Beginning of the End

And just like that, there goes another year of residency. Every July 1, all around the US, hospitals start seeing a new set of faces taking care of patients, working with the rest of the staff. They are the new doctors, the interns. That same day, the previous interns also take their role as the new second-year residents, and the previous second-year residents become the new third-year residents. Every resident physician, old and new, shifts into a new role with new responsibilities, and new position in the pecking order. It’s a day of adjustment, of wandering into the wrong hallways or confusion on how to put in orders into the electronic medical records. I know. I’ve been there. How this affects patient care every July 1, I cannot say, but we do our best to help make this transition smooth. I look forward to working with the new group of interns.

So grateful to be able to both work and hang out with this group of fine doctors.

So grateful to be able to both work AND hang out with this diverse group of fine doctors.

Looking back over the past year, I have enjoyed this second year. While the learning curve this year has certainly not been as steep as intern year, it came with its own challenges. As a second-year resident, I was given more autonomy, and it was rewarding being able to establish continual relationships with my own patients, and making more clinical decisions on my own. However, with more autonomy came more responsibility as well, as I was more responsible for my own actions and the actions of the interns I was guiding and working with. Because of this, I have been studying a lot more, reading more peer-reviewed medical journals from American Family Physician, and guidelines, in order to make better judgement about my patients, and make better medical decisions for them.

Looking sharp at Jo's wedding

Looking sharp at Jo and Tom’s wedding. Jo is our awesome residency coordinator.

This past year, I also had to prepare for the USMLE Step 3, the final leg of the United States Medical Licensing Exam (USMLE), a brutal (and not to mention expensive) 2-day exam, lasting 16 hours total. It blows any other exam that I have taken out of the water, including the 3-hour SAT, 7.5-hour MCAT, 8-hour USMLE Step 1, 8-hour USMLE Step 2 CS, and 9-hour USMLE Step 2 CK. It wasn’t an easy test, but I’m happy to say that I passed it… no more USMLE exams ever again! Finishing the medical licensing exam also means I am now eligible to apply for a full state license, instead of working with just a temporary training license as a resident, like I currently do.  But exams aren’t exactly over for me yet, and won’t ever be until I retire. As a third-year resident, I will be preparing for the Family Medicine Boards, which is required to become board-certified in Family Medicine (NOT the same as being state licensed, which is what the USMLE is for).

Showing Lyra the etiquettes of the resident's lounge.

Showing Lyra the etiquettes of the resident’s lounge.

July 1 marks the beginning of the end of residency for me. This third year, I will be planning out my post-residency goals, determine where my family and I want to live, find a job, and prepare for the move to the next phase of my career. It’s exciting to think about the possibilities. To me, location of our next move is probably the most important, because it’s the one factor that affects my family the most. One thing Irene and I agree on is our desire to stay in Georgia. There’s always a special place in my heart for Macon. It is the city I was born and raised, and I have lots of memories here, and I feel thankful to be able to raise Lyra here close to the grandparents for the first 3 years of her life. However, is 3 years enough for us? If we stay in Macon, my daughters will continue to grow up with the grandparents and get a lot of benefit from learning from them. However, knowing Macon, I question this city as the best place to raise my family. The city still faces high crime rates, substandard education system, lack of public amenities, and although some improvements have been made in recent years in the College Hill/Downtown area, the pace of progress is still slow here for our immediate needs. Access to better school choices, language immersion programs, Spanish nursery, Asian groceries, parks, greenways, bike trails, splash pads, museums, and other things that my family would love are better found in bigger cities like Atlanta. Then there are charming mountain towns like Rome, fun college towns like Athens, beautiful colonial towns like Savannah, and beach towns like Tybee island… all tempting choices.

Irene, Lyra, and I with my parents over for a Chinese New Year dinner. The perks of living close by family.

Irene, Lyra, and I with my parents over for a Chinese New Year dinner. The perks of living close by family.

One of the things we like to do for fun is actually our nightly trips to the dumpster to dump out the trash.

One of the things we like to do for fun is actually our nightly trips to the dumpster to dump out the trash.

Lyra is now 2 years old, talking a lot, and understanding a lot. It surprises us (in a good way) what she learns from daycare. Sometimes we are like, “we know we did not teach her that!” She’s also a lot to handle at this stage, as she tests our buttons, and won’t take no for an answer when things don’t go her way. They call it the “terrible twos” for a reason. It’s something everyone goes through, and the “terribleness” has created a lot of memorable moments, good and bad, but more good I would say.

Ho Family

Ho Family

Like me on July 1, Lyra will also be moving up the pecking order this coming September 2… to become a big sister. We are expecting another girl, and we are excited… at least Irene and I are. Lyra is still clueless. Despite caring for Lyra, carrying Baby Gung-Ho #2, and taking care of business at home, Irene still works full time as a Physician Assistant. She is a strong woman and I can’t imagine having a better partner-in-crime than her. Looking forward to what adventures the next year will bring.

14 comments to Beginning of the End

  • Rebecca Howell

    Benji,

    I am so thankful that you have written this blog and posted so many ‘readable tutorials” for future AUC students like myself. I currently reside in ATL, GA and I am leaving in January for AUC and I have a world of knowledge about to surround me and encompass me for the next, Im guessing, 8-10 years. I am excited and nervous all at the same time; well, more like overwhelmed. I have so many questions…would you be able to IM anytime?

    CONGRATS on all your board exam passes!!!!!!!!

    • Benji Ho

      Thanks Rebecca, and congrats on getting into AUC. Feel free to post any question in the comments section of the post you have a question on. I will try my best to answer questions publicly. Best of luck.

  • Nison

    Hello, Benji. Glad to hear your doing well. Seems like the days in the caribbean and living in aventura are a life time away. I am thinking of applying to FM for next year but Im mostly thinking of going for IM. The major reason holding me back for applying to family is because I think it will feel like being a med student all over again going from rotation to rotation. What are your thoughts about this and any pointers? Also do you think its a negative to apply to the same hospital for both programs? Also I dont have a family letter do you think I can use the internal medicine letters, one of which was written by an obgyn? Thanks I know thats a bunch of questions but I really appreciate it.

    Good to see you make it. Btw I graduated AUC this january.

  • Nison

    Hey Benji. I think my previous post was deleted. Dont know if you remember me I used to live in aventura 4th floor. Im applying for next year and Im thinking of applying to IM and FM. FM im on the fence because I think it will be like 3rd year of med school going from rotation to rotation and always being lost. Can you please let me know if you have felt that? Also how do you know if a program is opposed or unopposed like if there are other residencies and if its a good thing. Also I dont really have FM recommendation letter only FM but one is written by obgyn doctor is this good or bad? But my main focus is it being like 3rd year again. Thanks!

    Its good to see you doing well. Seems like the days of aventura and the island are a thousand years away.

    Nison

    • Benji Ho

      Hi Nison,
      I actually do remember you. How have you been? To answer your first question, the experience of a resident and the experience of a med student are extremely different. As a resident, you are working, you have responsibilities, you have power, and you are busy… much more so than being a student. You put in real orders and prescribe medications that patients actually get. You make decisions that actually affect the patient’s course of management. Your interpretation of a patient’s labs can make a difference. This responsibility is much more than a student’s responsibility. The learning curve is steep and it is stressful… again, more so than being a student. You will do rotations, no matter which residency you get into: surgery, IM OBGYN, pathology, FM, peds…. residencies of all specialties have rotations. Some even share the same rotations. However, residency rotations are very very different than med school rotations because you are actually working, getting paid, and being responsible for patients. So no… I don’t think FM, IM, or any other residency will be like 3rd year of med school… not even close.

      A program is unopposed when there are no other residencies in the hospital. This could be a great learning opportunity, and you’ll have no problems getting your required procedure numbers. However, opposed programs can also be beneficial too because you see how other residencies manage problems. However, you do have to share your deliveries with the OBGYN residents, and some hospitals may not have that many births to begin with.

      For all residencies, you will need 3 letters of recommendation. To apply to FM programs, at least one of your recommendation letters will need to be from an family practitioner. The other two can be from any other specialty. That is a requirement for a good majority of the programs I applied to. Also, I definitely would not recommend applying to two different specialties in the same hospital. Program directors and residents of different specialties talk to each other. If one program you interviewed with sees you interviewing with another program in the same hospital, they will know that you are not dedicated to their specialty. Programs want to see that you are committed to a certain specialty. It would be a waste of an interview spot to invite a candidate who they felt was not dedicated to their specialty or perceive the specialty as a “back-up.” You should never reveal anywhere in your application or interview that you are applying to multiple specialties.

      Best of luck man.
      Benji

  • Nison kandkhorov

    Thanks a lot benji. Your advise is always great. Right now I am studying for the step 3 and researching and planning to which programs to apply to. I loved family but Im just nervous in that in family you only get to be in a rotation for 4 weeks before moving on to another speciality from the curriculums i saw and and not being to learn that much thus a steep learning curve. I also loved IM too. So debating between the two. Also from you personal experince does the personal statement impact a lot?

    Thanks
    Nison

    • Benji Ho

      Hi Nison,
      I don’t quite understand what you mean when you say you’ll be nervous that rotations are every for weeks in family medicine. The truth is EVERY rotation in EVERY residency are four weeks long. Surgery does a different rotation every four weeks. OBGYN does a different rotation every four weeks. Internal Medicine does a different rotation every four weeks. And certainly Family Medicine does a different rotation every four weeks. Many (if not most) rotations are repeated throughout the year, like this year, I have to do four rotations of family med inpatient service, three rotations of outpatient surgery, three rotations of medicine subspecialties, etc. I am also assigned outpatient clinic all year round on certain days each week, no matter which rotation I am on.

      Internal Medicine does rotations like inpatient medicine, critical care, infectious disease, cardiology, ambulatory medicine, night float, etc. Family Medicine does rotations like inpatient medicine, critical care, inpatient pediatrics, outpatient pediatrics, OBGYN, etc. Surgery does rotations like acute care surgery, general surgery, trauma, pediatric surgery, surgical oncology, etc. OBGYN does rotations like labor and delivery, outpatient Gynecology, female urology, high risk OB, etc. The OBGYN residents at my hospital even do two family medicine rotations with us on our family medicine service.

      So yeah, all residency programs, no matter the specialty, divide their curriculum into one month rotations.

      Benji

  • Nison kandkhorov

    Thanks for putting it into perspective. All this seems very scary and intimidating right now. But i guess its part if the process.

  • ACA

    Hi Benji

    Thanks for putting all this together and congrats on the new addition to the family. I have been thinking of a career change but am much older than most students (36 turning 37 shortly). I currently work in finance and am at (or close to) the top of the food chain for my industry. I have always wanted a career in medicine but never really concentrated on my studies (I was in the military while in college and was constantly deployed.) I would have to take pre-med requirements over but am considering med school in the Carribean, mostly for the scenery and school (no matter how hard) would be a vacation for me. Financially I will pay for school from savings or residual income from investments, no loans needed.

    It will be 10 years before I am done with school, I’ll be close to 50, do you think its worth the time commitment? Financially I would be taking a very substantial loss (opportunity cost and potential compensation) but money isn’t everything.

    I am also considering the military medical school (USHS) after education and my commitment I would be eligible for retirement given prior service.

    Appreciate any input.

    • Benji Ho

      Hi ACA, if you want to come to the Caribbean for the scenery and think school would be vacation, you got the wrong idea of what med school will be like and wrong reason to come to med school in the Caribbean. Med school is challenging and takes a lot of hard work, discipline, and time commitment. If you are expecting it to be like vacation then you will be disappointed and unhappy. If you truly want to become a doctor you will not choose the Caribbean as your first choice before trying domestic US schools first. Also I cannot help you to answer whether or not you should pursue a “dream” at your age. This is such a personal choice. I can tell you though, there are much older folks who go to med school, even grandparents that I know. Some can’t catch up and fail out and others do well and match into residency. Best of luck.

  • Kina

    Benji! I was thinking about you today and wanted to see if your blog is still active! It is! It is so exciting to see you have babies now! I hope you and Irene are doing well! Im finishing my PGY3 at Vanderbilt and am applying for fellowship this season. I miss your cooking! Especially the tomatoes and eggs!

    • Benji Ho

      Kina!!!! Great to hear from you and thanks for stopping by and visiting the virtual version of me. If you’re ever in Macon, let me know! Best of luck in your last year!

  • Alice

    Although this comment is quite a ways away from when your blog was originally posted, I would love to wish you good luck with your current year of (I think?) residency. Ironically, you reach a new set of responsibilities on my birthday. I imagine what that may be like if I ever reach my goal of working in the medical force, celebrating a new year and my birth, haha.

    I’ve just started reading your blogs, and I am highly intrigued. I hope you can welcome me to your group of followers, and I would love to come along on your joyous ride of life through the ups and downs. Have an amazing new year with your family! 🙂

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