The ERAS Personal Statement

The ERAS, or Electronic Residency Application System opened on July 1st. All Residency Applicants for the year 2009 are required to submit an application to ERAS and part of this process is to create a "Personal Statement", up to 28,000 characters, describing who you are and why you should be chosen by a Program to be their Resident. Enclosed is the Personal Statment that I have written while I was on the BonHomme Richard. I have enclosed it below just to make it a permenant part of my blog. I hope to look back on it one day and smile. Feel free to read if you like, my regular blog entries will continue soon. -RJ

I've been repeatedly asked four questions by my friends and family since I graduated from the Philadelphia College of Osteopathic Medicine in 2004: "Why did you decide to be a doctor?", "Why did you choose to be a D.O. versus an M.D.?", "Why did you join the military?" and "Why did you decide on Family Medicine?" The answer to each of these four questions is multi-factorial, but each provides an in depth look at who I am as a Physician, a Naval Officer and as a person, and each provides a reason why I would make an excellent choice for your Family Medicine Residency.

I remember the first time I was asked who my heroes were in life and who I wished to emulate. I was in 7th grade and while many of my classmates named famous sports icons or movie stars, I remember answering "my mom". Granted, this didn't help my efforts to avoid being picked on in Junior High School, but it was the first thing that popped into my head. My mother has been a source of great inspiration to me ever since I was a child. She never made a lot of money, she came home from work tired every day, and she never bragged about what she did, but what she did was truly amazing to me. She worked as a Licensed Practical Nurse taking care of elderly people with Dementia and Alzheimer's disease. I remember thinking that it must take a great deal of patience and compassion to work in this capacity. While I knew my mom genuinely cared for others, it wasn't until one Christmas that I realized just how good she was at her job. That year I joined her at work to wish a Merry Christmas to all of her patients who didn't have any family left or whose families had abandoned them. That experience was a pivotal moment in my life because I realized three things; first, that in order to be happy in your profession, your work has to come from your heart, second, that I inherited my mother's patience, compassion and care for others and third, that it was my calling to use those attributes in my career, although figuring out how would take me several additional years.

The University of Rhode Island (URI) had an excellent program in International Business. In fact, when I first arrived on campus and met with the Career Counselor, he essentially assigned me to the program. It seemed to make sense at the time. I knew I had a desire to travel and see the world. I knew I liked to work with other people and if high school had taught me anything it was that I excelled in foreign languages, German and Spanish being my two favorite. So for two years I studied Business Administration, German and Spanish. Then one morning in the depths of the URI library I remember sitting there with my thick accounting book open working out tax problems when it hit me. I slammed my book shut, got a couple of dirty looks because of it, and marched back to the Career and Counseling Office. I went back to the same gentleman who I had not seen for 2 years and said "I want to change my major". He asked me to what end, and I replied "I want to be a Doctor!" I was so proud of my exclamation. It took me all my life to figure out what my calling was, but finally I had. Anxious to hear how to embark on this endeavor, I waited for his reply. He looked at me, chuckled a bit, and responded "Son, you don't just decide to change majors and go into Medicine, becoming a doctor is something you decide early in life, it's an intensive 4 year curriculum here at URI." When I pressed on and tried to explain that I was serious, he said "I know Business can be tough, but try to stick with it." I left that day with my head hung low, but after several hours of pondering I came to the conclusion "Who is he to tell me what I can and cannot do?" While that would be the first of many tests I would have to endure, it was the last time I ever doubted my decision to become a physician or my resolve to accomplish it. The next day I marched back into the Counseling Center, spoke to a different Counselor and said "Tell me what I need to do!" A few 19 credit semesters, a summer devoted to Organic Chemistry, a Princeton Review course, an Emergency Medical Technician night class and I was on my way to success.

Growing up in the small town of Nazareth, PA, I wasn't exposed to a lot of diversity. I can remember there being one African-American student, one Indian student and one Chinese student in my high school class of 250. So when I got the phone call from Barry University inviting me to start their Masters Program in Biomedical Sciences in Miami, Florida, I knew it would be a culture shock, but an exciting and necessary part of my journey. Necessary because even though I completed the Biological Sciences major at URI in just 2 years, in contrast to some of the other students who were on the normally spread out 4 year track, I got a somewhat disjointed picture of how all the sciences were interconnected. My MCAT scores reflected this lack of cohesive understanding. When initially applying to medical schools, I did not get any positive responses, but I didn't let this daunt me or my resolve. I simply knew I had to work a little harder to achieve my goal. Perseverance is one of my strongest attributes. I knew that completing a Masters Degree with straight As would show medical schools that I was serious about my endeavor and prove to them (and to myself) that I could handle the curriculum. Except for that one B+ in Genetics, which I still attribute to the teacher's heavy accent that no one could understand, I did just that. In the process I was exposed to a myriad of life experiences both good and bad; different cultures, different races and different walks of life for example. A weekend job working in the DJ booth of a nightclub opened my eyes to a lot of real world problems I had never even seen before - drug addiction and alcohol abuse, just to name a couple. From my two years in Miami I not only learned about different kinds of people, but I learned a lot about myself as well. The most rewarding endeavor I undertook was accepting a position as a Career Counselor Graduate Assistant for the university. I wanted to give undergraduates the kind of guidance they needed to make the best choices possible. I never wanted any undergraduate to be told "no" or to be laughed at when they shared their dreams with me, instead, I told them what they needed to do to make it happen. Despite the negative experience I had with the Career Counselor at URI, it was very rewarding for me to shape these student's lives in such a positive way as their Career Counselor. I left Barry University confident, accomplished, more cosmopolitan than before and most importantly with an acceptance letter to Philadelphia College of Osteopathic Medicine.

In college the Pre-Med Department ironically never talked about Doctors of Osteopathy, aka "D.O.s". They were a different type of doctor known only to me through my research. I remembered that my family doctor growing up was a D.O. and I remembered that he was a great man and an amazing doctor. In my research on D.O.s, I discovered that over 100 years ago Medicine branched off into two types, Allopathic Medicine (an M.D.) and Osteopathic Medicine (a D.O.). I uncovered words like "homeopathy" and "osteopathic manipulation". I learned that D.O.s believe that the body works as a unit, that all of it's systems are inter-related and that dysfunction in one part of the body can cause dysfunction in another part of the body, even if it's far away, due to this relationship. For a very basic example, that headache of yours could be caused by an abnormal gait, putting excess strain on your pelvis, causing dysfunction in your back musculature, which is of course connected to your head. This didn't seem to be far fetched in any way and to my dismay I saw many doctors who would just write prescription drugs to cure the headache without considering other causes. D.O.s also believed that the musculoskeletal system was primarily involved in a great deal of the body's dysfunction. By correcting it through Osteopathic Manipulation, a technique similar to Chiropractic Manipulation, one could resolve many of these dysfunctions. I learned that D.O.s were very primary care oriented and that many were Family Physicians for this reason. While it is true that the pre-requisites for admission into D.O. schools were for some unknown reason slightly less stringent than their M.D. counterparts, I decided to pursue becoming a D.O. because it seemed to fit who I was and what I wanted out of Medicine and it made my sister quite happy because she got free treatments to her back on the weekends I would come home.

Two nights before taking Step 1 (of 3) of my Medical Boards, my best friend Victor decided to tear me away from my last minute review and take me out to a restaurant in downtown Philadelphia with some friends. I was reluctant to go and nervous about my upcoming test because despite my preparation, I have never performed well on standardized tests. (I have a tendency to read into questions a little too much.) Well that night I figured it would probably do me some good to take a break and so I agreed to go out, just for an hour or two. Little did I know that this night would be one of the most memorable of my life, as it was the night that I met Barbara Delia. After finishing dinner we left the restaurant and I happened to notice a frail mid 50s woman standing on the corner of the street. She looked confused and disoriented. Something in my gut told me to go up to her, and despite my friends' protests (they wanted to move on to a bar, assuming she was a bum), I approached her and grabbed her arm as she was about to step into the street. She said her name was Barbara and she was holding a key in her clasped hands. She smelt like alcohol and she was crying, yet she somehow must have blended in with the city because I was the only one who apparently noticed her. She said repeatedly that she needed to "get to Miramont". I asked her for her address, which was just 3 blocks away and I decided to walk her home. In her apartment lobby she asked if I could help her upstairs. In tears, she told me repeatedly how ugly she was. When I got her to her door, it was unlocked and cracked open and an empty bottle of vodka lie beside a large knife on her living room table. I took them off and on some questioning I learned that Miramont was an alcohol rehabilitation unit located just a few miles outside of Philadelphia. I called them and they said they were expecting her that morning but she never showed. They told me to have her sent to the ER via ambulance and that they would assume care from that point. As I watched her pull away in the ambulance, she looked at me through the glass and I saw her lips say "Thank you". Two days later I took the boards and after a week I returned from vacation to a message on my answering machine. It said, "Hi RJ, my name's Barbara, the woman you helped about a week ago. I just want you to know that all of the people at Miramont and me think of you as an angel sent by God. That night, as you grabbed my arm, I was a second away from throwing myself in the street to kill myself. You intervened and saved my life. (She began to cry.) Thank you so much for what you've done." At that moment I also shed a tear, not just because of Barbara, but because all of my stress about the boards seemed silly to me. I knew that a simple score on a piece of paper wasn't going to dictate how good of a physician I would become, I knew in my heart that I was going to be a great doctor because of the person I was. To date, every year I get a phone call and a Christmas card addressed to "My Angel" from Barbara and it reminds me of why I closed that accounting book years ago.

My father was a Sailor in the U.S. Navy, and while on the surface I would deny that it had anything to do with my decision to join the armed forces, I think every son wants to do things that make their fathers proud. I was elected as Class President of my medical school and shortly thereafter was approached by a fellow student who told me I had leadership qualities and would be "perfect for the military". He was sort of the Military Rush Chairman for the medical school and while I didn't consider myself "perfect" for the military, for the first time in my life I gave the notion serious consideration. The Navy offered 3 year scholarships, which suited my needs perfectly since I wouldn't be commissioned until the summer after completing my first year. The military would pay for the rest of my tuition, my books, my supplies and they would give me a stipend every 2 weeks. Having paid for my own education up to that point, I was already in quite a bit of debt from both undergraduate and graduate school loans, in addition to loans from my first year of medical school. This was a huge financial incentive. Furthermore, I knew that joining the Navy was an opportunity to travel and see the world and it was a noble cause that I was proud to undertake. In return I would grant the military 3 years of service as a physician for the Navy. Joining the military was a decision I became very proud of, especially after 9/11 occurred the following year. I was and always have been proud to serve my country and to give back to her in this fashion. Furthermore, it is nice to hear my father speak of me with such high regard and pride because of my service.

Ever since I can remember it has always taken me a long time to make a decision and for this reason, I have learned to listen to my gut more often, as it is almost always right. Even so, when I entered into my 3rd and 4th years of medical school, though my gut told me Family Medicine was the way to go, I decided to make the decision carefully, because there were so many medical rotations that I both enjoyed and excelled at. It was a fascinating time for me, to discover what my strengths and weaknesses were in Medicine. For example, I have always been great with kids. I'd hold babies and they'd stop crying, I'd get through to adolescents when no one else seemed to be able to. I truly had an affinity for Pediatrics and Adolescent Medicine and this was one of my favorite rotations. As a kid in 5th grade when people asked me what I wanted to be when I grew up I'd either say a priest (I went to a catholic grade school) or a psychiatrist. So it wasn't a big surprise to me that I really enjoyed my Psychiatry rotation either. I already knew from Graduate School that I liked being a counselor and as a young adult people had a propensity to open up to me and lean on me for advice. Some people told me that they felt like I was the only one they'd feel comfortable opening up to (some of my Marines say this even today). So I gave some consideration toward Psychiatry. Obstetrics and Gynecology were fascinating to me, and it was on those rotations that I loved waking up early (or in the middle of the night as it was sometimes) to come into work. I thought that delivering a baby was a miracle and it never got old - it was a miracle every time. I was fortunate to select an Internship strong in OB and by the time I graduated from Naval Hospital Bremerton I had delivered over 150 babies! Before doing my Dermatology rotation I wondered what could possibly be so fascinating about skin. After a few weeks working with one of the best Dermatologists in Atlanta, I discovered that this was yet another facet of medicine that I found very interesting - I can still remember extracting my first toenail. I was fortunate to have strong rotations in Orthopedics and I got to use my Osteopathic Manipulative Training quite a bit there. I liked treating musculoskeletal injuries and this was an area well within my comfort zone (and still is today as I see this in my clinic every day). So when I was completing my rotations and needed to decide on a type of Internship, Family Medicine made perfect sense to me. It was only in that specialty and on those rotations that I saw components of each of my favorite branches of medicine. I began to select more Family Medicine rotations as electives and developed some great relationships with Family Doctors. I was confident in my selection and have never looked back since. Each day that I work in my clinic I am reaffirmed that my decision was the right one, and while I may not currently be seeing the full scope of patients that I would see outside of the military system, I still act as a Pediatrician, Psychiatrist, Obstetrician, Gynecologist, Dermatologist, and Orthopedist every day to my Marines. Despite many attempts from my colleagues to pull me away from the specialty, I know that I was born to be a Family Physician.

I remember my thoughts just moments before the rush of Iraqi and American IED casualties were flown in during my first Mass Casualty in Iraq, "this is it, this is the moment that you've trained for, be strong, be brave, focus, you can do this!" Having successfully completed my Family Medicine Internship at Naval Hospital Bremerton, I was a young Doctor off to Flight Surgery School in Pensacola, Florida. For seven months I studied Aerospace Medicine, learned how to fly both fixed and rotary winged military aircraft, and endured the grueling rigors of Water Survival Training (I never had a swimming lesson in my life prior to Flight Surgery School and I nearly drowned on multiple occasions, especially in the Helo Dunker). On completion of this military training I was pinned a United States Naval Flight Surgeon. While I have to admit that being coined a "Fly Boy" was pretty cool, I was charged with a very important task. It was my duty to coordinate the medical care, occupational health and medical readiness of approximately 1000 Marines and Sailors. I would work in a Primary Care Clinic in Kaneohe, Hawaii for 3 years as the Flight Surgeon for Heavy Marine Helicopter Squadron 362. This contingency comprised almost 200 pilots, aircrew and maintainers, all of which were Marines. I had never worked with the Marines before and I was uncertain how much of a role I would play in their unit. I had been with the squadron just six months before deploying with them to Al Asad, Iraq, and when we landed in Kuwait en route, I knew that it was going to be 7 months of my life I would never forget. The deployment itself put all of my previous military training to use, but the entire past 3 years as a Flight Surgeon changed me in many ways. Indeed, I had an integral role in the squadron. I was the final word on whether or not any of my men would fly or be grounded. I had to determine if they were healthy enough to complete their mission, or if their poor health was such that it could jeopardize it. Besides making a lot of friends and learning to interact with a lot of very different and distinct personalities, I gained a great deal of confidence in myself and in my clinical abilities. This confidence allowed me to stand up in front of my Commanding Officer and make recommendations to him, while others were intimidated to speak up. At one point I was even asked to provide medical assistance to the Commandant, the highest ranking Officer of the Marine Corps who reports directly to the President and Joint Chiefs! I learned the difference between normal and not normal and while this may seem simple enough, sometimes the only medical tools you have at your disposal are your gut and your instincts. If you're not confident in your abilities, it can be very easy to miss something. I've literally performed thousands of physical exams on my Marines and while 99 percent have been essentially normal, keeping due diligence with each exam and knowing when a sign or symptom requires further attention allowed me to diagnose lymphoma in a 20 year old Marine and a rare, invasive testicular cancer in a 24 year old Marine. This is a skill that comes with time and experience and my tour as a Flight Surgeon has afforded me both of these items while ever reaffirming my desire to be a Family Physician. I will end my experience with the military this January with my head high, feeling a tremendous sense of pride unparalleled to anything I've ever known, knowing I've served my country and knowing that I've truly made a difference.

When I was Class President at PCOM, I assisted with medical school interviews and I can say first hand that I know how difficult it can be selecting applicants. It's important to look for someone that stands out, someone with integrity, and someone that is going to make a positive contribution to your program. It's important to have confidence in yourself, and while a great deal of that confidence is learned during one's residency, I can offer you three years of real world experience in a primary care setting, in addition to successfully completing a Family Medicine Internship - things that have directly instilled confidence and ability within me. I have demonstrated on multiple fronts that I am a pro-active individual, always willing to lend a hand in any way possible, always willing to go the extra mile in whatever I do - that's all I've ever known. I will be your Chief Resident and I will always endeavor to represent your institution in a positive light, as I have represented my medical school, my military and my job as a Doctor in this fashion. In February 2009 I will complete my service with the Navy and I will be looking to complete my Family Medicine training from PGY-2. While I am not averse to acceptance into a program as PGY-1, it is my hope that my experiences over the last 4 years as a Flight Surgeon, including a 7 month deployment to Iraq, coupled with the successful completion of my Family Medicine Internship at Naval Hospital Bremerton, will be looked upon favorably and will be thought to bring both experience and a unique distinction to your program. I appreciate your time and thank you for your strongest consideration for acceptance into your Family Medicine Residency.