When young whippersnappers arrive at medical school in the fall of their first year, it’s not uncommon to hear them declare, in a voice giddy with idealism, that they want to cure cancer or save babies or dedicate their careers to small inner-city clinics. But check back in with them four years later—after they’ve racked up $200,000 in debt, contemplated having kiddies and been scared witless by the prospect of piddling reimbursements—and many of them will say they want nothing so much as good pay, flexible hours and few midnight emergencies. Your future lifesaver wants, in a word, a nice lifestyle.
This is said to be particularly true of the grade grubs, the ones with the scores to get into ultra-competitive fields, and they even have a mnemonic to help them remember which are the styliest of the lifestyle specialties: If you want to be happy in medicine, follow the ROAD—Radiology, Ophthalmology, Anesthesiology and Dermatology. ROAD!
But is that all there is to it these days? In medicine, as in love, everyone has his or her type.
Each fall, when the weather turns gusty and romantic, the city’s fourth-year medical students embark on a mass professional mating ritual designed to hook them up with the residency program of their dreams. The ritual is known as the Match, and like all frenzied dating rites, it is as much about defining who the students are as about finding their medical soul mates.
Are they ultra-alpha gunners with a latent urge to slice and dice? Then perhaps they’ll become surgeons, overworked but well paid. Or maybe they tend more toward the brainy-hipster type, with dog-eared copies of Dora in their pockets. Then clearly psychiatry is the field for them.
This year’s match frenzy kicked off on Sept. 1, when a vast electronic database began accepting student applications. By now, most students have already dispatched their carefully crafted personal statements to 10, 20, sometimes 40 programs, but a few poor souls are still scrambling—still trying to choose a specialty, in some cases—by the Nov. 1 deadline.
Then it’s on to interviewing, praying and waiting for the big day: March 15, Match Day, when a giant HAL-like computer spits out a binding verdict for each student.
Why do some choose a life of treating rashes while others opt for curing cancer or fixing fractures?
The most popular theory of the moment is the aforementioned Lifestyle Theory. A slightly less cynical theory—in fact, a downright warm-and-fuzzy one—is the “mentoring” hypothesis, which states that students, like ducklings, follow the lead of their schools or advisors.
But at the end of the day, for many students, the big choice comes down, quite simply, to personality, attraction, even musk. Indeed, one of the great old medical-school clichés is that a practiced eye can identify which students will go into which fields on the first day of class. The Match, nearly four years later, just seals the deal.
So who’s going to be setting your sprains, delivering your tykes or—God forbid—changing your catheter? Whoever they are, we just hope they’ll take our insurance!
To hear many doctors describe it, there are two distinct breeds of modern-day physician: those who “do,” which is to say, pin joints, slice open patients and zap people with radiation; and those who “think,” which is to say, diagnose diseases, titrate medications and monitor symptoms.
The students who choose internal medicine—the largest residency in the Match—fall by and large into the latter category. Often hailed as the “intellectuals” of the med-student menagerie, they’re the ones, according to Mount Sinai fourth-year student Bryan Mahoney, who “love thinking and thinking and thinking about diagnoses and treatment plans.” They’re the scrabble players and chess types, the crossword puzzlers and, in the case of oncologists, the baseball-card collectors. Why?
“Because oncologists [have to] know a lot of chemotherapy regimens in terms of scheduling, dosing, adjustments, all the minutiae,” said Daniel Zandman, also from Mount Sinai, “they’re masters of esoteric knowledge.”
Some might call it indentured servitude: at least five years of hard, suturing labor in an environment of screaming supervisors, pressure-cooked peers and geysers of blood. But the students who choose general surgery can’t seem to get enough of it. They’re the kind of people who take pride at staying at the hospital far longer than they have to, who complain about the laws limiting residency hours, who elbow each other out of the way for the chance to scrub in on a 12-hour surgery. Think Tracy Flick with a scalpel.
Certainly prestige has something to do with it—surgery has long been regarded as the pinnacle of the profession—but it also goes deeper, subcutaneous.
“General surgery has people who really are passionate about doing it, because honestly, I look at them and think … ‘Your lives are absolutely miserable,’” said Mr. Mahoney, who himself contemplated surgery before opting for anesthesiology. “But then I see 70-year-olds who still work 90 hours a week, and I have to admit they must sincerely love what they’re doing—or hate their family. I can’t tell which.”
Among the many accomplishments required of the would-be dermatologist are perfect skin (the pimply would never dare apply), a fine sense of fashion and a love of the well-shaped heel—high heel, that is.
“You can always spot the dermatologists among the medicine interns,” said one lady student from the Columbia College of Physicians and Surgeons. “They’re wearing sling-back heels with a white coat. They look like Clinique women.”
“All you hear are their shoes clicking down the hallway,” observed another Columbia student named Jon.
But don’t be fooled by the clip-clopping of well-shod feet: The derm girls are no shuffle-lumps. Thanks to its good hours, high pay and cushy lifestyle—how many dermatological emergencies can you get a month?—dermatology has heel-clicked its way from being one of the easier fields in the medical kingdom to one of the most competitive. Said Dr. Suzanne Rose, associate dean for academic and student affairs at Mount Sinai: “You almost have to have a Ph.D.” Or at least a good C.V.
“Dermatology is for people who have the right résumé, but they’re not the most intellectual,” said one student. “It’s the same kind of people who go into investment banking.”
For the overachievers of the overachieving set, the career of choice is, and perhaps only can be, neurosurgery.
Only a handful of students dare apply from each school, but, lucky them, should they match, their big reward is … work. At least six head-splitting, spine-slicing years of it while they scalpel their way through residency. And at the end of that, they are rewarded with yet more work—although this time, the grind is tempered by the sweet smell of fat checks, fast cars (which they park conspicuously outside the hospital) and their very own TV icon.
Still, ladies trawling the neuro-surge wards for their own Dr. McDreamies, beware! “You just can’t be normal and work 100 hours a week for the rest of your life,” said the Columbia lady student, adding that the neurosurgery residents’ behavior was, at times, so “inappropriate” last year (think off-color jokes, for starters) that they were banned from doing rounds with med students.
Indeed, the on-call pager extension for Columbia’s pediatric neuro-surge service is, reportedly, *-*-*-D-I-C-K.
Throughout the New York med-scape, this year’s residents-to-be are lining up for a spot on the “other side” of the operating-room curtain. Once dismissed as a job for medicine’s “techie” types, anesthesia has slowly been building its way up from a field that couldn’t fill its slots (in 1996, Weill Cornell didn’t place a single anesthesiology resident) to one of the trendy residencies-of-the-moment (in 2006, 10 Cornell students chose anesthesiology).
“Anesthesiology,” said a Columbia student named Aaron, “is extremely popular this year.”
The anesthesia lifestyle is certainly a big part of the appeal: You can work five days a week, rake in the ducats, and still have time to play catch with the kids. But for many people, the lure of anesthesia is also about the strange thrill of putting people under.
“The classic analogy is that it’s like flying a plane,” said Mr. Zandman. “There’s takeoff and landing, which are really eventful, and then you sort of can put it on cruise control in the middle.
But,” he added, “you have to love five minutes of fear.”
No matter how idealistic med students are when they crack the spines of their first-year anatomy books, after four years in New York’s ambition mill—to say nothing of its debt-grinder—few retain enough of that early glow to go into family medicine. And if they do, it can mean only two things: They’re Mother Teresa reincarnated—or they bombed their board exams.
The “poorhouse” wages are partly to blame. But the demise of the do-gooder family doc is also part of the larger trend away from the gritty grind of primary care toward the luxe appeal of the lifestyle specialties.
“People are discouraged from entering family medicine because it’s just looked down upon,” said the Columbia lady student.
A Mount Sinai student painted an even grimmer picture. “Even the students from Caribbean medical schools, which traditionally just take the leftovers in terms of residencies, even they don’t want to go into family …. It’s a suffering field.”
Thirty or 40 years ago, when orthopedic surgeons were seen as the glorified carpenters of the medical trade, the word on the wards about students who opted for ortho was that they were “strong as an ox and half as smart.”
These days, the “half as smart” no longer applies—students have to score top grades to get into this ultra-competitive residency—but the “strong as an ox” still resonates. Among the students who rush ortho, an impressive number are said to be “tawny and brawny,” with 20-inch biceps, 18-inch necks and a mantel full of varsity trophies. One Mount Sinai senior said he was convinced one of his friends was trying to pack on 20 pounds of muscle to help guarantee an ortho placement.
Such a cult of beefiness hasn’t always been friendly to lady applicants. “I think they guard their profession,” said the Columbia student named Jon. But this has started to change in recent years, as a few fearless broads have begun breaking the bone-doctor barrier, determined to show they can retract with the big boys.
Still, there is room for progress. Said one woman who ultimately decided against orthopedics, “I realized I was trying to mentally prepare myself for being discriminated against.”
In the bowels of every hospital, beneath shvitzing pipes and fluorescent lights, lurks a breed of doctor that thrills to the stench of formaldehyde and the chill of death, the company of a corpse over a live, kicking patient.
And in each med-school class, there are a handful of students—say one or two, maybe three—who can’t wait to join them. These are the country’s future pathologists, the quirky, mole-ish types with librarian hearts and Tim Burton minds. Some call them the mad scientists of the trade, others the “weirdos” who “like to be in the equivalent of broom closets cutting up people.”
But like all true great oddballs, their day might be dawning.
“Everyone says pathology is the next derm,” said Mr. Mahoney, “because the hours are great, the pay is wonderful, and right now it’s not competitive …. People are starting to look at path.”
For the confident, the quick-thinking and the kids who grew up crushing on Dr. Doug (George Clooney) Ross, the emergency room is becoming an increasingly alluring place to hang their stethoscopes. A relatively new specialty, emergency medicine attracts the steely-nerved and intense, the students who don’t shrivel up at the idea of making spot diagnoses—and then, say, jabbing a needle into a patient’s chest to inflate their lungs.
“It’s pretty dramatic,” said Mr. Zandman.
Not everyone is so full of admiration, however. Because E.R. docs work “just” three 12-hour shifts a week, some deride it as shift-work, a flexible, well-paid way to be an M.D. But the emergency “shift workers” might have the last laugh.
“I think people would like more going into it, because there seems to be a shortage of emergency-room doctors,” said Dr. Albert Kuperman, associate dean for educational affairs at Albert Einstein College of Medicine. “All the big hospitals are enlarging their emergency-medicine departments.”
OBSTETRICS AND GYNECOLOGY
Once the province of creepy, specula-wielding old guys, obstetrics and gynecology are all about estrogen these days—and, girl, can it be intense! Though it’s not considered one of the “competitive” residencies, OB/GYN is nonetheless filled with hyper-competitive types—people who are determined to deliver babies, cure chlamydia and defend women’s health, all while not sleeping, slaving for attendings, and facing a future of endless hours and skyrocketing insurance.
Needless to say, the effect can be traumatic.
“I definitely saw more residents cry during my OB/GYN rotation than I saw in the rest of medical school combined,” said one Columbia student.
Indeed, Columbia’s OB/GYN residency is somewhat notorious, at least among the med-student throng. While the reigning image of the young OB/GYN is of the feminist crusader, stridently devoted to helping her sex, the Columbia residentrix trends more towards sorority chick. Toward Mean Girls, in fact. Like Lindsay Lohan in scrubs.
“It really feels like an all-girls school, in bad ways,” said the Columbia lady student, recalling the bleary mornings of her OB/GYN clerkship, when the residents would page her to do pre-rounds push-ups. “There is a lot of passive-aggressiveness.”
Farewell, crusty old pediatricians with the icy stethoscopes, old-grandpa smell and bedside manner inspired by Dr. Spock. The lasses who want to become kiddie doctors today—and they are quite often lasses—are widely considered the “nicest” and “most compassionate” kids in the class, if not the most aggressive go-getters.
With its low pay and limited prestige value—these folks are “just” keeping our future generations healthy, after all—pediatrics tends to rank low on the competitive scale (the median pediatrician board score is the fifth lowest in the Match). But what the future peds might lack in cutthroat drive, they make up for in stubborn determination.
“Everyone understands that pediatricians go into pediatrics because they’re passionate about taking care of children, and not because they want to make money,” said pediatrician-to-be Celia Quinn. “So it’s really hard to talk someone out of doing pediatrics.”
It’s one of the strange laws of medicine that perhaps the most competitive field in the residency game is plastic surgery. And the students who set their sights on this prize—who go “straight to plastics,” as they say—are of necessity among the most ambitious, driven and grindy students in the class. In 2005, they had the highest median board scores of all the students in the National Resident Matching Program (NRMP).
But don’t worry, the leading lights of medicine aren’t sinking their talents into tummy tucks and boob jobs—exclusively. As Jon, the Columbia student, explained, “To have done that well to match straight into plastics, you’re going to have enough competitive spirit to want to be recognized as [a leader in your field]. So they’re going to do a lot of reconstructive work, burn work, grafting.”
At least at first. There is always time for face-lifts.
Funky glasses alert! More than 100 years after Freud unlocked the secrets of the unconscious, psychiatry remains the unquestioned realm of the bookish and bespectacled. Often mistaken for their neuro-peers, the psych folks are nonetheless their own individuated breed: a little dreamy, kinda cool, maybe with a background in the humanities or their own near-crazy experience. “They are people that are almost too empathic for medicine,” said Ms. Quinn, “because they can’t handle dealing with people’s physical illness—or not being able to deal with [it].”
This hasn’t always won them plaudits in the macho world of medicine, where doctors like to fancy themselves stiff-lipped doers rather than sensitive dreamers. “They’re not real doctors,” some physicians sneer—a fact that may explain psychiatry’s relative unpopularity in large parts of the country. In 2005, according to data from the NRMP, psychiatry filled less than 64 percent of its slots with U.S. students and attracted applicants with the second-lowest median board scores.
But fear not, New Yorkers: Your addled nerves will still be well taken care of. Here, in Therapyville, psychiatry is a pretty good draw, thanks in part to several top psychiatric programs. “At Columbia,” said the student named Jon, “it’s really popular.”