How to find a position: it's all about the people
There are times that medical school and residency feel like a sheltered island. When you start medical school, what you will eventually choose for a residency seems an eternity away, but by 3rd or certainly 4th year, most of you will have chosen one. And while that decision might have initially been a difficult one, the next steps seem automatically laid out--ERAS, The Match, starting residency. One step follows the next without very much need for serious decision-making. Sure, you choose where to apply, what geographic area you want to be in, and other factors, but ultimately a computer decides, right? It's not like the real world where you actually get to play a major role in choosing a job. And once in residency itself, the world of What To Do After Residency still seems far away indeed. For those who choose fellowship over practicing right out of residency, this process repeats itself, with further isolation and restriction of choice by another Match. Throughout all of this, who you are and how you are as an individual hardly seem to matter.
Of course, most of the paragraph above is a gross oversimplification. We obviously have choice in our career paths, choices in where we apply, and even some influence over where we match. But it is different from the regular job market. The Match, and it's computer-based assignment of slots in training programs, appears to remove human decision, choice, and influence from the process. Yes, we interview, and yes we are more than the collection of numbers on our applications, but ask anyone who has gone through a traditional job application process—where you compare multiple offers on factors like salary, benefits, job environment—and it is absolutely different. However, as I discovered when going through my own training path, there is much more of a human element than I at least had ever realized—a human element that can truly determine your future career.
When I sat down early in second year with my program director and he asked me "so what do you want to do when you grow up?", I thought I had some idea. I was thinking about pediatric hematology-oncology, pediatric infectious diseases, and general pediatrics, and I was pretty sure I would need more time to decide. By late fall/early winter, I had decided on pediatric infectious disease (peds ID), but it was too late in the application cycle for me to apply that year. Before I move on, I should note that this was before peds ID had a Match. But while my experience is different in the details from what can happen now, hopefully you'll agree it still applies. So there I was in mid-second year of residency, gong along biding my time until the next application cycle, when I received a very fateful email.
As a 4th year medical student at Columbia University, I had done a rotation in pediatric ID, figuring it would be helpful for a career in pediatrics no matter what subspecialty I chose (and I recommend this to any pediatrics-bound med student or resident!!). I had loved the rotation and done well in it, getting a great grade and good evaluations. I was enthusiastic. I was polite. I did my homework regarding patients as well as faculty areas of interest. I was more than just a diligent student, I was a diligent citizen of their community, something your mom or dad probably always told you to do—be nice, be polite, respect your elders, do what you're told, work hard, etc. After heading off to Mount Sinai for residency, I had not been much in touch with anyone from that rotation until that day and that e-mail. It was one of my peds ID attendings from Columbia, wanting to know if I was still interested in ID—they had a fellowship spot that was still unfilled and, if I was interested and able to come interview, it likely had my name on it.
I was thrilled—here was a chance to do pediatric ID without waiting a year, without delaying my plans. What's more, it felt great to be acknowledged, to be remembered. Needless to say, I interviewed, I accepted their offer of the fellowship position, I became a fellow, and here I am, now an assistant professor in pediatric infectious diseases. Now, who's to say that wouldn't have happened anyway? Maybe if I'd waited a year I would have done fellowship there all the same, or at a different institution. I can say for sure, if I'd waited a year to do fellowship, I wouldn't be in the job I'm in now—the position would have been filled by the time I had graduated fellowship.
The lesson from this, for me, is two-fold. First, and more obviously, if an opportunity comes along that seems like it should not be passed up, don't pass it up! Even with the Match, places don't fill and people don't match, and certainly the post-training job market is less restrictive. If an opportunity that appeals to you presents itself, take it--you can always back out later but if you don't take it then, it may not be around in the future.
The second lesson regards how and why it was that I earned this opportunity—yes I had gotten good grades in a rotation, but it wasn't the numbers that mattered—it was the people. I got offered my fellowship spot because I had made a personal impression on a group of individuals and they remembered me. Sometimes when we are busy in medical school or residency it can be hard to take the extra time to, for lack of a better word, schmooze. It feels like it shouldn't matter if you go to that cocktail party, or meet the chairperson, or go the extra personal mile on a rotation. I'm telling you now, it absolutely matters. I have had more opportunities for research, teaching, jobs, and really all manner of professional activities come because of social interactions; because somebody introduced me to someone and I stuck around to chat with them, or better yet, because I introduced myself. This very blog post came about because I re-introduced myself to Dr. Kind at a conference, after we had partially reconnected through social networking on Twitter. Never underestimate how far a personal connection, a recommendation, a remembrance of a meeting can go in opening doors in your future training or career.
I have spoken to some who feel embarrassed, or even ashamed to take advantage of personal connections and contacts—we all want to earn things on our merits. To them I say this—who you are as a person, whether you are memorable and nice to someone, is a merit. It's a talent and a skill to be honed and used, like any other. Remember why we are all here in medicine—we want to help people. And we're not just here to help patients, but also to help each other; that includes you, our junior colleagues. But we can't help you if we don't know you and we probably won't help you as easily if we don't know you well. So remember who you are—an individual who can easily matter a lot to another individual. Use that; it may just land you a job.