Feb 5, 2020

Dr. Chan: What's it like being a first-generation college student and choosing to chase your career in medicine while combating self-doubt? How do you flawlessly perform a scene from "The Sound of Music" in front of your new classmates during your medical school orientation? How does one go about deciding what to pursue their residency program in, particularly anesthesia?

Today, on "Talking Admissions and Med Student Life," I interview Max, 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: Well, welcome to another edition of "Talking Admissions and Med Student Life." Max, finally, we meet.

Max: Finally.

Dr. Chan: Since you've been gone for so long. Fourth-year student.

Max: Yes.

Dr. Chan: And we're going to wait until the end to talk about what you chose.

Max: Okay.

Dr. Chan: So let's go back to the beginning, man. When did you decide to become a doctor?

Max: So, for me, it was one of these things where I always revered doctors. I thought they were cool. I have an uncle who did family medicine and he did a ton of humanitarian work. He would go to Africa and come back and show these slideshows and I'd be like, "Yeah. That's something I want to do."

Service has been a big part of what brings me joy and I thought if I could pick a career where service is a huge component of it. You have a very steady life as well. You're not going to lose your job as a doctor. And it helps that I really like science. But all those things combined together led me here. I had a lot of doubt as to whether I could do it, but pushed through that and we're here.

Dr. Chan: Where did the doubt come from?

Max: In my immediate family, both of my parents did a little bit of college. Neither of them graduated. I have a twin brother who went to some college but didn't graduate. Older brother, same story. And so, for me, I was like, "Can I do this?"

I remember getting to . . . I started undergrad at The U. I remember getting up here having to fill out all the financial aid stuff and I was like, "You know what? Maybe I should just stay home." It was overwhelming.

Dr. Chan: It's daunting. Yeah.

Max: Yeah. I come from a pretty small hometown, Spanish Fork. It's getting way bigger, but it's pretty sleepy. A lot of people stay around there. And so I think when I got here, I had . . . My first semester, I remember thinking it was going to be like high school and it wasn't. You actually have to write papers and do stuff. So that was a little bit of an adjustment.

But once I hit my stride in college, I started realizing, "Oh, I can do this." General chemistry isn't the most impossible thing. Organic chemistry still is, but I made it through.

Dr. Chan: Okay. Well, let's back up a bit. How did you wind up at The U to start? Walk me through the decision-making process. So you grew up and went to Spanish Fork High?

Max: Went to Spanish Fork High.

Dr. Chan: Okay.

Max: Most people in Spanish Fork, if they go to college . . . I feel like a decent amount do. They'll just go to UVU. It's 20 minutes away. Pretty much if you have a heartbeat, they'll accept you. And a lot of people do trades as well. And for me, I was like, "I want to be a little different." And so I was like, "All right. I'll go 20 minutes further to Salt Lake City."

Dr. Chan: Did you live at home and commute or did you live in the dorms?

Max: So, starting out, I lived in the dorms and I have many dorm stories to pull from there. So, yeah, I lived in the dorms. That was part of the reason why I think I had some freshman struggles with classes. I had a lot of fun.

And I started out wanting to do exercise physiology, and partway through that, they actually just got rid of the degree. And so, eventually, I did about two years here, went on an LDS mission.

Dr. Chan: Where'd you go?

Max: I went to Japan, south of Japan, and . . .

Dr. Chan: Could you speak Japanese before?

Max: I took a class in high school.

Dr. Chan: But that was enough for them to say, "Oh, Max, you need to go here."

Max: Yeah. They're like, "He's interested? All right. Here you go." But that class was mostly like the teacher would bring in Japanese treats and show us cool shows from Japan and I . . .

Dr. Chan: Anime and manga?

Max: Yeah. Exactly. So, yeah, the learning . . . I thought I'd be set to go. And day one of trying to learn the language, I was already way over my head.

Dr. Chan: Wow. So you're at The U. Were you doing pre-med stuff before you left for your mission?

Max: I was, but I didn't have much direction. I just took classes because you needed to have so many credits. But yeah, it was always on my mind. Medicine was the ultimate goal. So did that, did the mission, came back. Since the degree was gone . . . I had a really cool physiology professor who taught some neuroscience within that class. I was like, "This is pretty cool."

Dr. Chan: I want to hear about a story about you in Japan because I just have this image of you running around the country doing your thing.

Max: Yeah.

Dr. Chan: And Japanese is a fairly hard language to master.

Max: Yeah. I feel like I really just dove in. Once I was there, I tried not to speak English as much as possible. I was about six inches taller than the average Japanese person, blonde hair, blue eyes, and so I stood out. A lot of people, I'd be riding my bike by and they'd say, "Oh, doitsunin," like, "That's a German. That's a German man." I have no German ancestry, but to them, they thought I was German.

So everywhere I went, I was either scaring people when they'd open their door because I'm like this big looming figure. But the younger generation of Japanese girls tended to gravitate toward Americans. And so it would be fun because we'd be riding our bikes, we rode bikes everywhere, and there'd be a little gaggle of high school girls who had been paying attention and they'd be talking to each other. And then I'd go say something to them in Japanese and they're like, "Oh, no. He understands.' But yeah, I scared a lot of people when they opened their door, hit my head on a lot of doorways.

Dr. Chan: Yeah. The apartments there . . . I just imagine you're on the 95th floor and they're like a cubicle and that's how you sleep.

Max: And pretty much everywhere, you sleep on the floor, and you have just this big blanket. They called it a futon. And that was a little bit of an adjustment. The food was . . . I learned to love it. There are some pretty gross things out there as well that as a point of pride . . .

Dr. Chan: So it was not just sushi for two years?

Max: No. I wish. But the gross stuff, even Japanese people don't like it. There's this one food called natto. It's fermented soybeans and you put a little soy sauce in, but when you mix it up, it almost becomes mucus-y and it's repulsing to most people. But there are the little old grandpas, they're like, "No. It's great for your heart. It's great for all these things." So I was like, "Okay. By the end of this, I'm going to love it." And so what I'll do is I'll buy it sometimes and make my American friends try it out.

Dr. Chan: Were you doing any community service in Japan? Were you teaching English or working in hospitals or doing anything like that?

Max: So I was there when the tsunami happened.

Dr. Chan: Oh, okay.

Max: I think it was 2009, and so we had a ton of service opportunities.

Dr. Chan: Did you hear about that? How did you learn about that happening? Were just people talking about it? You're not allowed to watch the news, right?

Max: Yeah, not much. And you sneak it on the . . . you're getting a haircut, you sneak some news. So I was actually on a train in the very south of Japan and we were headed to an area, and mid-train ride, they just stopped the train and they said, "Tsunami alert." And where I was, was almost as far away from the tsunami as you could get, but still, that far south, since we were close to the water, they stopped the train.

Dr. Chan: This never happens, right? People were freaking out on the train?

Max: Yeah. People were freaking out and they stopped the train and they're like, "There's a tsunami up near Sendai.' Everybody gets off. So we stayed in this random town. I have no idea where it was. Middle of the night. But we had a lot of other missionaries come from those areas and it was a ton of service.

We were able to go up there, help clean up. The hospital situation . . . I mean, everywhere was just over-flooded. And so me having no real medical training, we were just there to try to help direct people, help clean up, whatever we could do, but it showed me if this earthquake that's supposed to be coming to Utah eventually happens, there's a lot of work that we could do to prepare.

Dr. Chan: Yes. Walk a lot. Okay. So you're on your mission, and then I think you make a big decision during your mission. Walk me through that. Because you end up transferring, right?

Max: I did. So mission was nice because, for two years, you didn't really have to think that much about . . .

Dr. Chan: Life.

Max: Yeah. Exactly. It's like you just have a purpose and you go do it. So I had a lot of people who were like, "BYU is pretty good. It's cheap. They have good professors there. A lot of research opportunities." And for me, they have a neuroscience degree that I was really excited about. And so, during that time, I think I had companions and probably half of them were BYU students, so they were in my ear telling me it was a good choice.

Utah for undergrad, I'm sure I'd have been plenty happy staying up here as well, but yeah, for those reasons, I was going to save a lot of money down at The Y as well. I decided to transfer down there.

Dr. Chan: And so, after your mission, you went straight to BYU?

Max: Yes.

Dr. Chan: Okay. How was the jump from The U to BYU? Night and day? A lot more praying, a lot more scriptures?

Max: Oh, yeah. I remember getting in . . . it was like a class of 300, 350 people. Huge science, entry-level class for all the pre-med people. And they started out with a spiritual thought and a scripture and then a prayer. And I was like,"Can they do that?"

Dr. Chan: It's very embedded down there. It's kind of the way of life.

Max: Yeah. Exactly. So that was different. I remember my first three classes as well were in the oldest building on BYU campus. It felt like it was crumbling. And I remember walking in that morning and thinking, "What have I done?"

Dr. Chan: "What is this place? Why does it look like this?"

Max: Exactly. But no, eventually, I loved it. I had great research opportunity. I was able to teach, at the missionary training center, Japanese for three, almost four years. So it was an awesome experience.

Dr. Chan: And is that where you first saw me? Because I think I talked to . . . is that that class?

Max: Yeah.

Dr. Chan: Okay. Tell me about it.

Max: I remember . . . so, Dr. Chan, to those who haven't met him, he's very friendly and a very inviting person. But just knowing . . .

Dr. Chan: Thank you.

Max: Yeah. Just knowing that he's the Dean of Admissions was terrifying.

Dr. Chan: In a class of 350, I was terrifying?

Max: I was on the second row.

Dr. Chan: Did I call on you?

Max: You might have. I would have had no idea what I would have said.

Dr. Chan: Oh, my goodness. This just makes me laugh.

Max: So you walk in and I remember just thinking, "This is the man standing in the way."

Dr. Chan: Yes, it's me. It's the committee. It's not me. All right. So you're at BYU. How is it being a pre-med at BYU? Because there are a lot of pre-meds that come out of BYU.

Max: Tons.

Dr. Chan: Is it overtly competitive? Is it subtle?

Max: I feel like if you find a good group of people you can study with and get in with, it's not too bad of an experience. But yeah, there, it's very much . . . there are some people in the classes that are like . . . you know, they'll call out the professor because they want to make sure that their grade is high enough.

I think that's everywhere, but at BYU I think we had 300 in my class who were going into pre-med. And once I found out I got into The U, there were people who came up to me and they're like, "Oh, you got into The U?" I was like, "What?"

Dr. Chan: "You're the one."

Max: Yeah.

Dr. Chan: All right. So walk me through the application process. How many schools did you apply to? What was your strategy?

Max: So, for me, I think I applied to between 30 and 40. I just shotgunned to places that sounded fun living. I went through it with my wife and we thought, "Where would be fun? Where would be reasonable? And what are some schools that would actually be interested in taking me?" And so I applied to probably 25 MD, 30 MD, and then a handful of DO schools, because I did not want to reapply.

And most of the interviews that I got were in the West. So University of Colorado, University of Arizona, a couple of DO schools in the area as well, University of Utah. Went to all those interviews and I think it was pretty clear that we wanted to stay in the West after doing those. Well, I also got an interview at the Uniformed Health Sciences.

Dr. Chan: Oh, okay. Back in D.C.?

Max: Yeah. And that's like the military route, and I really thought about that one, but through some conversation, we decided I'd rather not have a military career. It has its pros, it has its cons, but for our family, we decided to do something else.

So, for me, it was ultimately between Utah, Colorado, Arizona. Once we got that beautiful call from you . . .

Dr. Chan: Yeah. I remember calling you. You were very excited. You were a little stunned at the beginning, but you were very excited.

Max: I was taking an exercise class. I'm not a runner, so I think I had just finished running two miles, which is pretty good for me. I was walking up a big staircase and I got the call from you, so I'm sure I was out of breath. I was stunned.

Dr. Chan: Was it an immediate yes or did you have to talk to your wife, or what was kind of the internal discussion?

Max: From the very beginning, my wife, she was so confident that I would get into The U. And I think we had just found out that she was pregnant with my son. He's 3 now.

Dr. Chan: I remember that. Yes.

Max: Yeah. So we just found out . . .

Dr. Chan: I met her at White Coat.

Max: Yeah, so we had just found out she was pregnant. Both of our families were here, a time of transition. So Utah just made sense. So once we found out, I was able to cancel a handful of other interviews. We knew we wanted to be here.

Dr. Chan: Okay. So there's a perception of med school. You can't really fully understand med school. I'm trying to do that with the podcast, but in a way, you have to actually be in med school to understand it. What was the biggest surprise to you? Because people have this notion med school is going to be X, but then you came, you started, and it turned out to be X, but maybe some Y. What were your thoughts? Was it a surprise? Was that a hard jump to go from undergrad to grad school like this?

Max: I think so. During undergrad, you're doing a lot of things to make yourself competitive. So I was working a job. I was doing all this volunteer stuff. I volunteered with hospice, so I was spending a significant amount of time doing that and other activities.

I was surprised that once I got to med school . . . I mean, it took time to figure out how to study and whatnot. I actually had more free time.

Dr. Chan: Really? Okay.

Max: Yeah. I had some more free time. You hear from everybody, "Oh, med school is going to kill you. It's going to be the hardest thing ever." And so I went in expecting that and it was a lot better.

Dr. Chan: So what were you doing with your free time?

Max: Golfing.

Dr. Chan: Preparing for the life.

Max: Yeah, exactly.

Dr. Chan: So it wasn't hard?

Max: There were things that were challenging about it. I think figuring out the best way to study . . . it's just so much more information. I remember we had our first lecture. It was Dr. Formosa, who's a big name in biochemistry, cell biology, microbiology stuff. And he did his lecture and it was so esoteric and the stuff he'd been researching for 20 years. I remember thinking, "Yeah, I'm never going to learn this."

Dr. Chan: Too much detail.

Max: Yeah. So I had a panic moment maybe the first week. I was like, "I don't know." But then I looked around and everyone else was panicked and it was like, "Well, there are 100 of us and we've got to get through it somehow." And I think safety in numbers, kind of this "we're all going through it together" helped through that initial shock phase. But once I figured out a way to study, figured out a way to prioritize my time, it was pretty smooth.

Dr. Chan: And then you were in my CMC, my Clinical Method Curriculum group.

Max: Yes.

Dr. Chan: So how was that? I'm just curious. I love asking this. What was your perception? When you found out I was going to be your CMC preceptor, did that freak you out or did that make you happy?

Max: Once I was in and had a couple of conversations with you, I was like, "Oh, Dr. Chan is awesome." You went from the gatekeeper to just an awesome mentor. And so I loved that. And I actually took Step 2 CS last week.

Dr. Chan: Oh, you did?

Max: Yes.

Dr. Chan: Okay.

Max: And then one of my patient encounters . . . I did JVD, jugular venous distention, and I recalled clear back to when you were teaching us JVD.

Dr. Chan: Oh, wow.

Max: Yeah. So it was a positive experience.

Dr. Chan: I would like to think that you used that often during your last two years, but I doubt . . . were you doing JVD in a lot of your patients?

Max: No. But you do it for show on CS.

Dr. Chan: Yeah. You do for OSCEs. You do it for clinical skills and CS.

Max: Exactly.

Dr. Chan: Okay. Yeah, and I remember that. You were like this big, burly, happy guy. I remember we could talk about the interesting fact about you. I remember at orientation, Dr. Stevenson called you out in front of the entire class for "The Sound of Music." Explain that to people.

Max: So I had never seen the movie, "The Sound of Music." My wife's family was super into it and the "Hills Are Alive, all of that. So once we got married . . . well, I guess as long as I can remember, people were like, "Oh, you're Friedrich from The Sound of Music. You look so much like him. And I was like, "Okay. Cool." And I eventually watched the movie. I was like, "Oh, I look a lot like that guy." It's weird. I had this weird out-of-body thing where I was like . . . Even his mannerisms are super similar.

Dr. Chan: Did you ever dress up for Halloween?

Max: No. I didn't want to do that to myself.

Dr. Chan: Okay. Maybe down the road.

Max: So, yeah, we have this lookbook for the entering class, and in it, it says, "Say something interesting about yourself." And I think I mentioned that I have a twin brother and that people mistake me for Friedrich from "The Sound of Music."

And at the orientation, Dr. Stevenson, who ran the whole thing, was talking about people's different interesting things they brought up. He called my name out and I thought it'd be a couple of questions about my "Sound of Music" experience, and it definitely wasn't. He was like, "Let's have you come forward." And he played one of the songs from "The Sound of Music."

Dr. Chan: Yeah. He went all-in on the audiovisual.

Max: Yeah. And so I did a very poor job of singing and dancing along.

Dr. Chan: Yeah. You danced. I remember that. In front of the entire . . . you just met these people. Oh, my goodness.

Max: Yeah. And one of my classmates', Jabber, he's awesome. I played basketball with him. He's hilarious. He, for the first six months of med school, thought that I was in the movie. He looked at me and he's like, "Bro, I can't believe you were in movies and stuff." And I was like, "That movie was made 60 years ago."

Dr. Chan: Okay. So, during the first two years, Max, what were you thinking of becoming? I think surgery was up there, wasn't it?

Max: Surgery was up there.

Dr. Chan: Emergency medicine maybe.

Max: Emergency, ophthalmology.

Dr. Chan: Okay.

Max: I had shadowed people in nearly every specialty, and I'm one of those people that you could pick for me and I would probably have a happy career. And that's a good thing, I think, because it helped me know that medicine was the right choice. But when it came time to actually choosing, I think . . .

Dr. Chan: So don't say it. So the future is wide open, a lot of different ideas. How did third-year start? How did you start ruling in, ruling out different fields? What was third-year like for you?

Max: So I think the big one that most people experience is medicine versus surgery. That's the big breakpoint. And I started with medicine and I liked it. I really liked my attendings. It was nice. But once I moved to surgery next, I thought, "Oh, rounding is not really my thing." There were some days where you would round for four hours before lunch, go get lunch, and then round for four more hours.

Dr. Chan: A lot of talking. A lot of thinking.

Max: Yeah, exactly. And my attention span, I'm good for a couple of hours and then my mind just starts to wander to the pain in my feet as I'm standing there.

Dr. Chan: Trying to look interested.

Max: Yeah, exactly. And so, once I moved to surgery, the hours are longer, you can have some attendings that are a little more intense, but I loved being in the OR. There's a problem right in front of you and you're there to fix it. I like the kind of immediate gratification that comes from that. So surgery was definitely high on the list.

I have people I know that have done emergency medicine, which is pretty high on the list as well. But then ophthalmology was up there as well. I had a cool mentor in undergrad, so I liked aspects of pretty much everything.

Dr. Chan: So how did you make your decision then if you'd liked everything? Walk me through that.

Max: So, for me, it was as I experienced it, I would talk a lot with my wife, talk with friends. I'd ask her, "What was I like coming home from surgery?" or, "What was I like coming home from this emergency medicine?"

Dr. Chan: So you would ask Kelsey, "Did you like ophthalmology Max or internal medicine Max or family medicine Max?"

Max: Exactly. And that was helpful. And I think one thing I really noticed was how I felt going in for shifts as well. Going in for surgery, I was always tired, but I was excited.

Dr. Chan: Yeah. The hours can be daunting. Waking up at, what, 3:00 or 4:00, going into the hospital.

Max: Yeah. So that was . . . you kind of get in the groove, but there are times where I was like, "I don't know if I could do this for 30, 40 years." But once I was there, it was really exciting.

So you have to choose to do an emergency medicine elective. And another one I was interested in was anesthesia because you're in the OR, but I had never rotated on it. And so, at the end of third year, it's coming that time where you have to pick and I was still thinking, "Okay. Emergency medicine."

So those that don't know, Dr. Chan does psychiatry.

Dr. Chan: Yep.

Max: Child and adolescent psychiatry. I had rotated through UNI up here and thought, "Oh, I could definitely do some child and adolescent as well." There's a program where you do . . . it's called triple board where you're peds, adult psychiatry, child psychiatry. So there was a month period where I thought, "Oh, that's something I want to do as well." So I was all over the board. I loved it all. I thought I could do it all.

Dr. Chan: What did you do for your elective time during third year?

Max: Yeah. So I did emergency.

Dr. Chan: Oh, okay.

Max: I did emergency. Well, I did research. It was my proper elective time, and that was in ophthalmology. And I figured out that the lifestyle is great, a lot of people really like it, but it wasn't a perfect fit for me. And then the rest of that time, I did emergency medicine, and then I stacked anesthesia right after that. That was the deciding point for me.

Dr. Chan: So why anesthesia?

Max: That's what I chose.

Dr. Chan: Yeah. Why?

Max: So anesthesia, for me, they felt like my people. Was just the very most basic. I would go into the OR. Generally, really chill people tend to calm the seas. They're somebody who you really advocate for one person at a time, which I loved.

The chair here at The U, Dr. Egan, he says that in anesthesia you have the mind of an internist, the technical orientation of a surgeon, and the heart of a psychiatrist. I mean, you don't dive in as deep into any of those, but you get to have pieces of different specialties, which I loved.

I could still work with my hands. You still use all that physiology and pharmacology that you pound into your head during med school. And a lot of times, you're meeting someone on the scariest day of their life. They're about to . . .

Dr. Chan: A lot of anxiety.

Max: Yeah. A lot of anxiety. A lot of times, they're leaving that surgery with a very different life than they went in. And as the anesthesiologist, you get to meet them, you get to greet them, you get to calm their nerves, and you're this advocate for them throughout this procedure. The surgeon does their thing. They fix it. You're the one who keeps them going throughout that whole thing. And I love the opportunity to be . . . one person at one time, you are 100% their advocate.

Dr. Chan: I love your eyes just light up when you're talking about it. So did Kelsey see that too?

Max: Absolutely. Yeah. So I did emergency medicine for a month, and then right after I did anesthesia. I wanted to see how the two compared, and I would come home from emergency medicine shifts and even though the hours aren't as long, I was tired.

And they generally funnel the cool stuff to med students, you know, suturing, iliac repairs, different things like that. And I started noticing before I'd go in, I have a pit in my stomach, and coming home, I was pretty tired. And so I thought, "Well, if it's not emergency, I really hope it's anesthesia because I've got to pick soon." And day one or two of anesthesia, I was in the operating room. They let me do some intubation and talk with patients before. I knew it was the one for me.

Dr. Chan: So what does anesthesiology residency look like? How long is it and what kind of rotations are there on it?

Max: Yeah. So it's four years.

Dr. Chan: Okay.

Max: Your first year is an intern year. You can choose between . . . there are basically three options. You can do a prelim year in medicine. So you're rounding, doing all of . . . you're basically an internal medicine resident intern for a year. You can do surgery where it's the same deal but for surgery, and then you can do something called a transitional year. And those are a blend of the two. There are some transitional years that have a reputation for being super chill. There's one in Santa Barbara where I think you work 30 hours a week. So everybody applies to that.

So you have your first year. It can vary widely. And then three years of anesthesia training. You spend . . . do you want me to keep going on?

Dr. Chan: Sure. Keep going on. Yeah.

Max: Yeah. So first year is just getting used to the OR. They'll rotate. The big disciplines within anesthesia are obviously OR, just general anesthesia. You can do regional where you're doing blocks, nerve blocks before surgery. A lot of times on the burn unit, they have a lot of pain, so you'll go in and do a nerve block to take away the pain.

Dr. Chan: Like for laceration repairs.

Max: Yeah, exactly.

Dr. Chan: Okay.

Max: OB is a big part of it where you go and you're doing epidurals. You're helping with pain management there. And then there's chronic pain, which is people with back pain, nerve pain. You're managing them long term.

Dr. Chan: Yeah. That's fascinating because when I think of anesthesia, you do have this image of they provide general anesthesia, they knock the patients out, bring them back to life. But yeah, you've talked about there's also this clinic component where you're treating people who have chronic pain. Yeah, I can see psychiatry being a huge part of that, like motivational interviewing and helping people. That's a fascinating dynamic when you think about it. I don't think too many people think of anesthesiologists like that.

Max: Absolutely. And I didn't know much about what else you did. There's a perception of people that go into anesthesia. When my non-medicine friends hear that I'm doing anesthesia, they're like, "Oh, you're going for the big bucks," or, "You want an easy job."

But when you're in the OR, it's not easy and it can be really scary at times. You are breathing for that person. You are making sure their heart is beating normally. You're the one making sure their brain is getting blood flow and you have to act quick. And I like that component. There's kind of the emergency medicine acuity there, but in a very set environment.

Dr. Chan: So what is or what was your strategy for applying to anesthesiology programs? How many are there? How many did you decide to apply to? How did you determine if you're a competitive person for these programs?

Max: Yeah. So I followed a rule where you apply to 60% of schools that you think you're a really good fit for, 20% that are fallback schools where you're like, "Eh, I'll go there," and then 20% that are reach.

Board scores is a big part of deciding where you fit well. I was pretty happy with how I did on my boards. I felt like I did well with clinical grades, and so there were definitely plenty of reach scores. Most of the schools in the middle, I felt if they're interested in me, I'd be a really good applicant. So we went about it like that.

There's a big list. Doximity does a list of ranking according to reputation, research output. You could spend months looking up all these schools. So I spent a good amount of time looking at how these schools rank up. And then location is another big one. I'm married. I have a 3-year-old son. We're from Utah. Utah is comfortable. The West is comfortable.

Dr. Chan: It's home.

Max: Exactly. And so somewhere in the West we thought would be ideal, but I still applied to programs on the East Coast and have loved those interviews as well.

Dr. Chan: So how many total did you apply to?

Max: So I applied to, all together, about I think 50.

Dr. Chan: Fifty? Okay. Wow.

Max: And that includes intern year applications as well.

Dr. Chan: Okay.

Max: So you have to apply to those separately.

Dr. Chan: Fun.

Max: Yeah. More money.

Dr. Chan: There are no programs that are combined?

Max: There are plenty of programs that are combined, but there are also a bunch where it's not combined. And if you end up getting in there, you have to find your own intern year.

Dr. Chan: So you have to go out and interview for these intern years?

Max: Yeah.

Dr. Chan: And kind of do the whole process?

Max: Yeah, exactly.

Dr. Chan: Wow.

Max: And it's a different feel. They're really nice. I did mostly medicine the intern years. They're super nice, but they also know you're only going to be there for a year.

Dr. Chan: Yeah. You're a hired gun for them.

Max: Yeah, exactly.

Dr. Chan: when you go on these anesthesiology interviews, do they ever test you for your skills? Do they say, "Oh, start an IV or intubate," or they don't do that? It's all just talking.

Max: So that's one thing. Another confirmation to why anesthesia has been great for me is it's just talking.

Dr. Chan: Okay. All right. No . . .

Max: No surgery.

Dr. Chan: They're not like, "Okay, IV. Do it. Go"?

Max: Yeah. And most of it has been super chill, super laid back. Depending on the program you're at, you can have anywhere from a 10-minute interview to a half an hour, which can be daunting because you're like, "What am I going to talk about for a half hour?" But people in anesthesia are generally laid back and those 30 minutes fly by.

Dr. Chan: Okay. This is fascinating, Max. That's why I love talking to you. What's the perception of nurse anesthesia? Does that get talked about in interview days or is that . . . I'm just curious what you guys learn about that.

Max: Sure. That was something I considered before choosing the field. Everyone thinks, "Oh, nurse anesthesia, they're taking over all the anesthesiologist jobs. It's cheaper." Every nurse anesthetist I've worked with has been excellent. They're wonderful.

And generally, in residency, the things I've looked for are, "Are you working to relieve nurse anesthetists? So are you going in to make sure the nurse anesthetists get home, or is it vice versa?" And if you're a resident who's relieving nurse anesthesia, you're probably going to work a lot more. You're maybe more of a workhorse in that environment, whereas vice versa, the program is prioritizing your time, your own study.

Dr. Chan: Your education.

Max: Yeah. But a lot of people in anesthesia in general, there's a concern that "Are there going to be less jobs because nurse anesthesia, they can do very similar things, more routine cases?" They can step in and . . .

Dr. Chan: And that leaves the complex cases for the anesthesiologists, which have inherently more risk. And then you talk about insurance coverage. It's hugely controversial. It's one of these things that I don't think there's an answer. It's just how the system has evolved.

Max: Right.

Dr. Chan: But I do know to get a bunch of anesthesiologists go and just talk, like, "Oh, what do you think about nurse anesthesia?" and then they go, "Oh . . ." and everyone has opinions on this.

Max: And most people I've talked to in anesthesia who've done it forever, they're not super concerned about it taking jobs away or killing their pay, anything like that. It more has turned into rather than doing one patient at a time . . . if it's at a surgery center where the acuity is lower, they'll just observe two or three rooms. And nurse anesthetists will be in those rooms. And if anything happens, you step in and can help.

So I would love to do one patient at a time all the time, but it's nice to have those skills to manage multiple rooms as well.

Dr. Chan: Yeah. It sounds like the field is evolving, like all fields do.

Max: Yeah.

Dr. Chan: All right. And so, going into your decision, because you have to make a rank list, wasn't it due in a couple of months?

Max: Yeah. I think it's due February or so.

Dr. Chan: So do you have some sort of really complicated Excel spreadsheet at home, or is this just by your gut, or is Kelsey in charge of your rank list and you just give her the password and she's just going to do what she does?

Max: I think it'll be an amalgamation of all of those. I'll say, "Honey, how do you feel? Where do you want to live?" But I'm very much a go-by-gut feel. I've done about eight or nine interviews at this point. The magic number to match almost 100% possibility of matching if you do about 12 interviews.

Dr. Chan: Okay.

Max: I'll probably do 10 or 11, but going into it, it's very much been a gut feel. The programs I leave where I was like, "Yeah, I really got along with the residents. I really like the area," those are the places that I tend to think about more.

Dr. Chan: All right. This has been great, Max. So, looking back, what advice would you give anyone who's listening out there who might be struggling with the idea of going to med school or unsure if they can do it or maybe has that doubt or doesn't come from a background in medicine? What would you say to them?

Max: I'd say medicine isn't for everybody and there are definitely those who get into medicine . . . their whole life, they were like, "Medicine or bust," and they get into it and they're disappointed. But if you know that it's something you're really interested in, give it a shot.

I had a lot of self-doubt, like I said before, but once I got in, once I put the time in . . . I think some people, they really want to do something, but sitting down and actually putting the time in, showing that dedication is another thing entirely.

So, for me, once I sat down, I was like, "Okay. I'm really going to study for this organic chemistry test. I'm really going to get through and do the hard stuff." That's where I gained some confidence.

And so you'll have hard classes. You'll have moments where you think, "Maybe it's not worth it." Just buckle down, get through that obstacle, and you'll have confidence coming out the other end.

Dr. Chan: Awesome. Well, we should have you come back, Max, after the match because I'm very curious to see where you end up.

Max: I'm curious to see where I end up as well.

Dr. Chan: It's been fantastic having you in the CMC group, but also just being part of our school and just part of our community. And everyone loves you and Charlie and Kelsey. Just keep on . . . I'm just so proud of you.

Max: Thank you.

Dr. Chan: All right. Thanks, Max.

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 thescoperadio.com.

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