How to Get a Job After Internal Medicine Residency: My Best Guess

It's April, third year of your internal medicine residency. You've slaved away the last 3 years of your life, perfecting your history taking, the finesse of using your healing hands (to order labs and studies), your charting skills are unBELIEVable, and now you're finally ready to graduate from your residency program. Ahhhh, time for sweet, sweet relaxation.

No! Wrong!!! Time for earnest, earnest job-seeking! In theory, this should have been done several months ago (think early fall, NOT late spring), but perhaps you lacked the motivation, know-how, or were counting on that Mayan end-of-the-world prediction to pan out. Spoiler alert: we're still here.

DAMMIT.

No matter! Now the heat is on to find a job (and by "heat" I mean "parental nudging towards a state of employment and away from their couch"). Let's break it down into easy to follow steps:

Step 1: Your CV

You remember your CV, of course. The last time you saw it was probably 3 years ago, when you applied for residency. You can update the education/training portion to reflect your internship/residency program,  and add your licensing and other certifications as well (who's ACLS certified? That's right, YOU'RE ACLS certified!). Now clear off the volunteer experiences and hobbies you used to participate in because residency has EATEN YOUR LIFE. Well, you can leave a couple of hobbies in there. Don't put the real things you do outside of work, like "Googling how to quit my residency program", "watching TV, lots of TV" or "stealing scrubs." Put something that makes you seem more normal like "biking" or "cooking," and will be hard to disprove at an interview. Did you pick "reading?" Strong work.

Step 2: References and letters

For most jobs they will ask for at least 3 references, and/or letters of recommendation. Who to chose? A lot of places want to hear from your program director. You might feel intimidated by asking your program director, but keep in mind that (a) they almost certainly already have a nice template letter that they use when everyone in the program asks them for a letter, every single year, and (b) your program directors want you to do well, because it reflects well on the program. Who else to ask? Pick people you have a good feeling about. It could be an adviser, someone you've worked with for a significant chunk of time, someone who you feel knows you well enough to speak to your strengths.

Who not to ask? Don't ask the most prestigious person you have ever taken an elevator ride with but doesn't know you from Adam. No future employer is going to be impressed by a vague letter that gives the gist that "I have no idea who this person is, but they were very polite during the ride from the 10th to the 14th floor," no matter who its author is. And don't pick anyone you get a bad vibe from. Why would you want to put your future in that person's hands?

Step 3: Where do I find one of these elusive jobs?
- Word of mouth: your program directors and other docs you work with hear about positions all the time; spread the good word that you're on the hunt!
- Recruiters: they come in hordes, relentlessly spamming your email inbox with vague job opportunities ("Ideal outpatient or inpatient position on the coast, competitive salary, near a major metropolitan area! If interested, email me your CV"). They can actually be very helpful in helping you find a position, because they are motivated by making a commission off getting you hired someplace.
- Journals: just to name a couple, the NEJM and JAMA (both in print and online) are good resources for job ads, and have search engines for sorting through the posts on their websites. You can also sometimes submit your application through the journal's job search website.
- Online: some of the large medical societies, such as the ACP, has a "career center" complete with job search engine. Government/military medical jobs are required to be posted for open application, and the same is true for some positions in university/academic settings; these are searchable online. Where can you find a job online? Where CAN'T you find one! There are even postings on craigslist. No joke. And if you're open to locum tenens (temporary) positions, your job options expand exponentially.

Step 4: You get the job
(We may have skipped some steps here)

You got the job? You GOT the JOB?!? Congratulations!!!

 ...can you put a good word in for me? 

Internist 4 Life

Some of you may wonder where I've been for the last year and a half. "What happened to you, Medicine Intern? Where did you go?" Some of you already know the answer. No, I haven't been trapped at home because of an unfortunate choice in soap! I've just been busy with life, mostly with residency. The work hour restrictions for medicine interns and residents basically came about at exactly the right time to not benefit me at all, and the effect in my residency program to shift more work and responsibility onto the junior and senior residents. It was funny, I thought I was so busy intern year, I had no idea it could get any worse. And by "worse," do I mean "better"? Like, "way better"?

Ha! No, hopeful intern, I do not. And if you're not intimately familiar with internal medicine residency, it used to be a system where first year you "hit the ground running," and by that I mean "feel like you've been thrown out of a helicopter onto a freeway and try to keep up with traffic," but at least it got easier over time, with senior residents serving in a supervising role over the poor beleaguered interns. Now the work load and culture are changing so that the interns have less patient care experience, with more of the patient care (including direct care as well as charting, paperwork, etc.) belonging to the senior residents, who are also still functioning in a supervising role. Ironically, having more of  what was previously the interns' workload means the residents actually have less time to carefully scrutinize what the interns are doing. Good? Bad? And for whom? Time will tell. But thank you, ACGME, for allowing me the opportunity to be an intern, if not for life, at least for 3 consecutive years. Or, "resitern" as we call it.

At any rate, I'm at the end of my residency now. In just a few short weeks I'll be released into the wild. And by the "wild" I mean "job market" and "real world." I have recently forced myself to apply for some jobs, and actually received my first job offer this past week. That was good.

It was sent via email, and immediately followed by an email to "recall" that job offer. THAT WAS LESS GOOD.

Seriously? Seriously? Does this stuff really only happen to me? Let me know what you think... especially if you're thinking of hiring an Internist4Life...

Next post to come:
How to Get a Job After Internal Medicine Residency: My Best Guess

He who learns must suffer. And even in our sleep, pain that cannot forget falls drop by drop upon the heart, and in our own despair, against our will, comes wisdom to us by the awful grace of God. -Aeschylus

Jungle Escape Day

I have been negligent in maintaining this blog. This is both regrettable and predictable. A brief recap of the last several months is pending. In the meantime, I am on vacation. Again.

The first day of my vacation I was post-call, which means I actually spent the morning working. Most people wouldn't consider that 'vacation.' I forgot what I did the second day until my friend reminded me ("You walked around pants-less eating marshmallows. You told me about it.") Third day: my friend kidnapped me and we had a jungle themed escape day; we went to an interactive rain forest exhibit at a museum (I think a giant spider actually winked at me), and then we went to a spa for a "jungle" treatment. Now I'm not usually the type to frequent, or even be very comfortable in, a day spa but this was a special treat that my friend surprised me with! The "jungle" treatment involved getting scrubbed with different sugars and then a papaya/pineapple concoction, then my hair was massaged with a honey conditioner, at which point I was basically relaxed, if by "relaxed" you mean "edible." I was given anticipatory guidance by the masseuse before she left the room- the room would gradually fill with steam, then a rain forest-like rain would fall from the ceiling, then in the next room I would find a pool with a jungle-like waterfall, and my jungle experience would conclude with special grapefruit lotion. (Jungle grapefruit?) Okay.

So I'm trying to relax and enjoy being steamed in my papaya marinade, but all I can think of is the chain of events to come. Steam. Rainfall. Pool. Waterfall. Drying. Grapefruit. I wished the steam phase would go faster because I still had a lot to get through and I was starting to think this whole process could be a lot more efficient... I realized in my internal monologue that I was still in "intern mode," even at a day spa. Internship has pervaded, and ruined, probably every aspect of my life. I began to ponder how to break free from the intern mindset, and as in uffish thought I lay, a FUCKING TORRENTIAL DOWNPOUR broke loose over my head. Basically imagine being outside in a monsoon and the rain has been heated to 120 degrees. Except oh wait, you're indoors, and you have actually paid for this to happen to you.

...so to make a non-story short, I got sugar-coated, monsooned, splashed around in a heated pool and I actually felt a little better about my life. I left, if not refreshed, at least smelling as fresh as a fruit salad. What I took away from this is that anything that helps me break free from the mental prison of internship, is a good thing. Even if it's a hot torrential downpour.

You're probably on the edge of your seat wondering, "How fast can I navigate away from this page?" "Where can I go to get an unpleasantly hot indoor rain punishment?" or "What else will you do on vacation?"

I'm open to suggestions.

This is the first week of the first vacation I've had since internship started. Ahh mind, I thought I'd lost you!

By the way, happy April 1st!

It's official. I have quit my residency program.