By JALAL BAIG, MD
Robert Wood Johnson Internal Medicine Residency Program, New Brunswick, NJ
We become acutely aware of the hurdles presented by the medical profession early on in the journey from pre-medical student to healer. As I run towards the close of my internal medicine residency, a lot of what was once insuperable has been conquered. Yet, past successes became meaningless the day I registered for the NRMP fellowship match.
I arrived to residency in July 2013 with the pure intention of becoming a skilled internal medicine physician. This remained my consuming desire in the early months. I expanded my differentials, repleted electrolytes and became more efficient with daily progress notes. As this process became second nature midway through intern year and I reveled over knowing the many forms of potassium chloride, the inevitability of second year and its more onerous responsibilities began to become more palpable. And with this inevitability came whispers about fellowship.
At first glance, the fellowship process seems quite benign. There exist an abundance of medical subspecialties with multiple programs in each state. This is all reassuring until one begins to dig deeper. Though some specialties have lost their allure to residents, Pulmonary Disease and Critical Care Medicine and Hematology and Oncology have become progressively more formidable. Cardiovascular Disease and Gastroenterology remain perennial giants. Couple these already competitive specialties (68% of total 2014 applicants sought positions in these four areas) with added considerations about an applicant’s pedigree and tangible research achievements, and a prospective Hematology and Oncology applicant like myself was left with a potentially toxic brew to navigate.
As second year approached, I was thus compelled to straddle the two worlds of residency demands and fellowship commitments. Because fellowship wasn’t a requirement, the requisite motivation was initially foreign to me. The path to internal medicine residency had been replete with hurdles – GPAs, MCAT, USMLE – that I was required to clear. Whether it was sincere self-motivation or the fear of disappointing others, I overcame these. Fellowship was a hurdle I had chosen to construct for myself. This would require not only self-accountability, but also an internal, ineffable force to sustain me when the desire to reverse course would become enticing. Given the rigors of residency, there were innumerable opportunities and excuses to turn back and find solace elsewhere. Yet I continued to toil, confident that the universe was my ally and conspiring to deliver me to Hematology and Oncology.
Many of the events from here can be fast forwarded to July 15, 2015, the day fellowship applications were submitted. A slow and intermittent stream of interviews followed. There was internal turmoil and anxiety, as periods of doubt would fluctuate with periods of certainty. At times, I would question whether the number of interviews amassed was sufficient to match in my desired geographic location. This was countered with moments of certitude about my ability to match into a top choice. My wife waged a daily campaign to keep me balanced, while a residency friend (also an applicant) incessantly assured me that we had exhausted all opportunities to optimize our applications and burnish our credentials. There was also a lot of ice cream. Things would more or less stay this way until December 2nd.
And so the day arrived. I FaceTimed my wife and opened the email. There was audible tachycardia and a potent sympathetic response. One scroll down and there it was: “Congratulations, you have matched!” The trajectory of my life had changed in this one second and I would be returning home for fellowship. Initial euphoria would soon transition to relief, which is now my enduring emotion. The last hurdle has fallen.