First Day as a Working Doctor

The long white coat

July 1st. The start of a new chapter. The unofficial day that all new interns start working and realizing their dreams as doctors. Also the day we realize how little we know. I'm already a week into work since my program started us on June 24th. It was a nerve-wrecking couple of days just learning the computer system and where everything is and what's expected, but so far so good. Luckily, I'm starting with an elective for chronic care and palliative services at Children's Memorial Hermann Hospital. It still hasn't sunk in that this is real yet. I still feel like a med student.

Ever Wonder How Residency Programs Rank Against Each Other? Meet Doximity

For the first time this match season, thousands of interviewing 4th year medical students had the opportunity to use Doximity's Residency Ranker before submitting their final rank lists. Released September 2014, Doximity opened its Residency Navigator tool to the medical world allowing anyone to see how each residency programed stacked up against others. There has never been a unified location where residency programs are examined and ranked on a list... until now. Using more than 50,000 physician evaluations of the 3,691 training programs in the US, Doximity has been able to provide more transparency in the performance and quality of training programs in 20 specialties. Unfortunately child neurology was not included in this year's rankings, but perhaps it will make an appearance when they release the new rankings in August 2015.

Anyone can see the top 10 residency programs in each specialty, but to get the full list you must register (for free) to Doximity.

Residency Ranker--> Here

List of Pediatric Programs that are Caribbean (IMG) Friendly

*Updated March 2016*

I know in my last post I went into the difficulty Caribbean med students have at getting interviews-- for every interview offer we receive, we tend to get 10-15 rejections. Within every specialty, you have the set number of hospitals who are historially IMG friendly and many Caribbean applicants will be getting many of the same interviews at these institutions, however people still can secure a couple more interviews at less IMG friendly programs that are intrigued enough to offer an interview. Factors that can lead to these interviews include: board scores that can't be ignored,"home field advantage" (if you are originally from the area of the program), or you know someone/ have a connection.

While going through the match lists from AUC, St. Geroge's, Ross, etc I pulled out the most IMG friendly pediatric programs that people from all these institutions were interviewing at. Aside from a few impressive matches for SGU pediatric hopefuls, most of the other Caribbean med schools had the same matches.

 I didn't see any real outliers. There's always exceptions of course, but the vast majority of programs were the same across the board. Hence this makes me think that people interested in pediatrics will be able to save a ton of $$$$ on applications by just knowing which programs to apply to. Without further ado, here's a list!

Interviews I Got: hence, I know for a fact these are Caribbean friendly

-John Stroger Hospital of Cook County Program (Chicago, IL)
-Hurley Medical Center/ Michigan State University Program (Flint, MI)
-Western Michigan University School of Medicine Program (Kalamazoo, MI)
-Atlantic Health Program (Morristown, NJ)
-Jersey Shore University Medical Center Program (Neptune, NJ)
-St. Peter's University Hospital Program (New Brunswick, NJ)
-Albany Medical Center Program (Albany, NY)
-Bronx-Lebanon Hospital Center Program (Bronx, NY)
-Nassau University Medical Center Program (East Meadow, NY)
-New York Methodist Hospital Program (Brooklyn, NY)
-Richmond University Medical Center Program (Staten Island, New York)
-SUNY Health Science Center at Brooklyn Program (Brooklyn, NY)
-SUNY at Stony Brook Program (Stony Brook, NY)
-St. Barnabas Hospital Program (Bronx, NY)
-Staten Island University Hospital Program (Staten Island, New York)
-University at Buffalo Program (Buffalo, NY)
-Case Western Reserve University (MetroHealth) Program (Cleveland, OH)
-Marshfield Clinic- St. Joseph's Hospital Program (Marshfield, WI)

Other Pediatric Programs Caribbean Students Matched At (taken from AUC, AUA, Saba, Ross, St. George's, and St. Matthew's match lists)

-University of California (San Francisco)/Fresno Program (San Francisco, CA)
-Florida Hospital Medical Center Program (Orlando, FL)
-University of Florida College of Medicine Jacksonville Program (Jacksonville, FL)
-Mount Sinai Hospital Medical Center of Chicago Program (Chicago, IL)
-Advocate Lutheran General Hospital Program (Park Ridge, IL)
-University of Illinois College of Medicine at Peoria Program (Peoria, IL) 
-Louisiana State University Health Science Center -Shrevport Program (Shrevport, LA)
-Our Lady of the Lake Program (Baton Rouge, LA)
-Sinai Hospital of Baltimore Program (Baltimore, MD)
-St. John Hospital and Medical Center Program (Detroit, MI)
-Children's Hospital of Michigan Program (Detroit, MI)
-William Beaumont Hospital Program (Royal Oak, MI)
-University of Mississippi Medical Center Program (Jackson, MS)
-University of Missouri Program (Columbia, MO)
-Cooper Univ Hospital Program/Cooper Medical School of Rowan Univ(Camden, NJ)
-Rutgers New Jersey Medical School Program (Newark, NJ)
-St Joseph's Regional Medical Center Program/ New York Medical College (Patterson, NJ)  
-Brooklyn Hospital Center Program (Brooklyn, NY)
-Flushing Hospital Medical Center Program (Flushing, NY)
-Harlem Hospital Center Program (Harlem, NY)
-Lincoln Medical and Mental Health Center Program (Bronx, NY)
-Maimonides Medical Center/Infants and Children's Hospital of Brooklyn Program (Brooklyn, NY)
-SUNY Upstate Medical University Program (Syracuse, NY)
-Winthrop University Hospital Program (Mineola, NY)
-Cleveland Clinic Foundation (Cleveland, OH)
-University of Oklahoma College of Medicine -Tulsa Program (Tulsa, OK)
-Albert Einstein Healthcare Network Program (Philadelphia, PA)
-Crozer-Chester Medical Center (Upland, PA)
-Geisinger Health System Program (Danville, PA)
-East Tennessee State University Program (Mountain Home, TN)
-University of Tennessee College of Medicine at Chattanooga Program (Chattanooga, TN)
-Driscoll Children's Hospital Program (Corpus Christie, TX)
-Texas Tech University Health Sciences Center Paul L. Foster School of Med  (El Paso, TX)
-Texas Tech University (Amarillo) Program (Amarillo, TX)
-Texas Tech University (Lubbock) Program (Lubbock, TX)


This list is not exhaustive. It's 53 IMG-friendly programs out of the 210 total pediatric residencies in the United States. There are a couple of outlier programs I saw on the SGU pediatrics match that don't traditionally like IMGs (Children's at Univ of Miami, Rainbow Babies in Cleveland or WashU in St. Louis), so I figure there were other factors at play, so I left them off the list above. Anyway...apply to the programs above and any programs in your general geographic region. Otherwise, especially with many of the big name institutions (Never apply to Yale or Boston Children's or CHOP, they throw out IMGs automatically), don't waste your money applying to them unless you have some sort of connection or outstanding board scores (peds= 240+). 

How Caribbean students do in the match (from my personal experience)

I think the big question people have when looking into Caribbean medical schools is whether or not they can get the residency they want. Or maybe the big question is *if* they can even get a residency. The answer is yes. The official stats haven't come out yet for AUC, but based on the highly accurate facebook posts and word of mouth news, the great majority of my classmates matched. Naturally we don't tend to match into the ultra competitive fields of plastic surgery, orthopedic surgery, neurosurgery, otolaryngology, dermatology, or ophthalmology (actually we had one person match in optho this year) but we have a good number of people matching into internal medicine, pediatrics, family medicine, OB/GYN, general surgery, psychiatry, radiology, anesthesiology, pathology, emergency medicine, and PM&R. And people not only match in their desired specialty, but the majority match into one of their top 3 choices.

With all that being said, however, I'm not going to lie to you... coming out of the Caribbean is tough during interview season. It will be used against you. You won't get interviews at many places just because you come from a Caribbean med school. I know excellent students with amazing board scores, high class rank, all honors in clerkships, and what's the result? They still get pigeon-holed into the same programs that are IMG friendly and are unceremoniously ignored by the majority of other programs. Even when they can get interviews at well-known and respected institutions, more often than not, they will be ranked lower than their US grad counterparts. It's not fair, but that's just the way it is.

I'm going to take myself as an example. I applied to both child neurology and pediatrics. I was a competitive enough applicant in my chosen fields.

My stats:
224 for Step 1 (first attempt)
226 for Step 2 (first attempt)
Passed CS (first attempt)
In the top 1/3 of my med school class
Numerous community service experience
Held a leadership position
Received an "Outstanding" recommendation in my MSPE letter
Had 3 strong letters of recommendation (2 of which were from Massachusetts General Hospital).

The results:
Out of the 49 child neurology programs I applied to, I was offered 12 interviews.
Of the 123 pediatrics programs I applied to, I was offered 19 interviews.

As sad as this may sound, coming from a Caribbean medical school, I did well for myself. To anyone else outside of the Caribbean system, those are some tough numbers to swallow.  Hell yes this was expensive, but the more you spend on applications, the higher your odds of getting an interview, and the higher your odds of matching. So that is why Caribbean medical schools encourage their students to apply to as many programs as they can afford.  If you are considering Caribbean, definitely know this before coming in.
  

A Little about Child Neurology

I’ve been getting a lot of questions from people regarding child neurology. It’s not a well-known specialty; it’s barely discussed in medical school, and there’s little to no opportunity to do rotations in it. I believe at AUC specifically, we only have one green book rotation option at the University of Florida in Gainesville, in which special permission is needed from a faculty member to even rotate there.  With so little exposure, it’s no wonder why so few students know about it.  

So what is child neurology? What do child neurologists do? What sort of cases do they see? 

Child neurologists take care of children with any sort of neurological condition.  It’s mostly an outpatient specialty where the bread and butter cases include AD/HD, Tourette’s (tics), epilepsy, autism, headache, and cerebral palsy. A great deal of the time, child neurologists examine and work up patients who are referred for questions in developmental delay of speech, fine/gross motor skills, social skills or learning disabilities. Other pathologies child neurologists see are children with genetic disorders such as Angelman’s, Down, Fragile X, Tuberos Sclerosis Complex, among others and on rarer occasion children with brain cancer, muscular dystrophies, and mitochondrial disorders. I personally have an interest in concussions, chronic traumatic encephalopathy, and traumatic brain injury within the pediatric population, so we’ll see how well my training deals with those issues.

Although much of child neurology is centered in outpatient clinics, there are a huge number of child neurologists who work in the inpatient setting. Getting consulted to the NICU for newborns with floppiness or brain injuries (i.e. intraventricular hemorrhage), performing lumbar punctures, overseeing the epilepsy monitoring unit, reading EEGs, getting called to the ER for patients with question of seizure, cases of status epilepticus, etc.

If any of this sounds interesting to you, then maybe a career in child neurology is something you should consider.

How to apply to child neurology?

Child neurology used to be part of the Philadelphia Match, and it only just recently joined the main NRMP match (it’s in its third year). Like adult neurology, you can match into pediatric neurology directly. There is no fellowship necessary after doing 3 years of pediatrics, although you can do child neurology after doing the 3 years of pediatrics.

Child neurology is a small world. There are only 72 programs in the United States with the majority being university-based at major teaching institutions. You can enter a program as either a categorical, advanced, or reserved resident. Historically, most doctors entering child neurology would do 2 years of pediatrics and leave before their third year to enter a 3-year child neurology program. The problem with this of course, is that most pediatric residency programs aren’t thrilled about losing a resident for the third and final year of residency. Of recent years, most programs now offer a combined pediatrics/child neurology 5 year categorical residency program where you spend all 5 years training at the same institution. You do 2 years of pediatrics like any other pediatric resident (a few elective blocks are swapped for inpatient blocks), and then you move on to neurology for the final 3 years. By the end of the 5 years you can be double boarded in both pediatrics, as well as for neurology with “special qualifications in child neurology”.  Although most residents opt to only take the child neurology boards since most never practice general pediatrics.

When I applied this past year, I only applied for categorical positions.  I did end up applying to pediatrics as a back up but had I matched into a pediatrics residency position, I’m not entirely sure I would have gone the neuro route.  I decided early on I would finish my full 3 years and re-assess where to go from there.