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Med School Minutes
Med School Minutes is where we discuss all things related to medical education. Provided by Saint James School of Medicine, this podcast tries to educate students on selecting and successfully completing a medical school. Our topics are fun and educational, and our hosts are knowledgeable and fun.
Med School Minutes
Med School Minutes- Ep. 45- Launching New FM and IM Programs - A Program Director's Perspective
Curious about what it takes to land a residency spot? In this episode of Med School Minutes, Dr. Raeleigh Payanes and Dr. James Kruer share insider tips on family and internal medicine programs launching in 2025. Whether you're an IMG, considering fellowship, or perfecting your application, this episode is a must-watch. Tune in for exclusive advice straight from the experts!
0:00 - Introduction to Med School Minutes
1:06 - Meet the Hosts and Guests
1:22 - New Residency Programs Overview
4:22 - The Growing Need for Doctors in California
6:00 - Affordable Living in Modesto
10:00 - Pathways to Competitive Fellowships
13:42 - Family Medicine and OB-GYN Opportunities
18:00 - Application Process and Tips
33:03 - Writing a Great Personal Statement
39:46 - Virtual vs. In-Person Interviews
47:03 - International Medical Graduates and J1 Visas
55:12 - Final Thoughts and Conclusion
#MedSchool #ResidencyProgram #MedicalEducation #IMG #FamilyMedicine #InternalMedicine #SutterHealth #MedicalResidency #Fellowships #ResidencyTips #Modesto
Hello and welcome to another episode of the Med School Minutes podcast, where we discuss what it takes to attend and successfully complete a medical program. This show is brought to you by St James School of Medicine. Here is your host, kaushik Guha.
Speaker 2:Hello and welcome to another episode of Med School Minutes, where we talk about everything MD-related, with a focus on international students, specifically students from the Caribbean. Today we have a very interesting guest and we have a little bit of a surprise with our host as well, but today we will be talking to Dr Pianis and Dr Krewer, who are from Sutter Health, from Modesto, california, here to talk about their brand-new family medicine and internal medicine residency programs. Every year we have student counselors who work at St James. These are some of our best students who come in and, just before residency, spend some time with us, and every year we have one of these student counselors host a show for us. So today we have Dr Sanket Chaudhury hosting the podcast on our behalf. So, without further ado, let's welcome Dr Payanis and Dr Kruer, as well as Dr Choudhury.
Speaker 3:Thank you so much, Dr Kruer and Dr Payanis for joining us today. This podcast is called Med School Minutes. We're going to start off by a brief introduction about yourself and about your program.
Speaker 4:Sure, thank you. Thanks for having us. I'm Raylee Payanes. I'm a family medicine physician in Modesto, california, and I'm new to the role of program director, and we're building a brand new family medicine program here at Sutter Memorial Medical Center in Modesto which is really aiming to meet the growing needs of the Valley. We need more primary care physicians in the area, so that is our mission and I'm super excited to be a part of that.
Speaker 5:And my name is Dr James Kroer. I am the program director for internal medicine and I'm also at Southern Memorial Medical Center here in Modesto, California, and we're building a large primary care presence. We're taking this we'll have 19 categorical and seven pre-lent spots for the coming year, starting in 2025. We're a brand new residency.
Speaker 3:Okay, and how about you, dr. Dr Pan, how many spots do you have for FM?
Speaker 4:We will have 13 per year.
Speaker 3:Okay, and I know about Dr Kure a little bit that he had previous programs before right.
Speaker 5:I've built two other programs before. For some reason, I started out my career in medical education right after I finished residency. I was a chief resident and I've had a lot of inaugurals in my past. I was an inaugural ambulatory chief resident and I was a clinic director for many years and then I helped start or build a program in Michigan and then after six years I started another program in Georgia and now, six years later, here I am starting a program in Modesto.
Speaker 3:Thank you and you, Dr. Pinus.
Speaker 4:Yes. So I graduated from residency in 2015 here in Modesto and right away I knew I wanted to continue teaching and wanted that to be a part of my practice. I knew I wanted to continue teaching and wanted that to be a part of my practice. So I worked closely with another residency program here in Modesto over the past nine years and teaching both in the inpatient and outpatient setting and predominantly with a focus in the woman's health and labor and delivery, delivering babies with residents and participating with maternal infant care and developing curriculum there. So I had a core faculty role there and I think it taught me a lot about residency work and how to develop curriculum and how to be a better teacher and how to be a better teacher. And now I'm excited to be in that role of program director and develop, I think, a unique type of program that's really focused on the needs of the community. So I think I'm looking forward to that.
Speaker 3:Amazing, amazing, Thank you. So these two programs are starting brand new. Right Any other programs or previous programs that are already there at Sutter's Health?
Speaker 5:Not at our hospital.
Speaker 3:Or FM and IM are the first ones.
Speaker 5:Yeah, we're the first ones.
Speaker 3:Not at your hospital, right Correct.
Speaker 5:This is actually not uncommon, by the way. If you look across the US, there's quite a few places doing this. As I mentioned, I was in Georgia. They had a big initiative across the whole state there about eight years ago, and a lot of hospitals got involved with starting new programs, and I know that this is happening in South Carolina right now. Texas has been busy building a lot of new residencies, yeah, and California is doing the same, so California has been supporting this work since, like 19 Saudi to actually, they have some grant money that encourages hospitals to start training programs, and so California needs more doctors, and so a lot of hospitals are doing this, and Sutter Health is the latest one that's planning to put residencies in all of our hospitals.
Speaker 5:So, Memorial and Modesto is the latest place to go live.
Speaker 3:We have some students that are wondering about Modesto, Because when you think of California, you think about it being very expensive. So is Modesto. Do we think it's more on the affordable side?
Speaker 5:I think somebody's a plant in your student group.
Speaker 5:I was laughing and saying, dr Pianas, I'm going to start branding myself as the most affordable option for residency in California. So the Valley, central Valley, is the agricultural heartbeat of California. So and a lot of folks from the Bay Area and stuff are building houses here in the Central Valley. So there's a huge demand for doctors, but they're all moving here because the housing is more affordable. So I'm not going to lie If you're outside of California, it's expensive to live in California. California is expensive to live in California.
Speaker 5:But from a cost of living standpoint, the Valley is way more affordable than some of the bigger cities.
Speaker 4:I've lived in California most of my life and I've never lived in any of the big cities where the cost of living is much higher. But throughout medical school training I did live in several different areas, live in several different areas and Modesto is definitely much more affordable, especially for the size of city that it is and the amount of like entertainment and, you know, good restaurants and lots of different businesses. For what Modesto as a city offers it's a very affordable place to live.
Speaker 5:I like to I like to say we're kind of an island that has everything here. We've got all the chain restaurants, all the shopping places, we have the malls, we have all that stuff. But it's just so easy to get around. The whole area is flats. There's not even any hills to go up and down. But it's beautiful and warm and sunny night on the side of the year. So it's just amazing Mediterranean climate. They call it Nice.
Speaker 3:Amazing it's close to San Francisco right, Like how far is it Do residents go there?
Speaker 5:Yeah, it depends on the time of the day. So we just say it's about a two-hour drive, but it's like 90 minutes if you go on a Saturday morning with no traffic. It's like a two-and-a-half-hour drive if you go on rush hour at five and six in the morning. So it's a very easy drive on a weekend.
Speaker 3:It's actually a little tougher if you're commuting for business reasons so there, uh, I was looking you guys up and uh, there was a new program. Uh, their sister program, I think sutter uh, is roseville, if I'm if I'm not mistaken right. They started two years ago. So some of those students were wondering, like in terms of fellowships, like how can the new pro, how would a new program help them, you know, get into maybe a competitive fellowship, for example, like cardiology, if they want to do that? So what are your thoughts on that? Or do you know any fellows from or anyone interested in fellowship on your sister program Of?
Speaker 5:course. So you know I've actually built programs that have started fellowships and I've done that before. Roseville is about two and a half years ahead of us on the trajectory. Roseville is one of Sutter's larger campuses and they are the campus that's building probably the most variety of residencies. And now they are on the journey to build fellowships. So they are building a cardiology fellowship. They, I'm sure, are going to build Palm Creek Care and some other ones. They just can't announce them yet until they're accredited. But there will be more fellowships built there. Not clear yet if we're building any fellowships in Modesto.
Speaker 5:But to answer your question, how do you get into a fellowship? I think you can get into a fellowship from any residency you want to. It's just a matter of building your portfolio and work. So you know you have to have a well-rounded portfolio of CV, you have to do quality projects, you have to do research, publish, you need to, you know, show that you've done some volunteerism, and you can do that from any residency.
Speaker 5:It's probably easier actually from a new residency because you get to basically be the first person on the ground and you can pick what you want to work with. You get to work at elbow with your faculty. Pretty easy to do that. We have a lot of cardiologists here so it would be quite easy and feasible to get onto a project and do that with your mentor. So quite easy. But the challenge is that most of the fellowships already have people hanging around hoping to get into their fellowship, so it's going to be much more face time if you're trying to get to know the fellowship director. Um, it's a little easier if you're actually from that residence. Yeah, but totally, totally a lot, of, a lot of fellowship directors I've met. They like to have a mixture of both people that train within as well as people from outside, because they don't want to become what's considered inbred. So a lot of fellowships will pick from both in and outside of a program.
Speaker 3:Would you like to say anything, Dr Pinus, regarding that?
Speaker 4:No, I think there's a growing number of maternal, infant care and maternity care fellowships, like in the in the area and in California also. So I have had several residents and students you know interested in some of those fellowship opportunities. Just like residencies, fellowships are increasing in number, which is really great for residents to have the opportunity to really focus their practice and what they are really passionate about. So I think there's no shortage of opportunity for fellowships for both family medicine and internal medicine.
Speaker 3:Okay, and just on the same track, we have like some students that are interested in the OB side of family medicine. Does your program have like a lot of OBs or a lot of deliveries that they get to see?
Speaker 4:Yes.
Speaker 4:So you know that's one of my areas of interest and so that's something I'm, you know, very passionate about, and it's such a need across the nation, but especially actually here in our community.
Speaker 4:We've had many OBGYNs leaving medicine from retirement or leaving the area. We're in such a crisis in need of physicians providing prenatal care and obstetric care, not to mention access to contraception and reproductive health options for patients. So, um, it is such a huge need and it's, uh, definitely a need that family medicine doctors can help meet, and so that's why I am very passionate about full scope family medicine and training all family medicine physicians. Even if they may not want the lifestyle of of, um, delivering and being on call and that type of thing, still they can provide prenatal care and be very experienced with women's health and caring for newborns also, and postpartum care. So I think that's an important part of the curriculum and we have excellent support here from our OBGYN colleagues and we are actively recruiting family medicine OB physicians. The hospital and the medical group are very supportive of that mission to meet that need.
Speaker 3:Now we're going to talk about some questions that students had and try to understand, like program director's point of view, since the application just opened up last week, right. So our students want to understand how, like, the whole application review process worked. For example, like do you download all applications on day one or do you download them as you go on? Like is it first come, first serve? How does the review process work?
Speaker 5:Well, they come in continuously actually. So if you have your application in advance you know Eris actually the application review software it holds your documents for like five business days before it releases it to the program. So one piece of advice I'd have is start early and students can enter as early as like September 9th, 4th I think this year was the day. So if you got it in early, when it opened to us on the 25th, we would see your whole application. If some of your pieces haven't been in there yet, like the letters or some other dean's letters, et cetera, those will trickle in as they get entered and uploaded by your faculty and so we will look at applications as soon as they come in on day one.
Speaker 5:If we have a large number, which we usually do in primary care, it'll take us a while to work through those. It'll take us a while to work through those, and so if we see some of them are incomplete, we might hold them and just come back later and wait for the rest of the documents to catch up. Okay, yeah, so so we we start right away, but we are constantly reviewing. So if you look at my website, we actually post on there that we'll be reviewing all the way through January, and so you know there's still an opportunity. We may invite some people who didn't apply right at the beginning but then decided to join later and apply in October, november, december. Dr Pounds.
Speaker 4:Yeah, basically we apply, you know, kind of a filtering strategy to try and prioritize specific qualities and characteristics that we want for residents. So we started that like right on the first day. But, like Dr Kerr said, those applications are still coming in. Some of the applications that are actually in the system are incomplete. They're still waiting for some of the documents to come through, or waiting for, um, the test results or something like this. So, uh, we do recognize that and we know we have to keep capturing that, that data, and keep looking back at it.
Speaker 4:So, um, it's kind of like on a rolling basis and, um, honestly, invitations for interviews now, pretty quickly on day one and we've just been continuing to, you know, go through those applications with our process and offer interviews. We give applicants, you know, a reasonable amount of time because we know medical students are busy and on different schedules and all you know, different time zones. Give them a reasonable amount of time to respond to, either decline or accept the interview position and then they get scheduled. And we've had a lot of success already scheduling applicants. And also, one thing that was really important to me was like making that process very transparent. So on our website there's lots of information about exactly how we're doing interview season, what to expect, so that applicants can kind of get an idea, if they haven't heard by a certain amount of time, or what our interview season looks like, so that they can kind of know whether to keep holding out and waiting and expecting to hear from us, or whether those interview slots have already been filled.
Speaker 3:All right. So would you advise someone to apply early but with an incomplete application, or wait a little bit and have a complete application and then apply?
Speaker 4:I think the best advice is to have your application complete on day one. I think that's the best best option. And if you're not able to have that application complete on day one, I think that's like the best, best option. And if that is not, if you're not able to have that for different reasons sometimes it's out of your control then I still think that having your application in the system as early as possible is probably the best way to go about it. That would be my advice.
Speaker 5:My advice is the same. I think you should always look to be there right at day one, but I wouldn't despair if you had to apply later. Like she said, we're used to seeing some applications come later, you know. The other thing that's been in place for a couple of years now is signaling. So if you really want to be noticed, you should spend one of your signals. You get like three gold tokens and I think it's 12 silver for internal medicine. So use one of your tokens if you want to get noticed, because a lot of programs have come to rely on that as a like raising your hand to say I want to be noticed.
Speaker 3:That's a good point you brought up. So that brings me to like. Our next discussion point is you would probably get like a lot of, like thousands of applications right. You can't really offer all of them an interview. So what would be your initial filter? If you had a filter, would it be signals, or would it be their status, maybe non-USIMG versus USIMG or USMD, or their scores?
Speaker 4:So that's a hard question.
Speaker 4:It's a little more sophisticated.
Speaker 4:The platform that we're using to filter through applications is quite sophisticated and we can really identify like positive factors and negative factors, and you can create filters that have like multiple different characteristics that can be isolated certain parties who are reviewing applications from things like the applicant's photo, the applicant's birthday and age, gender, race, ethnicity so there's a lot of you can blind to.
Speaker 4:History of felonies and convictions you can blind to. So there's a ton of things that can be done and you know it's it's a bit of a complicated process, but the priority for me was making sure that we're minimizing bias as much as possible and also identifying applicants who have a strong passion for primary care and community-oriented primary care and also have what we're kind of. We make some assumptions like that people from the area might be more interested in staying here and be more connected to the community and desire to stay here as a primary care physician in the future, and that is something that's a big mission for the programs. So so there's not one thing that we filter for or filter out. I don't know if that really answers your question, but it is quite sophisticated that you're able to create several layers of a filtering system to identify candidates.
Speaker 4:Some of our filters are isolating 80 to 100 applicants out of maybe 700 or 800, to give an example.
Speaker 5:I can maybe share a little bit how things have evolved. So back when I was starting other residencies, we didn't have the signaling. So what would happen is you would start with people like from your state. So you would assume, like maybe students from your state colleges, your state medical schools, people who had a hometown address in your state you would often filter had a hometown address in your state. You would often filter for that because you kind of assumed they were going to stay in your state and then you would maybe work to some surrounding states.
Speaker 5:So when I was in Michigan we would go to Ohio, indiana, illinois, and then we would sort of then go farther and farther and I can remember looking for applicants in the in the filters, and I would get all these people from California and I was like wow, I don't know how to discern like which of these people from California are seriously willing to come to Michigan and how many of them are actually just applying broadly just because they want to be be considered somewhere. And so now that signaling is in place it makes that a lot easier. So like if you're in New York or you're in Florida or somewhere and you want to move back to California. It's going to help you a lot because now I can sort of take all that external applicants from other states and I can say, okay, this one has definitely got a reason, they're trying to come to California. So the signaling helps us a lot to pinpoint people who are interested in being in your area.
Speaker 5:And I think you know there is some assumptions that might be made if you don't signal like maybe we're not one of your top 15. But on the other hand that's not really true either. So we look at all applications. So it's not just about signaling, but it's uh.
Speaker 4:but the signaling does sort of particularly help if you're coming from across country and trying to to get noticed and actually I want to just say one other thing, because you mentioned um filtering by like img or american, an american graduate and I do just want to say that I am an img myself, graduated from ross university, and I know that I had an excellent education there and I was a very competitive applicant and historically there may have been some different challenges that programs had to face with licensing for uh imgs and a lot of that has been eliminated in recent, you know, five to seven years. And so I am. You know I myself do not filter out by IMG versus American grad at all and it's much more kind of based off of like geographical preferences and just like like I said commitment to service, commitment to community projects, and you know all different things that we select for.
Speaker 4:And then I will also just say that different programs will have different priorities and, in addition to us wanting people who want to stay here in the community, we also are prioritizing diversity for our program. That can be a challenge when we're blinding for things to try and minimize bias.
Speaker 4:That can be a challenge when we're blinding for things to try and minimize bias. But there are ways that we can I'll say, you know, select for things like applicants who speak additional languages or you know different things that might be helpful to actually being a primary care physician in our community here, where we have 50% of our patient population here is Spanish speaking. So those are some examples of the things that we can look at in the filtering process.
Speaker 5:Yeah, I think patients like to sort of bond with people that can speak their own language. Right Culturally, they're very attuned to getting. They don't necessarily appreciate always having to have an interpreter. So I can remember when I've hired, like, for example, spanish speaking doctors in the residence clinic.
Speaker 5:The patients were loyal. It's all craziness. They were like, oh, if the doctor wasn't in clinic, they'd wait till the doctor came back just to have a Spanish speaking doctor, for example. So I think that diversity really matters here in the central valley. Uh, the logistics are quite diverse. We've got a lot of spanish-speaking patients, but we've got probably eight, nine, ten percent of the patients are from pacific, asian of all different varieties, you know, from chinese, yemenis and india, pakistani, and you just name it.
Speaker 5:There's a very diverse community in California, so we're always looking for everything but we're always kind of thinking how's that person going to be with patients and are their communication skills excellent? Do they have empathy? Are they very professional? So there's a lot of different things we look for when we're selecting people, but we're always looking for people that are kind of camera ready on day one to do a great job with patients. All right, awesome.
Speaker 3:There is one other thing I want to ask you about was you know, a lot of students find it very hard to write a personal statement and they kind of struggle to keep it within one page. So what do you look at when you're reading a personal statement and they try to, they kind of struggle to keep it within one page. So what, what do you look at when you're looking, when you're reading a personal statement? Like, what makes a good personal statement?
Speaker 5:well, uh, I've done a lot of work on coaching, uh, students in this area, uh, so I always just remind people that the name of the document should speak speaks volumes. It should be number one personal, and number two make a statement. And so if it's not doing either of those two things, it's probably missing the mark. And so I've read many a personal statement that starts with a quote from Osler or starts with a quote from some famous person, and I'm like I'm not reading it to hear from a famous person who's dead, I'm reading it to hear from you. So I always appreciate personal statements that are actually about you and tell stories about you and your past.
Speaker 5:I think a good personal statement should start with a hook. A lot of them start with a case or an interesting patient that maybe helped them decide that this is their specialty of passion. So what was that personal case that made you decide family med or internal med is your thing, that you want to do and make it your life's career? I also think that keeping it organized is important. So sometimes people just want to write like what I call a chronology, like, ok, I was born on this year and then I went to grade school and high school Really what we want to?
Speaker 4:really what we want to hear?
Speaker 5:is like your attributes, your you know your qualities, maybe your qualifications and experience that is going to make you a great internist or a great family doc. So so we don't want to know your whole life story, we want to know the key stories that are sort of defined, defining moments for you and how it's helped you discern that you want to be a great medical, medicine or family doc, for example.
Speaker 4:Yeah, I think I would just echo some of those same, some of those same things. It definitely helps if it is authentic and real sometimes vulnerability. It helps also if, when reading it, I can see that the person who's written this has insight into their own challenges or their experiences where they're coming from. Also, if there are, you know, challenges that have been faced you know in life or academics, I think you know it is a good opportunity to talk about them and be open about them and take accountability. Or, you know, just share your experience with that.
Speaker 4:And because we're looking for all medical students all medical graduates are excellent, you know, you know capable students and we really are looking for people who have excellent communication and you know interpersonal skills, able to build relationships, and people who are ready and open to have feedback and want to grow. And if you have a growth mindset, that's the most important thing that and want to grow, and if you have a growth mindset, that's the most important thing that we need for residents. And if you can kind of share some of your experiences or challenges, but then show what you know, that you've had personal growth from it, you've learned something about yourself from it, that's that's definitely better than hoping. Hoping some of those challenges you know, don't get noticed or brought up.
Speaker 5:Hoping- hoping some of those challenges, you know, don't get noticed or brought up Right. That's actually a pet peeve for me. Actually, I, if I see a failed exam and then I don't see anything about it in the personal statement, I'm just like, I think I'm done, like, wait, if we're not even going to talk about that, like we're just pretending nobody's going to notice that on the transcript, it's, it's just not the growth mindset I'm looking for. So I'd much rather see somebody say you know, I had a challenge, and this is my analysis of why I think I failed that exam. And then here's what I did to change my study habits. Here's how I changed my, you know, got through the personal challenge I was having, and then you know, show me how you succeeded. So for me it's a real turnoff when people ignore it and just like don't even bother to mention it.
Speaker 5:So I think you know if you've had a hiccup in your training. Uh, everybody has hiccups. Uh, no, he's perfect and we're not expecting perfection. So I think if you're trying to build an application and and say, hey, I'm the perfect person, that also comes across as fake. So I I think, uh, like director piano said, authentic and genuine is way better if you can, if you can manage to pull that off. I know that everybody's a great writer. In fact, most people going into internal medicine are science-minded people and they they're better at math and science experiments, probably. But if you can be articulate enough to put into writing, you know what you learn from some of those hiccups. It's way more interesting for us.
Speaker 3:So how long do you think would be a good, you know, personal statement, like one page should be within one page, or if it goes over one page it's okay.
Speaker 4:To me it doesn't matter much. I think it can be a little daunting because of just the sheer amount of information we have for each applicant. It's a lot to go through. But I mean, to me I don't think it matters so much. You definitely don't want it to be. You know, I think if it goes on to a second page, I think that's still probably reasonable.
Speaker 4:If it's more than that, uh, going on to a third page or something, that might be like a little excessive I tend I I actually am a writer on my you know, not in my non-medicine life and I I really enjoy writing and I tend to just be very brief with my writing. It likes to sync, but uh, you know, I think, I think it's just depends on the style and what we're learning about the applicant, what reading it, and it doesn't if it's a great personal statement, it doesn't bother me if it goes to a, to a second page.
Speaker 5:I'll echo that. I think um. I think one page is a perfect one.
Speaker 5:If you go a paragraph or two over not a big deal, I think. If you're on three pages, we're going to probably shut down. When I coach, when I coach people, when I coach people to write these, by the way, I suggest that you start with five paragraphs an introduction and a summary paragraph and then pick three things you want to say about yourself and put three paragraphs and sandwich it in between the opening and closing paragraphs. So if you can get it into five paragraphs, it'll be pretty normal and average, I think. And the challenge is picking what do you want to emphasize about yourself.
Speaker 5:So, like you know, some people usually start with like, oh, this is who I am, my character.
Speaker 5:With like, oh, this is who I am, my character, this you know, I'm from an immigrant family, or I'm from a poor family, or I grew up in a challenging part of the world. For me, it was growing up on a farm. So I usually start with something that sort of identifies who's your identity and then I'd say you know, somewhere in there you got to talk about your love and passion for patient care, and I think somewhere in there you should talk about highlights of successes. Maybe that's in research or in teaching or something that's really you want to point out on your CV, and definitely do not repeat your entire CV because it's already in there. So do not waste any ink or typing in your personal statement about the CV, other than if you want to call attention to something and say, as you can see from my CV, I did research at this place, you know. So definitely don't waste any extra words in the CV if it's already in the personal statement, if it's already on the CV.
Speaker 3:All right. So the next thing is the students that applied this year, when would be like a good time to write like a letter of intention, if they haven't received any interviews, for example, and they're interested in your program? Do you look at LOIs as a negative, positive or what time frame should they look into sending one?
Speaker 5:That's a really interesting question, because I don't think it's harmful to write, but I'd probably write to the. There's usually on your website, typically a residency email and I think that if you're not using that email of preference, that comes across badly. So if you're not using that email of preference, that that comes across badly. So so if you're like you're writing directly, you've managed to get the direct email to the coordinator, the direct email to the program director. I think that's a little bit annoying. It looks like you're trying to go around the normal route of communication.
Speaker 5:So I would start by writing to the actual website and email for the actual residency. And the reason for that is many programs are big and they have multiple coordinators and so they're constantly looking at those. Uh, you know, today might be somebody's day off and they're actually that in that email is getting covered by someone else. So so use the preferred email for the residency. You'll probably get a quicker response than if you, for example, email my other coordinator who's off. She has to come back and catch up on email and there's all these extra emails that somebody could have taken care of while she was away.
Speaker 5:So I would just say it's probably not a bad thing to write, but it's become more transparent now. So, like the family met um directors and the intro med directors have all sort of said you know, this is kind of coming from the double amc that you should make it very clear on your website when invites go out, and so, like some programs are down to the specifics, like we send it out on friday at three o'clock or you know. So pay attention to the website first before you go ahead and write to them, uh, and then also you'll see like, uh, we may be sending out every month until the month of january. So so you probably shouldn't worry about like writing that right now. Uh, because we're still in very early in the season and still in a busy reading mode.
Speaker 5:So so right now, um, like I think, on our website it said we were going to start sending out october one uh, so that would probably be too early to start writing at this minute, because we're still uh formulating, all right exactly yeah, the the letter of intent is a new, something new to me that I've learned about now in this role as program director.
Speaker 4:So I would just say it's probably it's not. If I receive those it's not negative, but it's not changing my filters or my characteristics that I'm looking for when I am deciding on who I want to interview. That's already been predetermined and it's a standardized process and we're trying to keep it as standardized as possible to minimize bias. Do receive those letters of intent or those emails with a lot of the personal information, personal documents kind of attached like a CV or USLE records. I just say thank you, we'll be reviewing applications through ERAS and that's kind of just the end of it. So it doesn't really impact on my end who we're interviewing. But it's not like a negative thing. I don't see it as a yeah, okay.
Speaker 3:Well, not necessarily a positive thing either, right? Based on that? Right, they're not going to have more chances just because they sent you an LOI? It?
Speaker 4:doesn't influence the decision for me specifically, and I don't know how other programs handle that. And similarly, you know, thank you notes after interviews. Yeah, those are a nice touch and especially if you had felt like a personal, you know connection with someone, I think it's fine to send like a thank you card or a note. But I think all of those things you know, we have to really try and be careful that, because we're trying to minimize bias, we have to put up kind of some some guardrails for those things and we don't want those things influencing our decisions, right. So I mean it is a good, it is nice and thoughtful to receive a thank you gift or thank you I mean a thank you card or something but it doesn't influence our decisions either way.
Speaker 5:Yeah, and they've. They've gotten more clear from AAMC and ARIS that we shouldn't really expect those. So we don't really expect them. They are nice if you really do have that extra. You want to give that wow factor, but it's not required and so similarly so, sending a letter of intent beforehand isn't going to get you noticed any better. You're still in that pool of names that we're working through, so I would say it's not going to help you. It's probably a waste of your time if you're just hoping that it maybe gets you some extra looks. I suppose from a marketing standpoint it probably does get you some extra looks somehow.
Speaker 5:But I don't think. Like she said, I'm not going to open the attachments number one and number two. My hospital's gotten so tight with the external email. It's flagging it already like don't open this, and you know it's external. So I almost think that you're better off to just go through ARIS if you want to send a communication, because at least then the coordinator is going to read it right, because at least then the coordinator is going to read it right. So you may not even get read if you send it through regular email because the hospitals are so worried about malware and viruses now. So I honestly think you're better just to be very thoughtful about who you send it and when you send it, and just send it through ARIS to the coordinator, if you're going to ask about where we are.
Speaker 3:Thank you. So next thing I wanted to talk about like a lot of, I've noticed a lot of people or a lot of programs are starting in-person interviews. Is Sutter Health going to do that this year or maybe next year, or is it all virtual this year?
Speaker 4:It will be all virtual this year which is in alignment with the recommendations from all the major organizations within both the family medicine and internal medicine specialties. And again, that is a really important thing in order to make sure we're minimizing bias and also making sure it's financially equitable for all applicants who are interested to be able to have the same opportunity to interview, and I think that that's really important. So I personally don't know that it will change for our programs, but certainly we're going to try and stay in alignment with what the recommendations are of those organizations that say like this is the best, the best process. I don't know what you think, dr Kerr.
Speaker 5:Yeah, I'll give you, I'll give you some behind the curtains. Look, since this is an audience of students and applicants, I think, I think I think, as far as predicting the future I never try and do that, doctors are terrible at predicting the future I think what I would say is, historically, I think historically, after the pandemic, there's a strong push, particularly in the primary care specialties, to stay on Zoom and to stay virtual, and the reason is that people realized it was so cost ineffective to do the inside interviewing. So in actually a lot of places the budgets dried up. So there used to be big budgets for, like, having people to have banquets and dinners and go out to eat and things, and all those budgets dried up and they never came back after the pandemic and so, uh. So from an equity standpoint, I think there's a big pressure to to stay on zoom and stay virtual because, uh, it's it's more cost conscious for the program, it's more cost conscious for the applicant and, and it's just, it makes the playing field a lot more level. So, uh, but uh, what I will say at the national level, at the program director meetings a lot of community hospitals want to have on site options because they feel like their little small town is so cute and they want people to experience that, and so there's this, there's this blended version that's in play right now, where people are doing virtual with an on-site visit usually at the end of the season, around January February again to
Speaker 5:mitigate the bias and the feeling that if I go and spend that extra money to travel there, that they're going to rank me higher.
Speaker 5:Are doing on-site visits because they still want the students or applicants to know this is a great place to live and that's hard to get a feel for over the internet. So I think you're seeing more and more places try to do blended, but I'm only speaking from primary care. I also see other specialties like surgical specialties and stuff. They don't really care, they're going to go all back to in-person. So there are some specialties I know that are pushing and they're itching to go back to in-person and so I would say it's going to depend really heavily on the specialty and it's going to really depend on how bad they feel that in-person is needed to get a feeling of fit with the program and I can imagine, if you're going to be operating in an operating room with somebody a lot, why somebody in surgery might want to have an in-person interview for sure, but I think the evolution is going to go back to somewhere in the middle.
Speaker 3:But I think primary care specialties right now are pretty satisfied with being virtual um so so you mentioned, like you know, site wizards right, like is it usually done after you finish ranking, or um is it most places? Yes, but.
Speaker 5:I think there are some that'll do it a little earlier, maybe before they're done with the rank list, but typically what they're going to do is you're not going to meet the PD, You're going to go to a site visit. They're going to have a big conference room, they're going to give you some orientation talk and they may have residents or chief residents take you around and show you the place. There's probably going to be some faculty or maybe associate program director to take you around. But I think you're going to see either it happens after the rank lists are done or you're going to see they're going to have it on site but you're not going to have a chance to meet the PD because they don't want the rank list to be biased or even perceived as being biased.
Speaker 5:So you'll see, I think those two types of options most likely.
Speaker 4:Yeah, I think those site visits really are there for the applicant. They're for the applicant to come and see the community, see the facilities and get a feel or sense of how the people interact and how with the culture, the faculty or the residents. And when there was residents there already, I think that is really important. And I as an applicant you know long ago, I remember you know a lot of my decisions at that time were based off of just how people interacted, how people welcomed me, made me feel comfortable or not, how they spoke about and interacted with, how the residents interacted with their faculty and how they spoke about their faculty. So I think you know there's value in that.
Speaker 4:Definitely it's fun, it's like a fun social activity to have you know social events happening during interview season. I remember that only as a resident too, but I think its purpose is really to help the applicant kind of get a feel for the community and the program and the people and make their decisions. And so you know, not for us as a program to get more information or to influence our decisions about ranking in any way right, because ultimately programs should be selecting applicants based off of their, their qualities and, um, the, the characteristics they need to be able to be a physician. Um, and so for that reason, you know, we we are choosing to uh for family medicine. Um have the site visit uh or the socials, only after the rate border list is finalized. Also, that means I can come and hang out with people and socialize.
Speaker 3:Oh, excellent. Coming from a student point of view, one of the biggest fear we have is, if we don't go visit, do a second visit. We're not going to match there. It's good that you cleared all these you know misconceptions. Last two questions. I just had two more questions. One was regarding J1. Do you think for, like you know, like Canadian IMGs or someone from international non-US IMGs are you planning on doing J1 in the future for future applicants?
Speaker 5:That's a really interesting question. So I've done a lot of work in the past with, like the ECFMG and I've been a big advocate for why we need to have J1s in the program. I personally think residencies are much more culturally rich and diverse when there's J-1s in the mix. So I'm very much not opposed to having J-1s and J-1s don't really cost the program that much. That's why you'll see a lot of places say like H visas need not apply, but J visas welcome. So I think there are a lot of residencies that welcome J visa holders because the ECFMG is the sponsor of the visa and so it doesn't really cost the residency that much to do that. So I think that's why you see, j1s are generally more welcome than H visas in many places. I think they add a lot of diversity. I think they add a lot of options to bring in a variety of people. So I'm not opposed to them. But I am going to say, going back to, one of the very first questions was how do we filter?
Speaker 5:Most places do what they call holistic review now and they're going to write a mission about what they're trying to do, and so you really do want to pay attention to the mission of the program.
Speaker 5:So and you should think about how does my experience as an international grad or somebody who's on a J visa, how will that help that that program that I'm applying to? Because, for example, if I say I'm looking to hire a lot of Spanish speakers for the Central Valley because 52% of my patients speak Spanish and you're on a J visa and you speak Spanish, you should use that as a way to introduce yourself as to why you think you would be a great applicant for my program. Similarly, if you look at programs that maybe serve like an African-American community and you're coming on a J visa, say from Nigeria or someplace in Africa, you should emphasize that you could bring diversity for your patients in that residency. So I don't know, I kind of have this sort of thing about when people love things together. It just sort of rubs me a little bit on the edge, like it's not about the visa at all, it's actually the visa itself. Doesn't cost me that much money to have have a j visa resident. Uh, so I'm I'm really, I'm really.
Speaker 5:It's not about the visa, it's about, uh, what do you bring into the program from a holistic standpoint, and I think the problem is folks from international think there's like it's what.
Speaker 5:It is definitely harder to get noticed and get in, but it's not impossible. You just have to do a little more research to find the programs that accept J visas. So for both of my prior programs, we accept J visas and you have a lot of great diversity. We had folks from the Middle East, folks from India, pakistan, asia. We had folks from South and Central America, africa. So I think you know, look at the programs website, look at who are the people that are already there as residents, and definitely you know, look and see, you know what are they selecting for? You know, uh, like I, in my programs we tried to do diversity across the continents, so so like we would try to make sure we were. If we were going to invite j visa holders, we were usually trying to make sure we were distributing across the continents and being not you know instead of just going into one country or one school or one type of applicant.
Speaker 5:We would try and make sure we picked invites for a variety of different parts of the world, but I think your chances are better if you can align. You know, maybe you're from India but you speak Spanish, and that would be a good attribute to sell to me as a person in a residency in the Central Valley. There's a lot of diversity in people, and helping me see what's that diversity that you can bring to the table is where I'm. That's what I'm looking for in a JVS holder.
Speaker 4:Ultimately, you know, we can advocate for the things that we think are important for the programs, like as program directors, but that decision of whether to accept or sponsor these is ultimately it is a decision made by, you know, the sponsoring institution or the organization as a whole. So just to keep that in mind, you know it's not just a decision that us program directors are making.
Speaker 3:Yeah, okay, fair enough. Last question that I had before I let you guys go was do PD talk amongst each other? So if a student applied to both IM and FM at your program, would you guys know, and is that something you'd be like? No, they're not interested in either and met your program, uh, would you guys know, and is that like something you'll be like?
Speaker 4:no, you know they're not interested in either or or? Would that be a negative? I don't think it's a negative. Um, it hasn't. Uh, of course we talk and you know dr guru's like a mentor for me, so he's um helping me in this new role, so I get a lot of advice from him. Um, so he's helping me in this new role, so I get a lot of advice from him. But I think I wouldn't be surprised if there were applicants who were very interested in this program here in Modesto. Could they could have that, that career in primary care, you know, through both internal medicine or family medicine. That wouldn't be surprising to me. It's not necessarily like a negative thing. I don't think Sometimes it. Sometimes I think what I see is more applicants who maybe are really interested in that OBGYN residency and that they're using like family medicine with some OB care maybe as like a. Maybe they feel a less competitive easier to get into option.
Speaker 4:I think that is. You know, it's. It's a little different than someone who's just wanting primary care and wanting a specific geographical region. I understand that because as an applicant I had family already and, um, you know, sometimes it's not, uh, it's not, it's not a it's not option, like, it's not an optimal option to have to move your, your family, like across the country or you know, to another state. So I think it's multifactorial. Why? Why people are deciding which programs are choosing. And to me, if somebody is passionate about primary care and they think they can do it both with internal medicine or family medicine and they just want to be here in their community, and to me that doesn't, that's not a negative thing, but it we have separate sign ins and separate a separate process, and so we're not really discussing or looking for those applicants in any way. But we do have a lot of students who've come through who maybe have expressed interest in both programs. So I think it wouldn't be surprising to see some overlap.
Speaker 5:Yeah. I'll echo that I think. I think you shouldn't assume that it's completely separated. So and I am probably not like, I think, people who've done a sub-I here we're going to look up and see if you applied, and if you didn't, then did you apply to the other program. But honestly, I think coordinators talk more than the PDs do.
Speaker 5:So I think, I think coordinators often you know they often sit together, they often sit together and they share duties and errors. So I think it's much more likely the coordinator is going to notice that you applied to both places than it is the PDs, and I think it doesn't necessarily come across as a negative. I think you do have to sort of show your love, for you know, and like Dr Pena said, modesto is kind of out here in the middle of Central Valley, there's only one other residency sort of in town, and so basically you don't have very many options. So if you want to stay in Modesto and do primary care, you got limited options.
Speaker 5:So it wouldn't surprise us at all if you're applying to both FM and IM. Not a surprise whatsoever. And I do think that you have to be able to explain it though. So, like, if you're interested in OB, obviously, why are you applying to internal medicine? So if you don't get FM with OB, how are you going to be happy? Like you're not going to see any kids, you're not going to see any women with babies, I mean, it's uh.
Speaker 5:So you have to get you have to kind of know who you are and you have to be able to explain you know who you are, who you want to become so for me I did med peds, by the way oh, I think that concludes.
Speaker 3:Yeah, I was just. Oh, was it really okay?
Speaker 5:that concludes yeah, I was just. Oh, was it really okay? Yeah, I was med peed, so I actually couldn't I couldn't decide either, so I I applied to med peed so I could be both and uh and ultimately I ended up doing internal medicine after the long run.
Speaker 3:So oh nice, thank you so much once again. Uh, for you know, come on joining us today for this podcast. Really appreciate it. Doctor, we really appreciate your point of view, what you do when all the applications come in, what you look for, all your advice that you gave today.
Speaker 2:Thank you so much, dr Pianist and Dr Kroer, for giving us insight into what goes into running a medical program and why you started your internal and family medicine programs. And thank you so much, sanket, for asking the really burning questions. We always thought it was a great idea to have somebody who is in the shoes of a potential resident to host this show, just so that we could get the relevant questions out there. But again, as always, if you liked our show and if you liked our content, please download more at any of your favorite podcast providers and give us a follow and give us a like. It goes a long way for us. A lot of work goes into putting this together, and always remember there is no shortcut to becoming an MD. Also, if you have any specific tips and tricks that you think would be helpful for our future residents for the upcoming math season, don't forget to put it in the comments. And also, if you think Sanket was a better host than me, don't hesitate to comment on that as well.
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