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Future tense

Those of you who know me in real life know that I graduated from an Irish medical school  last year but wasn’t able to get a US residency (ie entry-level doctor job) at the time.

This year I’m trying again. I’ll hear back from hospitals in mid-March. I think I have a good chance.

But a good chance is not a perfect chance. And a non-perfect chance means there is some chance of failure. And this is utterly terrifying to me, to the point where I’m literally having nightmares about it and going a little bit off the wall.

The problem is that these job opportunities only come around once a year, and that if I fail a second time there’s not a lot of reason to think I’d do any better next year. In fact, there are a lot of reasons to think I wouldn’t; hospitals are usually less willing to accept people the longer they’ve been away from medical school, and they’re usually less willing to evaluate people they’ve already evaluated before and rejected. And there aren’t that many hospitals offering residencies.

So if I don’t get a job this time, I’m going to have to seriously consider the possibility that four years and thousands of dollars worth of medical school were a total loss career-wise and that I’m going to have to do something else. And I have degrees in philosophy and psychology and not a whole lot of obvious marketable skills. I will be totally back at square one with no idea of what to do with my life.

The rest of this entry is really emo and privileged and people who are actually having serious life crises will find it enraging, so if that’s you please don’t read it.

I am very lucky and grateful to have amazingly generous and far-sighted parents and grandparents who among many other things gave me saving bonds every birthday as a child which have since spent twenty-five years maturing. As a result, I don’t have the problems with medical school loans that you were probably expecting this post to be about, and I have enough money to live comfortably for some time period greater than a year and less than forever. So there will be no immediate crisis. I even have enough money (and/or loan-take-out-ability) to go back to school if I need to. But there is a definite long term “I should probably get a career path or something”.

And since I expect my mental state to be way too shattered to do any kind of planning or decision-making if I do get rejected, I figure I should figure out a backup plan now while I’m still sane so I can carry it out on autopilot if worst comes to worst.

I love working for MetaMed, but they are a very ambitious startup and it seems unwise to bank my entire ability to survive or ever have a career on them sticking around. Besides, just in case they get tired of me accidentally misrepresenting their positions or projecting general cluelessness at them, I should try not to have all my eggs in one basket. MetaMed has thus far not had more work for me than I can do in free time between other obligations, so “continue working for MetaMed but figure out something else to do full time” seems like an obvious best strategy.

It would be nice to work for MIRI in some way. I have a lot of friends who have positions sifting through academic literature for them, and it seems possible I could get something like this if I begged hard enough. But this seems a lot like MetaMed in being a good part-time addition to my workload and not a stable long-term career plan. Harder to explain but more importantly, I think a lot of my sense of “I am useful to people and not just a parasite on the world” would come from being able to donate some of what I made to charity, and if I’m taking my money from what is possibly the most efficient charity already this becomes kind of a farce. Probably also a “good if it works, but do in between something else” option.

I would really like something where my MD is not completely irrelevant. Glibly dismissing “sunk cost fallacy” ignores the likely fragility of my mental state and the fact that my parents and family are also going to feel much better if all the work they put into helping me through medical school isn’t just tossed aside. I have heard that many MDs go on to do a Masters in Public Health. This seems to be only a one to two year course, which is at least a heck of a lot better than having to spend another four years in school. Problem is, I have no idea what a Master of Public Health does, and whether there are likely to be any jobs in it. Anyone here have any experience in that area?

I feel overprivileged just writing this, but I could always just take the LSAT. I’ve been told that lawyers with MDs can get cushy positions in medical law, and although this sort of offends my sense of ethics and not-being-parasitic, a sufficiently good job could give me enough money to donate to charity to make up for that. I know it’s hard for lawyers to find jobs nowadays, but I’ve heard if you go to a good enough law school it’s still not so bad. I could plausibly hope for exceptional LSAT scores – I got a perfect score on the SAT verbal which I hear is similar – so that plus my MD might be enough to get me in somewhere really good. Then again, it’s another four years of very expensive education once again without a guaranteed job at the end of it.

I’ve heard another route some MDs go if they can’t get into clinical medicine is getting an MBA and going into some form of medical business. The fact that I have no idea what forms of medical business exist seems to put me at a disadvantage compared to people who have been wanting to do this their whole lives, plus I think everyone who knows me agrees I would be the worst businessman ever (“Honestly, as far as I can tell the evidence for our product working isn’t that robust, and I’m not sure it meets your particular needs anyway”). This is also one where I’m concerned about whether I would have a good shot at a job at the end of it. Getting business jobs seems to require networking and self-selling and self-confidence other things I am totally unable to do.

I really like biostatistics. I just happen to be really, really bad at it. I can fake writing about them pretty well, but in terms of actual number crunching they sort of slip out of my mental grasp just like all other math. I’m not sure whether going back to school to become a statistician would force me to learn it, or just end up with me failing out of school and being even worse off than I started. Also, once again I really don’t know anything about the state of the job market here.

That leaves non-medical jobs. Mike Blume pushes his idea of “learn programming on your own and make money as a programmer”, and I have to admit it worked for him and that programming strikes me as an extremely honest job with good working conditions. On the other hand,  I don’t know if companies actually give programming jobs to people with no experience beyond independent study, and I don’t know if I could actually teach myself programming. People say that programming is easy and any smart person can learn to do it, but these same people also tend to say that math is easy and any smart person can learn to do it, which makes me think either they’re just wrong or that I don’t qualify for the current definition of “smart person”.

I’ve always sort of wanted to be a teacher, and it’s a decent-paying, decent-status, not-*too*-unethical job. The fields that I would probably be really good at teaching (history, English, etc) are totally jobless, but I’ve heard there’s a big demand for math teachers. I’m bad at math compared to genuine math geeks, but I bet I could be better than high school students and probably better than the average math teacher right now (seriously, some of them are horrible), so going to school to get a teaching credential seems like a good non-medical option.

There are also some super extra backup options, like just going back to Japan and seeing if my old English teaching job is still available and whether I can just do that for the rest of my life.

I’m kind of curious if there are any obvious low-hanging fruit jobs around right now. People used to say that it was both easy and lucrative to become an actuary and they had relatively good working environment/status, but that loophole in the rat race seems to have closed up now. All the ones I know about now (Australian outback, etc) seem more like summer jobs for college students than lifetime careers. Are there any I’m missing?

Right now, if I don’t get a job I think my plan is to stay in Berkeley until June, possibly studying just enough programming to see whether I have any aptitude for it. Then do some clinical rotations in Internal Medicine at any hospital that will take me over the summer to see if maybe the Internal Medicine people are mysteriously more favorably disposed to me than the Psychiatry people. Once the summer winds down and the hospitals kick me out for their normal set of med students, I could spend the autumn applying to, in order of desirability: Internal Medicine residencies if they seem mysteriously well disposed to me, medical externships (yearlong unpaid medical resume builders), law schools, MPH programs, MBA programs, and whoever trains teachers (note to self: look that up). Then wait until next March and take the best thing I get into. If I get into literally nothing, and I have aptitude for programming, go into that. Otherwise, move back to Japan (or Korea? or Arabia?) and teach English (or stick around and work for MetaMed if they’re successful) to earn enough money to subsist while I continue applying to things.

This is a bad plan. I do not like it. I really really hope I get a residency in this year’s Match.

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55 Responses to Future tense

  1. Randy M says:

    Teaching was what I defaulted into after college–chemistry and physical science for a high school in CA. You will need one more year of school most likely to get a credential, and the ability to get up every day and face utterly fruitless hours attempting to tutor, no instruct, no discipline, no simply keep track of a hostile audience who don’t want to be there and/or are incapable of grasping the basic elements of your subject in anything approaching the pace you are required to keep.

    At least, that was my experience. Perhaps it was mostly due to taking the first job offered. As a doctor I should think you could affored to use that prestige to get a teaching job at a community college or decent private school full of respectful scholars, so maybe you will enjoy it.

  2. Raemon says:

    As someone who tries to persuade people to donate money to charity on occassion… if you are working for MIRI you seriously do not have to do that to be a good person.

  3. Raemon says:

    (I’m sort of assuming you know that and the post is more about your psychological state, but maybe social proof and help with that. I could talk about this pretty extensively if you wanted but I don’t think I’d have much to say that wasn’t already obvious to you)

  4. As someone for whom programming is way easier than math, i say don’t let your lack of super math skills discourage you from trying out programming. (It is also a skill which can come in handy in a lot of other professions)

  5. Leah says:

    I was in a 5-year MPH program, but didn’t do the post-B.A. year since I got offered a job and just graduated normally. I was in it for Epistemology of Microbial Disease and was mainly interested in the modelling/programming/biostat aspects of it, so my experience may not help you differentiate this option from stat/math/programming.

    If you want to try out teaching without being certified, you can try to teach math at a private school. They don’t always require certification (some of my friends looked at/did this post-college). Here, the schools may have more of the consultant mindset that “Smart people don’t need training, they’ll just be smart at a problem.” This tends to have limited success. Teacher training will give you a lot of resources (heuristics, best practises, and a network of people to draw on) that just being thrown in will not.

    • Scott Alexander says:

      “I was in it for Epistemology of Microbial Disease”

      I am torn between being pretty sure you mean Epidemiology of Microbial Disease and really really wanting the original to be a thing.

      What is the difference between the 4-5 year program you did and the 1-2 year ones I see advertised?

      Do you think MPH would be a good way to test the waters with biostatistics and then if I find I am terrible at it I can switch to a less statisticky part of the field?

      What kind of jobs do MPH graduates get (as far as you know?) Is the job market for them any good?

      • Leah says:

        Ooh, alas, good catch. The 5 year thing was because I was an undergrad. My senior year, half my classes were MPH classes, and, if I’d stuck around, I would have done all MPH my fifth year. So, essentially, it was a slightly accelerated MPH spliced on to my undergrad.

        I feel like just poking around reading/koffeeklatsching with biostat people/shadowing for two weeks might give you plenty of data without applying/paying tuition. Most of the MPH people I knew were planning to work for NGOs doing health interventions. Most of the internship people who came in with NGO health consultancy groups.

    • gwern says:

      > Epistemology of Microbial Disease

      Did you mean ‘epidemiology’? If not, my curiosity is piqued and I am interested in hearing more.

  6. JRM says:

    Quick thoughts:

    1. I really hope you get that residency.

    2. Law school is three years, not four, unless you go to night school at Bob’s Waffles and Law (no law parking during breakfast hours.). I would expect you to get a 180 or 178 on your LSAT; it’s an IQ test with no math. (I am a lawyer; I wandered about and went to law-school in my late 20’s with an LSAT score that Dean Bob said she wanted to put up in lights next to the flashing waffle.)

    3. I think you’re wrong on MIRI, but that’s a much longer discussion and I doubt it would do any good, and I’m probably lowering my perceived accuracy by saying that. I don’t have any personal experience, but I think there are a lot of ways that working there would not work out well.

    4. If you end up having to do Something Else, a key point is to enjoy it. If you don’t, you won’t be as good at it. Money does matter, but I drifted about into a job I love. I make a comfortable, but non-extreme living at it.

    5. Embrace your awesomeness. You’re pretty awesome, it seems to me. If you decide to teach, teach really smart kids somewhere that has really smart kids.

    6. I’ve hung out with too many coders. The basic problem is that your ability declines with age, and most aging coders are stalled. Even if the pay is better, the people younger than you are better than you; you have to become a manager. I have little doubt you could do it; it might not be satisfying, though. I suspect you’d do better as a teacher.

    7. I really hope you get that residency.

    –JRM in NorCal. (40 miles from the nearest BART station.)

    • randallsquared says:

      6. You do not have to become a manager, and I suspect that most people younger than Scott will *not* be better at programming, once he’s spent some time with it. Programming effectiveness varies so much that the decline from ~25 to ~50 is only noticeable in a relative sense: A 10 percenter at 25 is still likely to be in the top 10 or 20 percent at 50. Also, after a year or two, you could start consulting, which brings in quite a lot more money at the expense of some stability.

      These still aren’t MD levels of pay, I guess; an average consultant probably only makes 150-200K in good markets (like the Bay area).

  7. fiddlemath says:

    I don’t know if companies actually give programming jobs to people with no experience beyond independent study

    It’s probably easier to get a professional job in programming without a degree than it is to get a professional job in anything else without a degree. It’s actually possible, I work with people who have done it. Admittedly, most of them were programming obsessively since they were 9 or 10 years old, but not all.

    The reasons are that (1) programming skill is insufficiently certified by earning a college degree in CS, and (2) programming skill can be well-evinced in a interview over the phone. I’m working at a rapidly-expanding startup, and we definitely pay more attention to how someone did in their interviews than whether they’ve collected a degree. On the other hand, we probably wouldn’t even offer an interview to someone that didn’t already look relatively impressive online.

    The simplest way to look relatively impressive online is to build cool things and release them as open source projects. This demonstrates that you can code, that you can design and implement large projects, and that you care about the craft. It’s a better signal than college, and it’s rather cheaper to do yourself.

    I won’t claim that this will get you an interview anywhere — if a place doesn’t have programmers involved in hiring decisions for other programmers, say, then they won’t be competent to judge aptitude regardless of certifications and degrees. On the other hand, such businesses are probably not great places to code for.

  8. Pk says:

    “It would be nice to work for MIRI in some way. I have a lot of friends who are doing researchy-type positions for them, and it seems possible I could get something like this if I begged hard enough.”

    This sentence dropped my opinion of MIRI’s institutional competence.

    “I don’t know if companies actually give programming jobs to people with no experience beyond independent study”

    They do, if you use your independent study to make something.

    “I don’t know if I could actually teach myself programming.”

    This is a more serious worry. It’s worth trying. A lot of programming is verbal thinking and logic and symbolic manipulation- and so it seems to me like most people who can become mathematicians can become programmers, but some people who can become lawyers can become programmers. The trouble is that with lawyering you have to convince people, and with programming (and to some extent math) you have to convince the machine / the truth.

    • Scott Alexander says:

      “This sentence dropped my opinion of MIRI’s institutional competence.”

      Please don’t. By “research-y”, I meant “doing literature reviews on academic subjects”, not “inventing AI”. I think I am pretty qualified to do the former. I’ve edited this to make it clearer.

  9. Avantika says:

    I’m curious why you list everything from history to math as potential teaching options, but not biology, when you are a doctor? But then, I have no idea what the American system of medical education is. Lack of knowledge about the system you’re facing (from the tone of your post I’m assuming that despite having a degree there is no way you can continue in the medical profession without getting a residency, though this seems faintly unbelievable to me) means I can’t offer much in the way of practical advice, but good luck.

  10. Berry says:

    Can’t offer you any advice when I know next to nothing about how the American job market is, but I just thought I’d pop by to let you know that I think reading your work is one of the single most impactful and insightful things I’ve done in my life so far. You are an exceptional person, and even if things don’t work out ideally, please don’t stop being awesome!


  11. Vladimir Slepnev says:

    Go to China, teach English, get lots of local girlfriends!

  12. Misha says:

    MIRI is important, but if you want to be a teacher and considering your proven ability to communicate and write a lot of content, isn’t CFAR a much better potential fit? Or do you view it as still basically a subset of MIRI?

  13. Deiseach says:

    (1) I do hope you get something in your own field.

    (2) Do NOT go into teaching unless you (a) really, really want to do that and/or (b) you are sure of getting a job in a decent school.

    My youngest brother is a science teacher in secondary school (12-18 year olds) and I worked in a clerical role for a local education authority, including office work in one of our secondary schools. We had the least academic students (there is a pecking order in the schools in town and we’re at the bottom when it comes to where you send your kids) and take in a lot with behavioural/emotional/learning difficulties, broken homes, substance abuse problems, likelihood of early school drop-outs, petty crime, etc.

    They can be great kids, but unless you are prepared to have chairs thrown at you, be sworn at, spend twenty minutes out of a forty-five minute class simply getting them to settle down, stop talking, get their books, not stroll in as late as they can dawdle at their lockers getting their books etc. etc. etc., then if you are not prepared and not passionate about being a teacher, you need to be very sure that you’ll end up teaching in a ‘nice’ school where the kids are steered on the high grades/good university track. It’s not easy money, there’s a lot of hassle, you won’t like it, and education cuts in teachers’ pay and perks are the first things when belt-tightening politicians want to share the pain.

    (3) Have you any chance of writing for technical journals/doing pieces on science, medicine, etc. for print media and their online versions? If you can write decent English and explain studies and the statistics in a reasonable, averagely-intelligent layperson manner, then you might have a chance. How much chance, I have no idea.

    (4) Lawyers are the devil’s spawn. Do you want to be a spawn of Satan? Really?

    Good luck!

    • Deiseach says:

      OH! I forgot to mention this!

      (5) Accountancy. There seem to be a lot of openings for accountants and those in that field. I haven’t a clue about the American education system, but over here you can do a 2-year Accountancy Technician Post-Leaving Certificate (that is, after graduation from secondary/high school) course which is certified and which our school has no difficulty placing its graduates into jobs. If you’re reasonable with numbers and can manage to learn an accounting software package, then that might be a thing to consider (as well as law school or teaching).

  14. rsaarelm says:

    If you’re already considering programming (nthing on it being significantly easier to pick up than mathematics), then maybe look into bioinformatics? If you have a domain specialty that’s not pure computer science, and you are reasonably comfortable with working with code, you’ll have a leg up on both the monomaniac programmers and the coding-illiterate domain people.

    I don’t actually know how much of the domain knowledge needed for bioinformatics work someone who studied to be a doctor will have, though.

  15. Nancy Hua says:

    I hope you get a residency!
    I think you’re a really good writer. Maybe you could write a book or something. I’d pay for it.
    I don’t know why the medical people wouldn’t take you. If it’s because of paperwork and signals that are incorrectly suggesting you’d be a bad doctor when really you’d be good, maybe you could advance/practice medicine some other way, like being a mob doctor (jk) or assessing current medical technology/research (like you informally currently do on your blog) (have you talked with Laura or anyone about Panacea Research? They’re showing there’s more opportunity beyond the current system).

  16. Karl says:

    Just assume you’ll get the residency. Other paths lead to madness.

    Alternatively, if you DON’T get that residency, come and visit us, work here for a while, go back when your resume carries more clout. NZ needs more doctors.

    • Anonymous says:

      This actually sounds like a really good idea. If your screwed out of a job in the states, try overseas for a while.

  17. Novalis says:

    There are plenty of perfectly good programmers who are not great at math (I’m one). The most advanced math I have ever used in programming is multivariable calculus, and that exactly once for an unpaid side project. (Well, I’ve also used computation complexity theory, but again only on an unpaid side project and then only to win an argument). Naturally, some fields will be more math-intensive; anything involving 3d will use some linear algebra, but that’s like at most 0.5% of the programming field.

    And there are plenty of jobs for programmers with no formal training and little experience; I know someone with no relevant academic experience (beyond a high school Pascal class) who got a great programming job roughly six months after writing her first program as an adult. If you’re going to go this route, I would recommend Hacker School, which is a programming unschool. You’re expected to know how to program before you get there, but “know how to program” is a low enough bar that a few months of self-directed practice will get you there. Also, if they like you, they will try to get you a job after you leave (that’s how they make their living). It’s run by some friends of mine, but I would recommend it even if it weren’t, simply because it seems to be a great environment to learn in. I would recommend it for *you* in particular, because you have said that you are sensitive to criticism, and Hacker School’s culture is friendly and accepting rather than being full of macho bullshit.

    There are, of course, a number of places where you could put your medical (or at least biological) knowledge to work along with programming. I can think of at least one that is hiring right now.

    In short, I recommend that everyone who is at all unsatisfied with their job situation try programming: at worst, it gives you a minor superpower which will be useful in almost any job that you end up in, and at best it’s a career that’s a lot of fun. Everyone has their own suggestion for how to start; mine is to read _Code_ and then start in on _Learn Python The Hard Way_ (or maybe Code Academy). Then think of a small project that you want to do, and start writing code. You’ll have to pause to look things up all the time, but that’s OK because professionals do that too. Finally, take the Stanford online algorithms/data structures course because you’ll need it to pass interviews.

  18. Salem says:

    Best of luck getting a residency.

    But if that doesn’t work out, have you considered getting a residency in a country other than the USA?

  19. James Miller says:

    We’ve only briefly met once so take this as contingent speculation rather than a signal as to your qualities, but consider the possibility that traits which will stop you from getting a job at a hospital would also make it difficult for you to do well at an interview with a law firm. Law firms will care a lot about the first impression you would make on clients or juries.

    “networking and self-selling and self-confidence” are vital skills for a lawyer.

    • Elissa says:

      There’s no reason to think Scott is not a good interviewer. From all I have read and heard, his situation (foreign med school grad with anything less than very strong step scores) is sufficient to explain his trouble matching into a residency. Seats in US medical schools have been increasing much faster than residencies in recent years, so going to a foreign medical school just isn’t as good an option as it used to be for people who want to practice in the US– this may have been less clear at the time Scott matriculated.

  20. JPH says:

    Why not use you Irish Med school degree outside the US? Cant you do a residency in the UK, Canada , Australia or NZ? Good luck anyway and whatever happens, keep the blog.

  21. @Johnwbh says:

    I’m in a very similar situation, if there’s an easy solution I haven’t found it. A lot of my compatriots are defaulting to hiding in Academia until the economy improves.

  22. philh says:

    > I don’t know if companies actually give programming jobs to people with no experience beyond independent study,

    To confirm what a couple of others have said, they do. I got one.

    > and I don’t know if I could actually teach myself programming.

    You could try to teach yourself programming for a couple of weeks, and then see whether or not you feel like you’re learning programming. I’m not sure how easy it is to judge oneself here, but it seems like that would be valuable data for low cost.

  23. Aaron Brown says:

    I’ll hear back from hospitals in mid-March.

    I’ve been meaning to ask you when you were going to hear. Good luck!

    I don’t know if companies actually give programming jobs to people with no experience beyond independent study,

    I’m one data point of this happening. By the way, a couple days ago I told my current employers that I’m moving to the Bay area in two to nine months. The wheels are starting to turn!

  24. John says:

    What were your Step scores?

  25. Joshua Fox says:

    Just out of curiosity, why did you get a medical degree in Ireland rather than the US?

    • Deiseach says:

      Hm – was he possibly tempted by the weather (cold, wet and grey – and that’s the summer), our exotic cuisine (you can have your potatoes boiled in their jackets, mashed – either plain, champ or colcannon , roasted, fried, made into chips or as potato cakes), the black wine of the country (Guinness, Beamish and Crawford’s, or Murphy’s) or our beauteous cailíní (as noted in the saying “Beef to the heel like a Mullingar heifer”, which means “When a woman has very thick legs, thick almost down to the feet, she is ‘like a Mullingar heifer, beef to the heels.’ The plains of Westmeath round Mullingar are noted for fattening cattle. “)


    • Scott Alexander says:

      Only realized I wanted to do medicine after college (majored in psychology, then decided what I really wanted was psychiatry) and US schools require a bunch of med-specific college courses that Irish schools don’t. Also spent a year in Ireland before and loved it. Also Deiseach’s reasons 🙂

  26. Joshua Fox says:

    The rationalist community has a lot of smart, capable people looking for jobs, and smart, capable entrepreneurs and managers looking for employees.

    MetaMed and MIRI are just two examples; Quixey has also hired out of the rationalist/MIRI pool.

    It is very hard to hire decent employees in any field, and so it seems that the rationalist network, plus transhumanists, Singularitarians, etc, would love to hire you, especially with recommendations from top people in the community who know your work.

    • Scott Alexander says:

      Contrary to my usual habits, this is one case where I have the networking and just need the competence. Now I just need to figure out what to develop competence *in* 🙂

  27. AA says:

    If your scores are as such, your letters of recc and grades are good, your motivation for psychiatry seems sincere, I think you might have to consider whether you are coming off well interpersonally. Do you feel like you are clicking with the interviewers/residents, if you aren’t getting in then you probably aren’t. Friends may not be the best at picking up reasons for interpersonal difficulties or the best people to give you a frank answer. Perhaps some regular psychotherapy could help you sort out what might be going on. Please take no offense, this does not have anything to do with your actual personality; just speculation.

  28. Moshe Zadka says:

    There is one question I am way-better-than-average on answering, so I will answer that and that alone. My mother has a Masters in Public Health. She worked for the Israeli Central Bureau of Statistics in the Health Section? Department? (It’s hard to know how to translate Israeli-beureacratese to English) doing research on life expectancy and health statistics (her BSc. was in Math and Statistics). I’m not sure whether there are equivalent positions in the states.

  29. Nestor says:

    Hm. Osamu Tezuka was a MD, you could draw lots and lots of comic books, see if you can become God of comics. 😉

  30. Mike Johnson says:

    I’m not sure if this is optimistic or pessimistic, but I think even if you were to get a US residency, you might find yourself in the same position you are now in a few years. With health care costs, our public fiscal situation, and disruptive medical technology on their current trajectories, it seems likely there will be a huge surplus of qualified candidates relative to openings for the ‘standard doctor career track’.

    So I think getting involved in startups probably isn’t as risky as it looks on the surface– or to be more precise, many of the same uncertainties you’re fretting about now would apply even if you got a residency… you just wouldn’t see them as clearly. That said, I wish you the best with your applications.

    p.s. It just clicked- I think I saw you at the H+ pre-event author talks (with Ramez, Hill, Annalee, etc). You were at the far side of the room, I was in a cushy chair nearer to entrance and asked about what H+ should be doing politically. This is neither here nor there; I’m just happy to put a face and online presence together.

    • Scott Alexander says:

      I think this is false. Everything I’ve heard is that there is a vast shortage of psychiatrists (exactly because of this residency issue I’m dealing with now) and that ones who have gotten through can pretty much name their salary and working conditions.

      I don’t think I’ve ever been to any kind of H+ event or author talk. I have no idea who Ramez, Hill, or Annalee are. Maybe it was a different Scott? Or a different person with a shaved head? A lot of people I sort-of-know tend to just assume people they meet with shaved heads are me. I think I have a forgettable face.

  31. Mike Johnson says:

    Ahh, probably a different person with a shaved head. My mistake!

    You’re in a much better position to know the facts on the ground than I am– I have to plead my ignorance here. But I will say those three factors I mentioned could have a significant impact on the field. I.e., I think technology is opening up alternate models of treatment, and our financial situation will force our hand into adopting them.

    I’m not sure which specialties come out ahead vs which get really disrupted here…

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  33. Arguggi says:

    I hope this doesn’t sound weird but if you want to learn programming I could help you if you want,

    I know C,some R and some Haskell. I’ve helped some of my friends with their Uni classes and I enjoyed myself.

    Some of my programs are on my profile, I’m not a stellar programmer but I should know the basics.

  34. anon says:

    (not leaving name publicly for obvious reasons)

    I work at a medical journal. Lots of medical doctors here who are not in practice. Worth looking at if you need it?

    • Joshua Fox says:

      For all its worth, I know of one medical startup — not MeetaMed, this one was ten years ago — that hired lots of doctors who were right out of med school but decided not to go into medicine. The company needed the credibility of saying that “real doctors” had approved all product features.

      If done right, this sort of thing can be the start of a very promising career.

  35. Paul Torek says:

    Knowing only what I read here, and I haven’t always followed the blog super closely, I rated 93% chance Scott gets his residency (on PredictionBook). Maybe if more of us register our predictions, this will ease Scott’s mind? And by the way, I made that 93% estimate before I noticed how underconfident I’ve been so far on PredictionBook.

    • gwern says:

      I think 93% is too high. Let’s consider Scott’s previous comments: 40 applications; all rejected.

      0/40 eh; this looks like a binomial distribution, the Bayesian version of which is the beta distribution ( A uniform distribution is α = β = 1. Stealing shamelessly from , we can ask what happens if he applied to 40 last year and 40 this year too:

      a=1; b=a; # uniform prior
      n=40; y=0 # tries, successes
      a1=a+y; b1=b+n-y # update; remind you of Laplace's rule?
      qbeta(.5, a1, b1) # median
      # [1] 0.01676
      qbeta(c(.025,.975), a1, b1) # 95% credible interval
      # 0.0006173 0.0860438
      m=40; ys=0:m
      pred.probs =1)) # at least 1 success out of 40
      # [1] 0.4938
      sum((pred.probs/2) * (ys>=1)) # halve all probabilities to penalize for being damaged goods
      # [1] 0.2469

      # redo with just 10 trials last year and 10 more this year
      # since 40 does sound implausibly high
      n=10; y=0; a1=a+y; b1=b+n-y
      qbeta(.5, a1, b1) # median
      # [1] 0.06107
      qbeta(c(.025,.975), a1, b1)
      # [1] 0.002299 0.284914
      m=10; ys=0:m
      pred.probs =1))
      # [1] 0.4762
      sum((pred.probs/2) * (ys>=1))
      # [1] 0.2381

      Some non-Bayesian calculations using the upper confidence interval instead:

      # Exact binomial test
      # data: 0 and 40
      # number of successes = 0, number of trials = 40, p-value = 1.819e-12
      # alternative hypothesis: true probability of success is not equal to 0.5
      # 95 percent confidence interval:
      # 0.0000 0.0881
      # sample estimates:
      # probability of success
      # 0
      1 - pbinom(1, n, binom.test(0,n)$[2]) # (1 - chance of less than 1) = chance of at least 1
      # [1] 0.8784

      # Exact binomial test
      # data: 0 and n
      # number of successes = 0, number of trials = 10, p-value = 0.001953
      # alternative hypothesis: true probability of success is not equal to 0.5
      # 95 percent confidence interval:
      # 0.0000 0.3085
      # sample estimates:
      # probability of success
      # 0
      1 - pbinom(1, n, binom.test(0,n)$[2])
      # [1] 0.8635

      So one way gives me 30-50% and another way gives me well under your 90%.

      • Scott Alexander says:

        If you want to be very precise about this, the best way to do it would be to look at . I have 13 programs on my rank order list, am an international applicant, and got a score of mid 220s on both USMLEs. This would seem to imply on their curve that I have an 85% prediction of getting in to a Psychiatry program.

        However, I also was very worried about getting in this time and so applied to about 100 programs. Getting 13 interviews after applying to 100 programs is probably very different statistically from getting 13 interviews after applying to 13 programs, since having interviewed at more places increases chances both because you have more people who might accept you and because it is caused by you being a better candidate whom more people want to interview. I applied to somewhat more places than average so I don’t know how valuable those data would be.

        On the other hand, my pet theory is that those curves are actually wrong; the real data show that international applicants with low-teens number of places on their rank-order lists do better than people with 16+, probably because some people get confused and just fill in all their rank order list slots (20) without having actually interviewed there (this has no effect). So it looks like getting 13 ranks may be somewhere better than what the curve would predict.

        Right now I think my main strategy is just going to be to be terrified but find out one way or the other soon enough.

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