Becoming a Doctor
“If you’re going through hell, keep going”
I went unmatched. Now I'm matched into my first choice sports medicine fellowship in California.
How did I get here?
I have a guardian angel, who is sometimes drunk. And I am very lucky.
I work hard and take chances. I never do anything the easy way.
Grit.
I was 18 when I entered medical school. I applied to one school, and got in. My best friend at the time was Polish, so we were going together. I dropped out of college, sold my car for tuition and left immediately. My mom would contribute to my tuition, which was low at around 100k over 6 years and her husband would help on a personal loan. She would then send me what she could to live on. 18 years old, I flew out and was picked up by an acquaintance. I distinctly remember staring up at the pale dorm ceiling, realizing I had no cell phone, no food, no local currency and no idea where I was and where to go. My friend was busy taking exams, he was a year ahead of me. I was just a dumb kid who bit off more than he could chew.
During medical school - there were highs and lows. The high points came when beautiful spring flowers bloomed in a gorgeous city rich with culture and learning the wonders of medicine surrounded by historic buildings and new and interesting friends from other countries. I made lifelong friends, the best man at my wedding was my medical school roommate. The lows came too; my first ass-kicking, loneliness, a failing and toxic relationship, standing over a bridge at 3 am alone in the middle of winter, only held back by my fingertips on a guardrail hanging over an icy river, willing myself both to jump and not to jump. But I would not give up.
Over the years money trickled in sporadically. There were weeks I ate only rice and soy sauce because I didn't have any money. Or I borrowed money from friends. I got good at composing meals with scattered, unrelated pantry items. My friend picked up bad habits, isolated himself and plummeted downwards, he developed a tragic illness, the kind your mind doesn't recover from. We grew apart. I was isolated from everything I ever knew, in a country whose language I was not fluent in, during a time where nationalism was on the rise and it got uncomfortable for foreigners. Despite that we banded together, our English division of this European university, and persevered, had good times and bad. I couldn't afford to fly home more than a few times in 6 years. Eventually I was food prepping tasteful meals, I knew the city like the back of my hand and traveling to beautiful countries for wonderful cultural experiences but it was hard won progress.
I paid 6,000 dollars for an externship because my school didn't offer US rotations.
At the end of that 2 month externship I said "I need a job after I graduate, I don't even have a credit score".
I was recommended to work for someone on the East Coast, far away from California. It was minimum wage 15 dollars an hour, on a 1099. Rent was 1,150 leaving me roughly 1,200 to live on pre-tax, which ends up at 840 or about 30 dollars a day.
Not enough to save for anything meaningful for the USMLE steps and applying to residency - a 10k endeavor. I began scribing and medical assisting full time.
The job was abusive but it promised a letter of recommendation which was gold at the time. By the end of the 1 year, the relationship was so sour that I didn't even want it. I wanted to get as far away as possible. At a certain point, only a few months after I had left. The FBI raided my old boss's home and took him to jail, there was a big medicare fraud task force that rounded up dozens of doctors in the area in one fell swoop. This was at the height of the Opioid epidemic. I learned bits and pieces about the situation over the years. Without saying too much, some good people got caught up in the storm. People I empathize with; I got a glimpse into what it looks like to have everything you’ve worked for taken away in an instant.
My next job was slightly better but the private industry doesn't care about you or your education. People make decisions to make money and shit rolls down hill, every one below the boss gets squashed.
I struggled. I stopped playing sports, I picked up smoking cigarettes. I developed anxiety. My self confidence was at an all time low. I learned hard lessons.
I commuted 6 hours a day 3 days a week by bus, over 3 states. It gave me time to study and the job was in the field that I wanted to go into. During winter I sometimes slept in the office on a chiropractic table with a sleeping bag instead of taking a 3 hour bus journey home in the snow. Sometimes I did make that journey though and I remember my eyelashes freezing as I crossed bridges walking home in negative degree weather, at midnight. That was if the bus actually showed up.
I was now making 30 dollars an hour which ended up as 3600 a month on a 1099, pretax. My rent was around 600, by then I had moved in with my girlfriend and we split the bills.
I took out a 12,500 dollar personal loan at a blisteringly high interest rate.
I studied 3-6 hours a day. After about 2 years, I had passed step 2 CK and CS, hard fought wins that cost roughly 2,500, not counting study resources like first aid and Uworld which costs several hundred dollars collectively. My scores were 226 and 243, first time pass for CS. I applied for internal medicine and PM&R.
I did research, I had a 50% chance to get in if I was lucky. I needed at least 10 programs to rank to have a good chance of matching. And if that was going to happen it would have been on the East Coast, where the reputation is what we call malignant but accepts IMGs. By sheer luck, this was the first year that California began accepting applicants without the PTAL, which I didn't have, but meant that I could apply to my home state.
I sent over 250 applications, which cost the rest of the loan. I interviewed at 6 or 7 programs, flew out to several states, uberred and took buses and interviewed as best as I could at the time.
I felt out of place and under prepared. And I think it showed. What if I didn't match?
One program was a dream come true, I felt at home. The interview went very well. The program director said "here is my personal phone, you're at the top of the list, just let me know if you change your mind and don't want to come here"
I remember popping champagne with my girlfriend when I certified my rank order list, we cried. She had seen all the blood sweat and tears and was as invested as I was, as so often happens with partners of medical trainees. By now I had ditched the cigarettes, picked up jiu jitsu, I was reading Jocko willink, Jordan Peterson and watching motivational videos on YouTube. I picked up boxing and rock climbing too. Things were going better.
We decided we had had enough of that part of the country and my family was out near that dream program. I joked, “let's move there now, several months before the match, and if we match then bang! We're already there. And if not, then we get a nice vacation in California, near family, and I'll get some job to pay the bills.” She worked from home. We packed up our stuff, our 2 cats and drove across the states in an old Cadillac. I had a fever for 3-4 days. I drove 10-12 hours on enough DayQuil to keep a horse awake. I never do anything the easy way.
While I was there I asked for an interview at a local competing hospital, I said if you have any openings due to cancellations, I'm in the area and would love to interview.
That actually got me an interview and that also went well. But I was clearly outclassed. Still, it felt good to pad my interview numbers.
The months came and went. Match day arrived and I opened the email. I didn't match - a chill swept over my body, my feet went numb and my heart beat out of my chest. I was crushed and I had to scramble. No time for falling apart. I sent out my apps. A surgery residency in Texas called, the program director said "I could make a surgeon out of anybody".. thanks? Another one came in, family medicine in California, no time to prepare just get on the phone. I spoke with a chief resident, we got along great, the chief and I had a long, inspired talk - it felt like a good fit. I had a good feeling about it, next was the program director and boy did the conversation and momentum flatline. I was dejected. I did not SOAP - and I would have to wait another year and repeat the process all over again.
My worst fears had been realized. My family and friends offered condolences. I bit down hard. A bitter, bitter pill to swallow. My stomach churned, a burning knot bore a hole in my gut. I was in significant debt. Had spent months interviewing and waiting, years studying and testing. Now, it was not that I may never be a doctor after everything, but given that the odds were now against me more than ever, I was likely never going to be one.
The pressure was crushing, too numb to even cry - although I did at times. I compartmentalized it, buried it miles below the surface. But I wouldn't give up. I would correct my course, get smarter and become a better applicant. Through gritted teeth and tears I told my wife, we will make it through.
I was unemployed and in a new city (again). And it was March of 2020. The pandemic was raging hard. People lost jobs, entire markets closed. Everything became more expensive.
I remember the streets were literally bare, not a car on the road. Inside a relatively major city - it felt illegal to even breathe outside. Finding a job wasn't easy but something needed to happen.
Thankfully (and purposefully) I had family nearby. My mother and her husband, for the first time in 10 years I was in the same state as any family member. Looking back, my father had left town after a bad divorce when I was 13 and we've had no contact since then, except for one fight as I started medical school, it was a disastrous relationship and it's probably better off the way things ended up but it still hurts.
Once again my mother mobilized everything she could to help me - through sheer luck, she had just finished her years-long lawsuit involving disability and had come into some money. I was given enough to do nothing but study for a few months and reapply for residency. I had my second chance.
To put things in perspective my mom was the 2nd oldest of 5 siblings. Her mother was an alcoholic and her father was in and out of the picture. She fought through 23 years of a bad marriage, never making much and yet fighting for and raising two kids on her own. We never went hungry, we always knew love and we had as good a childhood as anybody. But money was always a concern. She didn't go to college, we were comfortably lower class in an expensive city.
Getting back to residency. What does one need to do to become a better applicant?
Pass step 3, usually a test taken after 1st year of residency, after gaining experience - it can be done prior to residency with brute force. Get reputable letters of recommendation in the speciality you've chosen, preferably from faculty within a residency. Do a research year. Get a personal statement professionally edited. Seek out volunteer opportunities that align with your speciality and mission. Personalize every single personal statement to the individual program as much as feasibly possible, learn the buzzwords, "grit, passion, empathy, commitment, local ties". Study their websites and demographics, read the faculty bios, and find common ground. Find ways to relate to that city, state, nearby sports team, anything. Easier said than done.
How do you do this during a pandemic? It wasn't easy. I basically went door to door, I googled and called and emailed all the doctors in the area for opportunities to shadow, to just get my foot in the doorway. I dressed up, brought the office staff coffee. I tried to make a good impression and show interest. I signed up for a pandemic volunteer response.
A brief window of opportunity opened up! The nearby hospital which was 7 minutes away was opening up a family medicine residency and needed residents immediately. I rushed to put together my CV and documents. I threw on a suit and drove over to the hospital campus excitedly searching for who to give my paperwork to. After plenty of searching I found the interim program coordinator, he said I was a great applicant! “Unfortunately our last day for accepting applications was Friday and today is Monday, we were only open for a few days and we received more than we thought!”. He said to check in next year when the next match starts. Damn, I thought. Shut down again. There was nothing else I could do.
At some point a doctor, through a friend of jiu jitsu, said I could shadow. He was a family medicine - sports medicine specialist, a great guy, treated me like a resident, gave me life lessons and great advice about residency. I asked him for a letter which stated how hard I was working to get into residency.
By then I had re-evaluated myself soberly. I reviewed the specialities that I thought I had a chance for. It came down to family medicine and psychiatry. I eventually wanted to do sports medicine. So I zeroed in on family medicine. All of my letters, my personal statement, my volunteering.
I started door dashing. But the money wasn't good and I couldn't study. I applied for scribe jobs locally, and one person offered an interview. I am a fast typist and this would be my 3rd scribe job in 3 years, this was something I was good at.
I interviewed with the physician owner of a specialist group, a brilliant man, driven and no bullshit -sometimes intense but had a heart of gold. I asked for 20 dollars an hour at 40 hours a week on a W2. He hired me, I watched him run his business while I studied for step 3. I did every job he had, I was a medical assistant, a scribe, I filed faxes, I answered the phones and scheduled patients. There were opportunities to act like a resident - which I enjoyed. And he even took me into surgery a few times.
8 months later as we were saying goodbye he was telling me while laughing about how much he didn't like me in the beginning, but by the end we were hugging, he told me he was proud of me and kissed me on the cheek, a father figure at that point.
Throughout this time I studied anywhere from 4-10 hours a day, for months on end. I would lay awake at night with a burning pain in my stomach, worried it wouldn't work out. During the day I would stare at the ceiling in between studying, completely numb.
I kept doing jiu jitsu, I even competed around this time and won silver in a small tournament. As it turns out, having martial arts as a hobby is a major talking point in interviews, it made me stand out as someone competent, tenacious and passionate.
It was then 3 years since graduating medical school. A lot of programs decline applicants for just that reason. The ones that were left used this pretty much as the cut off. Meaning that this was the last ferry to the island. Next year I would have 10% of the programs left to apply to.
After another 1000 dollars, I passed step 3. A major win. My personal statement was brutally honest, essentially explaining how I was unprepared for the first match, and how I fixed it. That my time outside medical school was a strength, not a weakness. I had grown. I was just 24 when I graduated, now 27. I needed that time to evolve. I was now a redemption story.
Now I was a well seasoned scribe, I had all of my steps passed, I had letters from doctors who took residents. I was a motivated athlete who wanted to help underserved populations do martial arts. I was passionate about family medicine, learning Spanish. I was a local applicant with close family ties and professional connections. I made it clear that I wanted to practice in the area I trained, even become faculty. I had a glimmer of hope - all the confidence of a man betting his life savings on red because it was either going to work or it wasn't.
My boss was rooting for me, he gave me advice for interviews (and even let me use his office), counseled me and shook hands behind the scenes to get me opportunities.
I combed the Internet for interview techniques. I memorized answers to the top 20 interview questions. I filmed myself speaking. I watched endless YouTube videos, I practiced with my fiance. I picked out questions to ask. I researched individual programs' mission statements.
I bought a suit that fits and good shoes. Tried to keep my room clean - and metaphorically therefore my life. Practiced a firm handshake, good posture and confident eye contact.
I applied again, another 200 programs. At least this time during COVID I did not have to fly anywhere. Everything was online, which is difficult in its own ways. Cheaper, but less personable. Look at the camera, smile, don't fidget, speak clearly and plainly with well-practiced words. Speak in positives, avoid negatives. Keep it short and honest, don't ramble. Compliment people and express interest in their interests. Prepare thoughtful questions based on your online research. I told one program that given all of the people I've met thus far and seen everything this program has to offer, if they offered me a spot right now I would gladly accept. I made it a point after interviews to show up in person to drop off handwritten thank you letters and try to get face to face with faculty. I made friends with current residents and chiefs. I sent detailed letters of intent on personalized letterhead, highlighting my attributes and committing to their program as my first and subsequently "top" program, which I sent to my first 3 on my rank list.
Then it happened. An offer came through for a pre match, not 40 minutes away from where I was. Where family and friends were. Where sunshine and familiarity and nostalgia thrived. If I accepted, I would have a career, but I would have to drop out of the match early and forego my other options. There were better programs but this one wanted me and that's what made it special.
I accepted, I was elated. My wife screamed over the phone, we cried. We celebrated, I told my mom. More crying and gratitude. I was going to be a family medicine doctor.
I dropped out of the match. I met my future co-residents as the weeks went by. We were instant friends, we counted the days until we started residency.
Then tragedy struck, we waited for a contract that never came. I was fed up with waiting so after multiple attempts to find out, I was told that the company that sponsored the residency was going under. And that if a new company didn't take over then the program would be dissolved.
I had been in proximity to this before. There was a private hospital in the city where I met my wife that was a major private institution with dozens of residents, they served a large metropolitan area. The new owners abruptly decided that the hospital wasn't profitable, and dissolved the hospital in about as much time as it takes you to pack your suitcase for a weekend trip. The resident contracts were sought after by nearby programs (money) and trainees were scattered throughout the area, if they were lucky.
As it happens and in another case, the very same program that left me unranked after giving me an abundance of confidence about a match, had gone down the same academic year that I would have been an intern - reportedly due to the way they dealt with sexual harassment issues. Another dissolved program. More scattered residents.
Weeks went by, we panicked. Some of us re-entered the match behind the scenes, which was a breach of contract (which we signed but never received back). I picked up two more late interviews, did my best to present myself in a good light but nothing felt good.
Match day was around the corner. One of my future co-residents, infuriated with the situation, found another program and broke his contract. The time came for me to make a similar decision, stay and hope for a miracle, or certify my rank list and take my chances. I considered both.
At the last minute, an agreement was made. Another company picked up the contract. We had our paperwork signed. I dropped out of the match again and with caution, we proceeded. At least I still had a career ahead of me.
And then residency started, my first day in July was my first step inside a US hospital as a medical trainee/doctor. It was general medicine wards during the 2nd wave of COVID. Before I knew it I was calling families about their deceased loved ones, I was assisting code blues, working 80 hours a week, no time for eating or sleeping, completely lost with the medicine, despite all the studying. Books are not the real world. But I was glad to be there.
8 months in, I've collected scars and stories. I'm getting the hang of things, I've kept my head in the books almost every night. The ACGME came sniffing around looking to either give continued accreditation or dissolve the program - a familiar threat at this point. It did not look good, all indications pointed to the latter.
I saw the writing on the wall, most of the teaching faculty left in a hurry, our clinic hours were cut dramatically, I didn't see a clinic patient for 3 months. I made choices to prepare for the worst case scenario. I updated all of my paperwork, I got my CV and personal statement in order. I looked at all the programs in the area. Wondered about the possibility of transferring, found some websites online with residency slot postings. By another miracle a friend of mine had transferred to a nearby program, a newer program that had an opening for my year and they were interviewing right now, in fact they had already stopped taking applications. I shot my documents over and drafted a personal statement, I thought it was a long shot. What if my current program found out? What if we get accredited and none of this has to happen? What if that program is worse than mine? The grass is not always greener and be careful what you ask for. But I was convinced I needed to try. I had seen things go wrong so often and so fantastically.
I scored an interview and before I knew it I was accepted and transferring. 3 of the 6 of my year transferred to other programs as this ACGME process was drawn out - we were abundantly cautious and outright scared from our previous experience. We had worked so hard to get here, I wouldn’t let the carpet be pulled out from underneath me again without a fight. I found out later that at this new program, that they were about to offer the position to someone and by a stroke of luck they decided to interview one last person even though they were finished. My original program ended up remaining accredited after all but I don’t know if they ever truly recovered from the other issues like staff retention and clinic hours.
Another near miss. Another opportunity. At this point I felt like something was guiding me with a soft hand, maybe it was the universe taking pity on me after watching me for years cross that icy bridge at night or sleeping in the office. Maybe it was serendipity; plenty of bad things had happened already, maybe a few good things were just bound to appear in between. Lately however, it has felt like a guiding hand. After every tragedy something amazing has sprung forth, like flowers after forest fires. When I accepted my pre match offer we made arrangements to buy a house in an undesirable city. We wanted to grow up and start a family, we still do. We got as far as escrow and handing over the keys when the seller suddenly pulled out. We were devastated and had to scramble for a place to live at the last minute, we were leaving for vacation and had nowhere to come back to before starting residency and time was running out. A house for rent popped up online, that same week we saw the place, interviewed and begged for it. Our application was competing against 70 other applications, essentially during a housing crisis in a high cost of living area. Against all odds we were accepted, in our landlord's culture, having a couple getting married under your roof was good luck. Timing is everything.
Getting this spot was a new beginning and truly a boom for my aspiring career. Opportunities for education poured in, I was suddenly in multiple well functioning high-volume clinics, using 3 different EMRs, going to 3 different hospitals, I had away rotations and opportunities for electives. I focused on getting good scores and good evaluations - from 270 on ITE to 490, and then 510. I wrote a 400 page book of 360 diagnoses, procedures, ultrasound and physical exam templates for primary care and presented 6 sports medicine/lifestyle posters at multiple big conferences. There were challenges, and still are as I’m growing and learning.
During the transition, I needed a doctor. As it turns out, I had chosen a mentor before he had even known who I was. I went through a list of my insurance contracted doctors so I could finally get some much needed health care - I had injuries and had never had bloodwork done as an adult. I figured I would pick someone with similar interests. He was a sports medicine doctor with good ratings online, and also happened to be faculty at my new residency. We ended up doing a case study on my own carnivore diet, which tripled my testosterone. He then became my appointed residency advisor and esteemed mentor.
He would go on to become the program director for a new sports medicine fellowship at my new program. Just my luck. As the years went on it became more and more clear that I was meant for sports medicine. I would even have the first offer for a pre match at my new program with my mentor. On track to graduate and start my next journey - I was again elated. I felt like my life had meaning again.
As it happens, the ACGME would again come knocking around to evaluate for continued accreditation, and there were again no guarantees this time. New programs are tumultuous and quick-shifting. If I relied on a “sure thing”, I would leave myself vulnerable. So I made contingencies, just in case, I entered the match and made every effort to interview and consider programs in earnest. By the time match day came around again - and continued accreditation could not be assured in time, my wife and I had settled on a top choice. Close to family, regular travel to San Diego for lectures and leisure. Meaningful future prospects for work. And in a place we both love. Truly a dream program.
Fortunately for me but unfortunately in general, my mentors program did not take new fellows the following year and the future for it as a sports medicine program is unclear at best. My guardian angel at work again.
And throughout it all here I am. I’ve studied medicine for 13 years so far. Fully licensed and preparing to take my first board certification. Moonlighting at urgent care and learning how to market my first book. Matched to my first choice sports medicine program in California. 31 years old and starting a speciality that makes me happy. The path was rocky but I'm right where I'm supposed to be. I'm grateful for every breath that I take. Surrounded by things I love. My amazing wife. My 3 cats. My ride or die friends. My colleagues and mentors. My martial arts lifestyle. I am here for all of it.
Takeaways from my experience;
Having a mentor who believes in you and is invested in your progress can save you valuable time and effort. More than Internet research can provide you, someone who's been there before can give you the right way forward. If I was smarter I could have removed myself from several bad situations and anticipated things properly 1, 2 or even 5 years ahead. Maybe I had to go through those things, but maybe the right mentor could have helped me manage that better.
You are not only your upbringing. Transcend your parents' problems; defeat the negative voices within your head by constantly reaching towards your goals.
“Bad things” will happen, they're just around the corner. Prepare for them by asking yourself in every situation, am I prepared for the worst case scenario and if not, what would that look like? Have a CV ready every quarter.
While these are not trivials problems that I’ve faced, there are ultimately more dire circumstances that people face daily and with little hope for a better outcome. But I can only relay my experience and what it feels like to be in the crosshairs of potentially losing it all professionally for so long and so frequently. I am constantly in awe of those around me who suffer heroically; single mothers, soldiers, first responders, those struck with life-altering diseases and others. I will attempt to live heroically and not squander the gifts that I currently have, because someone somewhere would be perfectly happy to just be able to breathe.
Nothing worthwhile comes easy. And what the hell else are we here for if not to do hard things in pursuit of our dreams?
Thanks for reading!
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