The Big News... Prepare to be Underwhelmed!

This is the big news:  Mac has been approved to apply for a fellowship in otolaryngology.  We don't know where the fellowship will be, and we aren't sure if it will be for one or two years, but we are sure that it will begin in July of 2012.  We will be moving for fellowship, most likely across the country.  We are hoping to extend the fellowship to 2 years, but we will not know if that's a possibility anytime soon.  We may not know if we will be staying at the fellowship location for 2 years until we are actually already there!  What we do know is this:  we will have to move for at least one year.  For Kate, this will mean moving between 10th and 11th grade (yikes).  The twins will start 6th grade in the new place, and Luke will start 3rd grade.  Josie may start preschool, but that's clearly less of a transition!

Here is the back story, in case you may be confused as to what *fellowship* is...

Medical training is a complicated process.  There are many steps involved, starting with exams one takes to even be considered by medical schools as an applicant.  Medical training takes a long time, and for some, such as my husband, it takes such a ridiculously long time that one is left to question whether or not it is all worth it. 

Regardless, we as a family trudge onward. 

These are the steps Mac has taken in this arduous endeavor:

Step 1:  Graduate from college. 

He did this back in the 1990s!  A whole CENTURY ago.  (OK, so it was 1999, but still...)  He earned the Degree Most Common for medical school applicants:  Bachelor of Arts in Biology.

Step 2:  Take the MCAT and do well enough on it to be considered by medical schools. 
The MCAT is a souped-up version of the SAT.  It's a very Tough Exam.  I remember the days when we were newly married and Mac would spend at least 3 hours a night studying for this exam.  He ended up doing fairly well on it.  After taking the test 3 times, he achieved Acceptable Results which allowed him to proceed on to the next step of his medical journey...   Most students take the MCAT while still in college, but Mac is "nontraditional", meaning he had a career in between college and medical school.  Those were the "food inspector" years.  Ahhhhh, 40 hour workweeks.  Definitely a thing of the past.


Step 3: Apply to Medical School.

This is a Big Money process.  The centralized medical school application service has a large fee, then each school sends you their own secondary application with their own fee, and then a select few (hundred) are invited to come to medical schools to interview in person.  Mac was lucky to receive early interview invitations.  He took a trip to New Jersey to interview even before many schools started inviting applicants to interview.  He was offered positions from the Jersey schools, but continued on one more East Coast interview trip as well as interviewing in the only medical school within driving distance.  Mac was lucky to be accepted early on.  He had options, which is really something many applicants do not have.  We decided to pursue a military career, and that landed us in the only military medical school in the country.  This decision allowed us to have a very stable income throughout medical training, along with nice perks like completely free health care!  And discounted tickets to Walt Disney World.


Step 4:  Complete Medical School
Four years of studying, completing clerkships in various specialties of medicine, and taking more Big Exams. In retrospect, medical school was great.  Mac was home for dinner more often than not, he was excited by learning new things and getting to work with actual patients, and he was full of hope for the future.  In medical school, he felt like he was really taking great strides towards the day when he would be a Fully Licensed Doctor, able to do things on his own...  Ever present during the medical school years was the debate over residency.  The challenge during third year clerkships is to decide what field of medicine to focus on for one's future career.  Mac loved Orthopedic Surgery, but he ultimately chose Otolaryngology because he liked it a lot, it was surgery, and he thought it was more family friendly than Ortho.  At the end of Medical school, Mac was awarded his Medical Degree.  This degree allowed him to go to residency, but not to practice medicine independently.  One needs a little bit of medical experience before that big step!


Here is a picture of us before the big graduation ceremony.

And here is a picture of Mac in his Dress Blue uniform.  After receiving the medical school diploma, all the students removed the graduation robes for their next ceremony: a military promotion.  Army students promoted from the rank of 2nd Lieutenant to Captain. 

Mac had about 4 weeks off between medical school graduation and the beginning of residency.  We traveled and did some work on the house, which was a good thing because there has not been much time for major projects since residency began!

Well before graduation, Mac had applied for and been accepted into a residency program.  Since he attended the military medical school, he was only eligible to apply for residency programs within the military medical system.  This vastly simplified the application process, and we were able to avoid the dreaded "match" that most medical students are fairly obsessed with during their clerkship years of medical school.  Mac simply applied to the Army for a spot in otolaryngology, and waited for them to decide his future!   

Step 5:  Begin residency, starting with the dreaded Intern Year
The first year of residency is the Intern year.  In this year, you are introduced to something calle "In House Call."  Mac was a surgical intern, called a PGY-1.  PGY stands for PostGraduateYear.  His residency is 5 years long.  Not all residencies are this long, and some are even longer.  The "Graduate" from PGY refers to graduation from Medical school.  During "In House Call" Mac actually stayed in the hospital and answered any page about any issue for any patient who had any type of surgery.  Typically a call shift would last 24 hours.  He was busy.  There are exams to study for during the Intern Year as well.  I believe that Mac took a big general exam at the end, but I can not even remember specifically.  Funny.  It seemed like it was The Most Important Thing Ever at the time... 

Step 6:  Complete Residency

After the intern year, Mac focused entirely on Otolaryngology.  No more general surgery, thank you very much!  Every year of residency has brought more responsibilities, and he has been expected to have more knowledge and more surgical skills.  The pressure only intensifies for the resident to "know it all" and "have the best hands".  There are exams to study for.  Every year the residents take a practice exam for what used to be known as the "boards".  Mac calls it the "inservice exam", but I don't know if that's a technical name.  I just know that it's a Big Deal.  The results are very important to the residency programs, and there is a lot of pressure to do well on this exam.  The studying never ends. 

During residency, the doctor is introduced to lots of subspecialties off of the general residency program.  One can practice these subspecialties (legally) by completing a fellowship.  For otolaryngology, some common fellowships are: pediatrics, head and neck cancer, facial plastics, rhinology, etc.  A less common fellowship offered is sleep surgery.  This is the one that Mac is pursuing. 

Step 7:  Fellowship application

This is the step where we find ourselves.  In the military, one needs to apply for approval from the military to pursue a fellowship.  The fellowship needs to be in an area of subspecialty that the military needs to have filled.  Many are fond of saying:  The needs of the Army come first.  As it turns out, the subspecialty of otolaryngology that most interests Mac is also desired by the Army. But, of course, approval to pursue this fellowship is not quite that simple.  Mac completed an application this past fall, and was just given the news that he has been approved to continue in the fellowship application process.  More applications, interview trips, and waiting to hear from programs about whether or not they will offer him a spot.  That is where we find ourselves...

The next steps in the process will be:

Step 8:  Complete residency

Step 9: Begin fellowship training

Step 10:  Take the General Otolaryngology Boards exams approximately 1 year after finishing residency

Step 11:  Finish fellowship

Step 12:  Moving to whatever military facility the military decides is in need of a sleep surgery fellowship trained otolaryngologist. 

In the end, should he be accepted into a fellowship training program, he will have spent 11 years after graduating from college in pursuit of this dream of being a doctor.  We will have moved over 3000 miles away from family for medical school and residency, then moved across country (most likely) again for fellowship for maybe one or maybe two years, after which point we will move at least one more time to be stationed somewhere where Mac will start working as an autonomous otolaryngologist... 

Whew!  It's a LONG road.  And at this point in the game, no one is convinced it is worth it!  But nonetheless, we feel relieved to be one step closer to the end of the educational marathon.  We are glad that he's been approved for fellowship, and will update with any other news as to where that fellowship will be completed!