3 years and $30,000 later- Lulua Zulfikarali Bahrainwala

Scratch that- make that $ 70,000 if you add in my Masters fees. Or $80,000 if you factor in cost of living in San Francisco Bay area. Actually wait, that does not even account for the flights and electives and observerships. I matched, and it is easy to forget the small important steps and costs along the way, but keeping this in perspective, let me tell you my story.

The year of 2012 gave me two milestones. Graduating medical school from India, and getting engaged to the love of my life. I already knew I wanted to live and practice medicine in USA, so I worked hard during two electives in Baltimore, and started studying for my steps. Fast forward to 2013- finished CK, got my application ready to apply- and then I got my CK result. Fail. Setback number 2. Setback number 1 being a dismally low Step 1 score. This was just not looking good for me. I applied for observerships all over- USA and Canada, took any opportunity I was offered to get my foot in the door. Gave my CK and passed, not by much though- Setback number 3. Finally, moved to USA. Finished Step 3 as soon as I could. Then- applied.

Now to be fair, in 2014 when I applied for the first time, I was an international graduate applying to 300 programs, with abysmally low scores and an attempt, who needed a visa. Things did not go well. I gave up half way through the season waiting for interviews- decided enough is enough. I needed to earn money to support myself and be in touch with patients. I got a job as a dental front office manager/assistant. This gave me the opportunity to take medical histories of patients, learnt the ins and out of a private practice, built it from ground up- right from setting up the electronic medical records for the office, to dealing with insurance companies and doing the accounts. However I kept yearning for direct clinical experience though. So, did a few more observerships. This finally led me to landing a volunteer position in the biggest public hospital in San Francisco. I volunteered in the wards, but leveraged the opportunity of being in the hospital to attend grand rounds, noon conferences, observe rounds on the wards, access Up-to-date, network with professors, and keep my clinical knowledge fresh. Someone along the way told me- Oh you must get research experience! I had zero inclination towards research, but started with the constant emails to the millions of professors. Landed a position in Stanford University. It wasn’t clinical research, but the Health Economics research helped me shape the next steps for my career. Didn’t exactly get a publication out of it, but it was an amazing experience. I started a Health Startup with a group of people, which let me feed my entrepreneurial spirit for a bit- definitely something to return to. But- my red flags of my scores kept coming to bite me in my ass- as even second time around when I applied with a green card — I got a few interviews, but did not match.

The one thing I am grateful for, is I created a cheering squad for myself. Taking up every opportunity- nothing was too big or small, helped me network, create contacts, who rooted for me. I used Meetups- the app, to find health technology conferences and events in the area I could attend for free and went. Learnt what other people do in the field of health. All these people- are the ones who wrote my letters of recommendation, helped provide me with the next best opportunity. I did not even realize how seamlessly along the journey people went from “Well, Best of luck, I hope you get what you want!” to “Oh, you are so passionate and hardworking, let me know how I can help!” I pulled into this pool of people to help me get into my Master’s degree- a Masters in Global Health Sciences from University of California, San Francisco- the best decision of my life. When I reflect back- I remember a conversation I had with a physician in Wisconsin. He said “You are putting in all this money towards observerships and working in research for free, why don’t you do a Master’s degree? You will have a higher return on investment!” And I couldn’t agree more. My master’s degree has opened doors, allowed me to push my own boundaries, has taught me skills that I never dreamed I could have learnt, made me discover and explore a love for research, created lifelong relationships with peers and professors, and most importantly — reminded me why I got into medicine in the first place. In this rat race, I was so focused on the end goal for myself, I had forgotten who I was doing this for- patients, who really needed it. And that is why I matched this year. Remembering that there is a huge part of the population that is vulnerable. That needs primary care. That is spiraling towards Diabetes, obesity, heart disease and it’s the responsibility of the healthcare system to prevent, treat and manage these conditions in generations to come.

Too long a journey? Meh. It takes however long it takes. To be fair, I had a backup plan. I had lined up job opportunities, had planned out an entire alternate career with consultancy options, PhD ambitions, continuing my research as much as I could. But as they say, dreams do come true, as they did after this third time applying. (It’s so much easier to write these blogs when deliriously happy!).Time for my 14 cents.

1. Be passionate about what you do. Do not make your story to be about how much you want a residency spot, let your story be about how you want to treat patients, be a part of the greater good, serve a patient population who needs it. Let this story be reflected in the opportunities you partake in- be it in volunteering, in research, be it in the networking you do. This helped me in my interviews, as my passion for serving vulnerable patient populations became evident in my answers.

2. Please do not be a part of a factory line question answers. Do not have scripted word by word answers. Make bullets, practice yourself and with a heap of people, but let your natural flow of conversation take over. Mirror practices- however funny they seem, save the day.

3. Think of your interviews as Shark tank (popular TV show). YOU are the product, and you are trying to sell it to your investors (the PD). Leverage your experiences, your skills, stress on certain facts, sell them your story in such a way that they should feel that OMG we need to make this person join our program TODAY.

4. Create a timeline of activities. Use excel, make it landscape, make it colorful. When asked- tell me about your journey. BOOM-take out the timeline. Interviewers impressed- Check!

5. I applied 3 times. For the last 2 times, I applied to 250+ programs. I wrote approximately 200 SEPARATE new personal statements- each one mentioning the program name IN THE statement, mentioning the area and the commitment to the location too. I sent out MAILED follow up letters to the programs. Each one specific to the program with a paragraph on why that program specifically, how I could enrich their program and how they could help me achieve my goals- remember it is a two-way street. Generic emails and letters are pointless. Don’t send them.

6. No experience too big or small. By the time I applied I had over a year of clinical experience in USA and Canada, 1 year plus of research experience, 1 year plus of volunteering experience, a few months of entrepreneurial experience, and an ongoing Master’s degree under my belt. These experiences created my story. They placed me in a position to be able to sell my experiences and my wisdom (ha-ha) — well passion. Red flags remained- No publications, attempt and extremely poor scores. But all these opportunities made sure I had gap on my CV, and that I was active in the clinical scene and the community. I got letters of recommendations from all these categories, some of the best ones were from my volunteering experience. Yes, programs do want to know you clinically, but they also do want to know you as a person. Use these resources.

7. Please do not rely on spoon-feeding. Google first. Yes, we all need help along the way, but come on. Do you really not know what to write in an email? Do you really not know how to answer a question? You know your story better than anyone else. Sell it. Don’t give someone else the pen to write your legacy.

8. This is USA. Capitalistic society. They are going to gouge you for money however they can. I remember one place I enquired for observer ship- said 3500$ for a month, some 200$ application fee and then actually had the nerve to send me a slip for “ Please contribute to our research fund- weekly, monthly, etc. Spend money WISELY and stay away from places yearning to make a quick buck.

9. Do not let anyone ever make you feel any less about yourself. I had an interview for an unpaid research assistant position sometime last year on Skype. Throughout the 1 hour interview, the doctor insisted that I wasn’t going to work, that I would run back to see my husband every weekend, that halfway through the year my husband would stop supporting me, that I was being untruthful about my skills etc. I was seeing red throughout this interview, was very upset, but I remained polite and kept reiterating that I would love the opportunity to work with him. The final straw was at the end- he said “Well, I will give you the job, on one condition. Talk to your husband, ask his permission and then let me know. Don’t come to me without asking his permission”. I sent him a nice email stating why I wouldn’t work with him later that day.

10. USMLE Sarthi. Support, help and advice. I invested in myself by using the services of Sarthi- they did not spoon-feed, but helped tailor the CV and Personal statement to make it focused, helped with my answers to make sure I highlighted key parts of my journey and focused on my specific skills and experiences. The Panel interview was extremely helpful as he realized immediately where I was going wrong, and what I needed to talk about a more, which helped a ton to build confidence. And most importantly- Pawan. He is genuinely invested in the students. If I did not appear on the whats app group for a while, I’d get a message asking how I was doing, asking me how I had followed up with programs, how my progress was going etc. Right till the very last day, he was and STILL is concerned about my wellbeing. (score for lifelong relationship!).

11. Pass the torch along. Help everyone. Every single person. Whether they deserve it or not- you aren’t supposed to judge. Even the ones who do not help you- help them. You do not know their life circumstances. People who need help communicating- help them practice. People who need help writing- help them write. People who need help getting experience- advise them. People back in your home country who need help- take the time to talk to them so that they know what they are getting into. All within the boundaries of how much time you have of course. But be selfless. It makes you sleep better at night.

12. Old graduates- Stop paying for observerships. I was told by Profs in 2 universities that this is a waste of money. And I tend to agree. Try to find free observerships as much as you can, or hands on experience. But I would be doing a disservice by not stating that all that money you put towards observerships- put it towards a master’s degree if you can. It will open doors and give you opportunities that you did not even know exist. It’s through my master’s degree I learnt how to advocate for the poor, fight for women’s rights and health, becoming more cognizant of the environment I live in, the communities we interact with, and how health is so important to everyone’s lives.

13. Have a SOLID back up plan. I don’t mean — oh yeah I’ll do more observerships, or I’ll find research. No. Before Match day, you should have already figured this part out. Infact I strongly suggest that in September after applications have been sent out- use that ONE month to figure out your backup plan. Send in emails, requests, apply for whatever you want to apply for. Yes, easy to say I need a break, but trust me, the day you don’t match (god forbid), goes much easier if you have something to fall back on. Be working in research, be volunteering, be studying for step 3, be working as a scribe if you can, be looking for other opportunities in health- and focus on a few achievable ones. Use Linkedin as a resource- definitely have an ACTIVE filled out profile. Don’t let the year pass by with you “trying to get an observership”.

14. Leave no stone unturned. Respond to rejections, thanking them for reviewing your application. Use LinkedIn to research PDs at programs. Do everything you think you can do to be better prepared. I even used to tweet at a few residency programs sometimes, in the hope that they would realize I existed. Not sure if that worked though.

15. Your families and friends will constantly ask- what are you doing now, or are you earning yet ( maybe not in those terms exactly), aren’t you having kids yet etc.. Just stay calm and remember that they mean well. They are not trying to push you away from your career options, they are just concerned about your well being. They will celebrate your success along with you.
3 years of applications, spent over $30,000 in getting here. 4 interviews ONLY this cycle. Seems all worth it if you match! Most importantly- OWN your success. Whether you match or not- it is your effort, hardwork, smarts that got you here. We have family, friends and other well wishers who support us no matter what, but this is YOUR success. Be proud of your achievements. No one can take that from you.
Remember, there is a whole group of people who cannot afford this kind of luxury, of repeated applications, of paid observerships. Who are fighting to make ends meet, support their families and put food on the table. Be cognizant of what you do. Your small effort towards helping each other- or the next generation, goes a long way in that person’s life once they match. Be it through whats app, or Facebook, or forums- contribute. It is your responsibility as a fellow medical graduate who has faced and endured the hardships they are now going to. In this Trump-Era we need good people to do good things. Be a part of that.
If you read till here- well at least I can say I did not bore you! Write to me for help, give me a shout on Facebook, or even twitter. I will do the best I can to be of assistance in the time I have. Cheers!
Lulua Bahrainwala MD, MBBS, MS Candidate Global health sciences

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