Featured topic and speakers
Staying at an institution for residency can feel familiar but it comes with its own unique set of challenges. Avani Patel, MD, MHA, who attended medical school and did her GME training at the same location offers her thoughts.
Speakers
- Avani Patel, MD, MHA, practicing psychiatrist
- Brendan Murphy, senior news writer, American Medical Association
Host
- Todd Unger, chief experience officer, American Medical Association
Listen on the go to the full episode on Apple Podcasts, Spotify or anywhere podcasts are available.
Transcript
Dr. Patel: I wanted to be at a program where I could still pursue my extracurricular activities I was interested in, such as advocacy, organized medicine involvement and growth in leadership. And so being at a program that allowed me to do that and prioritize that would then, in my opinion, make me a better physician to my patients and just a better resident through the program. And throughout that process, there's definitely the question of, am I doing something because this is comfortable? And so, when you're looking at your home program, I think that's a fear many people have. Am I thinking about this in a way that is because it's my comfort zone or should I do something else because the grass is greener on the other side?
Unger: That was Dr. Avani Patel, a board-certified psychiatrist in Mississippi. Have you applied for your current medical school’s residency program? In today’s episode of Making the Rounds, Dr. Patel will share her experience and tips for ranking your current institution’s residency program as you prepare to submit your rank-order list. Here’s AMA Senior News Writer, Brendan Murphy.
Murphy: Hello and welcome to Making the Rounds. I'm Brendan Murphy, senior writer at the AMA. Today we're talking about the residency match, specifically tips on ranking your home program if you're hoping to continue your training as a resident after med school. My guest is Dr. Avani Patel, a board-certified psychiatrist and private practice owner in her home state of Mississippi. Dr. Patel is a strong advocate for patients as an AMA member. She's also an expert on ranking your home program because, well, she's done it herself. How are you today, Dr. Patel?
Dr. Patel: I'm doing great. Thank you for having me. I'm really excited to talk about a topic that I'm very passionate about, especially when we're thinking about spending many years of your life in a location.
Murphy: A great place to start would perhaps be you walking us through your Match experience. How'd you ultimately end up at your home program?
Dr. Patel: Thank you for your question. I think it's a really great one because it's a very personal question, right? And it's a very personal decision that we make as we think about the Match experience and reflecting on all of those memories. So I was a pandemic Match medical student. Therefore my experience was slightly different. However, the sentiment and the value and the importance of the decision of where I was going to be still felt the same. And so I, spoiler alert, ended up matching at my home program and this was definitely a choice that I felt very strongly about. I'm fortunate because my home program is a place that I knew would give me great clinical training and it also would allow me to be close to my family and serve my community in the way I've always wanted to. And so, as I'm reflecting, I remember it being a very nerve-wracking time because the biggest question that came to mind was: Would they want me to stay? Do they want me to be here? Would they want me to serve the people of Mississippi? And now that I get to be on the other side, I'm so grateful that they chose me because it's like a dance. It's like picking a partner in life, whether it's friendship, romantic, you know, some things you can't choose like your family. But this is one of those things where you do get to choose and you're kind of put in the hot seat to see if you'll be as good of a fit for them as they are for you.
Murphy: You went to medical school at the University of Mississippi and then did a research year, wasn't it?
Dr. Patel: I did, yeah, so I actually went through four years of medical school, and I thought I was going to be an anesthesiologist. I had planned for this all throughout college, all throughout medical school. I did everything in terms of extracurricular activities related to anesthesiology and as I got closer to Match, I realized I was very, very unhappy and thought to myself, this is not normal.
Everyone should be thrilled because they get to start the next step in their career journey and you're closer to becoming a physician and practicing on your own. And when I realized that I was unhappy, it's because I knew in the back of my mind and deep down that I wasn't sure that I chose the right specialty for me. So, I took a risk, and I did something a little bit different and out of the box.
I actually ended up withdrawing from the Match because I had only applied anesthesiology at the time and I knew I needed to figure out where my passion really was, as well as what I wanted to get out of my training experience because I realized I was starting to feel a little bit burned out as well, only because I knew this wasn't necessarily the right fit for me, even though this was always in the plan. So, I ended up talking to my family, talking to leadership at my medical school and explained that this was something that was weighing very heavy on me and I think I needed to choose another specialty. And I'm a plan A, B, C, D, E type of person. And so, I was already looking at different options of what I could do with my time off. And so, I actually interned at the AMA, which was one of the coolest experiences I've ever had and it's only made me more passionate as a member and as an advocate. I also actually ended up getting my master's in health care administration and executive level leadership. So, CEO or CMO of a hospital system thinking that I may want that in my future one day. And so, I wanted to have as many options as possible. And I also feel education is never wasted. And so, it was a very fruitful year.
Dr. Patel: And when the pressure was off and I had some time to think about what I truly wanted, I knew I wanted to be a psychiatrist. And so, then I shifted gears in terms of my application and I ended up applying to several programs across the country, hoping they'd understand that sometimes we don't always know what we want and it's okay, but we always end up right back on the path that I think we're meant to be on.
And I was very grateful for how gracious my home program was and understanding as I was on the path to discovering my happiness so I could be a better physician for it to my patients.
Murphy: So your journey to psychiatry, even if it was sort of a local destination, was a bit roundabout. How did you go about your rank order list? How high was your home program? And how did your preferences evolve during the process?
Dr. Patel: Again, that's another great question just because I think these are questions that go through every single applicant's mind. And I'll tell you, as you're interviewing at other places, it's exciting. Everyone's putting their best face forward. You're putting your best face forward. And it all sounds great. It's very enticing. And every program is going to feel like a program that you love because you're getting to hear all the best parts of them.
So one of the things that I did was research each program I was interested in, programs that may have been a reach for me, programs that were around locally, and then my home program as well, just to see what message they were putting out there versus what my experience was as a medical student there. And what I realized throughout that process is that we have to ask ourselves other questions outside of just what can a program offer, because they're all going to have different strengths. Some of them will be incredible from a clinical training standpoint, others will be research heavy. So understanding each program's priority is super important. And that was, that was something that was very important to me to understand and to ask of as I was interviewing at various programs.
The other questions that I think are really important is understanding what your priorities are. And so for me, I wanted to be at a program where I could still pursue my extracurricular activities I was interested in, such as advocacy, organized medicine involvement and growth in leadership. And so, being at a program that allowed me to do that and prioritize that would then, in my opinion, make me a better physician to my patients and just a better resident through the program. And so that was something I always asked as I was looking at each program whenever I was on the cycle. And this was a different time because I was doing virtual interviews due to the pandemic. And throughout that process, there's definitely the question of, am I doing something because this is comfortable? And so, when you're looking at your home program, I think that's a fear many people have. Am I thinking about this in a way that is because it's my comfort zone or should I do something else because the grass is greener on the other side?
And I think there are a lot of other life factors that we have to take into consideration. Family, the financial piece, the location of where we want to be and where we may find our happiness. I mean, I'm a Southern belle through and through, and so I knew I wanted to be in the South, but I've always been curious about training in another area. Also understanding your specialty and the cultural aspect of how it would relate, I feel is really important.
So, for example, the mental health issues of the South may be very different from the mental health issues on the West Coast. They all have their own flavor of things. And if I knew that I primarily wanted to serve a population that's in the South with a lot of our issues regarding poverty, health equity, et cetera, then maybe training somewhere that would allow me to be better educated in that realm is a better idea.
So these are the types of things that I considered as I was looking at other programs. And again, I will fully disclose that my number one program was my home program. So, it was one of the most rewarding experiences when I got to open that letter and I was just looking for variations of M-I-S-B hoping that it's exactly where I wanted to be.
Subscribe to free AMA email newsletters
Get the latest news from the AMA on the topics that matter to you—delivered to your inbox.
Murphy: Some applicants worry that ranking their home program highly might seem like a default choice. How did you ensure it was really the right fit for you?
Dr. Patel: So I'm going to go back to what I'd said earlier about figuring out your priorities. I think one of the most helpful things, and I laugh because I know it's the most psychiatrist thing to say but making a pros and cons list and really weighing what your priorities are is really important. I've known friends. I even have family members because both of my siblings are in medicine and have one of them already gone through that process. Another one is going through that process.
You have to ask yourself what's important to you. Is being closer to family important to you? Is the prestige of a certain institution more important to you? Is research a huge part of your life? And being able to be honest with yourself in that way and writing it down and seeing it tangibly is really important. And then taking those priorities and ranking these other places that you're looking at, including your own.
So for me, I knew there were going to be pros and cons to being at my home institution, but there were more of the pros than there were the cons. Now, I will not lie to you. There's a fear of, well, I've already gone through as a medical student and I understand I've gotten to learn from many of these teachers and these professors who have been a part of my training experience. Will I get to learn any more from them? Will it be any different? Will I know enough for what I want my goals to be?
But I think that when you're self-driven, which just about every single medical student is, otherwise I don't think you can survive the process, you're always going to be able to find what you want, even if you end up in a place that's not the right fit for you or you thought wasn't the right fit for you. I think understanding and going back to what your priorities are and always placing a focus near there is going to help you make the best decision.
And sometimes choosing your home institution may be the answer to being outside of your comfort zone because it's something you never thought you wanted, but then it ended up checking more of the boxes than you thought it would.
Murphy: You had a unique experience in interviewing with your home program in that most interviews are unfamiliar. Surely there was some familiarity to you. How did that work out?
Dr. Patel: This is one of my favorite questions only because interviewing at your home program can make people feel either way too comfortable and I find that you may not perform your best or you're so anxious because you feel that many people have already formed opinions about you and have some familiarity with you that you're worried that bias will take place within the interview. So for me, I'm an extrovert through and through, and I actually really enjoy interviews because it gives me an opportunity to meet people and to see what they care about, what they're proud of, with where they're at, and if I would be a good fit for them and I get an opportunity to share things that I'm passionate about to see if those align. And so, there's less fear for me in that way. But interestingly, at my home institution, there is way more fear involved because they have an opportunity to get to know me. I've rotated through and there are going to be people who are on your team and there are going to be people who, you know, worry about what you would be able to bring to the table. And that's every single person, right? And so, for me, I felt like there were higher stakes because I didn't know how much of that bias and those previous opinions would play into the role of how I would be ranked at my home institution.
And generally, most people are very excited and supportive of people at their home institution, but I didn't want to make that assumption. And interestingly enough, the program director at the time when I was interviewed was, you know, a little bit concerned saying, I was worried that maybe you would be uncomfortable because I know we get an opportunity to know you but just be yourself and do your best. And we're going to try to leave what we know about people at the door.
And I think there was a sense of comfort in that because it's nice to know that they're trying to make it as even of a playing field as possible.
Murphy: What were some of the biggest challenges you faced in transitioning from medical school to residency at the same institution?
Dr. Patel: So it was a little bit unique for me only because I did have a gap year. So really, I was out of clinical training for a little over a year because fourth year is the fun year. And I definitely enjoyed my final year of medical school and getting unique experiences. Therefore, I spent a little less time clinically.
And then you take a full year away from that, away from clinicals and being in the trenches in the hospital. And that made me very, very fearful. I was also worried there would be this expectation at my home institution that because I'm familiar with many things that they would assume I would be ahead of the other interns in my cohort and that there would be more expected of me. However, although there were some expectations about familiarity because I've been through the system, I was still given quite a bit of grace, which I was appreciative of. And I was able to share those things when I felt uncomfortable or felt like I needed more time to learn something because giving yourself grace in that process to transition is really important. And I think that's also a great thing to ask of a home program when you're interviewing is what are your expectations if you were to have medical students who have matched in your program and what that transition time is like? I think that's a fabulous question to ask because you will have many people who actually match in their home program and it's nice to know what the expectations are going to be.
Murphy: So you've given us a lot of nuggets. Do you have other advice you'd offer to students who are considering their home program as they get their rank order list in line?
Dr. Patel: Yes, I think it's really important to give yourself permission to want what you want. And if you want to stay at your home institution, that is wonderful. If you do not want to stay at your home institution, that is also okay because you can always go experience a different training experience. And if your home is somewhere that you're passionate about, you can always bring back those nuggets of information back to your home institution and be able to serve the people in the community you want to be in. And I think giving yourself that permission to say it's okay either or and to follow what you really want is quite therapeutic, validating and freeing. And it's something that I notice many people don't do because it's so high pressure. And the other piece of advice I would give is not to really live in fear because the Match process can be quite nerve wracking and scary and very vulnerable, right? Because you're hoping that someone will choose you and you would hope that at the very least your home institution will choose you. And I think it's really important to remember that everybody's going through the same process and no matter what, it's going to end up being okay and I'm a firm believer you'll always be placed in the right place at the right time, where it's meant to be.
Murphy: That's a great reminder for our students and they also should know that the odds favor you're going to match in your top three places and the odds overwhelmingly favor that you will match somewhere. And I think that those are helpful nuggets as rank order deadline approaches. Do you have any other insights for our medical student listeners, Dr. Patel?
Dr. Patel: Yes, just remember that it takes two to tango. So, I understand there's this pressure as you're being interviewed and interviewing with various institutions, but it has to be a good fit. And when it's not a good fit, it doesn't have to be permanent. So understanding that matches an exciting time, this is wonderful. But if you find yourself in a place or a program where you feel it may not be the right fit, it's not the end all be all. You can have a unique pathway. You can have a non-traditional way to have a career. In fact, I had a friend who ended up matching internal medicine, went through her program for a few years, decided this was not the right fit for her, and she actually transitioned into another specialty in a different location completely. So, it's okay to want different things. It's okay to feel like maybe this wasn't the best place or maybe it was the best place for me. But understanding that nothing has to be permanent is really important. And I think when you have that mindset, it can make Match in the whole process that much more fruitful and that much more valuable to you because that's a part of what we're the risk we're taking when we have a career in medicine. This is one of the few career spaces where you don't really know where you're going to be and what specialty you're going to be in. And I can only imagine how nerve wracking that is because when I think about jobs in a traditional way, you really know exactly what you're applying for, exactly what you're getting, exactly where you'll be. And there's a lot of that question mark. And so, embrace that sense of uncertainty because I think the best physicians and the most valuable people are the ones who are okay with sitting in discomfort and embracing the unknown. And that's a lot of what medicine is. Where it's not really formulaic. We don't always know what's going to come up, but we always step up when that time comes and I think matches the same way, which is why it should be celebratory whether we get the outcome we want or we don't.
Murphy: Dr. Patel, it has been a pleasure having you on the show. Thank you so much for joining us today.
Dr. Patel: Thank you, I appreciate it.
Murphy: I'm AMA Senior News Writer Brendan Murphy. Thanks for listening to Making the Rounds.
Unger: Don’t miss an episode of this special series as you prepare for Match Day. Subscribe to Making the Rounds on your favorite podcast platform or visit ama-assn.org/podcasts. Thanks for listening.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
