The Shuffle

Medical school applicants cannot hold more than one acceptance past May 15. Before that magical date, you can sit tight, waffling back and forth, filling out pro/con charts, and otherwise hem-and-ha over which school is right for you. Once accepted applicants are forced to take a stand, the flood-gates open, so to speak, and there is pretty active movement happening on waitlists throughout the country. Schools suddenly find themselves with openings and there is a rapid shuffling to fill them. My husband was hoping that tomorrow might bring an acceptance for me from my state school. Considering that I withdrew my application from them a week ago, it is highly unlikely.

So why did I do it? I'll spill the beans. Out-of-State University of Awesomeness is a Texas school. Have I already sung the praises of Texas medical schools? Let me tell you, they are fantastic! You see, Texas is pretty darn picky with their out-of-staters. State law requires that at least 90% of students are Texas residents. Some admissions offices set that number at 95%. That said, many applicants don't bother to apply to Texas since (1) the chance of getting in is so low and (2) Texas has its own application system for its eight medical schools. [FYI: Baylor is a private school, but it does receive some state funds and shows a preference for Texan applicants. Baylor uses the national AMCAS application.] Though I wasn't a fan of sending transcripts and entering data into an entirely separate and time-consuming database (TMDSAS), I was very pleased with the entire application process. My state school interviews many, many, many more people than they intend to offer positions to. Roughly one-quarter of interviewees are offered admission. Some schools offer admission to about half of their interviewees. Texas schools tend to do a more thorough screening prior to interview. That means that some schools extend acceptances to nearly three-quarters of the applicants that they interview. Got multiple Texas interviews? There is a good chance you'll get in to at least one of them.

Texas does a Match Day for med school that is similar to residency matching. As an out-of-stater, I did not go through the match process, but found it fun to follow on applicant forums. Even without applying early decision, Texas residents (as a whole) were more likely to know where they would end up significantly earlier than the typical med school applicant. Out-of-state applicants are offered admission on a rolling basis. My acceptance came three weeks after interviewing at one school.

But I really haven't gotten to my favorite part. Texas is affordable! The tuition at Texas medical schools is some of the lowest in the nation. My in-state school has a rate of $35,000 per year. Out-of-state tuition at a Texas school is lower than that. Tuition for Texas residents ranges from about $15,000 to $18,000 per year. If you are awarded a competitive scholarship as a non-resident, you may qualify for in-state tuition during your first year. Unlike many states, you can establish residency during your first year and be reclassified. (That is, if you actually meet legal residency requirements.)It's pretty amazing. I am planning on a career in family medicine. The affordable tuition in Texas really makes it possible to pursue that path without feeling over-burdened with debt.

There are other reasons why I am ready to move to Texas. Lots of them. But the freedom of moving into a new career relatively late in life without much debt is one of the greatest feelings imaginable.

Don't let the turkeys get you down

My father was fond of saying, "Don't let the turkeys get you down." He'd usually quickly add, "Gobble! Gobble!" and a big smile.  Shortly before Father's Day one year, I found a button (it was the '80s)  with an illustration by Sandra Boynton. A somewhat clumsy-looking elephant was pinned down by a rafter of clueless turkeys.

 As a kid, I had a vague idea of what Dad meant. I thought of it as "don't get sad about things idiots do  or say to you." As a parent, I've hoped to instill a sense of resilience in my children. Life has many upsets and learning to roll with it--to adapt--is a valuable skill. It just seems that, at times, the turkeys are just a little too close to home.

Dozens of congratulations popped up on my wall when I posted my acceptance to Facebook last week. It felt great. It reminded me of the many people who have been cheering me along the way over the past few years as I headed back to school and prepped to apply. One person made a comment reminding me not to forget my kids while I was in medical school. Nice. I just shrugged it off. I've been a mom long before getting into medical school, and I'll be a mom long after finishing medical school. That turkey didn't get me down.

But then Christmas happened. Or, rather, dinner at my in-laws happened.

On the way to their house, my 14-year-old daughter asked, "Mom, are you going to tell Grandma that you've been accepted to medical school."

"I don't know if I'll bring it up," I answered. "When I told Grandma and Grandpa a few months ago that I was applying, they just kind of stared at me." I thought for a moment. "Yes. Definitely. If they ask, I'll tell them."

"What if they don't ask?"

"Well, I guess that means they don't care. Maybe?" and I just shrugged my shoulders.

I've been struggling this week with the idea of going to school out-of-state. Moving means losing so many familiar things, especially for my kids.  My father's parents were gone before I was born and my mother's parents lived on the other side of the country. With both of my parents gone, it has been important to me to make time for my kids to see their grandparents who live just an hour away.

Not too surprisingly, my in-laws did not ask me how the application process was going. Back in October, I explained to them that I already took the classes and the "big exam." My applications were turned in and I was waiting for invitations to interview at places that might be interested in me. Hopefully, medical school would be part of my near future. "What are you going to do with that?" my father-in-law had asked.

So when it came time to get our coats back on and head out the door after the visit, I had a very odd feeling. I didn't want to keep a secret from them, especially if it meant we would be moving, but I also didn't want them to burst my bubble. Then my husband spoke. "Guess what? Vieve just got the best Christmas present imaginable, and it wasn't from me."

My mother-in-law's face lit up. She leaned in, "What was it?"

"She just got accepted to medical school," and he put his arm around me.

Suddenly, I felt swept away with excitement. "Yeah. I had three interviews last month, and I was really afraid I wouldn't hear back from any schools before Christmas, but Med School in Another State let me know on Friday that I was accepted and I'll even get a scholarship, and I'm just so excited!"

She leaned back and looked perplexed. "Are you going to do that online?"

Pop.

"Um," I couldn't help but smile a little, "there are no online medical schools in the country." Feeling a bit confused, wondering if they were a bit confused, I added, "I'm going to be an MD."

My father-in-law spoke up. "You know what 'MD' stands for, don't you?"

He was standing directly behind me, so I turned around to meet his smiling face. He always has a corny joke to tell, and I thought that it might help take the edge off of the disappointment I felt. I smiled broadly, "No, what?"

"Mostly Dumb. After all, they can only practice and never get it right."

I just hugged him and said, "Merry Christmas."

I hugged my mother-in-law, too, and thanked her for dinner. My sister-in-law and her husband were also standing by the doorway and had said nothing so far. She just looked at me and said, "Uh. That's exciting news."  I gave them good-bye hugs as well.

Maybe it isn't fair of me to expect them to be excited about this. Maybe they are just deeply concerned about the welfare of my children, like the aforementioned Facebooker. Maybe they're just turkeys.

Such a LONG road

This is one ridiculously long road to go down. (Yeah, yeah, yeah--I know that applies to all of medical education.) If you are thinking about applying next cycle, push your "submit" button as close to June 1 as possible. Maybe, just maybe, that might make the wait a little less painful?

I applied to medical schools through three systems in July: AMCAS, TMDSAS, and AACOMAS. I started AMCAS first (in May) and submitted it last (early July) as I felt so particular about what I wrote for each of my 15 extracurriculars. I hope that extra crafting helped, because it took the full six weeks ("expect 3-6 weeks") to get verified. That was nerve-wracking. The Texas system was the quickest one to verify. I got verified with them in just under three weeks. AACOMAS was three weeks and a couple of days.

As of August 21, my application is complete at 9 schools. (It helps that Houston, San Antonio, and Gavleston do not require a secondary application.) Right now I am insanely excited to finally be verified by AMCAS and feel the urge to push out three or four secondaries by the end of the week. A little reality check, though. School starts tomorrow for my kids. I'm retaking the MCAT in 10 days, and I just started a genetics class at today. Secondaries must wait until after the MCAT is put to rest.

The Security Myth

One of my coworkers just found out that the "guaranteed" funding for her job just got pulled. Most of the people at my office are paid through federal grant funds. I've heard it said many times, "They don't pay us enough, but at least we have job security." It's amazing to me how unhappy people are willing to be in order to feel secure. Fear traps us.

I'm not immune. I recognize the illogical appeal of this false sense of "security," yet I still crave it. If I put off applying to medical school for one more year, then I will be vested in the retirement program. Delaying my dream will give me a mere $308 per month in retirement. Logically, I know I will be much better off as a retired physician, but I'm human and that $308 is "guaranteed" if I just stick around another year. That's crazy! Why do I even think about it at all?

The desire for security is part of human nature; we seek security even if it requires us to trust in a broken system. But our work culture is changing. Job mobility today is akin to our ancestors' ability to follow the heard. You've got to be able to adapt, reinventing yourself and actively navigating your own career. Becoming a physician in my 40s is definitely a reinvention.

In many ways, physicians today are in the same boat as any hourly wage earner. There is always the possiblity of having your job replaced by lower-level (and less expensive) employees or becoming redundant in the face of a merger. Having said that, physicians are uniquely trained for change. Rotations and residency are all about overloading and adjusting, while learning as much as you can. I see limitless possibilities for me as a physician: practicing in small clinic, working as within a hospital system, developing quality improvement intiatives, teaching public health, administering evidence-based practices. Job wise, nothing is secure; but as a career, medicine offers an incredible breadth of opportunity. After all, in today's world, security is what you make it.