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Tuesday Feb 23, 2016

Finding Right Fit Key to Match Process

"I'm going into family medicine."

This statement could be easily overheard in a multitude of settings, including the classroom, clinic, hospital or community. Yet it took me three years to develop the confidence to openly express my true passion.

Here I am visiting Yosemite National Park between residency interviews in California. I interviewed at 11 programs from Seattle to San Diego. Match Day is March 18.

Although I already was interested in family medicine before entering medical school and specified my interest upon matriculation, I was surprised to meet a lot of resistance toward my chosen specialty.

While attending one of 10 U.S. medical schools that lacks a family medicine department, I have listened to multiple lecturers comment on how family medicine "will be replaced by nurse practitioners and physician assistants," and I have been told that I am "too smart" for the field. This quickly taught me to tread cautiously. I would say things like, "I'm interested in primary care but open to other specialties," to ward off unwanted advice.

I didn't express my interest in family medicine again until during a family medicine elective rotation at a nearby community hospital. It felt so validating to hear words of encouragement from both the residents and faculty. Furthermore, the diverse range of patients I interacted with -- both inpatient and outpatient -- reminded me of the primary reason why I chose to pursue a career in medicine: to provide quality healthcare for all, regardless of background.

As I started the residency application process, I quickly realized how dramatically different residency programs could be. I initially searched for programs through the AAFP Family Medicine Residency Directory, but I was overwhelmed by the sheer number of programs in ONE state. I contacted my family medicine advisor from the community hospital (who ended up being the mentor for all three of the family medicine applicants from my school), and the first question she asked me was "What kind of program are you looking for?"

This simple question stumped me. While my classmates who were pursuing subspecialty interests were focused on finding large academic institutions with strong reputations and opportunities for fellowships, I had the unique opportunity to reflect on the differences between a community-based program affiliated with a medical school versus one not affiliated with a medical school, rural versus urban, underserved settings, as well as opposed or unopposed programs.

Most importantly, my mentor pushed me to probe deeper and contemplate how I envisioned practicing medicine. Based on my goals, we reviewed programs whose mission and philosophy seemed to align with my own. I had never heard of half the programs she suggested, but I maintained an open mind and applied to them.  

Once I started on the interview trail, my fellow classmates and I often shared our interview experiences, and we noticed dramatic differences between the processes followed by primary care and surgical subspecialty programs.

  • My pre-interview dinners typically occurred in a resident's house, sometimes with homemade food while my classmates often went to either a happy hour or a three-course, sit-down meal.
  • My interview days had three to 12 applicants compared to my classmates' sizeable 30- to 40-person groups.
  • I typically had two to three interviews that lasted 30 to 60 minutes, while my classmates had up to 10 interviews, lasting 15 to 20 minutes each.
  • The questions I was asked focused on getting to know more about me, my view of wellness and my vision of family medicine in 10 years. My classmates reported occasionally answering medical knowledge or research questions.
  • My interview days lasted approximately five to six hours. In contrast, my classmates' days lasted up to 10 hours.
  • My interviewers were more likely to ask me, "Why is X program a good fit for YOU” rather than “Why are YOU a good fit for X program?"

How often do you hear medical students comment on finding the right "fit"? That seemed to be a much bigger concern to the family medicine programs than the subspecialty programs. The process of the Match should be a two-way process in which not only is the program looking for particular characteristics in a candidate, but that the program knows candidates are also seeking specific qualities.

The applicants I met from across the country shared their various visions of how they wanted to practice family medicine, and these interests sparked unique discussions throughout the interview day as well as at dinner. My appreciation and pride for family medicine continued to grow throughout the interview trail as I learned more about the increasingly diverse scope of care family medicine can provide.  

The most difficult part of the application process isn’t necessarily the interviewing, but rather, the rank lists (which are due this week(www.nrmp.org)). Each program has a unique approach to training future family physicians. Some programs' styles paralleled well with my own vision, and I did indeed experience the visceral reaction people often label as a “gut feeling of finding the one.” Certain programs spoke to my goal of training in an underserved area focused on community-oriented primary care with dedicated time focused on behavioral health as well as opportunities to pursue the numerous other interests I have.

Ultimately, while some of my classmates created extensive excel sheets to numerically rank factors, and based their decision on the total sum, I viewed each program as a potentially new family. The most important part of a family is the people who are willing to support each other through the ups and downs presented in life's journey. In the end, I know I’ll get great training no matter where I go, but it's the people who matter the most to me.

This journey on the interview trail has taught me how unique family medicine is compared to other specialties. I’ve met a lot of incredible individuals during this process, and I would be honored to grow and learn with them.

I'm proud to say that I'm going to become a family physician. Soon, I'll find out where.

Tiffany Ho, M.P.H., is the student member of the AAFP Board of Directors.

Posted at 01:02PM Feb 23, 2016 by Tiffany Ho, M.P.H.

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