He says, “Doc, can you give me a medicine?
The name ought to be on my chart
But it’s safe and it’s strong
And it helped me along
When I had a younger man’s heart”

♪ ♬ La la la, de de da, la la la de da, da dum ♪ ♬

Give us some drugs, you’re the evening doc
Give us some drugs tonight
Well we’re all in the mood for some opiates
And they’ll get us feeling alright

Now John in bed five is a friend of mine
He gets bouts of COPD
And he’s quick with a joke or to light up a smoke
Which I guess is what brings him to me

He says, “Doc, I believe this is killing me”
I agree he is probably right
And he tells me that’s it, and he swears that he’ll quit
And he asks me to pass him a light

♪ ♬ La la la, de de da, la la la de da, da dum ♪ ♬

Now Paul is a boy with leukaemia
Who never had time for a wife
And he’s talking with Meg, who takes food through a PEG
And will probably have to for life

And the man in bed ten yells obscenities
As the lady in six gives a moan
She’s paying eight thousand for hospice care
But it’s better than dying alone

Give us some drugs, you’re the evening doc
Give us some drugs tonight
Well we’re all in the mood for some opiates
And they’ll get us feeling alright

It’s a pretty good crowd for a Wednesday
And the pharmacist gives me a vial
‘Cause he knows that it’s that, they’ve been coming to get
To forget about pain for a while

And the corridor smells like c. difficile
And the bed alarm sounds like a jeer
And I take some caffeine and I stare at my screen
And think God, what am I doing here?

Give us some drugs, you’re the evening doc
Give us some drugs tonight
Well we’re all in the mood for some opiates
And they’ll get us feeling alright

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.