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Episode 122 – Kyle, fourth year medical student at University of Utah School of Medicine

Apr 17, 2019

"It wasn't just me trying to be a doctor, my whole family, my wife and my kids, they just loved the idea and were supportive and kind." Kyle started medical school at 34 with full support from his wife and kids. It wasn’t until his psychiatry rotation that he realized where he wanted to be. With a background in social work, Kyle came to understand that the experiences from his past were an important part of his future. We discuss how that journey transpired, what makes medical school a different challenge than regular university, and finally how it feels to first anticipate your match results, then work through the emotions of finding out where you will spend the next several years of your life.

Episode Transcript

Dr. Chan: What makes medical school so uniquely difficult? How do you carve out that precious quality time for loved ones? What's it like to finally embrace your past as part of your future? And what's it like to anticipate Match Day? Today, on "Talking Admissions and Med Student Life," I interview Kyle, a fourth-year medical student here at the University of Utah School of Medicine.

Announcer: Helping you prepare for one of the most rewarding careers in the world. This is "Talking Admissions and Med Student Life" with your host, the Dean of Admissions at the University of Utah School of Medicine, Dr. Benjamin Chan.

Dr. Chan: Welcome back, Kyle.

Kyle: Thank you.

Dr. Chan: I'm so glad you're back. All right, Kyle. I know we chatted a long time ago.

Kyle: We did.

Dr. Chan: But we're here now. You're a fourth-year student.

Kyle: I made it.

Dr. Chan: You made it. You made it. Hallelujah. Amen. All right. Okay. So let's jump back to, if you can, first year, your second year at the beginning. As a non-traditional student, how'd it go?

Kyle: It was a lot harder than I thought it would be. I remember having a conversation with a third-year medical student before applying and he told me, "It's hard." And I could see the defeat on his face. And I remember thinking, "I have done a ton of stuff. I've taken, you know, 17 credits while working full time managing a family. You don't know what hard is, man." But then you get here and you realize that it's not the amount of effort, it's that it's relentless, that it doesn't stop coming and it is challenging. But I made it. Most of us make it. So it's not designed to make you fail, but it is very challenging. It's hard.

Dr. Chan: If you're comfortable sharing, how old were you when you started medical school?

Kyle: I think I was 34.

Dr. Chan: Thirty-four. Okay. So you're out of school for a fair amount of time?

Kyle: Yeah. Yeah, a little out of practice.

Dr. Chan: So how was that jumping back in? I mean, was it just like deep end of the pool, fire hose kind of feeling or . . .

Kyle: Yeah, absolutely. Again, because I'm comfortable in the classroom setting, I love learning and I wanted it. I craved it. I came back for it. But then it just . . . it hits you and it's the transition where you're spending most of your day now in trying to acquire knowledge and you get tired. Your brain can only do so much. And yeah, it was a challenge, but it did get easier as time went on to kind of stay focused and to stay in the books.

Dr. Chan: How'd you strike that balance? How did you find that balance between family life, family responsibility, because you have kids, and giving it all in med school, studying? Small groups, all the interest groups they have running around, all the different activities. Like how'd you find that? How'd you do that?

Kyle: I think it kind of finds itself. I mean, we all kind of accommodate to the best of our abilities, and then the rest kind of just goes by the wayside. I think the challenge is in kind of allowing yourself to kind of make mistakes, and, you know, sometimes you're overcommitted at home, sometimes you're overcommitted in the classroom, sometimes you're overcommitted in extracurriculars and it's this constant fluctuation. And they're not all equal. But, you know, for me, I had a very supportive family. And so it wasn't just me trying to become a doctor. My whole family, my wife, and my kids, they just loved the idea, and they were so supportive and kind.

And, you know, quality time isn't quantity time. And I think when you have less time, it helps you prioritize what's important. And so, for me, I would take 5 to 15 minutes a day and spend it with one kid at a time and do whatever they wanted to do. And they loved it. And they missed me and I missed them a lot, but we felt like we were getting enough attention. I might need to run this past them. I felt like I was getting enough attention from them. I think they were happy with it. They seemed happy, but . . .

Dr. Chan: So it sounds like they also, you know, in a way, they've earned their M.D. too. It sounds like a team effort.

Kyle: Yeah. And I'm guessing that doesn't stop. I think, you know, even from here on out, it's I may be spending less time studying at home, maybe not actually, but I think that is part of being a physician is, you know, that responsibility, that privilege comes with the price, not just on us, but on our families and it takes special people, special families to do this.

Dr. Chan: Did you ever hit the wall? Did you ever think about . . .

Kyle: Oh, man.

Dr. Chan: . . . you know, "I made a mistake. I shouldn't be here," kind of imposter syndrome, thought about quitting?

Kyle: I always said that the only thing worse than being in med school was not being in medical school. And so absolutely, absolutely, hit walls but . . . Absolutely wanted to quit. But the option was not being a physician, not being successful, not showing my family that, you know, they can accomplish the goals that they set out to do. And that kind of feeling of responsibility was helpful to me. I felt like, you know, this wasn't just for me. This was all of our journey and that was really helpful.

But, yeah, you have those moments where it just feels like you can't take any more. But the breaks come and people are supportive. I think the challenging part is letting people know that, "Hey, I'm struggling." But if you can learn to do it, your peer support is huge.

Dr. Chan: Are you saying letting people know that you're struggling, like among peers, or like the administration, or both, or . . .

Kyle: Absolutely both.

Dr. Chan: Okay.

Kyle: Absolutely both. But I think your peer support is probably the most essential because you're kind of all going through it together, you understand and, yeah. That's helpful.

Dr. Chan: So, at the end of your second year, you probably had an idea, right? You were probably leaning towards a field before third year started. Do you remember what you were thinking about back then? Or were you kind of like, "Everything's on the table. Well, I'm going to experience third year," or what were your thoughts back then?

Kyle: Radiology. So I wanted to be on a team at primaries that kind of assesses for child abuse. And I loved radiology, I loved imaging, but it was kind of interesting because when I came to medical school, I wanted to do primary care, and for some reason, they kind of talk you out of it in the first two years, so you don't have a lot of exposure.

Dr. Chan: I don't think, officially, that's supposed to happen.

Kyle: Okay. So unintentionally.

Dr. Chan: We're supposed to like advertise everything, I think.

Kyle: Yeah. I don't know if that happened. Like I feel like you get a lot of exposure to some really amazing specialties. And, yeah, radiologist just kind of piqued my interest. So I did some research in radiology, found a mentor in radiology, and just really liked part of it. But when you're a med student, things are exciting, and it's not like what it will be like as a physician. And so, as I kind of got closer to time to choose, the thought of being a radiologist became less attractive.

Dr. Chan: Okay. So back up here. So the first two years of med school you were doing research and shadowing radiologists?

Kyle: Yeah.

Dr. Chan: Okay. And, you know, you're in a dark room, you're watching, you know, it's all about pattern recognition. And did then you sort of liked it, it sounds like.

Kyle: Oh, it's exciting. But then, you know, I leave my two hours with the radiologist and I go back my huge social groups, sitting in class learning, but they stay there in that dark room and they have to keep looking for patterns.

Dr. Chan: And the list grows. There's a lot of imaging going . . . Trust me, there's a lot of imaging. You probably saw there like the list.

Kyle: Oh, man.

Dr. Chan: The list, like the six computer screens.

Kyle: Which is what I thought looked amazing. But, again, I like talking to people and that just wasn't going to do it for me.

Dr. Chan: Did you actually do a radiology rotation during third year?

Kyle: I was . . .

Dr. Chan: Because there's some elective time built in, so.

Kyle: It was scheduled to. I canceled it.

Dr. Chan: Oh, okay. So you're thinking radiology. Third year starts, and what were the highlights of third year? What rotations just kind of resonated with you? Like, "Oh wow, this is great rotation."

Kyle: There were . . . There was only a few I didn't really like.

Dr. Chan: Okay. So, okay. I guess it means . . .

Kyle: I liked a lot of . . .

Dr. Chan: . . . We can focus on the negative. So which did not resonate with you?

Kyle: Surgery was really hard.

Dr. Chan: What about surgery?

Kyle: The public transportation doesn't get to this school until, you know, 5: 45, I think. And we had to be here at 4: 30, which means my wife had to drive me. And we live about 30 minutes away.

Dr. Chan: That's love right there.

Kyle: Oh, my gosh. I know.

Dr. Chan: Where do you guys live?

Kyle: Midvale.

Dr. Chan: Midvale. Okay.

Kyle: So it was a taxing experience on the family. And then . . .

Dr. Chan: What do you talk about on the drive in at 4: 30 in the morning, repeatedly?

Kyle: "I'm so sorry, sweetie. I love you."

Dr. Chan: Let's just try the radio at this moment.

Kyle: Yeah.

Dr. Chan: Okay. All right.

Kyle: We talk about the day and the kids, because she's not going to see me again till later. But, yeah, surgery is very time-consuming.

Dr. Chan: You coming in at 4: 30, pre-rounding, rounding. OR opens up 6: 37.

Kyle: And the OR's fun. It's fun to be in there. It's fun to be in that environment. It's fun to see a body that is alive, because we do our anatomy and cadavers are amazing. But that's not what living tissue looks like.

Dr. Chan: Yeah. Living tissue is very different.

Kyle: And it is amazing. It's amazing to see it in action. It's amazing to see how surgeons see humans and some of the amazing things they can do. So being in the OR was always fun, but that's only a small part of it. And, you know, a lot of surgeons say they like doing stuff with their hands, but I saw mostly laparoscopic and so they're just like turning their wrist slightly. And I was like, "Man, that's not using your hand. That's like wrist-turning."

Dr. Chan: Did you ever get to turn your wrists?

Kyle: I did. And it didn't go well.

Dr. Chan: Did they make the comment like, "Whoa, seasick. Rocking the boat"?

Kyle: Yes, all the time.

Dr. Chan: Because I remember when I got to drive, it's like, you know . . . Because they make it look so easy.

Kyle: They do.

Dr. Chan: It's like steady. It's like steady. But when you're doing it, it's like, you know, like it's rocking. It's rocking.

Kyle: It is actually . . . I was so surprised because they do make it look so easy, and you think, "Eh, it's just these little turns." No, there is a skill involved, and yeah, I'm not willing to put in the time to acquire that.

Dr. Chan: What time are you getting home at night?

Kyle: So I did vascular surgery the last two weeks, and I think the shortest day I did was 17 hours.

Dr. Chan: Wow.

Kyle: And it was brutal. We got one day off a week, but I left every day before my classmate who wanted to go into surgery, and my shortest day was 17 hours. So that was a challenge.

Dr. Chan: Does the public transportation run that late at night?

Kyle: It did.

Dr. Chan: Okay. So your wife didn't have to come back and pick you up from work?

Kyle: She did not come back and get me. And I needed that train ride home, honestly, to just kind of get back into family mode, because the environment is so serious that if I came home too early, my emotion was serious, and I had a harsh reaction to my family often. But, again, they're so flexible and understanding.

Dr. Chan: So it's good to kind of have like that break, that process of driving or taking the train home?

Kyle: Yes. Let it go, to just kind of let it go.

Dr. Chan: Wow. So surgery was not the highlight. Well, did not resonate with you, I guess.

Kyle: Absolutely not, just the lifestyle. Like in being in the OR is amazing, but the lifestyle was challenging and I didn't think that I was up to that task.

Dr. Chan: I remember when I was a third-year, doing my surgery rotation, because I agree with you. I love the OR. The thing that was hard was like it was like the time and not just like the hours, but it's like, you know, surgeries are blocked X amount of time, but something happens in the middle of the surgery and all of a sudden, the schedule just kind of, you know, everything . . . A one-hour run-of-the-mill procedure can turn into a three to four to five-hour . . .

Kyle: Yeah. Without being able to plan for it. You don't know which one of those is going to require more time going in, and it's never the one you think it is.

Dr. Chan: Yeah. Yeah. And I remember being jealous sometimes because I remember like, you know, the schedule pushes late and then the . . . You know, God bless the anesthesiologist, but they're on kind of the shift schedule.

Kyle: Yeah.

Dr. Chan: So like, you know, 7: 00 rolls around.

Kyle: Someone comes and . . .

Dr. Chan: So the anesthesiologist says, "I'm out of here," you know, like in right in the middle of the procedure, and, you know, another anesthesiologist shows up to get kind of report, to get signed out and then, you know, and then the surgical team stays there because they finish the surgery, but the anesthesiologists rotate out.

Kyle: Yeah. They're like, "It's time for me to go."

Dr. Chan: Yeah. It's like, oh, you know . . . Yeah. I just remembered that like, oh I wish, I wish. Yeah. So.

Kyle: But what they do is incredible, and it was hard not to . . . So at no point did I ever want to be a surgeon, even though I did really love the OR. But I'm kind of glad, because I got to stay there in that environment and it felt all informative. It didn't feel like I was wasting my time. It felt like this was an opportunity. And I will be forever thankful for that, because what they do is truly incredible. And unless you were there, it's not like what you see on the movies. I mean, it is mundane. They stay focused, they stayed dedicated, and they treat every patient like they matter while they're on that table. And it's kind of incredible to see. The sacrifice they make is amazing.

Dr. Chan: So going back to the radiology, I mean, because like all throughout third year, I would argue, you're exposed to radiology because of the different services or ordering images, and you kind of hustle on down to radiology and get them read. So did those kinds of radiology kind of experiences resonate with you, or did you start to feel yourself pull away a bit?

Kyle: I started to pull away. Again, as you go into third year, your focus stops being academic, which was comfortable. I knew how to be a good student, even though I found that the material's super difficult, but I knew that life and I was comfortable with it. As you go into third year, you're seeing that clinical life is not academic life. It's very different. And I think what I found rewarding was not the time I spent in front of a computer screen. It was the time I spent in front of patients, the time I spent talking with, you know, my classmates with attendings, with residents.

And although radiologists do get some of the communication with their peers, they don't get as much time with patients, where I feel like that's kind of where I wanted to have an impact, and I did, I started pulling away. I started just kind of realizing, I guess, what my preference was. So, yeah, when you're sitting in front of a computer screen for two years studying, because most of my resources were online, sitting in front of a screen as a physician doesn't sound that bad. But when you actually get to talk to people and get to interact in their life and just be part of these defining moments, it feels kind of just incredible to be in that moment with them, to share it with them. Although it's sometimes sad, sometimes it's very happy, and I wanted to be in that moment.

Dr. Chan: So what started creeping up on your list? What started to . . .

Kyle: Family medicine. Internal medicine. I really liked the inpatient setting and then . . . So I was thinking internal medicine pretty heavy, honestly. And then my second to last clerkship was in psychiatry. And once I was in that environment, I couldn't believe that I had ever considered anything else. And it was almost immediate where I was like, "This is what I want to do."

Dr. Chan: What about . . . made that difference, what about psychiatry?

Kyle: You know, they talk about finding your people, and that was part of it. I was with like-minded kind of people who were not afraid to analyze themselves and kind of just moved past it. Their interactions with patients was beautiful. It was . . . You know, they possessed skills that I didn't have, and that I desperately wanted, where they could get to information from people who are not capable of communicating it, people who, especially . . . So I started on 5 West, so people with severe mental illness and medical complications.

Dr. Chan: Yeah, comorbidity. Yeah.

Kyle: And so you get some of the medicine, but at the same time, these people are often unable to communicate. They're trying, but because of the mental processes that are going on, they lack the ability to structure any kind of I'd say understandable communication. But over the time, the psychiatrists were able to get to what they needed enough to treat it, and you got to see improvement that was just astounding. But, again, just kind of being in that environment with people who I felt were very similar to me was just instantly rewarding. And I know that makes me sound so selfish. But I mean, really, I'm thinking about what I'm going to do for the rest of my life. And I found them very comfortable, and I wanted to be there. And I just found it really easy to get up and get motivated and . . .

Dr. Chan: So, Kyle, if you asked me four years ago what you would end up in, I would have put psychiatry pretty high, because I know, you know, you had a background, if I recall correctly.

Kyle: Social work.

Dr. Chan: Yeah. You have a social work background. I remember, didn't you like live or you're a parent at a residential facility for a while?

Kyle: Yeah. Yes. You got a good memory. Yes, sir.

Dr. Chan: So, yeah, I think that's part of a little bit of who you are. So do you . . . And so, I mean, do you feel like you kind of resisted that the first couple of years in med school or . . .

Kyle: Hard and intentionally, and it was a mistake. But, you know, I came to medical school to be different, and I felt like part of that was in kind of denying who I was prior to coming in. I didn't know what it took to be a doctor, but I knew that I was striving for a goal that I felt was out of reach. And so part of that focus was in me kind of denying who I was and saying, "I want to be different. I want to be more." And that was not necessary. You know, that was kind of a mistake in how I just viewed this process.

And part of third year was coming to the conclusion that those skills that I had acquired for a decade before coming to medical school were useful. They were a part of who I was. They were what made me a good candidate. They're what made me a good student and what could make me a good physician. And I didn't want to kind of deny those skills. But I did, those first two years and the start of third year, it was full denial of everything that made me capable of being here. I was like, "I got to be different. I got to be a doctor." And so it was kind of healing, a healing process to kind of come to terms with who I wanted to be and that I already had some ability that was going to be useful. It's amazing.

Dr. Chan: When you told your family about the psychiatry idea, did they also kind of push up back against it? Because like . . .

Kyle: Not at all.

Dr. Chan: Okay. So they saw it?

Kyle: Yeah. They're like, "Oh, good, finally." I mean, kind of, you know, you said that you would have guessed. They were all like, "Yeah, it's about time." And so . . .

Dr. Chan: Or did you say, "Oh, actually, I want to be a vascular surgeon."

Kyle: They would have been supportive no matter what.

Dr. Chan: Okay. Okay. All right. But that would have been tough . . .

Kyle: They have this tendency . . .

Dr. Chan: . . . tough bridge to across.

Kyle: Oh, man. That's the problem is that they are . . . They're too supportive at times, and so they won't tell me what their preference is often until after I make a decision. And so they did it in med school. When I told them I was coming to the U, they said they didn't have a preference of where I went. And then I was like, "I'm going to the U," and all of a sudden it's a party. And they're like, "Thank goodness." So they have this tendency of being like, "Oh, yeah, we're fine with it." Really, they have a preference. So they loved the idea of me being a psychiatrist, no pushback at all.

Dr. Chan: Okay. So fourth year starts and, you know, to become a psychiatrist, there are different roads. And I know you were hoping and considering a somewhat different road. So could you talk about that?

Kyle: Yeah. So in my third-year clerkship, I got to work with triple boarders. I had never heard that term before, but there are people who are pediatricians and psychiatrists and the resident . . .

Dr. Chan: Pediatrician, adult psychiatry, child psychiatry. So that's the Triple Board? Yeah.

Kyle: Yes.

Dr. Chan: Sorry, go on.

Kyle: So I only interacted with them in the inpatient, adolescent, and child psychiatry at uni. And their skills were amazing. But in talking about their program, it was five years and whereas everyone who works with children, I believe, has to have at least a fellowship in child and adolescent. Is that true?

Dr. Chan: Yeah.

Kyle: Okay. That took five years as well. The difference is that they also acquired a pediatric board at the same time. And a lot of my work prior to coming here was in kind of underserved areas and people who've had a lot of mistrust in physicians. And I liked the idea of having a board in pediatrics, because, you know, in my mind, in kind of thinking how I would utilize this, it's always my desire to be inpatient somehow. And so in wanting to do inpatient child medicine, I thought, "You know what? I could also spend some time in a community setting, maybe offering free services and going to these communities that didn't have access." And how nice would it be to not just treat people for their psychiatric needs, which are vast, but to be able to say, "You know what? You know, there might be these medical concerns, and you might want to go see someone else." And so that became very attractive to me. In reality, I knew and I was being told that triple boarders don't use peds.

Dr. Chan: Not as much as they should.

Kyle: No, they just don't use it. And so, in most cases, it kind of falls off and they stop getting licensed.

Dr. Chan: Yeah. You have to be certified in pediatrics every seven years. And I've known a fair amount of triple boarders who've just let that lapse.

Kyle: Yeah. It seems like that's just kind of how it is. But, again, it was just so attractive.

Dr. Chan: Yeah. You're like the marines. You're like, you know, Triple Board, you can jump out of a plane . . .

Kyle: Do whatever.

Dr. Chan: . . . You can fly a plane, jump out of a plane into water and swim, jump back on the plane.

Kyle: Yeah. It was hard to find a downside. And . . .

Dr. Chan: So, as you're creating your application, you were dual applying? I get the sense.

Kyle: I was dual applying.

Dr. Chan: Okay. So you're applying to Triple Board programs as well as adult psychiatry programs?

Kyle: Yeah, which is what you do because there's only nine Triple Board programs now. And it's just getting more and more competitive in psychiatry. And so you dual apply, and the only question is do you dual apply as a triple boarder in pediatrics or in psychiatry?

Dr. Chan: I see.

Kyle: And so I dual-applied in psychiatry. And it's about 50/50, but some will dual apply in peds. And so, that way, you have a backup. But most will also apply to all nine Triple Board programs.

Dr. Chan: Did you?

Kyle: No. Not at all. And so my number one choice was the Triple Board program here at the U. And my number two choice was psychiatry. So . . .

Dr. Chan: So your strategy, from the outset, it sounds like was to stay in Utah?

Kyle: Yeah, for the family.

Dr. Chan: For the family. So did you like . . . So you submitted your application?

Kyle: Yeah.

Dr. Chan: Did you apply to other programs?

Kyle: I did. But only in adult psychiatry.

Dr. Chan: Okay. So how many interview offers? Or first of all, like how many . . . So when you're doing this dual applying, I'm sure you're talking to Dr. Stevenson and Student Affairs. You're coming up with a good plan. So how many programs did you apply to and how many interview offers did you get?

Kyle: So, based on my step scores and my standing, they have these algorithms that kind of tell you how many you should apply to, to get the number of interviews you want. And I ended up applying to about 30, but I didn't get as many interviews as I wanted to get. And so my goal was to get 12 interviews. I ended up getting 10.

Dr. Chan: All right. But that's still really good.

Kyle: Yeah, it is.

Dr. Chan: I guess that missing two caused anxiety.

Kyle: The whole process causes anxiety, and so you don't know where to put it. And so, yeah, you end up putting it on an arbitrary number of interviews based on a very minuscule part of your application. But that's the only objective information we have and so we're going to use it. And so, yeah, it did. It caused some anxiety.

Dr. Chan: Did you kind of focus in the West since, kind of close to Utah, as a kind of a backup? If you didn't match here, at least you'd be nearby? Or what was your strategy?

Kyle: So, you know, I told you just a second ago that wanting to stay in Utah was for my family and that was just not true. They want me to stay in Utah, and I did too, but I actually loved the programs here, so I got to throw that out. For me and my family. But in choosing where we wanted to apply, I think our biggest concern was cost of living. And so everywhere we applied to, we thought, "This is somewhere we could afford to live."

Dr. Chan: So New York City?

Kyle: Out.

Dr. Chan: San Francisco.

Kyle: Yeah.

Dr. Chan: Seattle, San Diego, no. Do not sniff it. Doing like a . . .

Kyle: Not even for a second. And we made a few mistakes along the way. We applied to Baylor, because when we looked at Baylor, it was in Waco. But their medical center is in Houston. It was not cheap. And so . . .

Dr. Chan: The internet lied.

Kyle: It wasn't a perfect process.

Dr. Chan: So were you a little surprised?

Kyle: Oh, my gosh. So surprised. So surprised. I shouldn't be, but, yeah, very surprised.

Dr. Chan: Some Western, Midwestern programs.

Kyle: There's . . .

Dr. Chan: Cost of living tends to be cheaper in those areas.

Kyle: Absolutely.

Dr. Chan: So we're looking at Oklahoma City, Iowa.

Kyle: Yeah, Nebraska.

Dr. Chan: New Mexico.

Kyle: Yeah. All over. And then some East Coast programs too. I grew up in North Carolina, so I applied to UNC and Duke. California just . . . Most of the places that had really good kind of hospital settings were just too expensive, so I didn't really apply there. But Texas had a lot of . . .

Dr. Chan: Yeah. Did your little surprise there in Baylor came in, you said Waco, Waco's cheap. Did you take your family with you, or did you go by yourself to the interview offer, interviews?

Kyle: The only one I took my family to was in UNC. And that's just because that's where I'm from. I wanted them to have some Bojangles' chicken, and it was as good as I remembered.

Dr. Chan: As good as Popeye's?

Kyle: U is so much better. To me.

Dr. Chan: Yeah. I remember Bojangles'. I remember Bojangles'. Yeah.

Kyle: To me. Well, so they weren't as impressed, but it's good.

Dr. Chan: All right. So you're interviewing. It's going well. I assume you liked most of the programs. Anything turn you off out there? You don't have to name names or programs, but did anything?

Kyle: Yeah. So, as you're applying, you realize pretty quickly that the resources you used to kind of choose are not accurate. Things change in residencies. Program directors change. Call schedules change. It depends on how many residents are there. There just are a lot of differences between . . .

Dr. Chan: A lot of variables.

Kyle: Yeah. And the only way you're going to know is by going and visiting the school. But also, I realized that, you know, there's a few different kinds of programs. There's programs where their name will set you up, and their name is what makes it attractive. And then there's programs where the resident life makes it attractive. And then there's a few where there's both, where you come out of a program that is well-respected and also you have a fairly good life. And for me, I'm older, I have older kids, and I like spending time with my family. I know I want to be there as much as possible. And it was a real . . . it was a challenge when it came to choosing a program with a name that I felt was well-respected or where the life was well-respected.

And I thought . . . I was surprised by how pulled I was to bigger names, but the allure wore off like pretty quickly when you get to meet residents and they just look kind of beat up and . . . Or one program that I won't talk about, but, you know, they hid residents. I got to see a lot of third and fourth-year psychiatry residents who are in their outpatient years and have time. But when you don't see one intern or one PGY2 resident, like it's a red flag.

Dr. Chan: Yeah. It sounds like a real warning sign. Yeah.

Kyle: Like can I get eyes on these humans? Are they alive? Yeah. So, yeah, there were some surprises. But it's fun. It's fun to go on interviews. You're in such a kind of non-stop environment, and then you hit interview season and you're not in any clinics and it's . . . You're going to places that are fun to go to. People are treating you well. You're getting free meals, and it's like . . .

Dr. Chan: I know.

Kyle: "This is awesome."

Dr. Chan: They roll out the red carpet for you. They try to put their best foot forward.

Kyle: Yes. It's not like . . .

Dr. Chan: They have like all these like really professional brochures and pamphlets.

Kyle: Oh, man. Yeah, they gave you swag, and, oh, my gosh. They treat you like $1 million. There's not a lot of scrutiny. You feel just like they want you, and it's amazing. You're not . . .

Dr. Chan: It's a good feeling, Kyle.

Kyle: It's so good.

Dr. Chan: I promise you. It will get better too when you apply for fellowships and attendings.

Kyle: Really?

Dr. Chan: Yeah. Their carpet gets a little bit more plush, a little bit more red.

Kyle: Stop it. Stop it. I feel spoiled already.

Dr. Chan: All right. So decision time. So when you created your rank list or your match list, what kind of like values . . . well, how did you set up your algorithm? How do you determine that?

Kyle: So the Utah programs were easy, because I loved the Triple Board program out here. It was the only one I wanted to interview at. It was the only one I wanted to be at. And then for this psychiatry portion, it depended on, again, cost of living was what excluded a lot of applications to residency. So that was clearly the most important. But, again, salary, environment, you know, being able to find affordable, safe housing, call schedule, how often are people on call? Didactics.

The University of Utah, I'd say, what made them most attractive was that they have a full didactic day, where you are in class and where you are learning. And I did not see that at any other program. There were a lot that had half days where you went in, you did paperwork, you saw the patients, and then you got to spend the last half of the day in class. But nowhere else had a full day of learning. I just thought that was incredible.

Dr. Chan: Yeah. Because I think the hard part is, is like what is a medical resident? And, you know, and like, to me, it's like residency is this weird transition from medical school, where you're a full-time learner, to an attending, where you're a full-time clinician. So what is residency? It's kind of this weird world where you are a learner but also a worker, you know, so like, so to have a full-time day dedicated to lectures is a big deal, because that's clearly kind of a statement that you're going to be a learner in our program and not have other clinical duties that would kind of infringe upon that.

Kyle: And I felt like it demonstrated a residency that was resident-oriented, that cared about their residents. Like that's, I mean, just kind of unheard of, again, unheard of. So I found that kind of amazing. But didactics, how often are they allowing you time to learn from people who are in the field and have the experience I'm hoping to acquire? But, yeah, cost of living and money.

Dr. Chan: So you send in your match. It sounds like Triple Board was number one.

Kyle: Yup.

Dr. Chan: And then the psychiatry program was number two here at Utah. Walk me through match week. So were you worried you weren't . . . I mean, that Monday. I know it's . . . And as I've learned over the years, because I don't . . . I'm getting so old, Kyle, I can't remember very well. But as I've learned, as I've talked to students, the Monday is actually more stressful on some level than the Friday. So were you worried about not matching? I mean, when you got that email on Monday that you did match?

Kyle: Oh, man.

Dr. Chan: So were you nervous? Tell me about that.

Kyle: Yeah. And so, again, I felt like I was a pretty good applicant, but it's hard to judge. And it doesn't matter, you know, because they're seeing so many residents that have all the qualifications they're looking for. We're not really that different. And so, all of a sudden, as I got closer to the Monday, to seeing if I was actually matched, the anxiety kind of starts to build and the stress of thinking, you know, "I'm either going to have a week that is normal, or I'm going to be very busy for a week trying to find a residency that will accept me."

Dr. Chan: Because on Monday you find out if you matched, and then the Friday you find where you matched.

Kyle: Exactly. And so the anxiety started to build, you know, "Did I make the right choices? Am I as good as I thought I was? And how's this going to go for me?" And so we, because we live in Midvale, we decided to drive up towards the University of Utah in case I didn't match, that I would be very close, that I could come in and have Dr. Stevenson and all the resources to kind of help me find a . . .

Dr. Chan: A residency program. Yeah.

Kyle: . . . residency. So we kind of creeped up here.

Dr. Chan: I didn't know that. Wow.

Kyle: We just kind of hung out around.

Dr. Chan: Would you say like, did you like stop at like little locations?

Kyle: We stopped at Starbucks.

Dr. Chan: Like do some errands on the way up towards the U? Okay.

Kyle: We stopped at Starbucks and just kind of sat there, and I had a Frappuccino and just enjoyed life and was like, "This could get bad." But, again, the goal was to be close to the U, but also to kind of contain some of the anxiety. And so my wife was with me, and we just thought happy thoughts and waited. But it's a different kind of stress, and it is absolutely more anxiety-provoking than Friday when you find out where you match. "Will I match?" And . . .

Dr. Chan: So when did the email drop?

Kyle: It dropped.

Dr. Chan: Or did you . . . Do you log in? How is it set up now?

Kyle: Yeah. No, they email you, and it came three minutes late and I was like, "This is ridiculous." That was the longest three minutes of my life.

Dr. Chan: IT, Waco, Texas.

Kyle: Yeah. They said it was going to happen at this time. Where's my email?

Dr. Chan: Baylor.

Kyle: So we're just sitting there waiting, and then the alert happens that, "Hey, you got an email." We logged in. It said we matched and it was a huge relief.

Dr. Chan: Instant relief. Retreat. Do not need to go to the U. Go back home.

Kyle: Yeah. I went home.

Dr. Chan: Go back towards the Midvale area.

Kyle: Yeah. I know. And it's wild, because it's kind of unpredictable in finding out who does and doesn't match. It's kind of random. And there are people that I talked to that expected not to match and matched, and there's many that expected to match and didn't. And so . . .

Dr. Chan: Yeah. Because all of you know each other, you're all friends, or at least colleagues, acquaintances.

Kyle: And qualified. And qualified to match. And so, yeah, it's just . . . I mean, almost everybody matched. And so, when you look at it as the likelihood of if you're going to match or not, it's kind of silly to feel so much anxiety. But until you know, it feels like it's a lightning strike, and it could happen to any of us.

Dr. Chan: So the anxiety ramps up on Monday.

Kyle: Oh, man.

Dr. Chan: Plummets after you find out you matched.

Kyle: Plummets, yeah.

Dr. Chan: And then the rest of the week . . .

Kyle: The rest of the week . . .

Dr. Chan: Does it start kind of creeping back up towards Friday again?

Kyle: Yeah, I think, but not to that level. I think it's not anxiety at that point. And, you know, there is very little difference between anxiety and excitement. But, you know, now the expected outcome is positive, and so it's more excitement and it's just like, "Let's just get to Friday. Why am I having to wait? Like they know where I'm at, just tell me. Just tell me where I'm going." And so it becomes more excitement. But that same kind of energy, that energy that is just like, "I got to find out. I can't contain this." And so, yeah, it does ramp up a little bit more.

Dr. Chan: And then what happened on Friday? I mean, whole family?

Kyle: So, for me, you know, it's my wife and my kids, but my kids were sick. And so they stayed home. The plan, initially, was we were going to find out all together, but, again, with them having the sniffles, we didn't want them around everybody. And so we had them stay home. But we came, saw everybody. The energy of Match Day is very exciting, because they pull us up to a building or the Rice-Eccles Stadium.

Dr. Chan: Yeah. The tower, yeah.

Kyle: Yup. The tower. I'd never been up there.

Dr. Chan: You'd never been up there.

Kyle: No. That was the first. . .

Dr. Chan: Well, okay. Gorgeous view. Would not want to be in that building during an earthquake because I feel . . . I'm sure it's very seismically safe. I'm not trying to diss anyone, disrespect anyone, but I just like . . . But that view, and then you just kind of look straight down and like, yeah, like the parking lot is right there. Yeah.

Kyle: Yes. Absolutely. But beautiful. They had it all decorated, and everyone's happy and smiling, and we're all just waiting for a time when they're going to let us go get an envelope and find out where we want to go. So super fun.

Dr. Chan: So you grabbed your envelope?

Kyle: Yup.

Dr. Chan: Opened it right there, or you took it back to your wife and do it together?

Kyle: I took it back to my wife. Yeah. This impacts all of us, and so I didn't feel like I had earned that privilege to just open it up myself and experience this on my own. So I took it back to her. We opened it together and . . .

Dr. Chan: What'd it say and how do you feel about it?

Kyle: It said that I had matched to the University of Utah in psychiatry, and it had a number of, you know . . . When you apply to match, you're applying with a number that identifies the program and it had that identifier. And I was like, "Man, is this just adult, or is this Triple Board?" I couldn't remember. And it wasn't specific enough to really tell me what it was. And so I had to Google it real quick, get on my device and find out which one it was. And it was adult psych, and it was very exciting for my wife, and I felt a little bit of sadness. And I was surprised.

Dr. Chan: Why?

Kyle: Because during the process of figuring out where to rank programs, they fluctuate constantly. And for a large portion of that process of trying to figure it out, the adult psych program at the University of Utah was my number one choice. And it fluctuates constantly. And, you know, that goes for the rest of the lists too, not just the top choice. So, you know, clearly, there was a lot that attracted me to just the adult program. But you get your order in. You let the programs know, "You're my number one or you're at the top of my list, please pick me." And then you open it and it not being my first choice kind of felt like a little . . . I felt sad. Like, you know, maybe like, "Well, why didn't they . . . They said they like . . ."

Dr. Chan: Yeah. Why didn't I get my number one? Yeah. Yeah.

Kyle: Why didn't I get my number one? And I think. . .

Dr. Chan: Am I might not good enough to be a Triple Boarder?

Kyle: Yeah, absolutely. And I think that it was a very similar experience for me and the few that have kind of . . . we've talked about not getting our first choice where, you know, going in, we all felt like our top three would be absolutely amazing and acceptable, but there is a process of grief in kind of everything you're missing out of. And, you know, even a few people who got their first choice, you have to experience a little bit of grief for what you didn't get.

Dr. Chan: Yeah. Saying goodbye to those other . . . The Match forces other doors to be closed.

Kyle: Absolutely.

Dr. Chan: Yeah. And there's one that's open, and that's great, but sometimes, I don't know, it's . . . To me, it just sounds like human nature. You kind of like, oh, it's kind of oh . . .

Kyle: "What am I missing?"

Dr. Chan: Yeah. Like these other programs. What does it mean? Yeah.

Kyle: But the sorrow is short-lived, and then, you know, eventually you just start thinking about all the positives. The programs, they contact you and welcome you. I got welcomed in emails from some of the attendings I had worked with on my site clerkship. And, again, it's short-lived sorrow. And you say goodbye to what you're going to miss, and then you start to welcome what is to come and it's become, you know, very exciting and just . . . again, just kind of ready to get going. And so I'm still in fourth-year clerkships. I'm still kind of living . . . It's actually a lot easier, but the end of fourth year, much easier. But at the same time, all this celebration, all this excitement knowing where I'm going to go and it's like, "Okay, now I just have to wait months."

Dr. Chan: I remember a week or two after the match when I matched, I got my . . . It was the first contract I've ever signed. Did you get the contract?

Kyle: Yeah. And I haven't signed it yet.

Dr. Chan: Yeah. It's because. . . To me, I was like anxious, like, "This is a huge document." It's like it mentions all this stuff I would never thought of before. So I remember, yeah, I sat on it for a few days, kind of read everything.

Kyle: Which is funny because I'm going to sign it.

Dr. Chan: Yeah.

Kyle: I don't know if it matters, but, yeah, I want some time.

Dr. Chan: Yeah. But it feels . . . I mean, like, you know, yeah. I mean, like I wasn't a non-traditional student per se. And I know you've worked prior to med school, but for me, that was like . . . Like my resident salary was a lot of money. I had never made that much money before in my life. And I just remember like, "Wow, this is a lot of money." You know, and I was just excited to be earning, you know, and then you know, all the benefits, like the insurance plan, everything is kind of put into it. I just remember like, "Wow, this is a big step." I felt like a grownup. You know, like this is the type of stuff grownups do, like who are working full time.

Kyle: You know, I feel old, but, I mean, similarly, I mean, even having worked as a social worker, I have never made as much as I will make as a resident, and it's . . . I'm sure that will wear off because I know that residents work very hard. But, yeah, it's exciting. It's exciting to think, "I will be supporting my family better than I ever have." And it's also weird to think that, you know, "Already, this process was paying off. Already, I'm seeing the benefits of the choices I made."

And, you know, that is one thing that's different, because when you're buried in second year and third year of medical school, there are moments where the problem isn't how hard you're working, the problem is that you don't see that it will ever benefit you and you feel kind of like you're spinning your wheels. And now, again, the windows are opening up and you're starting to see the light. And I'm starting to see the benefits not just in the salary, which, yeah, more than I've ever made. It's going to be amazing. But also, in my kids, because they're older, I'm starting to see, in their choices, their willingness to kind of work hard and pursue academics. And that was the motivator.

When I started this process, I wanted to demonstrate that, you know, you don't have to say goodbye to your dreams as an adult. You don't have to accept what the world gives you. You can work hard and achieve your dreams. And that kind of got suppressed as I was in an environment that was just so difficult and so continuous. But now coming out of it, again, getting to see the benefits, it is kind of amazing.

My daughter's pursuing an engineering degree at the University of Utah, and even though that is her accomplishment and she works so hard for it, I can't help but feel like, you know, part of this process in coming back to school had an impact in that although she will not pursue medicine, most likely, because she saw how hard it is, she also chose a very difficult profession and is fine with it and is like, "I can do this."

And, again, coming from a family that didn't value education and almost valued the opposite of education, it's just kind of amazing to see that change in my own children, in their goals, and in what they think is possible. I don't know how much of an impact I had, but, at least, it's what I wanted and now I am starting to see it.

Dr. Chan: Wow. Kyle, that's beautiful. And, unfortunately, we're almost out of time, But I'm excited that you were able to come back and that you're also going to stay local. So I can have you come back here, I mean, kind of check-in just to kind hear how intern year, and as residency kind of unfolds, and how you, you know, how you're still growing and you're going to start like another phase of your journey to become a doctor. And it sounds like this positive, beautiful aspect impact will have on your family too. Well, thank you, Kyle. I appreciate you.

Announcer: Thanks for listening to "Talking Admissions and Med Student Life" with Dr. Benjamin Chan, the ultimate resource to help you on your journey to and through medical school, a production of The Scope Health Sciences Radio online at