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How Your Surgeons Got Their First Jobs

They handed me an out-of-tune Martin, a high-end piece of acoustic craftsmanship, because I’d listed “electric guitar” as a hobby on my résumé, but there was no amplifier in the room where they were interviewing me. I tuned it by ear as best I could while the four of them watched me silently in their suits. Then, with a nickel from my pocket in lieu of a pick, I tried to muster the gods of heavy metal with a guitar meant for bluegrass or blues. When my one-man, acoustic rendition of Metallica’s Master of Puppets had persevered for longer than was comfortable, they were satisfied.

“That was terrible, but you pass,” said the greyest among them. They chuckled, and I chuckled. Now, I had to convince them that I should be a neurosurgeon.

After four tough years of medical school and student loans, facing down seven more grueling years of training, aspiring neurosurgeons enter a residency interview process that is as bizarre as it is effective. Your residency is your first job. It’s where you learn your craft and launch your career. You’ll spend as many years at your residency program as in middle school and high-school combined, and more than in the average marriage. You’ll share around 88 stress-filled hours per week with an intimately small group of colleagues, who you’ll see more than your friends, family or the light of day.

I hadn’t been playing guitar much recently, as I was traveling, and busy, and busy traveling, sleeping on friends’ couches or renting cheap hotel rooms with my student loan money. But I always stayed as close as possible to City X’s major academic medical center, because I couldn’t risk being late for my interviews in the morning.

And those mornings could be hellish. I would usually make my way from my hotel to the interview at around 7 a.m., tackling my unfamiliarity with the city I was visiting while grappling with sleep deprivation and a hangover, and recovering from having swallowed steaks to the point of discomfort only hours before. Then, I would explain why I should be the one operating on their patients’ brains.

This particular interview day started typically. I awoke to the sudden and stinging sounds of smooth jazz from the hotel alarm clock, evoking a throbbing pa-pain-pa-pain-pa-pain between my temples. The previous night had ended five hours prior, and I felt terrible. My dimly lit hotel room seemed blindingly bright, piercing straight through my pupils to my pituitary. I didn’t leave myself enough time to dawdle, so I rushed to throw on the suit I’d recently bought online — “modern fit” and “charcoal grey,” perfectfor the gentleman on the go! I let out a quick sigh and exited the hotel room, starting the act of being as awake and professional as I could.

My hangover resulted from a crucial part of the process. This interview, like most, was a two-day affair. One day had a social agenda, the other a professional one. Too few hours before my embarrassing acoustic Metallica cover, I was at the all-important social dinner, where applicants broke bread with the residents of the program. No faculty present. If recruited, we would spend most of our time alongside these residents for the next seven years. We watched how they interacted with each other, carefully considering whether we could see ourselves among them. They, in turn, would size us up, seeing if we would fit in as part of their crew.

As was typical, the dinner was held at a steak house that no one in the group could afford. The neurosurgery department picked up the tab using a “recruitment budget” that planned for three or four such interview dinners per year. The residents were in high spirits — interviews meant a light schedule tomorrow, with no surgeries on the queue. They could fill their bellies on the department’s dime, with food and drinks that easily beat the hospital cafeteria fare they were used to. We would all be having the tasting menu that night, and the wine bottles outnumbered the diners. I later looked up “tasting menu.”

Behind the seemingly laid-back atmosphere, is the competitive pressure of The Match, which can bring out the worst in some people. One study found that more than 30 percent of students applying to neurosurgery may be misrepresenting their accomplishments on their résumé. Medical students tend to have plenty of résumé-type accomplishments, but some begin to think that every line on their application is make-or-break, and that blank space is a liability. Two years ago, a student I knew was expelled for exaggerating his application, only months away from graduation, and with hundreds of thousands of dollars in debt. Worse still, he was a stellar candidate who would have done very well if he had only been honest.

But in medicine, honesty is as essential as embellishment is dangerous. Health care is delivered in teams, and team members have to know that they can rely on one another. Physicians are a proud bunch, and neurosurgeons are definitely no exception. But, it is dangerous for a surgeon-in-training, lacking in experience, to also be without the candidness to say, “I need help,” or “I don’t know.” Hiding weaknesses on a résumé foreshadows hiding weaknesses elsewhere, and calls into question the accuracy of what you say about the latest brain scans for Mrs. Jones in bed 209.

So when four senior neurosurgery professors asked me to play something for them on the guitar, what they were really asking me was, “Are you a liar?” And as I scraped the nickel on Jefferson’s face across the wound strings on the guitar’s lower register, I was really responding, “No, sir! Absolutely not, sir!” even while my lips were saying, “Sorry — Master of Puppets sounds better with distortion.”

Now, in my own defense, I would have played better with more hours of sleep, or less to drink the evening before. And while that wine-coaxed personality test served an important purpose, it’s not hard to see how such nights can get out of hand fast. Take a group of medical students and residents, usually shackled with high stress, tight budgets and limited free time, and then remove all three of those concerns at once. Add liquor and stir. Chaos.

But that chaos is an incredibly useful tool. Our future colleagues see who we are, not who we pretend to be, while testing our ability to know our own limits. If you fail, you’re likely to become one of the stories — that person who did such and such at University of Somewhere’s interview. Applicants and residents all hear stories passed through the grapevine of the intimately small world of neurosurgery. The stories are hilarious — if they happen to someone else. If you are the story, you might end up among the many who apply to neurosurgery in the fall but have no program to train with come spring.

And on day two, the haze and sleep deprivation serves another useful purpose. I’m not my best self when I’m not well rested. Then again, I’m about to go seven straight years without being well rested. A residency program may not want to know what my best self looks like, because that’s not the man they’ll see much of the time. Why would they interview my Dr. Jekyll, if they’ll mostly be seeing my Mr. Hyde?

Despite the hangover, I had carried the tune well enough to “pass” that morning. However, I was hardly out of the proverbial woods. Most interviews were conversational, but experience had taught me that they could be set with surprises. I had been asked to share my most embarrassing story. I had been made to tell the dirtiest joke I could think of to a group of grey-haired Gen X-ers. I had been ordered to make a sculpture with a Legoman, a pile of office supplies, and a sixty-second time limit. I had been challenged with finding the “best video on YouTube,” as well as my favorite one, as though I should have judged these categories differently. I was asked to imagine myself reincarnated at another point in history, and to describe the life I would lead there. I was told to graffiti over the headshot I was required to submit with my application, assured, of course, that I would be judged on my handiwork. And I sat in that chair, guitar-in-hand, knowing I would have seven more interviews by that afternoon, but not knowing what each might entail.

Now, the right fit is certainly important, but there are clear downsides to this kind of feeling-out process. The constant question are you one of us? is tough for some applicants to answer. I don’t envy the talented women who pursue neurosurgery, because the question is sometimes phrased, are you one of the guys? I know a gay applicant who worried about his identity’s impact on his application. Another interviewee, an observant Muslim, hid behind a constantly carried cup of liquor that he would never actually drink, in order to pass the likable/sociable test. Besides the occasional Asian joke, which I’m not the type to worry about, my path was smooth by comparison.

And there are certainly healthier ways to spend a few months of your life. My typical week is beerless and regimented, fueled by Cobb salads and coffee, with near-daily exercise and a disciplined diet. Not so during interview season. The trail is a riotous road of open bars and steak dinners, where medical students, used to scrimping their student loan money, suddenly experience excesses and extremes. I flew coast-to-coast, and to-coast again — twice in the same week. For the first time, I would eat until I vomited. Then, like a Roman, I ate some more. I rediscovered why I hate strip clubs, and fell asleep standing up at least twice. I had, in rapid succession, a Chicago-style pizza in Chicago, a New York style pizza in New York and a root canal on my second biscuspid. I had my first taste of the club scene in Iowa City — and it will probably be my last. I went to Texas, Los Angeles and our nation’s capital, and was astounded by the beautiful variety of my country. And by the end, though a weight had been lifted from my shoulders, I was nine pounds heavier, and my suit had become snug.

Now, the interview trail is over, but the rest of my story is just beginning. In June, I’ll have the terrifying privilege of starting my neurosurgery career at a world-class hospital in the city I call home. Pretending I got here because of my own accomplishments would mean ignoring how lucky I have been to have mentors who backed me, and patient support from friends and family. I don’t know where I would have ended up without them, but my next seven years could have looked very different.

“That was terrible, but you pass,” said Dr. O. (I know his name now). We all chuckled. And now, months later, I still chuckle to think of all that I’ve seen and done in the name of neurosurgery interviews. In the second half of my twenties, with degrees piling up, I’m finally a few weeks away from having a goddamn job. It is exactly the job I want, and it is one I am honored to have been offered. But while countless hours in the library certainly helped, they only got my foot in the door. I hope you never need surgery, and that your life is a healthy and happy one. But if you ever do, here’s an unsettling truth to contend with — your surgeon got his first job by being a person you want to have a beer with.

Michael Cloney (1 Posts)

Contributing Writer Emeritus

Columbia University's College of Physicians & Surgeons

Michael Cloney is a recent graduate of an MD/MPH dual-degree program at Columbia University's College of Physicians & Surgeons and Mailman School of Public Health. He writes as a Communication in Health and Epidemiology Fellow for The 2x2 Project, and a health columnist for Impakter Magazine. After 10 years in New York, he is excited to have moved home to join Northwestern University’s Department of Neurological Surgery this summer.