The First Obstacle

Down in the dumps. So f*ckin' depressed. That was how I felt when I received the results of my USMLE step 1. I know, I should be happy that I passed, but I just can't help but feel depressed. A long time friend pointed out that it must be because of my bruised ego. As someone who was viewed as a genius/ nerd a decade ago, getting a below average score is a major downer. Fine. My ego was bruised. It wasn't just bruised. It was crushed. But that's not the reason why I'm feeling depressed. I feel sad because for a fleeting moment I thought I really had the chance of getting into the program that I really wanted. Yeah, it was probably a long shot, but I still had that chance. And just like that, as quick as a blink... the chance was gone.

What exactly am I talking about, you ask? If you manage to read my blog from the very beginning, you'd come to the impression that I'm sort of a morbid creature. I get high with the sight of blood and guts. I get that adrenaline rush when I encounter emergency situations. The most obvious clues would be my entries from the year '07, when i was blatantly ranting about the residency program that I was in. I didn't want to be a doctor in the first place. But here i am now, it would be really impractical to make a sudden and drastic career shift. So if I had to choose a program to specialize in, it had to be something I enjoyed doing. Every incision I make gets me high. Successfully doing an operation, no matter how simple it is, gives me a great deal of satisfaction, a remarkable sense of accomplishment. In order to lessen the bitter taste that this profession leaves in my mouth, to make everything easier to bear... if I had to choose a residency program, it has to be surgery.

When one of my close friends told me I had a shot two months ago, as long as I get an above average score, I was extremely happy. I knew how hard it is for a foreign medical graduate to get into surgery in the US. One needs to have a lot of credentials. US clinical experience. Published research works. Recommendation letters from renowned American Physicians. Exemplary grades in Med school. Exceptionally high scores in the USMLEs. Most of which i don't have, but I still had a chance because my friend has relatives on "the inside", and they could help me out. I just had to get high scores on my MLEs. And when I got my score, that dream vanished instantly.

It's not a big deal really. Crap, I know this would sound selfish, but my main reason for wanting to train in the US is money. Yeah, I know the medical profession is service oriented, and financial matters should not be at the forefront... but I'm just so tired of getting such a paltry some for all my efforts. All those years spent in med school, with all those lavish expenses, those sleepless nights, the mental torture... all for what? For a job that offers salaries that can barely support a single person? Don't get me wrong, I like serving others, I like to help out. But how can I continue helping others when I can barely support myself? So yeah, financial gain is my primary purpose. If that's my primary purpose, then it shouldn't matter which residency program I get into, right? But is it so wrong to dream? To wish that i could get into that certain program that could make this whole profession I'm in a little easier to swallow?

Now reluctantly, I'm exploring other options. First is family medicine. They say it's the easiest program for foreign medical graduates to get into because it's the least competitive. Most American medical graduates choose other specialties, and I can't blame them. Because family practice, deals with primary care, they get the huge patient loads. Schedules can become hectic. On the upside, that means more cash. Plus, the option to take up Sports Medicine as fellowship makes the program attractive to me. And---! I heard that doing minor surgical procedures is part of the program, and sometimes family medicine residents even do major operations when no surgeons are available. i can do something I like, although it would be mixed with rotations that i hate, like obstetrics and gynecology. Yuk. The only problem is, the option to go back to my home country after residency is still an option for me... depending on how things go. In this country, other physicians look down on family physicians and emergency medicine physicians... the "jack of all trades, master of none" stigma... add the fact that family medicine is not a lucrative practice at all back here.

So... option number two would be internal medicine. Since med school i hated this subject matter. Even during clerkship and internship I hated rotating in this department, and now, every time i go on duty at the emergency room, I cringe whenever i have to handle medical cases. I'm also more hot headed when dealing with these patients. It just isn't my thing. At times, I even feel like a fish out of water when I encounter such patients. I know I can learn eventually, but when it comes to this subject matter, I have no urge to learn at all. Would the promise of hefty salaries be enough to make me last for years in a program that I absolutely detest? One upside would be a better private practice back home if ever I decide to go back. And there would be none of that family medicine stigma. And I could take up gastroenterology or pulmonology for fellowship, the two subspecialties that piqued my interest back in med school. But I just can't stomach the other subspecialties. Just thinking about those three years during residency where I have to go through those other subspecialties nauseates me.

The other residency programs are not for me. I just can't see myself as a pediatrician, an obstetrician, a gynecologist, a radiologist, an anesthesiologist... i just can't. So it's a toss up between family medicine and internal medicine... I don't really like both, so it's going to be difficult weighing the pros and cons, which program would be easier to stomach. Man, I hate choosing between two evils. But as they say, beggars can't be choosers. I'm in no position to be choosy.

But it's not over yet, is it? That's just one step, there are three more to go. Maybe if i get a better score on the next one, I might still have that chance again. It's a long shot, but maybe there's still a chance that I won't be spending everyday in residency drenched in utter misery.



Hey, the last time I checked, everyone is still free to dream.