Advice for Incoming Residents

In this TikTok Live video, Jeremy Faust, MD, editor-in-chief of MedPage Today, and Adriana Wong, MD, MPH, a fellow in reproductive endocrinology and infertility at the Los Angeles General Medical Center, discuss the intricacies of the residency process. Faust and Wong talk about whether the match system is worth keeping, staying compassionate toward your coworkers, and give advice for incoming residents.

Click here to watch Part 1 and Part 2 of this series.

The following is a transcript of their remarks.

Faust: Let's talk a little bit about the overall process, because people will watch this who are students who are thinking about going to residency.

Do you think the way it worked out for you and your colleagues was good enough? The talking point being, look, the match system is the most bizarre thing in the world, and yet -- does it work? I think it kind of does. What do you think?

Wong: I was thinking about this recently. My own experience with the match is complicated. My first time was going through residency match and then my second time was applying again through fellowship. I get very triggered thinking about it, because the whole thing is just so anxiety-provoking, thinking that it's just all being left up to some computer algorithm.

My first time going through residency match was very hard because I really wanted to be home back in California with my family and I initially didn't end up there. I stayed at my home institution and then I was able to transfer to the program that I finished residency at. So, that was actually a big change from where I initially matched at. Then for fellowship, it worked out great and I was able to be really happy on match day.

But I completely empathize with the people who are not happy with their match, because there's so much emphasis on this as you're applying through residency -- or going through medical school and going through residency because it's all people talk about. For all your fourth year, it's all you're thinking about. And so, so much of your energy and effort and financial investment is going into this. It was back at the time when I was flying everywhere and paying for hotels everywhere -- tens of thousands of dollars for interviewing all across the country, and it felt like this huge upset.

But I can't imagine it being any other way at the same time, because you see that the top applicants at certain medical schools will still get 30 interview invites for residency interviews. If they were to get 30 offers for jobs at all of those places, it would also be terrible. I just can't imagine it any other way.

Faust: Yeah. It's weird to think about this whole thing about how when you're a fourth year, you're trying to find "the fit" or where you fit in, but how does anyone even know that and what does "fit" even mean? "Fit" can even be a loaded term that could have negative implications about diversity and inclusion. Looking back on it, how does anyone know anything? How did you know what you wanted?

Wong: I know. I think it's kind of a romanticized idea, right? You're like, "Oh, I'm going to find the residency program that's going to be my home." In reality, most places will be okay and you'll become a skilled physician wherever you go.

Faust: How did you decide, "Yeah, I want to do ob/gyn"?

Wong: I actually went into medical school wanting to be an ob/gyn and I zeroed in on that pretty quickly. I think I just loved maternal and child health from the get-go. I did research on breastfeeding in college and so I kind of focused my interest on that. Then all of the extracurriculars that I involved myself in during medical school just confirmed it.

In retrospect, I think I probably should've kept a more open mind, because I was like, "No, I'm definitely doing ob/gyn," every time when I was on any other clerkship and probably could have explored things a little bit more. I think it would've been nice to see if I liked anesthesiology, it would've been nice if I liked other surgical subspecialties, but it's worked out completely fine.

Faust: Yeah, it's funny, I had an idea when I came in what I wanted, and I switched pretty early because -- look, I always say this: very few people enter medicine saying, "I'm going to be a pediatric urologist." And yet pediatric urology is an amazingly cool field where they save lots of lives and help people's quality of life, but no one ever knew what that was. You knew what a cardiothoracic surgeon was because you saw it on TV, but who the heck knew what a rheumatologist did, you know? So that's always hard, and I actually think that, in a way, there's so many ways in which it doesn't matter.

In my field, emergency medicine, you can differentiate so much later than that because it's like, well, do you want to do teaching or do you want to do policy or clinical stuff? With ob it's a little bit like, OK, are you going to be a surgeon, a clinician, or not?

Wong: Right.

Faust: What's something that medical students, early residents -- what's the message you want to give them that they can't possibly know yet because they haven't just finished residency and you just did?

Wong: OK, this is something that I recently heard that really resonated with me. I think that there's this sense that sometimes things feel like they have to be fair, but I think that something that I've realized was really helpful was realizing that if you're constantly waiting for something to be paid back to you or waiting for things to be fair, you will always be disappointed.

So shifting your mindset to thinking you will get what happens, and sometimes it'll work out and sometimes it won't, really is almost kind of liberating in a sense, because if you're always waiting for that payback, you will be disappointed. Making the most of it along the way and just getting whatever meaning and joy and happiness throughout the journey will be the most worth it for you.

Faust: That's great advice.

I'll throw mine in that generally, when people are doing something that makes no sense to you, it's because you don't have the full context. That's it. Like, they don't want to take a consult? That's because they just had six consults and they don't have the bandwidth. They don't want to see a patient? It's because they didn't sleep last night because they didn't have childcare. You know, there's something.

Almost 99 out of 100 conflicts are actually something that has nothing to do with whether the person's a good doctor or not, it just has to do with some other thing in life. When you remember that, it's easier to get through it.

Wong: Yeah, I think that's good. Giving people the benefit of the doubt and realizing that they aren't inherently bad people who are trying to just punt your consults.

Faust: And I like this. Someone told me something recently, "Everyone's doing the best they can." Now you could say, "Some people's best isn't that good," but actually it probably is better than you think. It's just they're doing the best they can with that perspective.

Where can we find you on social media? Because you are very active. Where can we find you?

Wong: I'm on Instagram and TikTok is @adrianawongmd. If you message me or email me through there, I'm happy to answer any other further questions.

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