As a welcome relief from all the sadder posts about the octuplets, I’m reminded that there are many optimistic diligent students who might someday be the RE’s of the future. Here are some of their questions:

How do you become an RE? What classes do you suggest I take in highschool? in college? I’m a freshman in highschool and I think I might be interested in this career. Is there anything I should know?
And another afterthought, are there any depressing side effects like couples (mainly females, I assume) that break down?

Ashley

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I thought it would be appropriate to introduce myself. I am a third year medical student that follows your blog. I have always been interested in Ob/Gyn and have been fortunate to shadow a couple REI’s from my hometown in Wichita, KS.

I am an aspiring REI. I was wondering if you could give me some suggestions on how to reach this goal. Also, do you feel it would help if completed an M.D. residency rather than a D.O. residency? I did read the part of your blog where you address that REI is extremely competitive and to make sure to be happy as a general Ob/Gyn if you weren’t able to get a fellowship.

I just completed my required Ob/Gyn rotation, and I really loved it. My attending did quite a bit of infertiity for a general Ob/Gyn, including FSH injections because of her unique situation of being in a small town. It was a great rotation.

Keep blogging! Thanks in advance.
Paige

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Hi Dr. Lee,

I’m Jay, a third-year medical student at the University of Missouri School of Medicine, undergraduate degree from UCLA 2005. I know you’re probably inundated by millions of messages like this, but I am EXTREMELY interested in going into REI as a career choice. My father is a general OBGYN but I’ve determined that REI is the way for me. Do you have any pearls of wisdom as I embark upon the rigorous application process for OBGYN residency? Anything would help. Thank you so much Dr. Lee, and congratulations on all your success. I came across your blog from StudentDoctorNetwork and have bookmarked it now to visit daily. Thanks!

Sincerely,

Jay

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Hello Dr. Lee,
I recently came across your blog and it’s so informative. I am currently an OB/GYN intern at Meharry and I have had a longstanding intrest in REI. I was just curious to know how you knew that REI was what you wanted to pursue. I guess a part of me is hesitant due to the competitiveness of getting IN to the field, but I am also not trying to let my possible future escape me due to fear! Any advice?
Look forward to hearing from you,
Nke

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Thank you all for your questions. I’ll start with the straightforward part. Ashley, in order to become an RE, you first graduate from college, and then go to medical school for four years. Afterwards, you do a four-year residency in OB/Gyn and then an additional three years of a fellowship in Reproductive Endocrinology and Infertility. You’re probably thinking “That is a quite a lot of schooling”. I’m sure you can do the math yourself, but I personally took an accelerated route (started early and skipped one year) and even so, was already 30-years-old by my final year of fellowship. Other RE’s who take a less direct route are already over 40 when they finish their training. So one big question to ask yourself is whether or not you’re willing to dedicate such a big chunk of your life to learning the knowledge and skills that it takes to be a good RE. The good news is that you don’t have to commit to that decision right this moment. You can take it one step at a time, focusing now on making the most of your high school experience and doing your best to get into a college that is good for you. By the way, if you want to immerse yourself in the field of fertility and don’t want to go the long route to becoming an RE, you could participate as a medical assistant, nurse or Physician Assistant. I realize that it’s not the same thing as being an RE, but it has its good points too. You could also choose to be an embryologist, although the everyday atmosphere is very different in that you would interact mostly with egg, sperm and embryos rather than directly with patients.

Ashley, right now, while you are in high school, rather than restricting yourself to any specific MUST-TAKE classes, your best strategy is to make the right decisions so as to maximize your options. What does that mean? I’ll share with you an answer your teachers and school counselors may never tell you. Here’s the secret. When it comes to a career in something competitive like medicine or law, there is a delicate balance between doing what it takes to “play the game”, and doing what it takes to really grow and learn as a person. Shall I explain? On one hand, many pre-med students take the extreme “Cutthroat PreMed” approach and focus single-mindedly on what it would take to get into the best college or the best medical school. Somewhere along the way, they find themselves losing their humanity and falling into the trap where every major decision is geared towards getting accepted and not necessarily towards becoming a well-rounded doctor. “Hmm let’s see, I will need to spend next summer pushing wheelchairs at the hospital so I can say I have some hospital volunteer experience and I’m going to run for Assistant Vice-Treasurer of the Lithuanian Pre-Med Students Association so that I can have some extra-curriculars to list”. If you single-mindedly focus on getting great grades, great MCAT scores and a long list of activities on your resume, but ignore developing yourself as a human being, your odds of getting into medical school will still be pretty darn good, but you have sadly missed out on a some great years of your life. And worse of all, you might find yourself being a very depressed resident or graduated doctor someday.

On the other extreme, some people take the “Rebellious Anti-PreMed” approach. They adamantly refuse to the play the game. “I’m not going to waste time studying for Organic Chemistry since I know that 99% of doctors will never use it in their daily practice. And I refuse to obsess about the MCAT. How does my performance on multiple choice questions reflect how caring and empathetic I’ll be as a doctor? I’m going to focus my energy on the practical courses like microbiology and anatomy and then round myself out with a lot of psychology, literature and history classes, as well as enriching my writing skills”. While I personally agree with this in spirit, I also have to warn you that in actual practice it doesn’t work. This attitude of not taking things like Organic Chemistry and the MCAT’s very seriously is one easy way to NOT get into medical school.

Furthermore, Ashley, it’s so good that you’re already asking questions at this point in your life, trying to get an edge for your future. If I could go back in time and meet my past self when I was in high school, one of the many things I would tell myself (besides save all my paper-route money and invest in Microsoft) is to develop a habit of regular reading. Many smart thinkers throughout the centuries have “figured things out” and put their discoveries down in words. Even if you could gain just 1% of their pearls of wisdom, your life could be significantly easier and happier. Now I know there are people who scoff at self-help books because we probably all know a friend who reads them or goes to self-help guru seminars, but yet their lives are not something that we would care for. Reading self-help books but not acting on the advice learned is like trying to get in shape by buying more and more exercise equipment. It’s not as powerful if you just read and don’t apply what you’ve learned.

Now if you want to know which specific books I would recommend, I would start by telling you that I’ve read tons of books and some of them have been tremendously helpful to me and others have been a waste of time. There are people out there who have read my “waste of time” books and found them to be the most helpful while my “changed my life” books did nothing for them. So the point is that everybody is different. To get started, visit this site and print out the books listed. Check out a few from the library. Devote at least two hours every week (more if you can) to leisurely looking through them. If a particular book does nothing for you, let it go. By the way, even if a book does not thrill you today, you can always give it another try a few years later. If however, you DO find a book that grabs you, share it with a friend and discuss it together. Anyway, Ashley, thank you for your question. I hope I was of help. If my answer was not what you were looking for, I only ask that you revisit it every few years as you progress in school. One day it will click. Oh by the way, in answer to your question about dealing with couples who break down emotionally, you are correct in guessing that this field of medicine contains some of the most emotional extremes. lt comes with the territory. You will share the agonizing pain of many couples as they have failed cycles and miscarriages, but the trade-off is huge as you get to rejoice with the many more couples who end up as happy parents! I can’t imagine many jobs that have more of these types of highs!

Paige and Jay, since the two of you are already in medical school, congratulations! You have already set yourselves above the rest of the pack, demonstrating that you have figured out what it takes to succeed. Maybe you would be better suited to give high school students like Ashley advice, since the timeline for your successful decisions is much more recent than for mine.

As for what tips I can give medical students, there is nothing secret other than to get into a good OB residency. One question is this: Is it better to go to a great OB residency that does not have its own REI fellowship? Or better to go to a lesser residency that does have a fellowship program? The answer, as always, is ‘it depends’. First of all, the question is tricky because it assumes that we know what makes a program better than another and the fact is that we don’t. Keeping all this in mind, when you are deciding how to rank your program choices, my opinion is that presence or lack of a fellowship SHOULD come into the equation. The reality is that people do their fellowships at the same place they do their residency much more frequently than could be attributed to chance. There are several reasons for this. One is familiarity. As a fellowship director, it’s safer to take someone who is well known to you and to the other faculty in your department than someone who is a total stranger.

Paige, as for your question about DO vs MD residencies, my general advice is to aim for the most competitive program that you can get. As some of you know, I am on faculty at UC-Irvine College of Medicine as well as Western Health Sciences, so I regularly lecture to hundreds of MD students and DO students each year. And while it is more than possible to become an RE through the DO route (I personally know some excellent RE’s who are DO’s), it is much easier to get there through the MD route. Again, some of this is out of our control. It’s easier for a football team to win the Super Bowl by first winning their division and getting a bye than it is to win as a Wild Card team that barely made the playoffs. However, as the 1980 Oakland Raiders, 1997 Denver Broncos, 2000 Baltimore Ravens, 2005 Pittsburgh Steelers, 2006 Indianapolis Colts and 2007 New York Giants have proven, it happens more often than one would expect.

One general tip for medical students, residents and doctors is to realize that our lives are “different”. With so much expected of us, we really need to make the most of our God-given 24 hours each day. This means we should strive to always do the best thing at any given minute. This should NOT be interpreted to mean that we should always be studying or at the hospital, because sometimes the best thing to be doing at the time is to be watching the sunset with a loved one or to be sleeping or to be at a funny movie, because only then can we be recharged to go back into the hospital at our fullest energy level. There is a term called ‘lifehacking’, which I define as squeezing the most out of each minute of life. I am a big believer in the concept. That’s why I try to learn and find the most efficient ways to do things like setting up macros for repetitive tasks on the computer and listening to audiobooks during commuting or while at the gym to make the most double use of each hour. One specific book that I highly recommend is Getting Things Done. If you find that it completely changes the way you organize your life, please drop me a line to let me know.

As for the tricky fact that in order to do REI, you have to go down the OB pathway, I can say this for myself. I’m guessing that had I not gotten into an REI fellowship and was now practicing general OB, I would still be happy. I can’t imagine I’d be as happy as I am right now, but it wouldn’t be that terrible. I say this even though I realize that the work-day (and work-night) of a general OB is very different from the work-day of an RE. So if you think that you would love being an RE, but hate OB, then my advice is not to take the gamble. As you can see from a previous post, the ratio of applicants to acceptances is around 2 to 1.

Last but not least, Dear Nke. Congratulations on not only making it through medical school but already being in the world of OB/Gyn. I hear words similar to yours all the time, not with respect to applying to a fellowship, but with respect to trying infertility treatment. Patients sometimes are afraid to try even a Clomid/IUI cycle because they have a fear that it might not work. They don’t worry about the cost or the time commitment or the risk of multiples so much as they worry about the misery of doing a cycle and failing. Sure it’s sad to do treatment and not get pregnant, but is it really all that much better to remain not pregnant because you never tried to do any treatment? As for your question about when I decided to pursue going into REI, it wasn’t until I was on my way to applying to Gyn-Onc that I changed my mind.

Anyway, I commend your attitude. You have already committed to OB, so that’s one bridge crossed. Now that you’ve done it, I encourage you to explore it open-mindedly. After all, this is just your first year of residency. Who knows? You might end up loving Gyn-Oncology or Maternal-Fetal. But I agree with you in any case. Don’t let fear of not succeeding prevent you from trying.