Tips for new attendings

I had written on a post when moving between residency and fellowship. You can find the link here http://neilnf.blogspot.com/2018/06/moving-tips-for-residents.html   

I am updating the post to make it more all-inclusive and financial savvy. 

Things to do before graduating and planning the move.

Disability insurance: 

This is one thing that skyrockets as soon as you get out of residency/fellowship. I would try to get this one ASAP since your earning potential and disabilities will only go up as you get older. This insurance just safeguards your family and you, should something happen to you. I have found the following links to be really useful when trying to understand disability insurance and would recommend reading the same. 

The White coat investor is an amazing site for financial literacy, and this is the one for disability.

• https://www.whitecoatinvestor.com/disability-insurance-introduction/. It is a series and I would try to go in order

The following links are quick facts on the same so that you can quickly understand it.

• https://www.whitecoatinvestor.com/what-you-need-to-know-about-disability-insurance/
• https://www.whitecoatinvestor.com/top-ten-questions-physicians-ask-about-disability-insurance/

Group vs individual (an eternal dilemma during residency is if we need it but I hope these links are useful)

• https://thephysicianphilosopher.com/group-disability-insurance/
• https://www.whitecoatinvestor.com/ama-disability-insurance/ 
• https://www.whitecoatinvestor.com/how-i-review-existing-individual-disability-policies/

Utilities

You will have to end your current utilities i.e., water, electricity at your current place and begin the same at the new location.

Use USPS mail forwarding service to forward any/all mail addressed to you at your old location to the new place https://bit.ly/3pPwqia. There is a charge of <$2 when I did this, but this is worth it.

Bank accounts

• Close old accounts that you will not use and streamline the ones that you will use going forward.
• Consider opening a new bank account in the new job place to get account opening bonuses (check https://www.bankrate.com/banking/ or https://www.doctorofcredit.com/best-bank-account-bonuses/ for the latest information.
• I would recommend updating your banks with your new details around 2 weeks before the move since this will help you in using the same as address proof for getting your driver’s license (they need 2 forms of address proof). 

Credit cards

Consider opening new credit cards since you may have a LOT of expenses while you are house hunting/doing a house make over. My list of credit cards is as follows https://maxrewards.app/refer/neilf120 

International graduates

Do not forget to update USCIS with your new address since your immigration is linked to the same. https://www.uscis.gov/addresschange 

Financial tips

This podcast/video by the white coat investor is worth a watch https://www.whitecoatinvestor.com/financial-priorities-as-a-new-attending/. In summary

1. Do a back door roth IRA 
2. Max out the 401k/403b
3. Max out the 457b if available- This is a judgment call since it depends on the financial stability of your practice.
4. Max out the HSA (please note that you can contribute money ONLY for the months you are eligible) For example, for me I became eligible in Aug and hence I can contribute only 300*5months= $1500.
5. DO NOT opt for COBRA since you can retroactively activate it should you become ill.

#tipsfornewattendings

The road to fellowship: aiming for the stars

This post is by my colleague who I had to hound to write this post once I knew where he matched. The reason I wanted him to write this was to prove that IMG’s do have what it takes to get into prestigious institutions and to not listen to the disbelievers!

"I was ecstatic when I got into the Med-Peds program. It was the perfect program for someone with a global health interest like mine. Also, after having worked in Mumbai in non-academic settings for a year, I was hungry to learn. Medicine became my life and I enjoyed every day at work. Finding my way into residency also gave me confidence.

I then made a decision. All my life I was aiming low, telling myself that I would never be good enough to go to AIIMS, Harvard or any of the Ivy league programs. I told myself that this time I will try. I will work hard to find myself in the best program in the specialty of my choice.

So, from the beginning of my residency, in addition to focusing on my clinical growth, which I must add is extremely important and indispensable, I starting thinking about what fellowship I wanted and how I was going to get there.

My interest is in the practice of critical care in a global health setting. I decided that I wanted to do Infectious Diseases and Critical Care- an unusual choice but an upcoming specialty in medicine. With my program director’s help, I found a mentor and worked on an ID research project. I completed it within the year and submitted it to IDWeek, an international ID conference. I presented there the year after. I also worked on workshops, papers and other teaching projects.

I realized in the course of applying to residency, that being on a visa is big negative for programs. H1B visa narrowed my fellowship prospects further. So I had to be the best candidate possible.

Somewhere in my third year, I realized that Med-Peds being a four-year program, left me with just two years for fellowship as the limit on H1B is 6 years, after which we have to have applied for a green card or leave the country for a year. I had to then make a choice. ID or Critical Care. I couldn’t do both, at least not initially. This was really hard. I knew I loved both but I couldn’t decide. Also, my profile was better suited for an ID program than a critical care program. After weeks of thinking about what I wanted, discussion with visa lawyers to get the specifics of visa and green card right, I decided to apply to both ID and critical care. My philosophy was that what I really wanted was to be in academics practicing global health medicine. It was important for me to land in a program that supported my career interests and helped me grow. And as I found out through the fellowship interview process, it is predominantly about finding a mentor.

I looked at ID programs and realized that I could not even apply to some Ivy league programs because they wouldn’t sponsor an H1B visa. I looked at 30-something critical care programs and found that only about 15 programs sponsor an H1B visa. I was indignant, but thankfully I had put in all the work to become a good candidate.

I heard from some really strong ID programs and I was drawn to all of them! Amongst the critical care programs, UPMC, Pittsburgh seemed most interesting. It is probably the oldest critical care program in the country and arguably one of the best. When I interviewed at UPMC I found out that they have a global health track. I also found a physician there who I knew would be the perfect mentor for me. My interview went well. I was well prepared (make sure you prepare for some behavioral questions) and my enthusiasm for my future career interest and the program was apparent. I got a pre-match offer for critical care (most critical care medicine programs are not part of the match) and I was thrilled to accept it.

I look back and see how far I have come. How many years it took me and how hard it was. But when I was inside it all, I never dreamed I would come this far. But I did not doubt my love for medicine, my enthusiasm or my stamina to do what it takes. My only motivation was, and is, to become the best physician I could become!

I won’t oversimplify the process of getting into residency and fellowship by saying that all that is needed is motivation and love for the field, because I know that unearned privilege like having money to stay in the US to do rotations, luck, meeting the right people and bunch of other factors all make a difference. But I can tell you that you will absolutely need hard work, motivation and perseverance to make your dream come true. It is possible to become that successful physician you want to be.

Dream big. It will happen.

Signing out

Varun Shetty

(varunshetty@protonmail.ch)"

Step 3

This post is more on the exam than on a study plan for sure since I feel that is more confusing than the study preparation itself. Basic format of the NEW exam is as follows

DAY 1

• Total exam duration - 7 hours
• Has 6 blocks – 42-43 questions with 60 minutes for each block.

DAY 2

• Total exam duration 9 hours in total. Has 2 parts
• Part 1 –

o   6 blocks with 33 questions and 45 minutes for each block.

• Part 2 – (CCS)

o   13 case simulations with each being either 10 or 20 minutes in length.

The MAIN change according to me is in the scheduling of the exam. I mean in the new pattern you can schedule day 2 of your exam at a different date but at the SAME test centre and within 14 days.

Materials I used:

1. OLD MTB 3
2. USMLE world - Qbank, CCS, UWSA
3. Archer introductory videos

The general question on everyone’s mind at the moment I think is should I read my basic science book like 1^st aid for Step 1 and go through biochemistry and learn the enzymes and also to buy the new MTB 3 (I have not read it so not sure about MTB 3 new addition) My advice would be a firm NO, as I feel step 3 is basically the same as CK but they are more focused on the management aspect of the patient and how you can apply your BASIC science concepts. At least for me it wasn't like step 1 where I had to mug up a couple of enzyme names and know the deficiency of which causes what and so on and so forth. My advice would be prepare the same as you would for the old step 3 examination. In addition to the Uworld qbank do the Uworld self-assessment test and USMLE.org practice materials.

Coming to the CCS part of the exam I felt this part was my Achilles heel. I would highly recommend doing the Uworld CCS cases as many times as possible and read the explanation. Also Uworld also gives you a PDF handout for 40 to 50 cases which I think is good enough. Furthermore to help in CCS there is a person called Archer who has a course.  I recommend watching his CCS Strategies video which is 2.45 hours long which gives you a quick over view of CCS. Also do the CCS cases that USMLE has on their web site.

The difficulty of the questions were essentially according to me like Step 2 CK, but as I do not have my result I would not like to say anything for sure. Also I felt day 2 was tougher than day 1 but some guys I spoke to felt both days were easy. Any how my study time was around a month and a half technically with studies being in between interviews and Christmas festivities. At the moment as my result is unknown I cannot exactly say whether it was sufficient or not but hoping for the best.

Good luck to all who are giving it soon!

(Update 25th March 2015- Pass)

List for electives/observerships

Last updated on 21st June 2015

I have no idea whether the list still holds good or no.

But during my search for electives in addition to umar tariq and electives.us the following lists come in handy.

Note : Links below open in a new window- On the top right corner of the new window click the Skip Ad and then you get the list. (Google Drive)

1. List 1
2. List 2
3. Observership opportunities  - Post from Facebook actually
4. Compilation - Some great people put together a HUGE list
5. Harshal Awasthi - Really great tips for applying
6. Dinesh Vinayak J- Good tips for new observers 

NOTE- Some people have contacted me saying that the links do not open. Do try the following.

• Check that the pop up blocker is turned off since the links open in a new tab/window.
• Add https:// before the web address
• Use a laptop or computer if does not work in your phone
• Ad blocker is turned off at least till you download the files

P.S.

• If you are the owner of the list or need me to take it down would gladly do so should you contact me. 
• Please add in the comments section if there is any mistake or additions that should be done.
• This is not the MOST updated list. Recommend mailing (emailing) the colleges to check if there are spots available.
• Kindly apply for electives spots towards the end of the year or in the beginning since there are higher chances to get opportunities then.
• Lastly no matter how bleak your chances are DO NOT GIVE UP!
• Do share the post if it helped you.
• Best of luck!!