Medical School: A Four Year Journey Come Full Circle

August 3, 2010:  Josh and I landed in Newcastle, England. 

It's been 4 years to the day since the journey through medical school really began.  We were brand new newlyweds, only married for a month.  We boarded that plane in Los Angeles with 7 bags, no place to live in the UK, and NO IDEA what the next four years were going to look like.  We were excited.  We were nervous.  We were kids starting the adventure of a lifetime.

Leaving for England

We didn't know the kind of stress that four years of school would bring, the kind of hardships we would face.  Thank God, because we probably would have run for the hills if we had known.  But we also didn't know the kind of friendships we'd make, the life lessons we'd learn, and the amazing adventures we would have.  We found a place to live the next day, in Jesmond.  Our first "home" together on Grosvenor Road.

Our Flat on Grosvenor Road

And Josh received his white coat not too long after.  A day that marked his entrance into the medical field.  I felt the weight of what we were starting that day. I remember it vividly.  Sitting in that elegant room with all the brand new first year students.  The excitement was palpable but I felt a sense of heaviness too, this day was marking a day where life would change dramatically.  I didn't know what was coming, but I knew it was big.

White Coat Ceremony August 2010

Josh fought his way through Term 1.  He pushed and Term 1 pulled.  He had to learn to effectively study and I had to learn how to be an independent yet supportive wife.  It was a struggle but once we had made it through, I felt confident we could do this medical school thing.

Thanksgiving in Newcastle

Tyne River, Newcastle

Jesmond Dene

First Snow

Term 2, though challenging, was a breeze compared to Term 1.  Josh had the study thing down, I had friends.  We had some time to travel and enjoy Europe.  England felt like a real home.  Life was good.

Sightseeing in Dublin, Ireland

Best Friends

Year 2 took us to the island of Grenada.  A place that will forever hold a special spot in my heart. Terms 3, 4, and 5 were challenging.  But Josh was diligent.  He studied and studied and studied and the term of absent husband took on a new form.  But, he did amazing and I thrived in Grenada.  We thrived in Grenada.  I loved island life.  I loved the people. I loved the Limes kids that I worked with.  I knew that when we left, I would leave with an emptiness, a void that would be difficult to fill.

Going to Grenada Party

Magazine Beach

Sunset at Grand Anse Beach

Dancing at Prickly Bay

Off to Fish Friday

Mount Carmel Falls

Easter with the Limes Kids

Flag Football Champs

Summer 2012 was dedicated to studying for the USMLE Step 1 and waiting for a clinical placement from SGU.  It was agonizing, all of it.  But those 2 months eventually passed.  The Step 1 was conquered and we got our first choice of clinical spots in California.  But year 3 of school brought new challenges, ones that we weren't necessarily prepared for.  Clinical life was difficult on our marriage. Long hours spent in the hospital, the stress of performing well, and grieving the loss of our island life all helped to make the reality of life back in California a nightmare.

First Day of Third Year

And then we found out we were expecting.  And while that news of course brought with it joy, it also created fear and anxiety and brought our marriage to a tipping point.

Josh and I struggled through my pregnancy and the remainder of year 3 of school.  But Ryan Cathleen made her appearance at the tail end of 3rd year and she helped to fill the void in my heart that had been missing since leaving Grenada.

Fourth year began in August 2013 and residency applications were due in September.   Things were pretty much a whirl wind at this point. Life with looming residency apps due, a newborn, a struggling marriage, and 4th year rotations was almost too much to handle.  But by the grace of God, we somehow survived.  And by Christmas time, we were starting to feel some relief in stress and a change for the better in our relationship.  Just in time for our next big life hurdle.

Christmas Morning

March 2014 brought the end of 4th year electives and Match Day.  The Lord knew that Josh and I would need to be a united front to conquer that difficult time. Amazingly, we lived to talk about that terrible week.  The relief that followed after Match week is a feeling unlike any other.  Sometimes I still can't believe where we are when I consider how awful that week was.

The day Josh got his residency at UMass

In April, Josh received his diploma and in May we made the big move to Massachusetts for Josh's General Surgery residency at the University of Massachusetts.  We were nervous, but also excited for a fresh start in a new place.

Leaving on the 3,000+ mile trip to MA

Ryan's first flight to MA

UMass Campus

In June 2014, Josh walked across the stage in New York City and officially became an MD.  We celebrated his hard work and success over the course of his 4 years in school with his family.  And he and I celebrated our four year anniversary and four years of commitment and support for each other through the schooling process.  My thoughts on graduation can be read HERE.

Graduation Day

In July, Ryan turned one and Josh started his residency.

August 3, 2014: Josh is now a month into residency.  

Life sure looks a whole lot different than it did 4 years ago on August 3, 2010.  These past four years were nothing like I ever expected and yet everything I had ever dreamed they would be.  Life is just funny like that. I wonder where we will be in another four years?  And four more after that?  This life of ours is an adventure to say the least but it sure is amazing to take the time to look back and celebrate the successes, mourn the losses, learn from the mistakes, and ultimately, give all the glory to God for this amazing adventure of life that He has given us.

MD: Graduation Day

Well, we he did it!

This past weekend we actually closed the medical school chapter of our lives and Josh graduated from St. George's University with his degree of MD.  We can now officially call him Doctor.  He had previously been matched into a residency, finished his 4th year and received his diploma, but I think walking across the stage in a cap and gown while being called Dr. Joshua R. Scurlock really made it the most official.

I'm not going to lie, watching him be hooded by his father, Dr. Scurlock and receive his degree got me pretty teary eyed up in the balcony of Avery Fisher Hall at Lincoln Center.  To say that I am proud of this major accomplishment would just be an understatement.  Of course I'm proud of him.

But, I'm more than proud.  I was witness to the entire journey.  I know first-hand the time and effort involved in Josh becoming a Doctor.  I was there for the days and nights of endless studying, for the stress of Biochemistry and Pathology midterms, for the intense 8 weeks of studying for the Step 1, for the 24+ hour call shifts, the time consuming residency applications, and the agony of not matching into a residency initially.  I know how much effort has been given this past four years.  I know how much money has been spent, how many loans have been taken out.

I know how much has been sacrificed.  We have missed weddings, anniversaries, birthdays, holidays, graduations, and babies being born.  In England we missed Summer, in Grenada we missed Winter.  We had to say goodbye to new friends family, almost every year when we moved to a new place.  We had to "start-over" in a new home more times than I care to count.

So,  I'm not just proud of Josh for his dedication to this profession, I'm honored to have been by his side throughout the journey.  And I'm proud of us.  Making it through medical school is tough.  Making it through medical school while keeping your marriage intact is even more difficult.  And making it through medical school while staying married and raising a child...well....honestly...we both probably deserve a medal.  A BIG ONE.

I hope Josh felt celebrated this weekend in New York City (more on NYC later) as we honored his very big achievement with many of his family members who flew out from California for the occasion.  He definitely earned it.

So, the school chapter of Josh's life is closed and although residency (which started today) will still require a lot of learning and studying, we are so excited to finally be moving in to the next chapter.  And receiving a pay check for all of his time spent in the hospital is of course, a huge plus!

Moving East

Have you ever had periods in your life that you want to speed up yet slow down simultaneously?

For instance, as a Mom, I feel like I am constantly anxious to get to the next "phase" of baby hood, always urging Ryan to do the next big thing, crawl, talk, eat, walk, etc.  I couldn't wait to have her sleep through the night, nurse a little less often, entertain herself a little bit more.  It's hard in the midst of the newborn stage to not wish for time to speed up, especially when you haven't had a shower in three days and the most solid meal you've had to date is half of a PB&J.  And yet, you want to keep them your little baby forever and you know you will miss the days when you can't just hold them in the crook of your arm.

Well that's how things are right now.  I want time to speed up and slow down.  We are moving to Massachusetts.  In fact, we moved out of our apartment in Redlands over the weekend and Ryan and I are currently shacking up at Grammy and Grampy Fairman's house.  As I type, my Dad and Josh are more than half way done with their cross-country trek via car.  Last I was told they are somewhere in Illinois.  Ryan and I fly East to meet Josh on Saturday.

Moving Day

Hitting the road!

I am ready for our things to arrive and to get settled in Worcester (apparently pronounced Wustah).  I'm anxious for the solo 5+ hour plane ride with a 10 month old to be over and of course ready to reunite with Josh and begin our new adventure in residency as East coasters.  It's hard for a type A person like me to be living in limbo land.

But, I also want time to slow down.  I'd be lying if I said I wasn't nervous about living so far away from our friends and family.  Sure, we've lived in the UK and the Caribbean and so this should seem like nothing, but we didn't have Ryan then.  I haven't yet done the Mom thing in a place where I have little to no outside support.  And obviously, we are going to miss having our families in Ryan's life tremendously!

So, that's my dilemma, not totally ready to move forward and not necessarily wanting time to stand still.

In other exciting and noteworthy Scurlock family news, Josh received his diploma in the mail the other day.  Like he is for-realsies a doctor and we couldn't be more proud.  I probably should stop saying things like "for-realsies" now that I'm a doctor's wife. Oops!

And not to be one upped by my doctor husband, I've had a few Etsy sales since opening my shop The Dandelion Lane on May 1.  How exciting is that?!?!  If the doctor thing doesn't work out, at least we can count on my savvy business skills to keep us afloat, obviously. ;)

International Medical Graduate. Would we do it again?

I've surprisingly received quite a bit of internet traffic on my blog this past week after my POST about Josh's trouble in the Match, in part due to the fact that he is an international graduate.  I believe the post sheds some light on some of the difficulties of being an IMG as well as the challenges and hurdles that every medical graduate must face along the road to becoming a doctor. There is and unfortunately will probably always be a stigma associated with being a foreign grad.  And so, it sparked the obvious question, given the choice, would we do this all over again?  Should anyone, especially a US citizen, consider matriculating in to an off shore medical school?

To be honest, I feel that this is such a personal decision that cannot be answered by any one person.  As with anything in life, there are pros and cons that must first be weighed to determine the best answer for you.  However, here is our experience.

Josh just didn't get offered an acceptance to a US medical school.  Whether that was due to an average undergraduate GPA, average MCAT scores, or something else entirely, he was never given the chance to go to medical school on American soil.  Perhaps he should have applied a second time.  Perhaps he should have retaken the MCAT again.  Maybe he would have been better off redoing undergraduate pre-reqs, but he was 24 years old, newly married, and ready to start down the long road to completing his dream of becoming an MD.  And St. George's University in Grenada, West Indies gave him the chance to do it.  It is extremely hard to pass up an offer to obtain your dream career when it is being handed to you, even when it is attached to a $200,000.00 price tag.

In hindsight, we were young and naive and we thought to ourselves, SGU is a US accredited program, he's a US citizen, and he will take the same exact boards, we should have no problems.  Well, SGU did what they promised us.  We paid them a lot of money and Josh and his class of over 500 students studied hard, passed classes, did two years of clinical rotations in American hospitals, passed boards, and applied to residency just like every other AMG student.  Obviously, from my last post, you can see that the residency part of becoming a doctor has been one of our biggest challenges, however, it did work out.  And it does work out the first time around for over 80% of SGU's graduates.  If you want to see just how SGU is matching their students each year, you can check out this SGU MATCH LIST 2014.  What you will see from this list is that most SGU grads match into primary care at non-University based programs (Internal Med, Family Med, Psych, Peds).  The point is that these graduates are making it to the MD, just maybe not the super specialized ones.

What we find most disturbing about the residency application process is that these students, especially ones trained at US accredited medical schools like SGU, Ross, and American University of the Caribbean, take the SAME EXACT boards, receive all of their clinical training at American hospitals and therefore receive letters of recommendation from US doctors, and yet still are considered second class choices for US residency positions because of the location of the medical school that they went to.  Are the USMLE's somehow a different test when IMG's sit for them?  Are the doctors at the hospital Josh rotated through training the SGU students in a different way than the medical students from Loma Linda University that rotate right alongside them?  The answer is absolutely not.  But, until more residency positions are opened across the US, or until the playing field is neutralized to take the strongest applicants regardless of the school they graduated from, this will likely remain the same and obviously, that is something to consider if you are contemplating attending an off-shore school.

With all that being said, our answer to the question, would we do this again?

In a heartbeat.

My husband is Joshua Scurlock, M.D.  And though those two little letters cost us a lot of money and a ton of blood, sweat, and tears along the way, he is now a doctor.  We are confident there really was never a choice of attending SGU vs. not becoming a doctor.  The United States is the land where you follow your dreams, even if that means following them outside of the US.

The Match, The SOAP, & the reality of being an IMG

This past week was Match week, which for those of you readers unfamiliar with this term, it is the means by which MD graduates get "matched" into a residency placement.  For many people, Match week is the highlight of your 4 years of medical school, when you finally have a job post graduation and the reality that all of your hard work has in fact, paid off.

However, what many people don't understand is that there are far more MD candidates trying to "match" then there are spots in residencies.  Every year, there are thousands of applicants, many of them international medical graduates (IMG's) who don't receive a spot in a residency.  Therefore leaving them with the degree of MD but unable to be licensed and practice due to the inability to obtain a residency position.

The Facts:

• Josh is finished with all of the requirements to graduate from medical school at SGU and will receive his diploma in June.
• Josh passed all of his board exams, Step 1, Step 2 CS, and Step 2 CK with scores above the average for both IMG's and AMG's (American Medical Graduates)
• He had strong letters of recommendation
• He is in the 1st quartile (top 25%) of his graduating class academically for both the basic science years (first 2 years) and currently
• He applied to 100+ categorical surgery residency programs both community based and university based across the entire US
• Josh only received a few interviews to residency programs
• We found out Monday that Josh did NOT Match

While not Matching did not necessarily come as a complete shock because of so few interviews, we were still very disappointed.  It is extremely scary to know that you not only don't have a job after 4 years of medical school, but you also have no job with $200,000.00 worth of educational debt that will have to start paying back after you graduate.

The SOAP (Supplemental Offer and Acceptance Program):

• When you don't Match into a residency, you can enter the SOAP, a process by which you send out up to 45 more applications to residency programs that did not, for whatever reason, fill their positions during the Match.
• On Monday afternoon, Josh sent out the full 45 applications to programs for Surgery (both categorical and preliminary), Family Medicine, Emergency Medicine, and Internal Medicine.  At this point he was willing to do anything.  We thought FOR SURE he could SOAP into something based on his grades and Step scores.
• From Monday through Thursday, applications are reviewed by programs, phone interviews may happen, and every few hours, offers to those programs are made.
• There were approximately 900 positions in the SOAP.  There were over 1100 AMG's unmatched and over 8000 IMG's unmatched trying to obtain these spots.
• Josh got ZERO phone calls or emails the entire week.  NOT. EVEN. ONE.
• It is our belief that international graduates, regardless of citizenship were filtered out from the start, that Josh's application was not even looked at all week.

Our interpretation of the SOAP from an IMG standpoint was that it was like being stabbed with a knife and then having it twisted around inside of you in order to kill you slowly and painfully.....a slow, painful death.  There is nothing like sitting around all day for a week, waiting for a phone call, and one never coming.  The stress level in our apartment was sky high and yet we knew there was nothing to do but wait and hope and pray that something would work out.  Josh was a part of message boards online for people in the same position and we know that AMG's with significantly lower Step scores were getting multiple phone interviews as well as offers.  Never has the stigma of being an international graduate felt more damning.  Both Josh and I were so discouraged.

Post SOAP:

• On Thursday at 5:00pm EST, the SOAP ends, and unmatched applicants are then allowed to contact programs by phone or email that still have openings.
•  At this point, there were less than 50 spots across all specialties left after the SOAP and programs are not required to fill their positions.
• Josh began sending out what I call hail Mary emails to programs with unfilled spots hoping that someone might throw him a bone and at the very least email him back.
• He received many automated response emails saying either the positions had been filled or that they had decided not to fill their positions this year.
• By Friday morning, Josh was beginning to look into alternative options for the next year.  These included doing an MPH (Masters of Public Health), unpaid medical research, delaying graduation in order to do more hospital rotations, and jumping off a bridge....joking...kind of.

On Friday around noon, Josh received a call from the program director at the University of Massachusetts, one of the programs he had emailed the night before.  He conducted a 10 minute Face Time interview and offered Josh a general surgery residency position for this year on the spot.  Within minutes of getting off the phone, an email with the offer came through, Josh signed it, and that was that.  Relief immediately followed.

What we learned/Our advice:

• Apply on time.  Do not wait even a day to send out your applications. Being the first to get them in is likely key to getting multiple interviews.
• If you can, have all of your Step scores IN before applications are due.  You are best off if you have a COMPLETE application at the time of submitting it.
• Have realistic expectations.  If you are an international grad, it will likely hurt you.  Most IMG's go in to primary care (FM, Peds, IM, Psych).  If you do not want to go into one of these, consider apply to some anyway as a back up choice.
• Avoid the SOAP at all costs!  It is NOT set up to be in the interest of the applicant, especially IMG's.
• It is better to have a residency of any kind than not.  Trust me.

We feel very lucky.  Not only did Josh end up in his residency of choice, surgery, but amazingly he is also going to be at a university program at one of the top surgery programs in the United States.  It is nothing short of a miracle and we are definitely counting our blessings.

****EDIT: Here is a link to the follow up post regarding our match process.  Josh did, in fact, match into categorical surgery in the 2015 Match.  Read about it HERE.

Starting Over

It's been almost six months since I last posted in this little space of mine in the blog-o-sphere.  Six months.  And it's crazy to think how much has changed.

My little baby Ryan Cathleen transformed into a little girl.

Just Born

7 Months

I hope to catch you all up on the life of my Ryan soon.  She becomes more entertaining every day.  She doesn't miss a beat and constantly keeps me on my toes.  And she brings so much joy to my heart.

Josh is less than two rotations away from finishing his fourth year.  We anxiously await residency placements and life after medical school.  It's hard to imagine life without school, although life without tuition payments sure sounds great.

My absence here is due to many things, most of which I have no intention of sharing.  It's easy in the age of social media to assume that everyone's life is perfect.  After all, we blog about, tweet about, Facebook about, and Instagram about all the picture perfect moments in our lives.  We have gotten pretty darn good (myself included) at making our lives, families, careers, children, homes, etc. look idyllic online.  And perhaps, your life is.  But chances are, each and every person is fighting a battle that nobody else knows about (no matter what their Facebook says).  What I will say is this. 

Marriage is HARD.

Medical School is HARD.

Motherhood is HARD.

Life is hard.  If you don't think so, well I guess maybe you're lucky.  Or perhaps you haven't faced a storm in your life.  But more than likely you will, someday. And it will probably come when you least expect it.  God never promised that we wouldn't have to fight battles or that we wouldn't face difficult times.  In fact, I think He uses the challenges in our lives to draw us closer to Him.  Our faith is strengthened during the struggles of life.

I hope to post a little more frequently than every six months from here on out.  I can't promise that each post will be picture perfect (although my child is pretty perfect) :), because life just isn't. But it will be real.