, take a moment to laugh at the neuroticism of that endeavor; someone compared each matched applicant to some AOA roster online (who has this amount of time?!). Stanford did not have an AOA chapter, but even if we did, I most likely would not have been in it because my strength is not in test taking. But you know what? I’m fine with that. Good test scores don’t make good doctors, and my ultimate goal is to be a kick ass dermatologist. I hope anyone else in the same boat that I was will feel this way too.
In 2016, I’m going to to try to have more honest and personal blogposts like this one, to show more fully what it’s like to be a physician at work and at home, the good, the bad, and the ugly. It’s going to be a great year!