Ask A Question / FAQs

Over the years, I’ve garnered substantial experiences during my undergraduate and medical careers with the admissions process, curriculum committees, roles of leadership, and spearheading new organizations. I’ve met and interviewed countless applicants from all walks of life, and feel I have a lot of advice to address common concerns posed by aspiring healthcare professionals.

Scroll down to read questions asked by other visitors and/or drop me a question below! Also, be sure to read the frequently asked questions (FAQs).

409 Comments

  1. Hello Dr. Kumar, so I was reading the other day in a textbook that the usefulness of vassopressors in septic shock is not proven, except there is target organ damage due to hypoperfusion, because lower bp and metabolism are defense mechanisms against infection. Do you agree with it/routinely adminuster vassopressors in these cases? It seemed counterintuitive so I wanted to check.

    • In true septic shock, yes, I’ll still use vasopressors/inotropes. I’m not necessarily trying to normalize blood PRESSURE, but I’m trying to optimize blood FLOW (oxygen delivery) while treating the underlying trigger (ie, pneumonia, GU infection, etc.)

  2. Dr Rishi,

    I was curious as to whether or not you have any advice on excelling in organic chemistry as an undergrad? Any readings, websites, videos, etc. that you used to effectively learn the material would be greatly appreciated by those of us hoping to do well in the class. As a side note I’d like to say that your content on both your website and Instagram is very useful as well as enjoyable. Thank you!

    • Hey Adam! First, please call me Rishi! We’re all friends here. 🙂

      For organic chemistry, I honestly just remember spending hours just drawing out mechanisms. It’s important to understand the different functional groups and patterns of electron transfer, reaction times (SN1, E1, etc.), but you’ve gotta practice mechanisms, and that only comes with repetition and practice. Unfortunately I don’t know of any shortcuts!

      • Thank you for the advice Rishi! I’m sure I’ll have more questions or comments for you whether it be in the science/medical section or in your tech section of the website. Keep up the great work! 👍🏻👍🏻

  3. Which app on macOS or iOS do you use for writing and posting your blogposts? Thanks Sir.

    • My blog posts are done on open source software (WordPress) I host on my webhost.

      • Oh yes sir. But I mean if you use any special app to draft your posts such as Ulysses, Notes, etc. (?) and how do you organize it.

  4. Hi Dr. K,

    I was wondering if you could write a bit about what exactly telemetry is in a hospital setting, the implications of being placed on tele, what elements of a patient’s condition are considered when deciding whether or not to place them on tele, etc. Surprisingly it’s been tough for me to find any online resources that do a good job at describing in detail what this accommodation actually is and what it entails. My current understanding is murky at best.

    I’m also interested in your views on tele from a CC anesthesiologist with a particular interest in tech.

    Thanks!

  5. Hello Dr Rishi,

    I have a question. I matched in a Family Medicine program, if I complete 2 years of FM residency. Can I apply to an advance anesthesia position without having to do intern or prelim year ?

    Thanks

    • Yes, I’m *almost* positive that your family medicine training will cover your intern/prelim year of anesthesiology.

  6. Rishi,

    Flight medic here, and aspiring cardiothoracic anesthesiologist; love your website. I have a passion for pharmacology, specifically vasopressors, inotropes, sedatives, and analgesics. I went through your recommended reading list and found Stoelting’s very helpful with advanced understanding of medication specific pharmacology theory. If I wanted to know everything about how a medication worked, what are your go-to resources? Thank you for everything!

    Landon

    • Thanks for the comment, Landon! When I was a resident/fellow, I mainly read pharmacology from the “go to” textbooks like Miller’s Anesthesia, but now I find myself reading more of the literature as a refresher since many meta-analyses include “what we already know” about specific medications and their indications, side effects, etc. Best of luck to you! 🙂

      • Thanks! I’m fortunate to be a part of an academic center with access to most of the literature out there. What are your journals of choice that you monitor for pharmacology reviews?

        • I don’t go out of my way to look for specific medications in the literature, but often times things are reviewed in the context of addressing other topics (ie, sedation options in the ICU). I read all sorts of things: NEJM, JAMA, Anesthesiology, Annals of Intensive Care, and Critical Care Medicine to name a few.

  7. Rishi- First and foremost; and in all seriousness, I hope you are aware of the myriad of degrees of help that every single one of these questions you answer; have resulting implications not just to the poster, but the 1000 others wondering the same thing. And more than that- the DEPTH of impact you advice has in changing the course of peoples learning by putting into practice your suggested actions and suddenly unleashing growth. Thank you by all.
    My question is probably simple for you simply because of the vast degree of personal (and learning through others mistakes/highly successful examples); but for me its the first biggest turning point Im facing in my new career. Before telling you the brief circumstance, my question is if you had a post-interview thank you template (or one you recommend) that I could obviously tailor to my situation
    OK: long story very short: been interviewing for my first job as an attending. There is ONE of the jobs that would be my dream come true to land, and they are just about to open a second clinic so its a one-shot deal. I had an interview with them last week, and the interview went well, but not great. I have the exact experience they need but I wanted this specific job so badly (which I never let onto) that it made me nervous like a newbie. They asked my salary requirements and didnt seem to have any negative reaction to the prices at all in their faces, but gave no answer to how they wanted to pay (fee for service? hourly?) its 1099 position but as many days as i choose. I also had mentioned in my original application that I had 3 ways which i truly believe I can benefit them over any other choice of anesthesiologist (which I truly believe I do- but in my nervousness, I didnt express it anywhere near as clear and powerful as I could have with passion. At the end he also asked me if i knew another surgeon that might be interested in renting use of their second OR at times and I said I actually might know one; and the interview ended with me emailing him that other surgeons info- which I just got 10 mins ago, as he was out of country on vaca.
    So my question: Im now going to send the thank you letter, explain why the delay as I wsa being told Id hve the other surgeon’s info emailed any day and it only came today,

    BUT PLEASE- HOW DO I WRITE THIS THANK YOU LETTER TO SAVE MY LACKLUSTER INTERVIEW AND WIN HIM OVER? I HAVE 11 YEARS EXPERIENCE, I HVE THESE 3 UNIQUE WAYS I KNOW CAN MAKE ME STAND OUT BUT WEN HE SPECIFICALLY ASKED ME ABOUT THEM THAT DAY I KINDA FROZE- I HAVENT INTERVIEWED IN YEARS. AND IM 50 BUT LOOK 42 SO IT DIDNT LOOK LIKE I WAS OF SLOW MIND. They open for surgery mid Aug. Do you have any templates or any you can recommend that I can personalize with any of your advice?

    Rishi, I would be eternally in your gratitude if you can help me save this ASAP!!

    • First of all, thanks so much for the kind words! I don’t have any templates for your purpose, but since you offer unique traits and this is the job that really meets what you’re looking for, perhaps you could schedule a second interview to really nail home your intention to work there. I suppose you already are helping the group by facilitating surgeon recruitment too, so that’s a plus! I find that when it comes to very important life decisions like this, thank you letters and letters of intent are very impersonal compared to face-to-face encounters (in person, Skype video chat, etc.) to reiterate the points you mention in this comment!

  8. Hey Dr. Rishi! Quick question about the Critical Care fellowship. Is there a difference between the fellowship that Anesthesiologists go through to become an intensivist and the fellowships that Internal medicine/emergency medicine applicants go through to become intensivists?

    Also, is there a difference between the Critical Care you do and like a Pulmonary/Critical care fellow?

    • Great questions! In general, surgical/anesthesia critical care fellows tend to have rotations more heavily centered around surgical ICUs (cardiac, thoracic, neurosurgical, etc.) whereas pulmonary critical care fellows tend to be more focused on medical ICUs. This isn’t a rule, by ANY means, but sort of where intensivists of different backgrounds landed in this country. Another difference is that a “pulmonary/critical care” fellowship is typically three years after internal medicine whereas a “critical care fellowship” (speaking about surgeons, EM, and anesthesiologists) is usually one year after our respective residencies. There is a LOT of overlap in the training though.

      • So it is possible for Anesthesiology Critical Care fellows to work in the medical ICUs?

  9. Hi and thank you for providing a more realistic look into life in medicine than what most online accounts show! A bit of background to my situation: I was a first generation college student who was totally clueless going into undergrad the first time around. I kept gravitating toward wanting to do something related to healthcare, but my family convinced me to pursue teaching (I’m from Oklahoma where there is a concerning shortage of qualified teachers) and I graduated with a degree in Elementary Education. From the time I changed my major to education I could tell that it wasn’t where my heart was but stuck with it because I felt that it would be a fulfilling career path. After a year teaching abroad in China I returned to the US and took time away from teaching, during which I took several science prereqs. I’ve already accepted a local teaching job for the upcoming school year but am honestly looking forward to changing fields at the end of my contract. At this point I’ve decided that working as a mid-level provider would be most suitable for my personality and my life circumstances, BUT looking at some of the program coursework I’m worried that I wouldn’t feel competent working as a PA or NP. Critical care appeals to me the most, but can an RN who does an online Masters program really get the quality of education necessary to be a competent NP in that field? I was wondering if you’ve seen a difference in performance from mid-levels you’ve worked with depending on what their path was to their position. The most realistic route for me would be to do an ABSN then complete an online or hybrid Masters while working as an RN, but have you found that NPs are way more competent if they went to a prestigious program full-time? I need to be realistic about my financial and time restraints, but being the best provider I can possibly be is ultimately most important to me.

    • Hi there! I’m not sure I’m the best qualified to answer this since I don’t have much experience with the actual nurse-related training paths/options, but the end result is very dependent on the individual. I’ve seen RNs that could easily run circles around NPs, and NPs who are good at what they’re trained to do. I really don’t even know what’s considered a “prestigious” among nurses programs.

      The best nurses I’ve worked with are strong advocates for their patients, understand their role in the team aspect of providing care, and dedicated learners who go beyond their shifts to learn more about their patients and medicine in general. As far as critical care specifically, there’s no substitute for experience (which comes with time).

  10. Hey Dr. Rishi. Thanks for your lovely Instagram. I am a pgy-1 looking to go into anesthesia. I didn’t match last year and looking for some encouragement and tips for the upcoming cycle. My board scores aren’t amazing and I don’t have any time in my schedule for an early elective to get an anesthesia letter, am I doomed?

    • As you’re already aware, there’s no magic number (number of publications, board scores, number of letters, etc.) that guarantees admission for anything, so the only advice would be to apply and interview as broadly as possible. Since you’re already doing an intern year, anesthesiology residencies with only “advanced” spots are also fair game for you in addition to the categoricals.

  11. Hi Rishi,
    I just started my clerkships in 3rd year. Today I had a midway eval from the chief resident on Gen Surg. His constructive criticism was to speak up more. To answer a question with confidence. To think better on my feet and say things strongly, even if it’s wrong… I do have many ideas that come to my head during rounds , but I tend to not blurt out whatever comes to my mind first and remain pretty silent sometimes. Another student I am rotating with talks his ear off and some interns are annoyed by him (as well as I). I feel overshadowed and the chief sorta reinforced this thru his informal eval since he didn’t give that speak up feedback to him. What are your thoughts with competition between students in 3rd year and confidence on the floors? I can’t learn everything so quickly, and don’t like looking/feeling like an idiot. Too much projection going on from myself to the minds of those around me

    • Hey Ricky! Congratulations on starting your clerkships! What you’re referring to is a view held by MANY medical students at some point in their training. Although there’s a multidisciplinary component to much of what we do, as a trainee in medicine, you’re well aware of the natural hierarchy (med students -> interns -> residents -> fellow/attending). It’s hard to balance confidence with being an obnoxious know-it-all, but no matter who your teammates are, you want to remain cordial and never badmouth a colleague (ESPECIALLY behind his/her back). If you have an overbearing colleague who likes to consistently talk, perhaps directly confronting them and splitting tasks/responsibilities may be prudent (ie, discuss different patients). I remember as an intern, medical students like that did not often translate to “better” or “smarter” by ANY means. The team values hard-working team players who SHOW their dedication to learning rather than SAYING it. Some of my very best medical students asked relevant questions at appropriate times, but SHOWED their commitment by spending significant time with their patients, helping the nurses, being friendly with everyone, and remaining dedicated to the “team first” mentality rather than “I have to show everyone how smart I am.”

      At the end of the day, remember that you can’t make everyone happy. Some people just don’t “click” well with others, and that’s just reality. Make the most of the experience regardless! 🙂

  12. Hi Dr Rishi,
    I’m a huge fan! I’ve worked for a couple of years in research and then realized that there aren’t that many free resources available about the basics of medical research. I was wondering if you had any advice or input about potentially working this into social media and making an educational account.
    Thank you!

    • My advice to anyone interested in starting an educational account (regardless of platform – blog, Instagram, Twitter, etc.) is just DO IT! Post quality information in a consistent manner. 🙂

  13. Is possibile for a doctor to do clinical job and also do (clinical and pure) research at the same time?
    For example a neurologist involved even in basic research in neurophysiology or an anestesiologist involved in physiology/ farmacology research?

  14. how Much physics Is there in medicine ?
    And which medical specialty is most heavily involved?

    • Unfortunately, not much. I’d say fields like radiology/rad oncology where understanding the physics behind how imaging modalities work are probably the most intense.

  15. Hi, long time follower. I’m just starting CA-1 year and was wondering how/what you studied during the first few months of your CA-1 year? Any advice in general? Thanks!

    • Hey Anna! Thanks for your readership! I’d reference you to one of my posts: Tips for Beginning Anesthesiology Residency.

      In general, you should pick a textbook (big Miller, Barash, etc.) to get through during residency. It’s no easy task, but you come from a strong medical background by virtue of going through medical school and surviving intern year and should continue to aspire for deeper understanding of everything we do as physicians.

  16. Hi Dr. K! I’m doing my first cardiac month in July, any recommendations in terms of resources and how to prepare for it?

    Thank you!!

    • Hey Maria! I used Kaplan’s cardiac anesthesiology text during my fellowship, but even a basic primer from another textbook (Barash, Miller, etc.) should suffice!

  17. Hey Dr. I am a CTICU nurse who who holds a bachelor in biology and minor in chemistry with a 3.3 GPA and a BSN 3.83 GPA interested in going to Medical school. I am 35 years old, what are your thoughts ?

    • See my response here: link to comment. While there aren’t any magic numbers to guarantee admission, and it’s important to be a “well-rounded” applicant, the reality is that numbers (GPA and MCAT) still matter a LOT as an objective means of screening applicants. Apply broadly!

  18. Timothy Blackwell Reply

    Assuming extracurricular activities and MCAT score are up to par, what should be the minimum GPA of an undergrad trying to get interviews for MD programs? Im aware it is hard to give a definite answer but i’d like to see what you think.

    Thanks

    • As you mentioned, there’s no definite answer and the applicant pool seems to be more competitive with each passing year. Based on the AAMC’s data from 2018-2019, applicants overall had an average cumulative GPA of 3.57 ± 0.34 whereas matriculants who were accepted had an average cumulative GPA of 3.72 ± 0.24. Keep in mind that’s an average GPA – you should always aim for the best you can possibly do!

  19. Hey Rishi! Do you think you can do a video about the day in the life of a critical care anesthesiologist? Just curious to see the role of an anesthesiologist in the critical care/ICU setting.

  20. I’ve read your Q&A about the role CRNAs have and Anesthesiologists have in regards to their knowledge base and what they’re capable of in regards to the field. And as a medical student who is about to make a decision on specialties, and has rotated through electives/rotations, I’m still concerned about the future of the field.

    From my readings from both professional organizations for CRNAS and the ASA for anesthesiologists, it seems that they are at each other’s necks in regards to who knows what and what each is capable of. Do you feel that lawmakers are just giving the upper hand to anesthesiologists due to the efforts of the ASA when in reality both parties know that CRNAs and anesthesiologists are capable of doing similar things?

    My other concern is the data coming from anesthesiology matches. It seems that the average for STEP 1 to match to Anesthesia is not as high as it once was, and the fact that there are more unfilled spots in residencies.

    I feel like I’m just being pessimistic about the field but my heart keeps drawing towards it. I love the mix of procedures, being in the OR, have a relationship with patients before and after surgery and possible opportunities for fellowship afterward.

    I feel like this can be a frustrating subject, but I would appreciate more of your thoughts on the matter. Thanks Rishi! Love your content!

    • I get this question all the time, and to be brief, if you’re concerned about the future of anesthesiologists being jeopardized by the growing plight of nurse anesthetists, then I suggest you look at all of the anesthesiologists who have established our niches as leaders in research, academics, and patient safety across the country. No nurse is going to replace an anesthesiologist as an ICU attending… or a board certified echocardiographer… or a chronic pain specialist… just to name a few. Plus it’s rather unnerving how many nurses I’ve met who went from nursing school straight to CRNA school with the absolute minimum amount of “critical care experience” required to apply. As a medical student, you’re already realizing just how many exams and steps there are to become a physician. Always remember that you are a physician first, THEN an anesthesiologist. I’ve been fortunate to interact with several nurses who have gone the medical school route, and they are the best sources to confirm that there’s a significant difference in the depth of study. We as a profession have done a poor job thus far in terms of informing the public about our training and the role we have in the perioperative setting. It’s time to change that.

      Don’t get me wrong – with the shortage of anesthesia providers in this country, we NEED AAs and CRNAs to fill appropriate roles based on the scope of their training… but they are NOT the same as anesthesiologists.

  21. Hey Dr. K. How important is to have research for a cardiac fellowship? Can you also comment about ITE scores as well?

    Thanks!!

    • Hey Laura! I think it really depends on where you want to go for fellowship. Some of the larger, more reputable programs would likely prefer some form of research, but I don’t have any clear-cut statistics to support this. ITE scores are very important since they’re essentially “USMLE Step 1 for fellowship” and one of the few, objective ways fellowships can stratify applicants (ie, everyone takes the same ITE exam, regardless of where you do residency). Letters of recommendation should also be considered very important in landing a good fellowship!

  22. Hi Rishi. Please how do I request for permission to use your Passy Muir valve image in a prospective publication?

    Thanks!
    Stella.

    • Just cite my name for the image! Thanks so much! Look forward to reading the publication!

  23. Which would be the best application to create a cloud storage platform to manage patient care data? (This is being created for a research study wherein patients will be entering data into an app on a weekly basis for a period of one year)

    • I’m honestly not sure. My gut tells me starting with a database like Oracle or SQL.

      • Thanks! Sql seems to be the easier way in this context.

        I had one more question on POCUS. For a primary care physician which would be the best courses/certificate programs for POCUS and Ultrasound training?

        • I honestly have no idea since I’m not familiar with the options for primary care physicians. I commend you for wanting to get certified in these important disciplines!

  24. Hello.

    I’ve been a nurse for about five years but I’ve only been in the ICU for about six months. In that short time I’ve seen exponentially more death than years of nursing in other units. I’ve noticed a few things that I’ve wanted to have a better understanding of the pathophysiology behind it.

    1. I assume it’s dealing with multi-organ failure, however, I noticed before patients expire, their blood pressure and temperature drop. Then their blood sugars drop and finally either their heart drops or SpO2 decreases which affects the other. Finally, I notice EKG changes and then the patient usually codes or passes away. Can you explain this process in more detail?

    2. Clinically I’ve noticed that Propofol tends to lower the heart rate of my patients along with their blood pressure. However, I recently had a patient who suffered an uncal herniation, with SAH, SDH, and IVH. We decided to give him Propofol because for ventilator compliance because more conservative measures were not working. His heart rate increased about 20 points while the infusion ran. Can you explain this?

    • What you’re describing sounds like the natural progression of critical illness. Usually there’s some degree and combination of hypoxemia and hypoperfusion leading to the aforementioned symptoms you described in your first statement. As far as propofol and hemodynamic changes, propofol itself causes vasodilation and some degree of myocardial depression. The body’s response to this can vary depending on volume status, depth of anesthesia, age, cormobidites/medications (ie, beta-blockers), etc. It’s not unusual to see an increase in heart rate that accompanies a drop in blood pressure.

      • When was it first when you started thinking to be an anesthesiologist and is second year of med school(before doing any rotations) an early time to decide a speciality?

        • Didn’t know till the end of my third year of medical school after I had finished all of my core rotations and decided to do an elective in general anesthesiology. It’s never too early, but you should also have an open mind as you go through rotations!

  25. Currently a medical student, considering the field of anesthesia. Just wondering, do you feel like most residents end up doing a fellowship in anesthesia rather than just staying a general anesthetist? Would love to see some feedback about pros and cons about pursuing a fellowship after general training.

    • Half of my graduating residency class did not pursue fellowship training, and they had no problems finding jobs! Although I don’t have statistics to support this, I feel like to land a job in academics at a large institution, a fellowship is implicitly required these days.

      The obvious con is the opportunity cost of an attending salary and another year (or more) of time. My reason for pursuing critical care and adult cardiothoracic anesthesiology stemmed more from academic interests and a desire to pursue advanced training rather than feeling inadequately trained coming from residency.

  26. Hi Rishi!

    I am a nursing student and have a friend starting med school in the Fall and she asked me about imposter syndrome and I was wondering what your experiences with this were and if you had any advice on how to deal with it that you’d give to someone just starting on their med school journey?

    • Hey Monica! Wonderful question! I’ll be writing a post on this soon… stay tuned!

  27. Hi Rishi,

    First of all just want to say thanks for putting so much effort into the Instagram page – it’s really interesting and a fantastic learning resource.

    I have an interview next week for an anaesthetics house officer post. I have no prior experience working in anaesthetics bar a couple of weeks of placement as a medical student so I really have no idea what to expect. I am considering pursuing a career in anaesthetics down the line so this job would be a great opportunity to try it out and see if I like it before going applying for the full training scheme. I’m just wondering if you have any advice/tips/any topics you think I would need to know before the interview? Would really appreciate it!

    Thanks !

    From Darragh

  28. Hi Rishi,
    Firstly, a massive thank you for all of the fantastic educational resources that you provide here and on instagram. I’ve found your instagram posts extremely helpful over the past couple of months since I discovered your work.

    One area that I struggle with is keeping on top of the ‘landmark’ papers in Anaesthesia. I’ve read your mendeley post and started using it to organise articles. However, as I am quite new to Anaesthesia I have trouble figuring out what are the important papers and there doesn’t seem to be any solid list available from what I can find online. Could you post a list of some of your favourite / what you consider to be the most important landmark papers?

    Thanks again!

  29. Hey Rishi,

    I’m a medical student who is split between anesthesiology and surgery. From what I’ve read, there have been mixed views on the issue of CRNAs and their impact on anesthesiologists. Some say that the anticipated increase in surgical volume from an aging population with more comorbidities will maintain the demand for an anesthesiologist’s expertise. Others say that apparently CRNAs are able to do cardiac, thoracic, and pediatric cardiac cases, although I’m not sure if they’re supervised during those cases or not. There are several opinion pieces/articles in the big anesthesiology journals calling for change in the field and to expand beyond just providing OR services/”commodity work”. The perioperative surgical home (PSH) concept was supposed to be one answer to this, but from my understanding, it didn’t seem to catch as much traction as the ASA would have hoped for. I’m not sure of the main reason for this, but from what I’ve read, a good amount of this work is sort of already done by NPs/PAs. Regardless, anesthesiology is a fascinating, varied, and unique specialty with a deep familiarity with technology, pharmacology, and acute patient management, but I feel that the politics surrounding it are detracting from its allure. My question simply is, if someone is training to the full extent of their license, will the job market still be favorable for that anesthesiologist in the long term? Do you feel that there’s a trend where jobs will eventually consist of mostly supervising CRNAs?

    Thank you so much in advance for your time and response. I’ve been following your Instagram account for several months now and learned quite a bit from each of your posts. I think I speak for many people when I say I appreciate all that you’re doing and your commitment to education through social media.

    • Hi there! Sorry about the delayed response! So this is naturally a tough question for me to answer, but also one that I’m well suited to address given my experience as a trainee in academic anesthesiology (and medicine at large). There are plenty of non-physician providers vying for more autonomy with less training across many disciplines in medicine: family practice, anesthesiology, radiology, dermatology – you name it! We have a shortage of anesthesiology providers in this country. CRNAs and anesthesiologists are both necessary to provide care to the growing demand; however, from what I’ve seen training alongside SRNAs and now occasionally supervising CRNAs, there’s an enormous difference in the knowledge base and procedural skills heavily skewed in favor of physicians. Obviously I’m biased, but there’s just no substitute for medical school and residency training. I tell residents that they are PHYSICIANS first, and THEN anesthesiologists emphasizing the need to utilize all aspects of pathophysiology, anatomy, histology, pharmacology, and clinical rotations from medical school when making important perioperative decisions. Additionally, there are so many potential extensions to being a physician anesthesiologist. I’ve decided to pursue two fellowships to become a cardiac anesthesiologist and intensivist. You won’t see CRNAs attending in the ICU nor will the overwhelming majority of them be doing complex cardiothoracic cases with intraoperative TEE.

      Again, there IS a need for CRNAs, but they are NOT equal to anesthesiologists and therefore not a replacement. I’ve worked alongside nurse anesthetists for years hand-in-hand as we both practice to the extent of our respective training paths. Although I’m still early in my career, I don’t have any regrets pursuing this field.

  30. Hi Dr. Rishi,

    I was wondering if it would be possible to shadow with you while you’re still in Houston? Most of my shadowing experience has been in pediatrics at TCH main and west campus in PEDS CVICU or adult congenital care but I would like to see the ICU from the adult perspective as well as any other aspect of healthcare available to me. Even if it is just for 1 day I would be appreciative of the offer. If there is a better way to contact you please let me know as well. Thanks for your time.

    • Hey Michelle! I actually leave Houston today and wasn’t doing any clinical time here (don’t even have a license to practice medicine in Texas yet!)

  31. Huda qaddah Reply

    Hi Dr.Rishi
    Do you have a youtube channel ?
    Can you give small lectures in Anesthesia
    Thank you

    • Hopefully in the next few months I’ll have something figured out regarding a YouTube channel.

  32. Hi Rishi,

    Just by coincidence I found your profile in Instagram and it makes me curious because right know I’m finishing my residence in anesthesiology and I really would like to continue with the fellowship in the cardiothoracic anesthesia, so I was wondering if you know if there is the possibility to make an internship in the Massachusetts general hospital as an exchange student or something like that because I’m living in Germany. I would be really thankful if you could give me some advice about it.

    Greetings

    Catalina

    • I actually have no idea! I’d imagine you’d have to apply as an IMG and, in a lot of cases, redo your residency in America after completing USMLE Steps 1, 2, and 3. 🙁

  33. Hi Rishi,

    I’m a new grad RN starting in the Coronary ICU. Any tips from a doctors standpoint on what you would like to see from the nurses. Also, do you have any books to suggest for me to read to help? Thanks!

    • Hey Bekah! I can’t speak for all doctors, but I always appreciate nurses who take the initiative in learning more about their patients. Have someone on a balloon pump? Learn about the device! See someone reading your patient’s chest x-ray? Ask them what they’re seeing. I know in the world of healthcare, teachers come in all forms (some better than others), but an individual’s desire to learn (and then teach others) speaks volumes about their character from my perspective. As far as books, unfortunately I can’t think of anything specifically for the CCU, but I read Vincent’s Critical Care for my ICU fellowship and there are plenty of chapters in there relevant to all units. Good luck and have fun! 🙂

  34. Karen Anderson Reply

    I am an NP with the CT Surgery group and there is the on-going, never-ending question of what BP to follow when titrating vasoactive medications, artline vs. NIBP vs. IABP (when it is present) and what measure to use, SBP vs. MAP. The surgeons have gotten into the habit of placing a femoral arterial sheath, telling the nurses to follow that pressure until the radial art line “correlates” with the femoral, then they can take out the femoral line and follow the radial art line. When I ask the nurses what value they look at to determine “correlation” they say SBP. I would just love to hear your take on this and recommendations for practice. Thanks!

    • Although clinical medicine and textbook medicine are often times different, it’s very important to consider WHERE an invasive arterial pressure is being measured and how that can potentially affect the systolic pressure, diastolic pressure, and mean arterial pressure. The more distal you go (dorsalis pedis > femoral > aortic), the higher the SBP and the lower the DBP. The MAP should remain relatively constant regardless of where the pressure is measured. To me, it doesn’t make sense to titrate vasodilators/pressors based on SBP since the location of the line can independently affect this number.

      I can understand why disciplines like neurosurgery and cardiac surgery like to go by SBP since this is the “highest pressure” that is felt by vessels, anastomoses, etc. However, I prefer looking at the MAP since this is an “average pressure” felt by different organs over time.

      Training in two large medical centers, I’ve come to realize that the tendency to follow MAP vs SBP is often times more cultural than anything. It’s well known that radial arterial lines sometimes dampen (especially post-bypass). In these instances, I ask the surgeons to place a femoral arterial line. Otherwise I think the practice of placing femoral arterial lines on EVERY patient is unsafe (the risk of retroperitoneal hematoma is a REAL threat).

      When comparing NIBP to invasive pressures, there’s always the tendency to go by the measurement that’s higher, lol. An IABP gives an aortic pressure and is helpful for calibrating the timing of ballon inflation/deflation, but I rather know the distal perfusion, so I prefer looking at the MAP off a femoral/radial arterial line.

      Sorry for this stream-of-consciousness reply! Hopefully it answers some of your questions!

  35. Hey Rishi, this is the second time I ask a question here, but congrats again on the excellent job you are doing spreading knowledge. My question is: Do you prefer opioids or an amide anesthetic such as Intravenous lidocaine for perioperative pain. If so, why? (I am doing sime research on the topic for med school)

    • Hey Sergio! While there’s a lot of hatred for opioids circulating in the media, they definitely have a role in perioperative pain management. In addition to other multimodal analgesic techniques (regional nerve blocks, NSAIDs when appropriate, gabapentinoids, NMDA receptor antagonists like ketamine), opioids often form the backbone for acute postoperative pain management. I use things like lidocaine and ketamine drips for patients with chronic pain since they have often become very tolerant of opioids.

  36. Hello, My name is Will and I am a 1st-year medical student interested in anesthesiology. I was wondering why you went on to do both critical care and cardiothoracic fellowship? What do you see as a benefit for doing both?

  37. Hi, Rishi,

    I am a certified Anesthesiologist in Europe and the last 9 years I worked in England. I thought many times about working in US and I do not know how the whole process works: do I need to go through the whole Residency there or is the alternate pathway still aplicable?

    Thanks,
    Emso

    • Hi Emso! I’m not sure what the entire process is, but I think you’ll need to pass all the United States Medical Licensing Exams (“Step” exams), and depending on the program, perhaps redo residency.

  38. Aamir Abbas Reply

    Dr. Kumar,

    I really enjoy your website and Instagram! I’m currently serving as a Navy flight surgeon and I’ll be starting my CA-1 year at BIDMC this summer. I’ve been practicing mostly primary care and aerospace medicine for the past 4 years and am worried about being overwhelmed with treating sick and complicated patients again in a few months. Which textbooks or topics do you recommend brushing up on before I get thrown back in the clinical “deep end?”

    Also do you have any recommendations for places to live in Boston? Thankfully I’ll be able to use my GI Bill for residency so I can budget $4k per month for housing. Thanks for the advice and maybe see you around Boston!

    • Thanks so much, Aamir! Congratulations! Here’s a post I wrote with tips for beginning anesthesia residency: link to post. On that page, you’ll also find a link for textbooks/question banks that I recommend.

      As far as places to live in Boston, I live in Back Bay on Massachusetts Avenue (really close to the MBTA train/subway). Its been a reliable and cheap way for me to get around Boston… plus there are lots of cool places within walking distance. Definitely take some time to look around since plenty of places will be within your budget!

  39. Siddhi Hegde Reply

    Hello sir. I’m a student in 4th year now. I have heard from my seniors that PG abroad is better than doing it in India. But I have no idea about which foreign exam is best for me like PLAB, USMLE or Australian entrance exam. Could you please let me know what is the best and easiest exam to attempt so that I can get MD Pediatrics abroad?

    • I’ve only taken the USMLE and don’t know anything about the other exams you mentioned. Not sure how to rank “best” and “easiest” since it’s the only one I have experience with.

  40. Hey Rishi!

    I absolutely love your instagram and the knowledge that you share. My mind is always blown! My question for you is, I am a nursing student getting ready to graduate in May 2019 and plan on going into critical care, what literature/podcasts could you recommend for me to use to expand my knowledge?

    Thanks,
    Tracy

    • Thanks for the kind words! I always recommend textbooks (ICU Book is a good start, I used Vincent’s critical care) and perusing popular journals (NEJM, JAMA, etc.)

  41. REEM Sabagh Reply

    Hi Rishi

    I saw your post regarding the Impella while I was searching for it. My father has heart disease and we were told he is a good candidate for it. However we are in part of the world where they don’t have it and we ha e go fly to Italy to do the PCI assisted by Impella. May I know your thoughts?

    Kind regards
    Reem

    • I don’t give medical advice over social media, but if his physicians thought he was a good candidate for it, high risk PCI is definitely an indication for Impella. I’ve seen it done more than once.

  42. Ben Robinson Reply

    Would you be willing to share your CV template? Obviously I’m a fan.

  43. Hi Rishi! I am not working in the medical field yet but your Instagram account is one of my favorites that I follow.

    I was wondering if you are at all familiar with epidemiologists or if it is possible to get a job as one without having any clinical experience. I originally majored in Elementary Education (long story how that happened, haha) and taught in China for a year. Since returning home I’ve taken Microbiology and A&P I and II while debating my next move. I’ve considered PA or RN as options, but epidemiology *sounds* like a field that has an investigative component that I would enjoy. However, I haven’t been able to find anyone in my area who I could shadow or talk to about the realities of trying to move in that direction. Online I’ve read that jobs are hard to come by if you have a Master’s but no clinical experience, and some people have suggested nursing as a precursor to an epidemiology career. Do you think it would be a waste to do an accelerated nursing program if my end goal is epidemiology or would working as an RN first be beneficial despite the extra time and money? It sounds like I might struggle to even get into a program with the current degree that I have.

    • Thanks so much for the kind words! I honestly don’t know anything about the path to epidemiology (how competitive it is, prerequisites, what traditional applicants look like, etc.), so I’m not fit to answer this question. I never think extra training is a waste, but as you referred to, the opportunity cost of time and money might be too much based on your life circumstances.

  44. Hi so I have noticed how you seem to be a tech savant, and I really really need to know, what is the best 3d anatomy or VR app for neuroanatomy/neurosurgery (if you don’t know maybe you could ask somebody for me) it would mean the world, because I am going crazy trying to find one. I have tried 3dmedical but it doesn’t have advanced anatomy parts, just the basics plus it doesn’t have slices.

    • Sorry to disappoint you, but I really don’t have any recommendations for that! I used Netter’s neuroanatomy throughout my training as a reference.

  45. Princess Rhenette Cedeño Reply

    What study tips you can advice for medical students? I am a Pharmacist, well soon to be cause’ i will be having board exam in Pharmacist on August 2019. And after that I have a plan to pursue medicine but I kinda scared because I don’t know what’s the first thing to do or what’s the first step. By the way, I’m from Philippines. Thank you.

  46. Ace Siddiqui Reply

    I am applying anesthesia this year, what do you think of the future of the specialty and CRNA autonomy?

  47. David Zander Reply

    Hello

    Just wanted to say hello and to let you know I find your IG and blog to a great resource. I am not an MD but I am very busy 911 pre hospital Paramedic and I Love it. I find you IG and bLog to be very interesting and motivating me to read and learn more about medicine ,
    anatomy and physiology and the human body. Thank you . Good patient care starts on the street. Not sure how much you know about Paramedics or our scope of practice, but if you would ever like to give a lecture about your passions and expertise . I could arrange that

    Dave

    • Thanks so much for the kind words, Dave! I’ve certainly had many colleagues who started their careers as paramedics, and their stories in the field are amazing! Kudos for everything that you do!

  48. sumbul kamran Reply

    Hello dr Rishi,
    Iam an Internationally trained anesthesiologist, currently residing in Canada.
    seeking any help in getting the fellowship. Any guidance will be highly appreciable.

    • There’s no special advice – have strong exam scores, recommendation letters, research experience, and personality traits.

  49. Hello Rishi,

    I recently stumbled on your IG and love the content so far. I am a perioperative nurse. I am starting school now working towards becoming a NP. I saw in a previous post you mentioned your experiences with DNP’s in (what it seemed) unfavorable manner. While I know there is a major difference in training and background, I am disappointed to hear that it seems you have had bad experiences in the past with NP’s? Please tell me more and your opinion of the NP profession. Personally, I hold 2 bachelors degrees, have high dedication for my patients and learning, and chose this path as a best fit for my lifestyle.

    • I’m sorry if it came off that way. During my training, I’ve worked with all kinds of healthcare providers including nurse practitioners, and my fundamental problem arises when individuals (a minority) try to exceed their scope of practice (whether they’re PAs, NPs, CRNAs, or even physicians!) I tend to get along with everyone, and those who I work with are all just as team-oriented as I am. It’s just when comparisons are constantly made to physicians in the media (ie, NPs are “just as good” as family practice physicians, CRNAs are “just as good” as anesthesiologists, etc.), I feel like face-palming because these individuals don’t understand that there IS a difference in training and background. We serve different but equally important roles.

      That being said, I commend you on your pursuit of higher training and for the dedication you’ve given to patient care! 🙂

  50. Marco Gunawan Reply

    Hey rishi.. im medical student from indonesia i want to ask.. Patofisiologi between post laparotomy surgery and infection of pulmonary ?..

    • Sorry I don’t completely understand your question. In general, big abdominal surgeries can affect a patient’s ability to have good pulmonary mechanics post-operatively. We need to focus on pulmonary recruitment (incentive spirometry, early ambulation, etc.) as well as adequate pain control.

  51. Hi Rishi! I know investment is a passion of yours. I don’t have anywhere near the earning potential of a physician, but I would like to dabble in ways to make my extra money work for me, and was wondering what your favorite resources are to learn the basics of investment. I know absolutely nothing!

    • Hey Alison! I get this question often, and unfortunately, I don’t have any earth-shattering advice since I learned how to invest through trial-and-error. I’ve always invested in companies that I actually know (ie, tech companies), and suggest that you look at companies you’re actually interested in as a consumer. Sorry I can’t give any specific resource recommendations!

  52. Hello.I come from iran .iam nurse.id like to go to America for working.can you help me ? Thank you very much

  53. Hi,

    I was wondering how were you able to register a two letters domain ?

    Thank you

  54. Hey, Any tips or guidance or any kind of rubric/template for writing a systemic review?

  55. Sonali Rao Reply

    Hey Rishi, hope you are well. Starting CVICU next month.. I was wondering if you could suggest any online material/handbook with focused reading?
    Thank you.
    Sonali

    • Nothing comes to mind – I just read textbooks (Vincent’s Critical Care).

      • Hi Rishi!

        In regards to critical care- Vincent’s book. Do you think there’s a big difference between the 5th (2011) and the 6th (2017 edition), because there’s one in price for sure ?!

        Thank you!

        • I have no idea since I’ve only read the most recent version. That being said, a lot of literature has emerged in critical care during that time gap (2011 to 2017), so the latest edition may have more of these updates incorporated into the content.

  56. Sonali Rao Reply

    Hey Rishi, as a CCM fellow I have a random question for you. Did your program enroll you in anesthesia CCM curriculum of any sort?
    Just curious, if yes, I could request My program to do the same.

    Thank you!!
    Best wishes,
    Sonali R

  57. Hi Dr Rishi,

    I think you are such a gem. Ive been wondering about your thoughts about physician suicide and if you had any ideas for prevention? Apparently anesthesiologists are right up there w surgeons…Thanks for sharing all of your great knowledge. You are truly appreciated.

      • This is such an important topic, and although there’s no way I can realistically think of to “prevent” physician suicide, there are definitely ways to help alleviate the triggers. Training programs offer confidential (and free) opportunities for counseling related to issues both in and out of the work space. So many efforts have also been poured into addressing the tremendous work load physicians must carry (duty hours, etc.) I think it’s important for us to also police our colleagues by recognizing signs of depression and feelings of being overwhelmed. I make myself available to anyone of my colleagues to discuss things, in privacy, when they need a sounding board.

  58. Daniel Pita Reply

    How do you approach patients with elevated blood pressure before anesthetic induction in the operating room? I am a cardiologist in Brazil, and I see some anesthesiologists cancel surgeries without any approach, even though it may only be a pseudocrisis, without signs of hypertensive emergency.

    • I think it comes down to personal preference. For me, it’s very unusual to cancel surgery unless the patient has an ongoing emergency (ie, hypertensive emergency). I stick with shorter acting agents (labetalol is a favorite). Most of the anesthetics we administer are myocardial depressants/vasodilators, so I keep that in mind too.

      • Hey hi…what if the patient has to be taken for a procedure say,lap cholecystectomy and the patient is elderly,k/c/o htn with elevated bp pre op.but 3D echo is normal??

        • Just depends on your comfort level and experience. Just like so many things in medicine, there’s often no clear cut answer.

  59. I feel like I would love some advice from you because I feel like I share your passion to provide the best care for a patient that I can. I am constantly torn between med school and a doctorate in nursing – always been drawn toward anesthesia. But I simply cannot find a satisfying answer. I want the general understanding of medicine that med school offers. But I am absolutely terrified of debt. The lifestyle doesn’t scare me, but I wonder sometimes if med school is worth it if I could be doing something similar in seemingly half the time with about 1/4 of the debt. Is it really as expensive as I feel it is?

    • As an attending who has worked with doctorates of nursing from multiple disciplines in various settings, I don’t think there’s much “similar” between the two as far as depth of understanding and clinical training. They’re both important professions but come from very different training backgrounds. For me, the decision was easy – make the sacrifices early in life to be the best trained I can possibly be as a future academician. In my opinion, that’s the physician route.

      • Ali Barbee Reply

        That is beautifully said, thank you.

        Side note: I’ve briefly heard on Instagram that you have spent some time interviewing (not sure if for med school or for residency spots). I’m curious how important it is to have volunteering experience and research time to be considered for med school. I have never gone to a school with research facilities and am not sure how to get that experience. Any insight?

        • With each passing year, more and more competitive applicants are making their way into the pool of prospective medical students. It’s important to distinguish yourself, and to SHOW admissions committees your activity (extracurriculars, scholarly, etc.) that attest to your commitment to medicine. Finding research requires a lot of work – calling, emailing, visiting hospitals and research facilities, looking for potential research jobs, etc.

  60. Hi!

    Love your accounts — super helpful and super interesting! Thanks for sharing your insight and information!

    I’m an anesthesia resident in a Canadian program and really curious what advice you have for studying for our AKT exams. I have the AKT 24 coming up in a few months and would love to know what qbanks/resources you used and any other advice you have.

    Thanks! Take care and bye for now!

  61. Sonali Rao Reply

    Hi Rishi, Hope you are doing well. Hats off to your perseverance and determination!!! Congratulations on finishing part 1 of dual fellowship.
    I just finished my Advanced Anesthesiology written boards and started CCM fellowship on August 1st. I am writing to you for your guidance.
    I would really appreciate if you could suggest me CCM related audiovisuals or websites or sources focused on current evidence.
    Do you have any tips/guide on organized concise problem focused ICU rounds?
    Looking forward to your reply.

    Best,
    Sonali

    • Hey Sonali! Thanks so much for the kind words! I used Vincent’s Textbook of Critical Care as my primary text in addition to articles from UpToDate. Throughout my fellowship, I used Mendeley as a reference manager for journal articles from JAMA, NEJM, Anesthesiology, Anesthesia & Analgesia, Journal of Critical Care, and our regular journal clubs to stay updated with landmark trials and the latest evidence-based practices. Other websites like Wiki Journal Club, Life in the Fast Lane and EMCrit were also useful.

      As far as focused ICU rounds, it just comes down to your style. Initially you’re trying to focus on every single issue, but the farther you get, the more you learn to delegate as you focus on the proverbial “forest through the trees.” You’ll get better with time! Just always remain cognizant of the BIG picture rather than getting caught up in every urine output and episode of hypertension.

      • Sonali Rao Reply

        Thank you so much, Rishi. I really really appreciate your effort to help us in spite of a crazy busy schedule.
        As far as reference manager is concerned, Any tips how to navigate Mendeley. Not so tech savvy…sorry!
        Best,
        Sonali

        • My pleasure! It’s mainly a drag-and-drop interface. I’d take PDF versions of journal articles, drop it into the interface, and Mendeley uses its algorithms to auto-populate the metadata (journal, volume, year, etc.) Take a look on YouTube for examples! 🙂

  62. Luzy sapnu Reply

    Dr. Rishi,
    Hi, after fulfillment ur dream as registered anesthesiologist.. Do you have plans to go on neuro surgeon? Someday?

  63. Hey Rishi,
    Starting my CA-2 year, and I got bit by the cardiac bug hard and so I’m researching potential fellowships.
    Few questions for you:
    1. What were the definite pro/cons of programs that you saw on the interview trail?
    2. What was the best resources for details on moonlighting, salary, and housing?
    3. Does a program specifically need to focus on TEE education for it’s graduates to pass the Advanced PTEeXAM, or will a run off the mill cardiac program provide enough experience for someone to do well?
    4. Do you feel as if having residents education as one of your responsibilities as a fellow is an undue burden?
    5. Any particularly awesome aspects of particular programs? Drop my a PM to my email if you have any insights.

    For reference these are the programs that have made my short list based on location:
    Cali: (Cedars-Sinai, University of Southern California, Stanford, UCSD, UCLA, UCDavis, UCSF)
    University of Colorado
    Emory
    Illinois ( NW, U ofChicago)
    Duke University Medical Center
    Oregon Health & Science University

    Thanks in Advance.

    Peace. Love. Propofol.

    Ben

    • 1.) How each program taught echocardiography was incredibly important for me, as was the ICU experience since I wanted to do both fellowships at the same institution. Outside of the program, the city was also important.
      2.) I asked the current fellows for this information.
      3.) I’m not sure – you’d want to target a program with a strong emphasis on TEE/TTE anyways. 🙂
      4.) Absolutely not a burden… especially for someone like me who thoroughly enjoys teaching. I want to do academics, so this is good practice!
      5.) I was honestly humbled by offers from several amazing programs, and all the ones you mentioned are great places! No matter where you go, there’s no substitute for self-driven study and taking the initiative.

  64. Hi Dr. Kumar/Rishi,

    So I was introduced to you by a friend, who told me that you put yourself through medical school on your investing acumen. Is this true? If so, do you have any tips for someone who might want to replicate your success?

    Your story resonates with me because my father also wanted to be a physician but was unable to, and I’ll be the first in my family (We’re indian so that’s uncommon, huh?) to be one. My parents are unable to pay for my way through, so I’m going to be incurring the full debt of med school. I have about 30K saved from undergrad scholarships, and am trying to self-educate on active and passive investment to see if I can cut the knees out from under ~250k worth of debt. Any advice you can offer would be much appreciated.

    • I got fairly luck with the stock market initially by investing in companies that took off. I don’t have any formal training in any of this, but as a rule, I only invest in companies I know (primarily tech giants like Apple, Microsoft, Intel, Google, etc.) I never got into cryptocurrency or foreign currencies, but the former seems to be a hot topic these days with all the “Bitcoin mining.” In general, the overwhelming majority of trainees will incur debt. I plan to “live like a resident” for several years after my training is complete to create a financial buffer for future endeavors, etc.

  65. Do you listen to music while studying? If so, what do you listen to?

    • I’m almost always listening to music of all varieties – top 40, old school hip hop, house, classical… pretty much everything except country. 😉

  66. Forgive me if this sort of questions appears too forward- I am simply curious. Are you single? Is it possible to have family life/settle down with a spouse while in such rigorous academic endeavors? I am currently a first year medical student and already sacrificing some relationships for my own success. I’m worried about being alone. What’s your advice/outlook on this? (I feel it is the thought in the back of the mind of many pre health/health individuals.)

    • I’ve had colleagues who were married coming into medical school and others who are still single in fellowship. The extent to which someone is willing to sacrifice their social life varies tremendously from person-to-person. Regardless of where you are on that spectrum, there WILL be some degree of missing out on important social events – this is just the reality of being a physician. Personally, I’ve never really needed social anything to motivate me or keep me happy as I get so much satisfaction and joy from my patients and caring for them. I knew this about me for a long time though, so look at this aspect of your life before selecting a residency.

  67. Do you have any advice or tips for the MMI process? I noticed your other post on interviews but it didn’t seem tailored to MMI. It’s quite nerve wracking and I was looking for some insight for my interview in a few weeks. Anything helps!

    • Hey Amelia! Unfortunately I have zero experience with MMI since it wasn’t used as widely when I was in your shoes. I’m sure you’ll do wonderful though!

  68. Your posts are amazing- they integrate so many subjects from biochem to physio and the clinical perspective is just the cherry on top. I started reading for entertainment, but then I got a question right on uworld because of one your posts and now I read for education. Thank you for doing this, your knowledge of the world of medicine really shines through. Also, you should do a post on the physio of inhaled anesthetics. I hear you talk about them a lot 🙂

    • Thanks so much! I love talking about anything and everything in medicine, regardless of organ system or speciality. 🙂 Volatile anesthetics remain a bit of a mystery, so I really don’t know what I’ll talk about specifically. 😉

  69. Hi rishi, I’m in the 4th year of medicine in Colombia, I had to rotate through anesthesiology this year and I started to like the specialization very much, but I’m not sure to specialize in this or in cardiology, do you have any advice or something that could help me decide if it is the specialization for me

    • I also loved cardiovascular physiology, so doing anesthesiology with an emphasis on adult cardiothoracic anesthesia (one of my fellowships) was a good fit for me. I didn’t want to go through an internal medicine residency since I preferred something more fast paced with a lot more procedures like anesthesiology.

  70. Any advice on how physicians can advocate for their patients? Especially is they are diagnosed with something with not much support such as EM-CFS.

    • Tough question to answer – I don’t think you would advocate any differently, but obviously you may be met with more challenges

  71. Aloha!! Hope you are doing great Rishi!
    Is there a usage preference different types of vasopressors & inotropes according to different type of shocks? Septic, cardio & so on… or just depending on Patient condition
    Thanks!

    • Hey Jay! So there is definitely evidence for certain pressors in certain situations (ie, norepinephrine as a first line in septic shock), but a lot of my pressor combinations (and weaning strategies) hinge on changes in the patient’s hemodynamics regardless of their underlying pathology. Monitors and bedside ultrasonography has significantly improved our ability to understand exactly what the patient needs at a given time.

  72. Hi Rishi!
    I have a question, why are consolidations normally seen on the right lung versus the left? Is it because of it’s anatomical structure? Also, why would a paraplegic individual that came back positive for K. Pneumonia from a sputum sample gradually start building interstitial markings on the right lobe over time. Could it be the bacteria that is causing that? Or perhaps the lack or movement from the patient? Aspiration? Thanks Rishi, i appreciate your time and effort in helping out!

    • Hey Emma! The pathway to the right lung is a little larger and more in-line with the main airway, so it’s a common site for aspiration. Interstitial markings related to a pneumonia could be from anything – the pneumonia itself, localized inflammation/fluid, and even atelectasis.

  73. Hi rishi, I recently started my internship in India, I want to go for USMLE. I have no idea how the preparation is done. Are the live virtual classes beneficial or live classes from home. How much is the maximum time for the perfect knowledge.? And which one is the best for opting for course, Becker or Kaplan?or if Thrz a chance that I can study by myself? Now I have to start my studies all over again. What r the resources that u suggest? Will u please tell what r the advantages nd disadvantages if I opt for slef study? And one more thing, did u take any coaching classes for USMLE?

    • Hi there! Haha, there’s no such thing as “perfect knowledge”, and everyone studies differently, so the amount of time they need will vary. To answer your question shortly, I have no idea what the “best” resources are since I didn’t do them all and, again, everyone studies differently. Here are the sources I used: link to article

  74. Rishi, I have loved following your instagram since I stumbled across it last year. I am a US IMG about to begin my PGY-1 preliminary surgery year in a great hospital and I would love to apply for an advanced (and/or categorical) position in anesthesiology for the following year. Full disclosure, I applied to ENT this year and unfortunately did not match. I love the OR culture and camaraderie and I loved my anesthesiology rotation. I think it would be an excellent alternative profession for me, but I am uncertain given my situation. I have strong letters of recommendation from attendings from my surgical Sub-I’s (in the US) and research mentors (in the US) and intend to get more letters during my prelim year. However, I have only done one anesthesiology rotation (honored), but no letters from an anesthesiologist. Do you have any recommendations on how I can best strengthen my application? Or is having no letters of recommendation from an anesthesiologist a dead end for me?

    Thank you so much for your advice and for teaching me so much via your instagram and website!

    • So in my (limited) experience with colleagues who were mainland US medical students who wanted to match to an advanced anesthesiology residency after completing intern year, it was often easier for them to match as internal candidates at the program where they were doing their intern year. That being said, doing well in your intern year and perhaps getting a letter from your internship’s program director (ie, usually a medicine or surgery attending) would be helpful. Obviously it’d be nice to have a letter from an anesthesiologist, but this might not be feasible given your circumstances.

      I would definitely contact the anesthesiology program director at the hospital where you’re doing your internship and see if he/she has any advice from applicants in the past.

  75. Hello Rishi. I am a last year med student from Italy and as you may not know we have to write a thesis that we have to present on graduation day. I am trying to write mine in anaesthesiology and I wanted to ask if you, as an expert, would consider these ideas as valuable topics for a potential experimental thesis, or if they’re completely off as far as applicability to real life anaesthesiology is concerned. Here they are:
    1. Dexemedetomidine + lidocaine infusion as a valuable non-opioid option for anaesthesia and post-op analgesia in IV drug abuse patients.
    2. Can (the same) opioid-free anaesthesia protocols help saving up on healthcare expenditure (shorter post-op ICU stays, lower cost of medications, etc.)?
    3. Could (the same) opioid-free anaesthesia protocols be a valuable strategy in fighting the opioid crisis?
    4. How does “extra-short term” ABX prophylaxis compare to normal prophylactic timing as far as SSIs are concerned?

    Thank you so much for your time!

    • Hi Lorenzo! All of those are great topics! I think #3 might take a long time because you’d somehow have to show the long-term effects of fighting an opioid crisis (which is hard to define in the first place). #1 and #2 are things we often do for the reasons you mentioned, but I always think it’s worth investigating further! Best wishes! 🙂

    • There are several routes – completing college, medical school, a residency (anesthesiology, internal medicine, emergency medicine, or surgery), and then fellowship training in critical care.

  76. Hey Rishi!

    Prem here, I’m a long-time reader of your blog, and if you remember, I am a TAMS grad @ UT. I will also be graduating in three years (this spring!) and taking a gap year before attending medical school. I’ve started confirming LoR’s with professors and other important supporters in my pre-med journey, and will be starting the personal statement process.

    As per your advice, I will be submitting it as early as humanly possible (MCAT on May 5), thus will have to wait till the June 14th. Anyways, I was wondering if you would consider reviewing my personal statement when I get to that step of the process. I know this is asking for a lot, and if you are simply too busy – I completely understand. However, from reading your blog and learning about your path to medicine, I feel that your perspective would be invaluable.

    If you’re open to potentially reading my personal statement, let me know! And if not, no problem – thank you for all your wisdom over these years!

  77. hello sir. m from India and m studying MBBS from China and I want to come u.s for higher studies n job. please guide me the procedure.

    • Hi Deeksha, unfortunately I don’t know much about this transition. You’re better off asking a colleague who has gone through this.

  78. Do you think scribing on the side would be a good idea? I work full time and go to school full time, I need pt care hours, my pt care isn’t really considered healthcare experience because its with animals. I don’t work in a small vx clinic, I work in an emergency facility most of our medicine is the same, pets also get some of the same illnesses we get. We see head traumas, intoxications, diabetes, DKAs, szeisures, and much more. Some, most of the medicine is the same. I have a work schedule of 6hr Mon, Wed, every other Thu, Sat and Sun are 12hr(15 in reality). Classes are Mon-Fri so it safe to say I dont have time to take a CRN or MA certification course?. But once I get a normal mon-thursday school scheduled I’m thinking of scribing on the side and use the knowledge I gain from observing while scribing and the knowledge from my type of medicine, to compare and constract. Patient care experice is the only thing that gives me anxiety, when I think about applying to PA school. From what I grasp from the few open houses I had went to, the experience is needed to help you through the program. Do you think that scribing on the side is a good idea? Would it work? Or should I work with what I have and just mention it on my personal statement? Would this make me stand out as an applicant?

    • I absolutely think you need clinical experience before pursuing PA school, nursing school, med school, or any other field that deals directly with patients. Although I never scribed in undergrad, MANY of my colleagues did and used it as an opportunity to read more about what they encountered. Interviewers and admissions committees want to see experiences which led you to your career path. Without having any clinical experience, it’ll be difficult to justify why you want to enter PA school. Just my two cents. 🙂

  79. Hi Rishi, I currently work in healthcare and have been considering applying for medical school. If I get in, I’ll be 30-32 by the time I start, putting me at 40+ by the time I finish Residency/fellowship and begin my career. I worry always about the age thing, about the financial repercussions of leaving a good paying job and postponing the opportunity to buy a home, save and invest, travel, etc until my 40s hit. I’m also single and a female and worry that if I follow this dream I’ll never get married or have a family. I love medicine and I love caring for patients, but I’m scared I will have regrets if I pursue my dream, but at the same time know I’ll regret not pursuing it… I’ve wanted to be a doctor since I was 16, and that desire has never really gone away. I was wondering if you had any advice. If you started this late in the game with the associates lifestyle/financial repurcussions would you still pursue medicine? Do you feel that squeezing in those life experiences along the way (relationship, kids, travel) is possible during medical school and residency?

    • I can’t give *personal* experience similar to your situation, but I had classmates in their 30s, 40s, and even 50s when starting medical school. Obviously you’ll be taking a huge time/financial hit for many years and have to sacrifice time outside of work to dedicate to your studies; however, I’ve had plenty of female colleagues over the years who had children, raised families, and somehow found a balance between work and life throughout their training. Definitely not easy, but it’s do-able with the right mindset and support system! If it truly is your dream, I say go for it! 🙂

  80. Hey Rishi.

    I am a 4th year medical student in Pakistan (medicine here is a 5 year program). I am still not sure what field should I pursue for my residency in, and I don’t have much time to decide. I am really worried, I just know I don’t wanna do surgery.

    • Consider something that’ll leave your options very open like internal medicine. You can always choose to subspecialize (fellowship training) later in your residency.

  81. Rahul Aggarwal Reply

    Hello Dr. Rishi, I was streaming the web about LVAD wires and somehow dropped by your website! My name is Rahul Aggarwal and I am a high schooler who sees himself pursuing a career in medicine. After noticing your credentials, I wanted to ask: how can I do lab research at a nearby university? I was told by Harvard faculty that I should focus on more public health research opportunities at nearby institutions, however, I wanted to satisfy myself with more hands-on work such as working with diseases, etc. In order to do this, should I make a research project of my own or should I apply to nearby universities? My friends came up with their own research ideas and went to universities through that venue. Anyways, I wanted to know more about research and would really appreciate it if you could reply with details. Also, if you could let me know how this would look on college applications, that would be even better.

    Thanks!

    • Hey Rahul! Thanks for the question!

      I’d definitely see which institutions your colleagues were able to land positions at. I think coming up with areas of interest, calling around and figuring out what kind of research opportunities are ongoing, and seeing if you can jump on with one of the projects would be the way to go. Once you’re actually in the research environment, it’s much easier to network and find other projects/faculty to join. Naturally, any kind of research experience (especially publications) will look great on college applications.

  82. I’m a new ICU nurse and cannot stop thinking about medical school. In undergrad, I majored in biology and earned mostly Bs and Cs in my science classes in part due to lack of motivation and in part due to extreme financial And familial hardship. When I went to earn my second bachelors in nursing school, I fared better while working full time as a CNA and graduated with a 3.7.

    I’m 26 now and the road to applying to medical school seems impossible since I’d have to retake so many of my classes. In your experience do you think AdComs would take me seriously? What do you think about older medical students (i would realistically be in my starting in early 30s if I were to matriculate) but nothing else (NP, CRNA, PA) seems quite right after the experience of working in critical care with an amazing CCS and CCA team.

    • I think you have a tremendous career and a lot of experience that goes with it! Trust me, I know plenty of people who started medical school in their 30s and 40s (even 50s). Because of your clinical background, you’ll have that experience to show WHY you wanted to pursue becoming a physician compared to someone fresh out of college who may have some shadowing experience but has never truly worked in the settings we have.

      It seems like you’ve already considered other fields in healthcare and remain steadfast with the physician route. I’d 100% say go for it! 🙂

  83. I’m a current ICU nurse, and I’m head over heels with critical care. As I contemplate advancing my education, I know that I want to stay close to the critical care field, but am having trouble deciding between CRNA/NP. My undergraduate grades were too low to ever get into medical school (though if I could turn back time, I would have reprioritized and worked harder for the option to be a physician) but was wondering if you could share your experience in working with critical care midlevel providers (NP/PA) and what their role looks like, as well as job growth potential. I’ve shadowed a few CRNAs, and it seems that their role is mostly confined to the OR as an anesthesia provider and less with following patients, managing them in the ICU, etc. Would greatly appreciate any insight you might have!

    • Because of my training path, I dabble in both the OR and ICU settings. You’re right about CRNAs being outside of the ICU regarding patient management in the unit itself. On the other hand, the critical care PAs I’ve worked with are tremendous and, at least where I’m doing my fellowships, will serve the role of a resident: doing notes, calling consults, presenting patients, placing orders, doing procedures, etc. I don’t really know about the job growth potential for any of the aforementioned professions, but from what I’ve gathered as a fellow, critical care jobs are always in demand. Best of luck in making your decision! 🙂

  84. Hello
    I’m Hilaria from Namibia I wanna study medicine where you studied.
    I’m a very hardworking lady.How can I apply to your university?

    • Hi Hilaria! I’m not sure what level of training you’re interesting in pursuing, but you’d apply the same way as everyone else – AMCAS for medical school, NRMP for residency.

  85. Hi! Just fyi- love love Your blog and IG, thank you for all the education and enthusiasm you bring to all professions of healthcare. I was wondering if you have any experience with nurses becoming physicians.

    I am currently an ICU Nurse in a busy academic center and cannot stop thinking about being a physician, specifically an anesthesiologist. Anyone you’ve worked with, went to school with, interviewed, etc? If you can off some insight to someone already in the medical field/non-traditional that wants to pursue medicine….. thank you!!!

    • I haven’t interviewed anyone specifically who was a nurse prior to applying for medical school; however, I’ve had several nurses express the same desire to me. I think your background in nursing will serve as an incredible cornerstone to your med school application in terms of clinical experience and knowing how a hospital works. Best of luck! 🙂

  86. Hey doc!
    Rebecca here.I’m a 3rd year med student.Your posts are very motivating and wonderful.You are a very good role model for med students like us and I hope I could be like you some day very inspirational and motivating,above all a good doctor!My question is…..
    Should a patient of vaso vagal attack of a very mild level take precautions especially when it is due to stress and such patients are they prone to develop other heart diseases in the future?Is ‘hereditary’ one of the causes for this condition?

    • Thanks Rebecca! I honestly don’t know that much about hereditary vasovagal syndromes, although a quick Google search does suggest a possible autosomal dominant inheritance pattern. If there’s a clear trigger (ie, stress), work on curtailing it through relaxation techniques. If the vasovagal episodes are truly non-cardiac in etiology, I don’t think they are prone to other heart diseases compared to the general population (but I’m speculating).

    • Thanks doc! Well,I will be reading more on it. The topic interests me a lot. It would be great if you could post on Vaso vagal attack some day though.

  87. Hi Rishi,

    You are an inspiration. I am currently doing my MD through a non traditional university. We have to find our own clinical placements and internship in Australia(that is where I live ). Do you have any tips or suggestions on working on being the ideal candidate? How can a medical student make their resume strong? . Thank you.

    • A strong application includes stellar entrance exam scores but also some diversity in the form of clinical experiences, research, recommendation letters, hobbies, etc. There’s really no such thing as an “ideal candidate” as it is our unique differences which make us appealing to medical schools. Thanks for the comment, Sheen!

  88. I am part of Michigan Med’s accelerated curriculum where we take shelf exams during our second year and then take the step 1 exam at the end of our core clinical year. Do you have any advice on how much time should be spent on clinical shelf studying vs step studying ? Are there any resources you would recommend as being highly advantageous for both?

    • At Baylor Med, we also had an interesting system where we basically did a year of clinical rotations (so many shelf exams) before actually taking USMLE Step 1. The shelf exams are centered around each clinical rotation whereas USMLE Step 1 tends to focus more on basic sciences, so I can’t think of any resources of the top of my head that would be beneficial for both simultaneously. That being said, the time you spend just depends on your comfort level with the material. USMLE Step 1 is undoubtedly the most important exam you’ll take in med school, so naturally, treat its preparation like a full time job.

  89. How did you keep yourself motivated and focused while studying medicine in school and preparing for the licensing exams later? I am a final year student. I really need some tips to focus and avoid procrastination.

    • My motivation throughout training has been keeping the patient as the center of my mission. Not shelf exams. Not boards. Not trying to impress anyone. The PATIENT. Train and study hard for those who cannot, because they’ll rely on your knowledge and skills one day.

  90. Hey Rishi, I’m starting a fellowship in Cardiothoracic Anesthesia and ICU and wondered whether you had any recommendations for a good ECHO text?

    • Hey Sherry! Congrats! I’m doing ICU first, but when I was a resident I dabbled in Perrino’s TEE text in preparation for CT anesthesiology. Where are you going to be training?

  91. Hey Rishi! Prem here (TAMS Grad, UT premed)

    I have a question regarding gap years. I am graduating in three years from college, but will be applying next Spring (my graduating semester), thus will be taking a gap year.

    I’d like to plan ahead so that I can use this gap year effectively for both professional and personal growth. That said, do you have any pointers on things you would have done if you were in my shoes?

    Thanks!
    Prem

    • Hey Prem! I was in a similar situation after graduating in three years and decided to teach MCAT courses during my gap year. After I received an acceptance from my #1 choice for med school, I spent the rest of the gap year just relaxing – probably the best decision I ever made! Pursue activities which require lots of time like traveling or learning a new trade. You won’t have any extended periods of time off in medical school (well, maybe as an MS4) but especially residency/fellowship, so use this time wisely. Do NOT try to study for med school in advance since you’ll have plenty of time to learn the material once you start. 🙂

  92. Hi Rishi, I’m currently a prelim in medicine and will be starting my CA1 year soon. So far I’ve read M&M, but I was wondering what resources you would recommend? Which books would you aim to get through in CA1? CA2? Which qbanks would you recommend? Love your blog, it has been a great resource!

    • Hey Dan! Great question. I’m glad that you’ve read through M&M, but as I’m sure you’ve heard, this is NOT a “textbook of anesthesiology” by any stretch. Our program gives a hard copy of Barash, but we have free access to “big Miller” through our library. I dabbled in both, and about halfway through my CA-1 year, switched exclusively to Miller. Towards the end of CA-2 year, I started reading Stoelting’s Anesthesia and Co-Existing Disease, and have more recently been reading Yao & Artusio’s Anesthesiology: Problem-Oriented Patient Management for oral boards. As far as question banks, honestly, do as many questions as possible. M5, Hall, ACE, TrueLearn, etc. are all excellent. You want to feel like you’ve “seen all the questions” before you start taking your ITEs.

      Best of luck man! CA-1 year is exhilarating! 🙂

  93. I’m a third year medical student interested in critical care. I’ve tried looking this up but it seems I’ll just have to ask someone who’s got first hand experience. How does the job of an anesthesiologist intensivist differ from that of an intensivist from an IM background? Are they essentially the same in terms of being able to lead an ICU? What advantages do you see yourself having in terms of critical care given that you are coming from the anesthesiology background?

    • Hey Sandip, this is an excellent question! The internal medicine background definitely confers knowledge of long term pulmonary conditions. After all, their fellowship is “PULMONARY and critical care” medicine (PCCM). When it comes to things like COPD, interstitial lung disease, cancers, sleep disorders, etc, my colleagues in internal medicine are certainly more experienced right off the bat. In contrast, I’ve spent my entire residency in anesthesiology in perioperative and acute care medicine. Managing ventilators, hemodynamics, massive resuscitation, trauma, and the like has become second nature in addition to various procedures (ultrasonography for nerve blocks, FAST, and cardiac exams, arterial/central line placement, intubations, etc.) Having gone through the fellowship interview process, I also appreciate the fact that my ICU fellowship class will include former surgery and EM residents. This blend of specialities allows us to learn a great deal from each other as we all become proficient intensivists in the year long fellowship.

      It’s not fair for me to compare the two tracks, since I’ll only have experience with one of them. At the end of the day, I know several people who chose IM residency to their “options remain open” with regards to fellowship choices (cardiology, PCCM, endocrine, GI, etc.) That’s a pretty good reason! 🙂

  94. Hey Rishi,

    A first year anesthesia resident here, and I am looking at potentially doing a combined fellowship in ACCM/ACTA. I know that specific programs like Penn, Stanford and Brigham and Women’s have an established 2 year track. My question is two fold, what resources did you use to find out which programs offered a combined program? And in cases where a combined program was not offered but the facility had both fellowships available how did you broach the topic of doing a combined fellowship with the institution?

    Thanks Again!

    • Hi there Ben! As inefficient as it seems, I honestly found the programs’ websites very helpful. Some of them alluded to combined fellowship tracks for interested applicants. For the programs which did not explicitly state they had these programs, I contacted the secretaries for one of the departments (in my case, critical care since that’s what I’m doing first) and inquired about the possibility of interviewing for both programs on the same day. Everyone was super nice about it. 🙂 Good luck man!

  95. Hey Rishi

    Do you ever believe Anesthesiologists will have trouble finding a job in the future with the increase amount of CRNAs practicing in this field.

    Do you know whether Baylor Medicine accept/discriminate to DO students. Step 1-235 I would like to attend Baylor for residency in the future.

    Do you believe research is needed to match into any anesthesia residencies.

    Thanks 🙂

    • Hi there!

      You refer to a growing concern among med school applicants considering anesthesiology. While there is a movement towards a team-based anesthesia care model (ie, perioperative surgical homes) where physician anesthesiologists, CRNAs, etc. have well defined roles, there are still many practices where anesthesiologists basically serve as supervisors for CRNA-run cases.

      I constantly remind more junior residents the importance of distinguishing ourselves as physician. Pursue additional enrichment (fellowships, research, etc.), read the “big textbooks”, ace the exams, and focus on becoming the most polished perioperative physician one could be.

      While research certainly helps, I think a strong clinical background, extracurricular experiences, and stellar test scores are just as important. I have a classmate who is a D.O., so BCM has definitely accepted applicants with osteopathic backgrounds in the past, but I’m not sure what kind of objective data (namely USMLE scores) the admissions committee faculty look for.

  96. Hey Rishi!!
    I’ve been rolling you blog for awhile now and I must say it’s extremely fascinating. I really like that fact that people like you share you experiences with the rest of us trying to get there. Nonetheless, I see that you will be in Boston for Fellowship… I will be attending MCPHS for my undergrad!!!! Hopefully we can connect!

    • Thanks for taking the time to reach out, Kenneth! Best of luck in undergrad, and indeed, I hope we can meet each other soon! 🙂 Stay in touch man!

  97. Hi Rishi!

    This is Prem – TAMS grad, and current UT student.

    I am graduating in three years (two more) and I know you went about HBU in a similar fashion.

    In regards to timing my medical school applications, I was wondering if I can contact you. My case is a bit unique in that next summer, I will not be able to dedicate to MCAT as I am biking across the country to raise money for MD Anderson.

    If you can provide a way for me to contact you, I would greatly appreciate it!

    Thanks for your continued support!
    Prem

  98. Hey,

    How long did you study for STEP 1? I hear a lot of people say not to start early so you don’t burn yourself out.
    And Hindsight being 20/20 do you have any other all around advice or tips for medical school? Things that you wish you would have done or things you wish you would have taken advantage of?

    • Hey AJ!

      I took roughly two months off but studied just under six weeks for USMLE Step 1. I used some time at the beginning and end of that two month stretch to unwind. 😀

      Many of my colleagues who spent more than 6-7 weeks studying for the exam felt that they peaked earlier than they anticipated and regretted waiting longer to take the exam. That being said, once you sit down to start studying, that’s your full-time job, and you should take it very seriously. To a large degree, this exam will determine your future career options.

      A few nonspecific tips I have about med school:
      – There’s plenty of time to study, so don’t try to get a “head start” for the next block or semester. Just be diligent every single day, but also learn to balance life with your studies.
      – Don’t be too serious. Med school is difficult but will also be some of the best years of your life. Take each day as it comes and be grateful for the opportunity. It’s a marathon, not a sprint.
      – ALWAYS remember what got you to this point in life. It’s those hobbies, people, and experiences which will continue keeping you sane.

      Other than that, hang on for the ride. It’s incredible. 🙂

  99. Gurbinder singh Reply

    Hello Rishi,

    I was offered Preliminary IM residency and I took it. can you guide me, what is process of finding PGY2 position in IM?

    Thank you!

    • Hi Gurbinder!

      Congrats on the prelim spot! You’ll need to either be offered an advanced spot for the rest of your residency at the program where you’re doing your preliminary, or apply through the ERAS system this coming application cycle for the rest of your internal medicine residency. I’d strongly recommend talking to your program director sooner than later to discuss this issue and options he/she might have to offer.

      Good luck! 🙂

  100. Hi Rishi,

    I am finishing up my second summer of undergrad research, with no publications, no posters, and no LOR (different labs)

    I feel like I need more experience to make it worthwhile, but I do not enjoy research as much as clinical opportunities because frankly, I’d rather be talking to people, not working with mice.

    That said, how many semesters of research did you pursue, and what did you get out of it (posters, publications, skills)

    Thanks!

    • Hey Ajay!

      I did a few months of research during undergrad (through opportunities within the science department), but overall found that I didn’t like many aspects of benchwork. I didn’t have any major publications as an applicant (only posters/presentations) but did gain valuable insight regarding the research process (IRB funding, ugh!), lab skills, etc. My med school application was very heavy in clinical experiences given my limited research.

      • Thank you for your reply!

        It seems that I like clinical work a lot more than bench work as well!

        I did hospital volunteering in high school, but my official “pre-med” clinical experience will start with a shadowing program at my school, where I will get 80 hours of shadowing in various specialties like pediatrics, general surgery, cardiothoracic surgery.

        I feel like I will need more to be more competitive.

        What kinds of clinical experiences did you enjoy?

        • I think my favorite experiences involved quality improvement. After you spend time shadowing and rotating around various places in the hospital (floors, EC, OR, etc.), you’ll begin to see areas which are in need of more efficient, streamlined processes to improve patient safety and reduce wasted expenses. 🙂

  101. hello?

    just wondering your thoughts on crna…

    i was dismissed from med school, then got a bsn at uth, 2 years icu after that, and now graduating from crna school. is this wrong?

    thank youl

    • My thoughts about CRNAs? To be brief, they’re important members of the anesthesia care team model, but they’re not a replacement for physicians in perioperative care. Plain and simple.

      We all have different career paths, so there’s nothing wrong with yours.

  102. Rishi,

    I understand the importance of the MCAT, and am determined to work effectively to prepare for the exam.

    I am going to start my preparation now, and am wondering what the optimal strategy is to prepare for the exam.

    I purchase the EK review books, and am thinking of reviewing the Biology book (subject I believe I am weakest in), and then progressing through all 7 books.

    However, I feel that this is a waste, as I may review too much and have it forgotten.

    any thoughts on your strategy?

    Thank you so much.

    Prem

    • Obviously everyone’s study habits vary significantly and the exam has changed considerably since my undergrad days, but I focused on fewer resources (just the EK books for me) and doing hundreds of practice questions. Literally any question book I could find, I tried to complete in its entirety. This included old MCAT exams.

      For this exam, there’s no such thing as “reviewing too much.” It’s important to maximize your efficiency, but that’s why I’d recommend a quick review of the EK books and then spending the majority of your time completing practice tests/questions. Really try to simulate the actual exam by taking the questions in blocks too. 🙂

  103. Hey Rishi!

    I’m planning on acquiring clinical exposure in terms of shadowing through a program offered at UT.
    I was wondering what kinds of clinical experience you gained at HBU, and anything unique I could look into.

    I am very interested in clinical exposure with Spanish speaking populations, and am also interested in medical technology.

    Thanks!

    • Hey Prem!

      At the time I was at HBU (2005-2008), the campus was much smaller than now. We didn’t have an organized way of providing students shadowing experiences, so they were left to find them on their own. Fortunately, the campus is walking distance from Southwest Memorial Hermann Hopspital, so I had some opportunities to work around the various departments (EC in particular). Additionally, a colleague of mine had found some opportunities at St. Joseph’s Hospital in downtown Houston to scrub into neurosurgeries.

      Wherever you go, it’s all about taking initiative making the phone calls/emails/visits to various hospitals to see if any faculty are willing to accept a pre-med. 🙂

      • Awesome, thanks for the guidance, Rishi. On another note, I am interested in rekindling my interest in technology from high school by pursuing mobile app development as a hobby. Did you have any experience with this and have any pointers on getting started?
        Thanks a ton

        • I’d first pick the platform you’re more comfortable with (namely Android or iOS). Android offers Android Studio and iOS is shifting more towards the Swift language set on Xcode. I’d go to a book store like Barnes and Noble to peruse different manuals about beginning a programming endeavor in one or both platforms. Find what kind of book layout you look, set up your programming environment, and have at it!

          I’ve also found that online forums are an incredible resource for code samples. Don’t rewrite code that’s already out there! 🙂

  104. Hello Rishi!

    I just found your profile through SDN, and wow, does it amaze me to finally find someone that is very similar in some aspects. I also trade stocks and manage my portfolio on a daily basis, I started at 18 and it’s an integral part of my life. I’ve amassed thousands of followers on social media platforms that I can teach by posting informative charts, in addition to managing my own LLC. Not only that, I self learned how to proficiently code Java and Swift (for iOS) and now make my own medical based apps. It’s so cool to see an inspirational figure like you. My first question: what or how is the best way to bring this up during med school interviews? I keep trying to think of ways to tell admissions committees what this all truly means to me and what I’ve learned but I just can’t figure it out!

    And secondly! I am about to apply to medical schools in TX through TMDSAS, and I may have hit a bit of a wall. My GPA is a 3.78, however, my first MCAT attempt was a 505 (28.5 equivalent) and then my second attempt was a 504 (28 equivalent). The odds are stacked against me at this point. Do you think I have a real shot at MD in TX? I have been very active with research and have a first author publication, with very strong LORs, one from the undergraduate department chair of chemistry whom I have gotten to know for 3 years personally, and another from a retired UTSW adcom member.

    Of course, I can’t type out everything on my CV because I know you’re a busy person! I just don’t know what to do, it really disheartens me to think my chances are so slim.

    • Sounds like we have a lot in common man! 🙂

      A lot has changed since I applied (especially the MCAT), but back then, an overall score of 30 was considered “competitive” in Texas. As you know, the pool of applicants becomes increasingly competitive each year and skews that average upward. You certainly only want to apply to med school at your absolute best because, statistically, it’s VERY difficult to get accepted the second time around. I’m going to be honest – if I were in your shoes, I might consider taking the MCAT a third time or apply to DO schools as well since you didn’t improve with your second attempt. Your application sounds really well rounded, but at the end of the day, numbers matter a lot. 🙁

      As far as conveying your other experiences, there are multiple ways to do so on the application and especially during the interview process. I often asked my interviewees what they like to do in their free time, or to tell me about a non-medical project or hobby that’s important to them. Don’t worry about that. Just focus on making your experience in technology and business the cornerstone of your application in terms of “unique traits” you can bring to a particular program.

  105. Hey Rishi!

    My name’s Matt, and I’m a third year Biochem major at UTD. From my talks with current med students, I get the impression that crafting a coherent application is critical – you need to have a “theme”.

    I’m guessing your theme was your interest in tech and IT and how it plays into medicine. My question is, I know I want to be a doctor, but I want to discover what area of healthcare I want to fit into. You pride yourself as a techie, with that skillset. What kinds of activities did you list on your app to reflect this character you have attained?

    Thank you!

    • Hey Matt!

      Although I listed programming, certifications, code contributions, and freelance projects on my CV, the tech thing is primarily just a hobby. Whenever the topic came up during medschool, residency, or fellowship interviews, I enjoyed talking about how I envision technology to advance medical education, bedside teaching, and patient safety.

      The cornerstone of my application was my experience in business. I rarely talk about my stock portfolio or small business ventures on this blog, but they were instrumental in teaching me people skills, leadership, delegating tasks, identifying the strengths of individuals, and dealing with all the logistical aspects of entrepreneurship from an early age.

      You are absolutely correct in having a theme to your application. It’ll keep your interview focused and remind the admissions committee about what uniquely qualifies you as a candidate to their program. Best of luck man! 🙂

      • Thanks for the speedy reply Rishi!

        A theme I’m trying to follow is the entrepreneurial spirit, I’m working on organizing a community health project using mobile Health pedometers and curriculum to teach people how to be healthy.

        The eventual problem I run into is how will this look to Adcoms? It’s something im interested in pursuing, but im afraid I may be listed as “not devoted” to the practice of medicine if I portray myself as a health_tech innovator

        • Quite the contrary! I’d argue that it shows your desire to stray from the mainstream application (good GPA/MCAT, some shadowing, etc.) Do it! 🙂

  106. Hey Rishi,

    I am a junior at HBU, with a solid GPA, but I have not inmersed myself in premedical opportunities yet. I was wondering what clinical/research/ leadership you recommend.

    • I’d definitely try to get involved ASAP. Back when I was a student (~8 years ago), I was heavily involved with Alpha Epsilon Delta, Alpha Phi Omega, the South Asian Student Association, and several honorary membership societies. I did some Welch scholar research through the chemistry department over the summer and shadowed between Southwest Memorial Hermann (next to HBU) and St. Joseph’s Hospital (downtown).

      I’m sure the opportunities have significantly changed, but having served on the med school admissions committee at Baylor Med, I know that extracurriculars are super important. Your numbers (GPA/MCAT) will land you the interviews, but your face-to-face conversations will revolve around things you’ve done in your undergrad career.

      I can’t tell you the number of times I sought guidance from the wonderful COSM faculty. They were paramount in steering me towards my goals. Stay focused and get involved in anything you can!

  107. Hey Rishi,

    Should I write a love letter to Baylor saying they’re my number 1 choice for anesthesiology? I’m thinking that it’s kinda late being that it’s February and programs have probably decided their rank list already…

  108. Hi Rishi,

    I’m an MS4 who is currently applying to anesthesiology with intentions of doing critical care/cardiothoracic fellowships. It’s weird reading your blog because often it seems like you’re writing down my thoughts.

    Anyways, I was wondering what your thoughts are on Interventional Radiology? I just recently discovered it and it seems like a field that occupies a novel intersection between technology and medicine and allows for many of the more direct life-saving interventions (e.g. pelvic embolization, GI stenting) that anesthesiology generally lacks. I was wondering if you ever considered the field and what your thought process was if you did.

    Thanks,
    John

    • Hey John! Thanks for the comment! Glad to know I’m not the only crazy one out there pursuing this dual fellowship thing. 😉

      Interventional radiology was always fascinating to me for the reasons you mentioned, but I’d argue that anesthesia (especially critical care and cardiovascular) incorporates a great deal of technology through emerging standards in monitoring (TTE, TEE, hemodynamic monitors, evoked potentials, etc) and patient safety. Combine that with the acute care aspect and incredible pathophysiology/pharmacology we must know… and that solidified my decision to pursue anesthesia. 🙂

  109. Hey Rishi,

    Now that I’ve taken Ochem 1, Physics, Bio, Chem, and Psych/Soc, I’m going to start studying for the MCAT.

    What sources do you recommend for beginning to self study the content?

    Do you recommend starting with a conceptual overview of all the subjects, then take practice testS?

    • Hey Nathan! Although the MCAT has changed since I took it, I strongly recommend Examkracker’s manuals. They strike a balance between being concise yet comprehensive. Take preparatory courses (Kaplan, Princeton Review, etc.) if you do better in a more structured environment. The most important part in studying for this exam is doing tons of practice questions. There’s no substitute for this. And make sure you read all of the explanations (even for the questions you answer correctly).

      Best of luck man! 🙂

      • Thank you Rishi, I will look into EK 🙂

        Did you start with a general content review of all subjects, ie, reading the material again? Or did u start directly hitting problems and assessing your weaknesses from there?

        • I went through each manual once, then started doing practice questions, and then went back through each manual as many times as I could while doing 50-100 practice questions each day… until I couldn’t take it anymore. 😉

  110. Hi Rishi! this may be random but I seen you crossing the street from TCH going towards the O’Quinn medical towers. I wanted to say hi but I didn’t want to catch you off guard lol.

  111. Good afternoon Rishi!
    I just wanted to say that I would hope to be a cool anesthesiologist like you when I cross the undergraduate bridge. What made you want to specialize in anesthesia? And do you think that it’s too early for me to say what I want to specialize in (anesthesia)even though i’m an undergrad?

    • Hey Alexia!! I wrote a post a while back outlining why I wanted to pursue anesthesiology: link to post

      It’s never too early to have something in mind, but it’s also important to understand that people change their minds in medicine all the time. I came into med school wanted to do neurosurgery, and between undergrad and the basic science portion of med school, that’s all I tailored my extracurriculars and research for. It wasn’t until the very end of third year that I discovered anesthesiology and saw the proverbial light. 😉

      I’ll be publishing a post in the coming day highlighting how my perception of anesthesiology has changed since my undergrad days. Stay tuned! 🙂

  112. Good Evening Rishi!
    I am a student at Houston Community College, and I just declared that I wanted to become a doctor. I was doubting. myself because I was starting from a community college. I know that it’ll be a long road ahead of me but I am very determined to become a doctor. Have you came across any doctors that attended a community college? Any advice?

    • Hey Jasmine!

      Thanks for the comment! Although I don’t know anyone off the top of my head who went to a community college, I went to a small undergraduate college but had wonderful faculty mentors who pushed me to succeed. I participated in many leadership activities, research, opportunities to immerse myself in the healthcare environment, and did well academically (GPA/MCAT are incredibly important). The MCAT sort of standardizes things since everyone takes the same exam regardless of your undergrad. For this reason, I’d say it’ll be one of the most important things to focus on as you begin your journey.

      The road is long and filled with many exits. Stay focused and let your desire to serve your future patients guide you! Best wishes! 🙂

  113. Hi Rishi,

    Thank you for this wonderful blog. As an IMG, I would like to get into Anesthesiology residency. I would like to ask you what would be your recommendations for me ? Are there any advices or tricks to catch the attention of program directors as an IMG ? Would you advise me to send an email to every program director ?

    Thank you so much

    • Hi there!

      I’d say my recommendations are the same for any applicant. I wrote a post a while back outlining tips for the application process.

      After each interview, I would send an email to the program director describing what you liked about the program and how you think you would be a good fit.

      Best of luck! 🙂

  114. Hey Rishi!

    This is Prem, TAMS grad currently finishing up undergrad @ UT Austin. I am starting a blog to journal my pre-med journey and this new experience I will be a part of:

    I recently was accepted into an organization on campus, the LIVESTRONG Texas 4000 for Cancer team. I will be biking from Austin to Alaska to raise money for cancer research. I’d like to blog my preparation and the stories of cancer patients I’ll hear as I volunteer, train, and fundraise towards the disease.

    I was wondering what platform you suggest blogging with and any other words of wisdom.

    Thank you Rishi, and keep up the good work on RK.md!

    -Prem

    • Without a doubt, WordPress. My advice for new bloggers is to blog about what matters to you. You don’t need to make formal essays out of all your posts. Have a voice and let your personality show.

      That being said, blogging is becoming an invaluable way for employers, your colleagues, and the general public to find you online. Be careful about controversial issues, and especially in our case, about compromising patient confidentiality (HIPAA). If you have even the slightest doubt that someone may be rubbed the wrong way, don’t publish it.

      Have fun and be sure to share your blog URL. I’d love to read it! 🙂

  115. Kabir Shah Reply

    Hey RK,

    BCM is a dream school of mine. I’ve got a good undergrad GPA, the general set of good ECs, and am currently a senior completing a honors thesis. I’ll apply in May 2016 for entry into 2017, so I will have a gap year which I currently plan to spend doing research in the TMC.

    However, my biggest weakness is my MCAT. I scored a 26 the first time and the equivalent of a 28 on the new MCAT recently. Do you have any suggestions for me? If I take it again and score well, do I still have a shot at BCM?

    • While it’s sad how important your GPA and MCAT are for consideration to med school, it’s just the reality of things… and I don’t think it’s going away anytime soon. 🙁

      I’ve always advised pre-meds to apply only at their best, so if you can afford it, I personally would retake the MCAT again after seeing where your pitfalls were with the first two exams. Was it the same section that hurt you? Was it an issue of finishing the questions in time?

      Yes, BCM has definitely accepted applicants with MCATs less than 30, but it just seems too risky (this applies for all Texas medical schools) given how competitive the applicant pool is becoming.

      • It was the new psych/soc section that hurt me. I scored the equivalent of a 12 in PS, a 8-9 in VR, and ~10 in BS. But the psych score brought me down and hurt me. So I do feel that retaking with an improved psych score would increase the overall score. But would having the three attempts hold me back at a place like BCM? I’ve got an excellent GPA and ECs otherwise. It’s just the MCAT thats holding me back

        • That’s a tough call. I retook it twice because of a low verbal score and because I thought the MCAT really was that important. Come to find out… it is. If you think about it, GPAs can vary so much depending on the institution. The MCAT, on the other hand, is much more standardized. In my opinion, having a good score on the MCAT matters more than a good GPA (although both are important).

          If I were in your shoes, I’d take it again with the focus of completely destroying it and leaving no red flags in your application. I think as long as you’re making progress with each attempt, it isn’t necessarily a huge problem.

  116. Hey Rishi,

    I’m a current Bio major at UT Austin & I have the opportunity to switch to Public Health, which it a new, interesting major here. In terms of medical school/MCAT preparation, should I make the change to public health? Will it be advantageous?

    Thanks!

    • The advantages to being a science major are obvious – exposure to some of the topics you’ll cover in medical school as well as fulfilling a lot of the med school prerequisites while simultaneously fulfilling your degree course requirements. However, with the way medicine is heading, I certainly think public health will become an even more important issue.

      At the end of the day, people from all backgrounds (social sciences, arts, sports, biological sciences, theology, etc.) can do well in medical school. It’s just an issue of being dedicated. 🙂

      Best of luck man! Stay in touch and thanks for the question!

  117. Rishi,

    Are you using Exparel off label for nerve block or do you have to wait for FDA approval? Also, what do you think the odds are of FDA approval? Thanks,

    Jonathan

  118. Hey Rishi,

    My name is Shawn, and I am a current premed at UTD. From my volunteer experiences in the hospital and health situations of my family, I have become more and more interested and working as a physician to fight obesity. I know this is a tall task, but this field, which I presume is public health, is in dire need. I was wondering if you could suggest any organizations or internships that are related to my interest. Also, in an admissions point of view, when I interview for med school and focus on my application, would it hurt me by stating my interest in public health and work towards making America healthier?

    • Hey Shawn!

      That’s a great cause, but off the top of my head, I’m not familiar with any special interest groups aimed at combating obesity. 🙁 Ask around, find people doing research on obesity, or just ask people who deal with it every day (bariatric surgeons, primary care docs, etc.).

      Definitely mention it in your med school application and interview; however, place the emphasis on HOW you want to make America healthier (no easy task, as you alluded to). It’ll be a good way to show the admissions committee how you’ve thought about the challenges and current situation facing American healthcare.

  119. Hey Rishi,

    How many semesters of research did you pursue in Undergrad, and did you present any posters, or publications?

    What is more valued at UTSW/ Baylor for MD, a heavy clinical applicant or a research heavy applicant?

    • I had a few ongoing research projects spanning several semesters in undergrad (poster presentation worthy), but never went as far as publishing anything. My sincere interests were and continue to remain in clinical medicine, so the majority of my extracurriculars were focused on unique shadowing and enrichment experiences.

      Obviously if you’re going for an MD/PhD track, research is going to be a cornerstone for your application. The majority of MD-only applicants I interviewed had some sort of balance between clinical and research experiences. I wouldn’t say one is more valued than another – just depends on your career goals and how meaningful these experiences were. Focus on achieving stellar numbers (GPA and MCAT), good recommendation letters, and meaningful extracurriculars (research, clinical, leadership, etc.)

      Thanks for the comment, Steven! 🙂

  120. Hey Rishi,

    Prem, TAMS graduate here. I’m closing in my start to UT Austin and had a few questions regarding my transition into the premed curiculuum.

    With my TAMS credits, I’ll be taking 15 hours first semester classes:
    Ochem, Genetics, Poetry, Sociology, and Medical Terminology.

    In the past for my Bio, Chem, and Physics pre-med classes, I usually supplemented my learning with a “For Dummies” book. Now that I’m taking Ochem, I think i should prepare for the MCAT ochem portion while taking the class. Do you recommend any resources for going through Ochem with the MCAT in mind?

    Thanks,
    Prem

    • Before I even finished reading your comment, I was already thinking about the ExamKrackers books. Its been quite some time since I took the MCAT, but they do a great job of having easy-to-read manuals for each subject. You’re obviously going to learn a lot more in your organic chemistry course than you’ll need to know for the MCAT, but you’ll at least know which topics are “high yield” (SN1, E1, basic mechanisms, functional groups, etc.)

      • Thanks Rishi, will definitely look into EK for Ochem.

        Also, since you’ve spent time on medical school adcom, I figured I’d ask you this:

        My courses for first year @ UT are:
        Ochem, Genetics, Poetry, Intro Sociology, and Medical Terminology.

        However, the sociology prof I am signed up for has a bad rap for assigning too much readings and making tests cover the most minute of details, unlike most other intro classes.
        I am considering dropping the sociology and simply taking 12 hours of Ochem, Genetics, Poetry, & Med Term.

        However, I am afraid that this would look unfavorable to admissions because it seems like I am not “challenging myself” by taking 12 hours. In reality, I am new to UT, Austin, and Ochem so I want to devote my main academic time on Ochem and Genetics. Also, sociology is a course I can easily take in CC, it is not mandatory to take it and stress out unneccessarily.

        What do you recommend? Is 12 hours my first semester a good idea? What would you do?

        Thanks as always. (and sorry for the long post)

        • I went to a school that was based on a quarter system (instead of semester), so semester hours are difficult for me to gauge. That being said, taking “challenging” courses is always something health professions advisors encourage mentees to pursue.

          I’ve interviewed applicants from countless undergrads across the country which offered all sorts of courses. How am I supposed to know which ones are more challenging than others? Honestly, it was the GPA (science and overall) which mattered more for most people.

  121. Hey Rishi,

    I’m a rising pre-med Sophomore at UT Austin. I have made a 4.0 GPA at UT my first year completing the majority of my premed reqs besides ochem, biochem, and genetics. Despite my high GPA, I have had no extracurricular experiences during my first year besides a summer research position the summer before college. I KNOW that I need to step up my extracurricular game in order to be a competitive applicant. However, I do not enjoy research. I will do it because it will get me into med school, but I see no career for me out of it. I enjoy volunteering and will be doing that. However, I feel that I will be a cookie-cutter applicant in the end if I dont pursue those “wow actitivities”

    I was wondering any experiences you suggest that will help me in my medical journey.

    My hopeful list during my college years is:

    Study Abroad in Europe
    -continuing my interest in running marathons and weight lifting.
    -Maybe starting app dev ( I dabbled in windows phone development in hs but don’t know if it is worth it as a pre-med. But it was FUN)Mission Trip
    -Research for one more summer
    -Setting up a non profit summer program in my home city for underprivileged students in DISD

    Any feedback?

    • Honestly, research is not an absolute “must” for medical school if you have a significant amount of clinical experience. The amount of research on my application was meager at best, but my clinical experiences in terms of shadowing, doing health-related workshops, med-tech projects, leadership, and just promoting the health professions likely made up for it. To this day, I consider myself to be 95% clinical and 5% research. 😀

      I can’t stress this enough – the MCAT will be incredibly important. Keep that GPA high and ace the MCAT, and you should have a great shot (even if you feel like you have a “cookie cutter” application). Also, why don’t you take some time to reflect on why you want to go to medical school and start drafting a personal statement? It’s never too early, and it’ll undergo many revisions before you submit it. Start early! 🙂

      Clearly you’re off to a great start. Get involved in extracurricular programs on campus, work with colleagues to find shadowing/research opportunities, and just enjoy your time in undergrad! Keep up the great work man!

  122. Hello Rishi!
    I’m getting ready to start college, and because of the amazing opportunities that my high school offered, I will be starting as a college sophomore. I’m going to embark on a career in medicine, and I’m very excited to get started.
    I’m aware of the types of grades that I need to make to get into medical school. However, a couple of grades that transferred from the dual enrollment institutions are not so great (passing grades, just not in the eyes of a medical school). I spoke with my advisor about them to see if I should retake them, and he told me that he thought that I should wait to retake them after hearing what my pre-med advisor says about them. I took these classes when I was in the 10th grade, so it certainly doesn’t show how dedicated I am now about pursuing medicine. What would you do if you were in my shoes?

    • Hi Erin!

      First of all, congratulations on finishing high school and getting ready to embark on the next chapter of your education. I was in a similar situation having accrued enough AP credits in high school to start college as a second semester sophomore but have little knowledge regarding dual-enrollment courses. My biggest concern is how “passes” will affect your college GPA. Obviously you’re aware of the importance of numbers (namely the MCAT and GPA) when it comes to applying to med school, but depending on how well you do with the rest of your college courses, it may or may not be worth the extra cost to retake those courses.

      You’re going to end up finishing college early, so you have less time to get involved with clinical shadowing, research, and extracurriculars. Jump on any opportunities as soon as you can!

      Best wishes. Let me know if there’s anything else I can assist with! 🙂

  123. Hey Rishi,

    Whats your opinion on the Deandre Jordan fiasco? Do you think he was in the wrong? As a Mavs fan for over 15 years, this is complete heartbreak.

    -Prem

    • No comment! All I can say is that the Mavericks have been jipped BIG TIME in the last year between Rondo and Deandre, lol.

  124. Where did you get the furniture to your apartment and how much is your rent apartment??

    • I got most of my furniture from Ava Furniture. My rent is roughly $2200 a month, but I’m in the process of downsizing in the same complex to something a little less pricey.

  125. Hey Rishi!

    I recently graduated the TAMS program, and will be an entering sophomore at UT Austin. I plan on graduating college in 3 years (similiar to what you did at HBU) as a Bio Major. Regarding pre-med activities, do you recommend conducting research during the school year (10 hrs/wk) or during the summer (40 hrs/wk). Also, when do you recommend studying for MCAT? I am straight out of high school, but I will only be at university for 3 years, thus I know you were on a simliar path, and would like to know you insights.

    Thank you!
    -Prem

    • Hi Prem!

      Congrats on graduating from TAMS! 🙂

      Your goal of graduating from college in 3 years will likely mean a lot of summer classes and full course loads during the regular semesters. That being said, try to find research projects early (talk to seniors as well as professors in the bio/chem departments), so you can contribute throughout your time at UT Austin. Hours don’t matter as much as quality involvement.

      For the MCAT, don’t worry about it during your first year. Get adjusted to the college dynamic by pursuing extracurriculars and ensuring your GPA remains strong. A lot has changed with the MCAT since I took it, but I’d imagine that starting to study for it after you take some basic general chemistry, organic chemistry, physics, and biochemistry courses will be prudent. Personally, I used ExamKrackers and did whatever question banks I could get my hands on with great results! Take the exam well before you apply, so you get a score back and have the opportunity to retake the exam without delaying your application.

      In hindsight, graduating early from both high school and college was extremely challenging (just a logistical nightmare, especially for high school), but it kept me driven and focused on the goal of becoming a physician.

      Best of luck bro. Keep in touch! 🙂

  126. What is the future of anesthesiologist? as more crnas are coming into the field

    • This is obviously a hot topic among prospective anesthesia providers, but in my experience thus far as a resident, the future looks bright for both careers. In the majority of states, anesthesiologists still supervise CRNA cases. There are no good studies showing that CRNAs provide equal levels of care to physician anesthesiologists across all patient groups, so many fellowship trained physicians are still preferred in niche specialties (cardiovascular, pediatrics, obstetric, chronic pain, regional) as well as supervisors of CRNA elective cases in academic centers. Additionally, many of the seniors who are graduating and going straight into the work force are joining physician-only groups without any difficulty.

      I train at a residency program which also has a top notch CRNA program – our relationship with the nurse anesthetists is remarkably good, and I feel like we implicitly know our roles in the grand scheme of things. As with the rest of healthcare, who knows what the landscape will look like in the coming years?

  127. Accepted.com runs an interview series (http://blog.accepted.com/tag/med-student-blogger/) with med school applicants, students, and residents in which we feature your blog and talk about some of the successes and challenges you are facing (or have faced) your experience so far. We’d love to feature you and your blog. Are you available to answer 6-7 questions via email? Can you please email me at rebeccab@accepted.com? Thanks!

  128. Hey Rishi!

    I am a junior at the University of Houston, and am wondering what the best way to get a job shadowing experience is. I just moved to town, so I have a small network of contacts here. I’ve spoken to most of the people I know, and they don’t know anyone in the medical field. I also read some blogs on the internet, and cold calling people seems like it not be the best idea. What is the best way, in your opinion, to secure a job shadowing in the field of my interest (pediatrics)? Thank you!

    • Hey Heli! Welcome to town!

      Since you’re already a junior, I’d get in contact with counselors or health professions advisors at the university and ask for recommendations based on what routes successful alumni took during their undergrad careers. U of H is a huge campus, so I’m sure the professors have connections with physicians and/or hospitals in some manner.

      In reality, calling the human resources department at various hospitals might also not be a bad idea. At least you can say you did your due diligence in pursuing shadowing experiences.

      Since you’re interested in pediatrics, I’d start with Texas Children’s Hospital and Children’s Memorial Hermann Hospital. Don’t be disappointed by rejection… it’s expected! Just move on and keep looking!

  129. In your professional opinion, does the college that you attend for undergraduate studies make a difference when it comes to applying/being considered for medical school? The college that I am going to is on the smaller side, not TOO well known, but I can’t see myself anywhere else. I’m just worried that the collegiate decision that I’ve made now will hurt me in the future.

    • Great question, Erin! In my senior year of high school, I turned down an acceptance from MIT to attend a very small school in my hometown. In retrospect, this was one of the most difficult decisions I’ve made in my life; however, it was also one of the best. I was able to make the most of my experience, do very well in my coursework and MCAT, and accumulate virtually no debt due to scholarships.

      My advice is go where you’re happy, excel in difficult courses, get involved with extracurriculars, and destroy the MCAT! When I interviewed med school applicants, their undergrad had ZERO influence on what I thought of them. Make the most of the opportunities your college presents you with. 🙂

  130. Hi i am currently a student at university of houston. Im doing Pre-med i was wondering what is your take on taking some science classes at community college? And how bad will it effect my chances to get into medical school?

    • Hey Jack! Thanks for the inquiry.

      In general, you want to convey the strength of your academic ability to med school admissions committees. If they see you taking many pre-requisite science classes at a community college (typically “easier”) just to get better grades, that will definitely be a red flag. I took a lot of summer classes at my undergrad to knock out credits to graduate earlier, and I know a few others who did that at Houston Community College for enrichment and since classes were often times cheaper. I’d say that these reasons are more inclined to show your dedication towards academics.

      No matter what people say, numbers (namely your GPA and MCAT) really matter! Take classes which show your scholastic ability and will prepare you well! Own the MCAT!

      GO COOGS! 😀

  131. Hey Rishi – I am going to be a Biology major/pre-med student this fall in a university. And my end result is to become an anesthesiologist!(But thats for another story). My main question is that because I’m not that smart(I have decent grades but I had a really low SAT score) and I probably won’t have a good shot at medical school, do you have advice for achieving good grades as a pre-med and any suggestions? Are there any mistakes you made in pre-med that I can benefit from(sorry if that sounds mean!), just like any things you would’ve changed? Thanks Rishi.

    • Hey Jason! Sorry for the delayed response!

      Undergrad is your chance to start over and establish your mindset for the coming years of rigorous pre-med and medical training. Really spend some time and focus on where your weaknesses were in high school. Did you procrastinate? Did you spend too much time doing recreational activities? Did you just not prepare enough?

      There’s no guaranteed way of success in terms of achieving good grades as this is highly dependent on the individual. Personally, I studied a little each day and really ramped up before exams with good outcomes. A lot of sacrifices have to be made, of course. I can’t tell you the number of times I turned down invites to dinners or get togethers just so I could focus on studying. In retrospect, my undergrad experience was exceptional, and I made a lot of good friends at the student and faculty level which only helped me become a competitive applicant.

      With that said, I may have not had the typical “college experience” going to a small, primarily commuter undergrad; however, the curriculum helped me tailor my knowledge base, graduate in three years, get involved in extracurriculars, and have no significant regrets along the way! 🙂

    • Hi Amit!

      Honestly, I’ve never really been interested in private practice (of course I say that now as a resident, lol). I LOVE teaching and can only foresee myself in academics working with medical students and residents. At the same time, I know I want to do a fellowship, but I’ve been bouncing around between so many options!! Hopefully the next few months will bring more clarity.

  132. Hi Rishi,

    My name is Alex and I’m a rising freshman at UT-Dallas. I am currently registered as a premed Biology major, but am looking to change majors. I am looking to change because I believe that medicine is more than science. I want to major in something that gives me practical knowledge that will help me as a doctor. I was wondering what your $.02 are on majors.

    I know that “what you major in doesn’t matter” but I want to know, if you had to choose again, what would’ve helped you the most.

    My options thus far:
    Psychology/Sociology: understanding people, in clinical settings
    Econ: private practice
    Biology with BA in Healthcare Administration: UTD has this cool option. Don’t know how useful it would be though.

    • Hey Alex, I was actually reflecting on this not too long ago. At the time, my college made undergraduates select two majors. I chose chemistry and biochemistry molecular biology (BCMB) as both really nurtured my analytical thinking skills in the context of my future medical career; however, since grade school, I’ve always had a deeply rooted passion for physics and mathematics. In retrospect, neither would have really helped in med school, but I would have enjoyed expanding my mind in areas which I won’t get to necessarily visit as a physician.

      My advice is simple – major in what interests you and take difficult courses. Don’t try to pursue things with the intent of preparing yourself for med school. There’s PLENTY of time to learn the med school material, and as far as the social/business aspects of medicine, many of my classmates took electives and/or dual degrees (MD/MPH, MD/MBA) for the extra enrichment.

      Some of the most interesting applicants I’ve interviewed had studied the fine arts, mathematics, social studies, etc in college.

      That being said, keep up the great work and always have your goal in mind. 🙂

  133. Suhas Joshi Reply

    Dear Rishi,

    Greetings….!

    We are interested to offer Online Short Study to current Medical Students of your organization so if you can forward us the details of the current students in Xl format so we can contact them for the online short surveys.They will be paid very good “Honorarium” as soon as they finish the online study.

    Full Name :
    Contact No:
    E-mail address:
    Which Year Students:

    With Warm regards,
    Suhas Joshi

    • Hi Suhas! One of my tenets on this website is to strictly avoid all commercial activity. Thanks for your consideration though!

  134. Hi Rishi,
    My name is Prem. I am a TAMS Senior and avid reader of your blog. Deciding which college to attend is very stressful, and has major implications on my future as a doctor. I was hoping you give some guidance:
    ***I am deciding between a full ride @ UT-Dallas, no aid A&M, or no aid UT
    I know that UT-D is the best choice financially, and as a Dallas native, close to home.
    However I feel that part of growing as an individual is also not found at UTD. I am an introvert and hope to break out of that shell in college, but feel the social life at UTD will not benefit me and actually worsen me off for med school. The last thing I want is to go to med school with no real friendships.

    In a sense I prefer smaller class sizes, but am at a tough decision for my future growth as a person.

    If you were in my shoes, what decision would you make?
    Thank you
    -Prem

    • Hey Prem!

      I was in a very similar situation going into college, but opted to attend Houston Baptist University (HBU) in my hometown. It’s well reputed for its pre-med program, and between living at home and scholarships, I saved a TON of money. I’d highly recommend attending UT Dallas and saving all that money with your full ride – this will make you incredibly happy down the road.

      As far as the social aspect of college, it’s really what you make of it. HBU was mainly a commuter campus, but I had an incredible experience between my extracurricular activities and roles of leadership. Going to college anywhere is already a chance to sort of start a “clean slate” and break free, so save money while you can, stay on top of your studies, ace the MCAT, make friends, and enjoy the journey! 🙂

  135. Cousy you write a post about you study plan for the basics?

    Have you used trulearn vs m5? Thoughts?

  136. Hey Rishi, as I plan for my activities this upcoming year I have a couple of questions:

    1) as a pre-med how did you get involved in education and meded? I LOVE helping other people about the process of becoming a doctor, and hope to eventually sit in a admissions comittee like you. What activities can I pursue that help me gain this activity. Other than teaching or supplemental instruction.

    • Hi Jason!

      As a pre-med, it’s pretty hard to really be a good mentor to anyone since you yourself are still trying to get into medical school; however, I took up opportunities to teach wherever I could (namely by serving as a tutor and lab teacher’s assistant). Once you’re in med school, ask the admissions committee deans how a current student can actively get involved with admissions. Some schools are better about this than others, so it’s better to ask well in advance to not miss an opportunity!

      Another thing my undergrad did for recruitment was periodically having “open houses” for potential pre-med applicants and their families. I served as an ambassador for our department and shared my experiences with the coursework, research, and extracurriculars essential to become a competitive applicant. 🙂

  137. Hi Rishi,

    I read your post about taking step 3 before residency. Were you able to sign up and take it in the limited time between graduation and residency orientation? I have about 4 weeks between graduation and residency and was wondering if that’s enough time to be able to sign up and find an open date to take it.

    • Hi there! Unfortunately, by the time I got my registration token, the only available dates to take Step 3 were after starting my intern year (which sort of defeated the purpose of taking it early). I ended up taking it towards the end of my intern year.

      In retrospect, this was a totally unnecessary pursuit, and I shouldn’t have wasted so much of my last summer break studying for this exam. 🙁

  138. Great stuff Rishi. I have an medical admissions related question. Most med schools want different “crafts or niches” of applicants. They may want the next Nobel laureate in medicine or the next surgeon general. They want you to be the best applicant for you goal in medicine. That said, how did you craft your application into a niche and what was your goal as a physician?

    • I tried to make my experiences with business and technology the cornerstone of my application – their harmony with medicine provides me with insight and innovative thinking. The further I’ve gone into my training, the more I’ve encountered instances in which having a “tech-savvy” background benefits me, my patients, and my future practice in anesthesiology.

      Currently, my ultimate goal after residency is pursuing a fellowship and staying at a large, tertiary academic center to teach residents and medical students. This may obviously change in the coming years, but I think I’ll be the happiest in an environment of teaching. 🙂

    • Absolutely! Possibly two. If you asked me in med school, I would’ve said pediatric critical care. Now I’m considering pain too. Cardiovascular is neat as well. Too many choices, but dead set on doing at least one fellowship after residency.

  139. Did you find barash easier read than miller?

    How did you get better at PIVs? Everyone expects anesthesiologist to be the best but I have minimal experience with place IVs. I feel I’m more likely to place a central line.

    • It depends on the chapter – some of the chapters in Miller are unquestionably better (neurophysiology comes to mind). It also depends on how you like your textbooks structured, so personally preference plays into it. Just read parts of both and see which one you like better for a given topic.

      PIV skills are just like anything else in anesthesiology – mastery comes with experience. I was horrible at first (my arterial line skills were WAY better), but I’ve improved considerably with more practice. That being said, there are definitely patients who have difficult peripheral access for various reasons (obesity, collagen vascular disease, etc.), so that’s when our skills with ultrasound-guided IV placement come in handy. 🙂

  140. AKTs count at my program. What’s the best way to prepare for it since you’ve been through 0,1,and 6 now.

    • Doing lots of practice questions (Hall, ACE questions, M5 Review) after having a decent foundation (reading M&M). Even if the scores count, it’s gotta be scaled to other people at the same level in their training. Thanks for the comments!

  141. When you started CA1 year, why did you decide on barash as your main text? Is there a reason you didn’t pick miller or MM? Trying to pick one to go with.

    • Our didactic series has references to Barash chapters – plus it’s considered one of the “Bibles” of clinical anesthesiology. The further I got into CA1 year, the more I began to appreciate Miller as well as a reference text. I read M&M during intern year as a good primer for CA1 year. I honestly think it gave me a great yet incomplete knowledge foundation which Barash/Miller have rounded out.

  142. Hey Rishi, nice website makeover! Are you using a WordPress theme or anything of that sort, or is this just you HTML/CSS skills at work?
    Cheers,
    Arun

    • Thanks Arun! I’m using a version of the Sahifa theme which I’ve heavily modified. Don’t have time to make themes completely from scratch anymore! =(

  143. I want to start start a wiki. I was running one for my fellow residents but unfortunately the host is shutting down the service. To avoid this happening again I wanted to actually go about hosting the service page myself. Any suggestions on how to go about signing up for a domain, getting a server, running wikimedia on it, etc? Inexpensive at this time is a plus.

    • Hey Gabe! What kind of traffic volume was the Wiki receiving? If you look into any of the large shared hosting companies (iPage, Bluehost, Hostgator, Justhost, etc.), all of them offer some form of easy installation for a Wiki page. They all also offer domain name registration too, so you can get your domain and hosting through the same company. Personally, I’ve been using Bluehost for the last 5+ years without many issues (but it comes at a price of about $10 per month).

      I’d be more than happy to help you get the site on its feet – send me more information using the contact form (click “Contact” in the navigation bar).

    • Great question, Jin! I honestly didn’t directly include it, but I talked about my interests which have stemmed from blogging and web development (namely programming). I know some people include their domains on their official CVs (which I do too), but I excluded it from my AMCAS/TMDSAS.

      Interestingly enough, some of my interviewers had “found” me online prior to my interview. It was a great way to break the ice and open up discussion.

        • The concept of intellectual, social-media based conversation. I was blogging before Facebook and Twitter, so that interest just carried over to other platforms. I’ve connected with countless other people in and out of healthcare discussing topics ranging from med school admissions and politics to abortion and the death penalty. Bouncing ideas off each other is always a great thing. =)

  144. Hello Rishi,

    I am a current senior in high school, and am contemplating starting a blog like yours to serve as an outlet for my thoughts on medicine. How helpful was your blog to your professional development and when did rk.md start?

    • Hey Ayush! I’d say go for it! Keeping a journal is a wonderful way to reflect on your own life while sharing experiences with others who might be interested in similar life journeys. I’ve had the privilege of meeting countless healthcare professionals, students, and even been offered job opportunities because of my site. Plus, it allowed me to grow my knowledge of web programming. =)

      I started blogging back in 2005 (wow, 10 years ago!) and changed my blog topics as I started undergrad, medical school, and most recently my residency training.

      Good luck with your blogging endeavors! Be sure to drop your link once you get situated. Let me know if you need any help!

      • Thanks for your thoughtful insight Rishi.

        I am going to start my blog soon. When you started out, what ideas did you try to reflect on? I am considering writing about my methods of productivity, studying, and premed things. Also my interest in my Dallas sports teams

        • I wrote about my coursework and special interests (namely technology) interspersed with thoughts on headline news throughout the years and anything else which crossed my mind. That’s the best part about blogging – it’s your journal and your own voice. Some posts will be purely for self-reflection. Others will be useful for many others.

          My only word of caution – be careful when your express your opinions on highly controversial topics or discuss issues which are even remotely a violation of privacy. When you hit the “publish” button, make sure the content is something your closest friends and mentors would approve of. If you start your blog with this sort of mindset, it’ll save you countless troubles in the long run.

  145. Hey Rishi, weird question, but what do you do at
    RK Creations LLC?
    And do you suggest as an undergrad premed to learn how to code? I did Compsci in high school and don’t know if it is worth continuing.

    • Hey Lucy, the LLC is basically an umbrella for several small business ventures my family has undertaken. My brother and I are managers for it. =)

      As far as coding, I think computer proficiency is undoubtedly becoming increasingly important in our digitized society. Knowing the basics of coding will give you a foot in the door to a growing number of jobs in the booming tech sector! Plus it’s a valuable skill in any field. I can’t tell you how many times being the “tech support guy” has helped me have a niche among social circles, haha.

      Thanks for the comment!

  146. Rishi, I remember coming across your blog before med school and thought it was pretty helpful and neat. I’m now an MS4 going into anesthesia and had a couple of q’s for you if you had the time. Not sure if this is the right place to ask them so if I can contact you via email, let me know. Thanks!

  147. Hey Rishi. .Any suggestions for AKT 6? Was it similar in subject content to AKT 1?

    • Didn’t take the AKT-1, but our didactic series really helped prepare us for the AKT-6 (high yield chapters from Barash) supplemented with sections from Miller (it has an excellent neurophysiology chapter). I feel like most people read through M&M for a foundation and did questions (Hall, ACE, etc.).

  148. Hi Rishi!
    My name is Anand, and I am a 4th year Bio major at U of H. I am taking a gap year to apply to med school and am starting to write a “resume or application” to narrow down my experiences. Do you mind sharing a sample of a premed resume so I (and many other students) have a taste of what to include, not to include, what I should fit in before my application, etc.
    I would really appreciate it!
    -Anand

  149. Hi Rishi!! I’ve been following your blog for a long time now and was recently accepted to BCM 🙂 I’ve heard that there’s a diagnostic exam around time school starts, is it something I should study a bit for? Also, do you suggest brushing up on certain topics? I graduate this May and have a light course load so wanted to make some solid use of my extra time (besides watching tv shows LOL).

    • Congrats on your acceptance and making the EXCELLENT decision to matriculate to BCM! =)

      If this “diagnostic exam” is the one I’m thinking of, it’s given a few weeks into the first block and covers the lectures you learned to that point. Under no circumstances should you spend the next few months trying to prepare for this exam (it’s a DIAGNOSTIC, first of all).

      One thing you’ll quickly learn in med school is that yeah, there’s a lot of information to learn… but you have plenty of time to learn it! By studying in advance, you’ll likely cover topics in an inefficient manner. Trust in BCM’s curriculum and enjoy your time before med school! I really can’t stress this enough!

      Hope you have a great start to the new year, and thank you for your readership! =)

  150. Hi Rishi,

    For a premed who’s taking their MCAT exam in 3 weeks, what advice and tips would you give?
    Thanks!

    • Three weeks is still plenty of time to review material! Hopefully by now you’ve taken some practice tests – spend this time reviewing the topics which you struggled with the most. Definitely review all the relevant chemistry/physics equations and do some verbal passages every day to stay focused. The key for me was doing hundreds upon hundreds of practice questions.

      I’ve found very little new information is learned in the last 2-3 days before an exam. You already know how important the MCAT is, so instead of being nervous, be confident and mentally focused on the task at hand!

      Good luck and have a happy new year! DESTROY THE MCAT! =D

      • Thanks so much, Rishi! So my concern is that I’m only at a 20 on 3 practice tests. There’s time to learn and improve on the areas that I’m weak in (like physics, o chem), which is what I plan to do. Have you heard anything about the new 2015 MCAT? It is my backup plan if I take the current test and get a not-so-good score, or if I’m not prepared by 2 more weeks. Happy New Year!

        • So one of the caveats to my previous comment – take the MCAT only once, and when you’re fully prepared for it. It’s an expensive and exhausting exam which should not need to be repeated (and risk a lower score). Med schools do note how many times you’ve taken the exam and your score trend. Have you thought about postponing the exam and continuing your preparation?

          I honestly don’t know anything about the new 2015 MCAT besides the addition of a social and behavioral sciences section, so I won’t comment on it, haha.

  151. Hi Rishi,

    I am a MS3 that just finished OB, Pediatrics, and FM and am currently on Medicine right now. I’ve been getting great feedback about my clinical performance but I’m feeling a bit discouraged because my shelf scores have dragged down my grades and I’ve gotten 3 Passes so far. My rotations are graded on a scale of Fail, Pass, High Pass, and Honors.
    Do you have any input on clerkship grades and how much weight “passes” are on the competitiveness of my anesthesiology applications? I’m worried that I am just not competitive enough.
    And given my grades, what do you think is the best time for me to take my Step 2 CK?

    Thank you so much for any advice that you have!!

    • Hey Laura!

      I feel like the overwhelming majority of clinical medical students receive positive feedback from residents/attendings and are evaluated similarly, so the only grounds for stratifying “honors” from “fail” is, unfortunately, the shelf exam… no matter how small of a percentage it counts towards your grade for a given rotation.

      That being said, I think many will agree that USMLE Step 1 is a fair assessment of the basic sciences, while your core rotation grades and Step 2 CK reflect your clinical science knowledge. Doing well with the remainder of your rotations will become increasingly important as too many “passes” will be red flags on your residency application. Furthermore, I’d advise taking Step 2 CK (and having a score) prior to residency applications. You’ll have to take it before graduating medical school anyways, so use it to your advantage! Maybe August of your MS4 year?

      While there’s no magic formula for getting into residency, you want to minimize the amount of red flags you raise with an admissions committee. Focus on your shelf exams and study harder than ever before. Doing tons of questions helped me more than any review book, but everyone is different. =)

      Trust me, I know shelf exams are difficult and it’s discouraging after a great rotation with wonderful feedback from everyone to only “pass”, but this is just how it goes. Fix what isn’t working, seek advice from your classmates who have already completed the rotations and did well, and always keep your career goal as a motivating factor. Knock that medicine shelf out of the park!! =D

  152. Hey Rishi, thanks for your awesome website! I love it. I don’t know if you’ve already answered this somewhere, but I’m wondering since you’re a very tech savvy guy, why you chose anesthesiology over something else like radiology? Just curious, but either way keep up the good work dude! 🙂

    • Hey Patrick!

      This is a question I receive all the time… even from anesthesiology attendings! Truth be told, radiology (specifically interventional radiology) was something near the top of my list of potential career paths during the clinical years of med school. I’m fascinated by the physics and mathematics of imaging modalities like PET and MRI, and the prospect of being able to work from anywhere by remotely accessing PACS databases and whatnot. Yeah, that’s pretty cool. =D

      In the end, it really was the application of physiology, pharmacology, and procedural skills in an acute setting (the operating room) which drew me to anesthesiology. While we may not get reputation of “high tech” compared to radiologists, there really are a number of neat gadgets we routinely utilize in the operating room which I get to tinker with. No regrets at all about pursuing this field!

      Hope you have a great new year, and thanks for the comment!

  153. Have you ever encountered bullying by surgeons in the OR? If you have, how do you deal with that? That’s one thing that scares me about becoming anesthesiologist and why I don’t like surgery! But anesthesiology seems so cool so maybe I shouldn’t be so worried about interacting with surgeons.

    • Fortunately, most of the surgeons I’ve worked with have been extremely cordial in dealing with their residents/fellows and other operating room staff (anesthesia residents, scrub techs, circulators, etc.) From time to time, I’ll be in a room with someone who, to be politically correct, woke up on the wrong side of the bed. You’ll quickly learn how to deal with these personalities… especially as an early trainee where you’re making tons of minor mistakes and are relatively slow in turning over rooms.

      My advice is simple – people who go into anesthesiology should have a short memory. Take constructive criticism and leave the rest… placing patient safety ahead of anything else. I’ve never had a surgeon chastise anything I do in pursuit of improving safety. Don’t take anything personally. Use it to enhance your skills!

      Also, to address the last part of your comment, interacting with surgeons is an absolute MUST to be a good anesthesiologist. We need to work in tandem throughout the case and even more so when things go awry. I’ll routinely ask surgeons how things are looking in the field and if they’re in agreement with administering certain medications. This helps tailor your anesthetic accordingly.

      Any healthcare provider should leave their ego at home and come to work with patient safety at the forefront of their goals. Sometimes this isn’t the case, but you learn to deal with it – the more competent (and confident) you become, the more surgeons will trust you.

      • It seems to me a lot of the older surgeons are more like curmudgeons, but the current or younger generation of surgeons are more respectful and less given over to the uglier sides of what we are used to seeing in surgeons. Do you find this is true in your place too?

        • To a large degree, this is certainly true! Some of the “older surgeons” are extremely friendly too! 🙂

  154. Hey Dr.Kumar,
    So I recently finished my first semester of MS1 a couple days ago. It turns out I didn’t do as well as I planned and it looks like I’m going to have to step it up for next semester. I’m just a little depressed because I feel like I worked so hard and didn’t accomplish much. Do you have any advice or tips that you can share or is there anything that you can relate my situation too?
    Thanks,
    George

    • Congrats on finishing your first semester! Much of it was undoubtedly spent learning how to learn from the often cited “fire hose” of medical knowledge!

      I completely understand where you’re coming from – I often felt like I was under-performing on exams relative to the amount of effort I spent studying. In the first few weeks, I tried so many different approaches to studying, and what ultimately worked for me was ignoring the associated lecture slides and actually LISTENING. I would either attend lectures or stream them at 2.5x the speed without having the PowerPoint open. Instead, I hand wrote notes as the lecturer gave his or her presentation.

      Writing is a much more active process than simply reading, so I felt more engaged with the material. I was able to retain things much easier and had a general “feel” for what certain lecturers considered important teaching points (high yield exam questions!)

      Above all else – please understand the magnitude of your accomplishment! It’s only your first semester of med school. It’s completely normal to feel this way. Enjoy your time off and hit the next semester hard!

  155. BigBalling Reply

    What are your views on the future of anesthesiology ie CRNA vs anesthesiologists?

    • This is definitely a hot topic among current and future trainees. In fact, a quick Google search for “anesthesiologist vs crna” shows the top two entries already comparing the quality of care provided by each provider. Training in a residency program which also has a top-notch CRNA training program has allowed me to work with student nurse anesthetists (SRNAs) for the last six months; I’ve never encountered any friction with them or the experienced CRNAs working at our VA hospital. Maybe it’s just my juvenile, happy-go-lucky CA-1 mentality? 😉

      I’ve rarely heard patients strike a comparison between physician anesthesiologists and nurse anesthetists. They probably don’t know the difference… or don’t even care. We could debate all day about the merits of our respective training paths, but at the end of the day, roughly 30% of the states have already opted out of the law mandating physician supervision for CRNAs. This permits them to practice independently. Sounds scary for job security, no?

      With the emerging “perioperative surgical home” (PSH) model of care, perhaps our roles will become more defined? We’re still forced to deal with a group which is constantly lobbying for more autonomy. Texas happens to be a strong advocate of physician anesthesiologists, and our political action committee is well-supported at the state and national levels, so nurse anesthetist lobbying efforts have been countered thus far.

      To directly address your question, I think the future of anesthesiology is strong for both groups. Physicians are pursuing fellowships to occupy specialized niches; however, a large number of graduating residents are also being employed by “MD only” practices. The reality is CRNAs are going no where. Oh, and if you want autonomy, go to medical school and complete a residency.

      Sorry for the disorganized response – I might write a much more comprehensive opinion in the future.

  156. Hello, im really impressed doing my homework in your page. I wanna to ask you, if you know about the preparation for the steps for the exams. Im IMG and i love also tech, so i wonder if you know something interesting.

    • Hi Cato! Thanks for the comment! If you’re interested about preparing for the USMLE exams, check out some of my posts: link here.

      If you’re looking for a structured preparation program, some of my classmates used Pathoma and Doctors In Training with great success!

  157. Hey Rishi, great post! My name is Arun, and I am a senior at high school at Clements (Houston). I am interested in staying instate for premed coursework and am looking at either UT Austin or HBU. I was wondering how the social life is at HBU. Did u live on campus? How were the research opportunities? I know UT has plethora of research opportunities and social life with the indian student organizations; but I am seriously considering HBU, because I think I can get good recommendations and develop more in a small achool

    • Hey Arun!

      When I was an undergrad at HBU, it was primarily a “commuter campus” with the majority of students living 10-20 miles away – I had a lot of friends who lived in the Sugar Land area. Despite the distance, we still managed to have a lot of active organizations dealing with pre-health, service, and culture. I wasn’t a huge researcher by any means, but a few of my close friends would make the short commute to the Texas Medical Center to take part in projects at Texas Children’s, MD Anderson, or Baylor Med.

      By virtue of HBU being such a small campus, we grew close to our professors, and they always put forth excellent recommendations for applicants. In retrospect, being sort of a shy guy, I feel like HBU’s size was much more conducive to providing me with a learning environment I could grow in.

      Speaking of growth, the campus has since grown significantly and now offers multiple housing facilities on site. Unfortunately I don’t know the details nor how this has affected the student-to-teacher ratio, but I’d surmise it’s still an excellent institution with continued success in placing applicants in health-related professions.

  158. Hi Rishi,

    I was wondering what activities you pursued outside of school that

    1) made toy more informed of current state of medicine
    2) interested you (hobbies)
    3) gained leadership skills

    Thank you!

    Ravi

    • Hey Ravi!

      1.) I talked to my classmates and professors about issues in medicine. It’s always interesting to learn the perspectives of others as they will help sculpt your own outlook on certain issues. National news has recently become a joke by instilling unsubstantiated hysteria and fear about ebola to the masses; however, there are a lot of good YouTube videos outlining the Affordable Care Act and healthcare at large.

      2.) I’ve been a tech geek forever but became more interested in investing over the last decade. Most of my free time is spent programming or watching the public market sectors.

      3.) Most of my “on paper” leadership skills were gained in undergrad and med school by leading extracurricular organizations or spearheading new initiatives. Learning how to maximally utilize your resources and delegate tasks to your colleagues are invaluable skills, but the most important lesson I learned is to “begin with the end in mind” (a la Stephen Covey’s novel).

      • Speaking of being a tech geek, do you have any recommendations for a med student who wants a good tablet to read books on (e.g., pdfs) and also take notes on? I know everyone picks the iPad but the iPad is so expensive and I’m not sure Apple is that much better than Android? I was hoping for something around $250-$350. But maybe it would be best to get an iPad since they’re so popular and people seem to use Notability and it looks nice? But I’m hoping for other options. Thanks Rishi! 🙂

        • Personally, I’ve not been able to hang on to Apple mobile products for very long. iOS is simply way too closed off for me. In fact, I wrote an entire post outlining why I exchanged my iPad Air for an NVIDIA Shield, a decision I’m incredibly happy I made. The Shield Tablet is much cheaper, has expandable storage, and is getting very frequent updates (it’s already slated to receive the latest version of Android only weeks after its release).

          I’d recommend checking out the Nexus 9 or NVIDIA Shield, but honestly, most people will find the array of note-taking/PDF apps on iOS to be more suitable for their needs. If you’re going to get an iPad, Apple usually has Black Friday deals, so wait till then!

  159. Hey Dr. Kumar,
    I know that medical schools value strong GPA and MCAT scores first, but once at the interview, your personality shows. What kinds of extracurricular activities do you recommend pursuing that adds value to an application. Currently, besides studying, I run marathons and just do regular premed activities (volunteering, clinical exposure, Cancer research). I feel that I will not stand out.
    I have always been interested in entrepreneurship, and I am thinking of starting a health and wellness startup during my undergrad. This will allow me to do something unique and also develop my leadership and management skills.
    Do you recommend pursuing an activity as far fetched as starting a company/nonprofit?
    Does it look insincere if my goal is to only become a MD, not MD/MBA?
    Thanks,
    Akash

    • Hey Akash! I think you’re taking the wrong approach – don’t pursue activities just for the sake of “standing out” to medical schools. This is your life. Do the things you want to do, and you will *always* have unique experiences. It looks like you’ve already got a well-balanced extracurricular portfolio between research, clinical experience, and other hobbies… keep it up!

      I’ve interviewed applicants who had stretched themselves between 10 organizations but had very little to talk about, and others who had 2-3 extracurriculars which they were passionate about and could therefore discuss in depth. In this sense, less is more. Interviewers want to see your commitment to a particular activity,

      As far as dual-degree options (MD/JD, MD/MBA, etc.), you can always decide to apply once you’re already in medical school. It might not be something you’re interested in now, but who knows? The exception to this is of course the MD/PhD route where you have to apply for MSTP funding ahead of time.

      If you’re interested in entrepreneurship, by all means go for it! It’ll give you something to do for self-enrichment and life experience, but please don’t do it for the sole purpose of having something unique on your application. Marathon running is unique. Not all types of cancer research are the same. You’ve already got two examples right there. =)

      Thanks for the question!

  160. Dear Dr. Kumar,
    Thank you for the great content on this site.
    My name is Prem, and I am a current senior at the Texas Academy of Math and Science (TAMS) program at UNT. TAMS is a two year early college program for high school students go complete two years of their undergrad degree during their junior and senior years of high school. At TAMS, my credits in Bio, Chem, Physics, English, and electives will transfer to any Texas public university (and some private) so I can graduate early and save money on education.
    I am applying to college and considering the following in-state options (in order of preference)
    1) UT-Dallas – good financial aid, can graduate in two years
    2) UT Austin
    3) TAMU
    4) Austin College
    5) HBU
    From what I understand, premed undergrad doesn’t matter as long as I get good GPA and MCAT scores. I would fit in best at a small college like HBU or UTD. My goal is to ultimately become a great clinician and practice in TX and attend UTSW or Baylor Med.
    Does it make sense to attend UT or TAMU? What are the pros and cons of HBU?

    • Hey Prem! Congrats on TAMS! I had a few friends go through their program, and all of them really enjoyed it!

      I think scholarships and grants are undervalued at the undergraduate level, so with all things being equal, go with the less expensive route… especially if you plan on finishing early. I spent three years at HBU with some funding, and feel like I received an excellent education which prepared me for Baylor Med. While it might not have the “college experience” that much larger schools do, I really didn’t care for that kind of environment as I knew my long-term goal was to stay in Houston for my medical training and beyond. I grew fond of my classmates and professors, and because it’s such a small school, the transition from high school to college wasn’t as drastic. I had plenty of opportunities to explore careers, get involved in extracurriculars, develop my skills, and pursue hobbies outside of medicine.

      That being said, does your undergraduate name really matter? Does Harvard University look better than UT Dallas? Perhaps, but in the grand scheme of things, your own personal drive is what guides your success in medical school… not your alma mater. You want to attend an institution that’s affordable and has a track record of people achieving their goals. Having a stellar GPA/MCAT is becoming increasingly important to remain competitive, but again, I feel that’s more up to the individual than the institution.

      Think about what kind of environment and extracurriculars each campus will afford you in the coming years. Think about the financial implications of attending each. And regardless of wherever you matriculate, focus on your studies!

  161. Any advice on choosing the order of your clinical rotations? I am interested in almost every specialty but am also worried about starting off with a difficult core rotation (e.g. surgery, ob gyn). Thank you!

    • So there are three schools of thought:

      1.) The order doesn’t matter since you have to do all the core rotations anyways.
      2.) DON’T do what you’re interested in first, because you’re going to “look dumb” at the beginning of clinical rotations which might hurt your evaluations.
      3.) DO what you’re interested in first, so you can establish whether or not it’s the right field early during your rotations and adjust your career goals accordingly.

      First of all, being interested in many specialties is a sentiment shared by many medical students, so don’t worry! I’d recommend starting with Internal Medicine as you learn many of the basic aspects of clinical medicine – performing a thorough H&P, presenting patients, writing notes, diagnostics, formulating a plan, etc. It essentially lays the framework for other rotations.

      I vaguely recall our clerkship director also saying that students who start with internal medicine do statistically better on all their subsequent shelf exams; in retrospect, this makes sense since you get to practice so many basics.

  162. Amanda Huggenkiss Reply

    Hello Dr. Kumar,
    I was wondering if you were single. I am looking for nice indian doctor man to bear my children.

  163. Hey! My husband is also an anesthesiology resident and has been searching for a good OR jacket. Can you tell me who makes yours or how I can possibly get one for him??

    • Hey Whitney, I’m not sure what the exact style is, but the brand is North End Sport. Check out their online catalog! Where is your husband doing his residency?

  164. Hi Rishi..Did you ever have second thoughts in MS1 ? How did you manage your time, how many hours did you spend studying ?
    Did you ever have free time in med school for personal hobbies ?

    • Wonderful question, Reya! I feel like more and more people are finding reasons NOT to go into medicine these days, and when the rigorous curriculum becomes a reality as an MS1, people definitely have second thoughts.

      The curriculum at Baylor Med provides MS1s with PLENTY of time in the afternoons and on the weekends to divide between studying, personal hobbies, etc. Plus with our block system, we had anywhere from 4-6 weeks before exams. I usually spent 10 hours a week in the anatomy lab, ~8 hours each week reviewing histology, and maybe 1-2 hours per day reviewing lecture material. Closer to exam time, my daily studying time lengthened.

      I never had second thoughts as I tried to make all my “plan B” options part of my personal hobbies. I spent my days trading stocks, playing computer games, going to the gym whenever I could, and playing basketball with classmates each week. My classmates would periodically have get togethers which I’d try to attend as well. The MS1 year is nice because your entire class has virtually the same schedule which makes it easy to schedule group events and vacations together. =)

    • I’m not sure exactly what model the jacket is, but the brand is North End Sport. You can check their online catalog out here. Hope this helps!

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