From Caribbean Med School to a US Pathology Residency

Introduction

Dr. Ryan Gray: The Premed Years is part of the Med Ed Media network at www.MedEdMedia.com.

This is The Premed Years, session number 220.

Hello and welcome to the two-time Academy Award nominated podcast, The Premed Years, where we believe that collaboration, not competition, is key to your premed success. I am your host Dr. Ryan Gray, and in this podcast we share with you stories, encouragement, and information that you need to know to help guide you on your path to becoming a physician.

This week I’m excited to have a guest back on a podcast; not this show. Our guest today was on the Specialty Stories Podcast, our first ever Specialty Stories Podcast, episode number, talking about her career as a dermatopathologist. Dr. Hure is joining me on The Premed Years to talk about her journey to medical school, and why she ended up in a Caribbean medical school, and the lessons that she learned from that. But also the journey from a Caribbean medical school into one of the most competitive residencies, and she talks about that journey and lessons learned. So hopefully if you’re on this journey to a Caribbean school you can learn from her mistakes, and her experiences so that your experiences will be better.

Michelle, welcome to The Premed Years, thanks for joining me.
Dr. Michelle Hure: Thank you so much for having me.

Dr. Ryan Gray: When did you know you wanted to be a doctor?

Meeting Dr. Michelle Hure

Dr. Michelle Hure: Oh boy. Well you know I had had inklings when I was really young. Like we’re talking five and six just because my mom was a nurse practitioner so she would always take me to work with her and I’d like sit under her desk and I’d look at her charts and everything. But I have to say I had a pretty bad accident when I was seven years old, and I was in the hospital for about half a year, and I was in a full body cast for another few months after that, and had to learn how to walk again. So I was seven years old and sitting in the hospital, and doing my- I guess it was fourth grade- third grade actually, yeah from the hospital bed. And I sort of knew like well this is a pretty special experience, I survived the accident which was amazing, they didn’t think I would, and they didn’t think I would have my leg after I did survive, and I sort of proved them wrong and I got a really great relationship with my physicians and nurses that took care of me and I realized, ‘You know, this is what I want to do.’ And it’s at seven years old, I think that’s pretty crazy, but in the hospital bed I said to myself I was saved sort of for a reason, people didn’t think I would make it, and I sort of want to devote my entire life to being a doctor and saving people the way that I was saved.

Dr. Ryan Gray: Wow.

Dr. Michelle Hure: Yeah so it’s not too many people have that experience to make them choose what they want to do in their life but- and I was very lucky. A lot of people think that the car accident I was in, such a horrible experience, and it really wasn’t actually. It was probably one of the best things that happened to me. I know it’s crazy to think that way but so many things happened that were so lucky; like this happened, and that happened such that I was able to survive, and able to have my leg, and they wrote about me in journals or whatever. And I survived, and I’m fine, and I can walk, and nothing really bad happened to me but I was able to one, realize what I wanted to do for the rest of my life, two, figure out what it’s like to be a patient, so be on the other side which a lot of doctors don’t get that opportunity, and then three is really I realized sort of my strengths and my weaknesses. And it’s interesting at such a young age to realize that you have limitations, you’re mortal, you’re not an invincible being. And being in the hospital was pretty easy. Back then they didn’t have like internal fixation so I was in my hospital bed, and traction, and all this stuff. And it wasn’t until after I left the hospital and got out of all of my many, many casts, body cast, leg cast, everything, that I had to learn how to walk again, that I realized how hard it really was. And that if I wanted to walk three feet that day, that was going to be something that I had to make myself do. No one was going to do it for me. I had to put the effort in, I had to work really hard, I had to endure if I wanted to see results. And I think a lot of times people don’t realize that. The success that I have in life, or whatever circumstances they want to have happen, they have to make happen. A lot of people think they’re going to sort of get a handout maybe, or they’re expecting something, or they feel entitled. But for me I had all these things, all of these great learning experiences at such a young age that I really do feel like that accident was the best thing for me. It sort of shaped me into who I am today. So I don’t know, it was a pretty exceptional experience.

Dr. Ryan Gray: So a very exceptional experience as far as the extent of the experience. It seems to be a very common thing that we hear of, ‘Oh I had a family member that was sick,’ or, ‘Oh I was sick and so I was exposed to doctors and that’s what made me want to be a physician.’ But how do you take that experience and then carry that forward and go, ‘Okay being a patient was obviously not very fun, but I got to experience what healing is like, and being a physician, and caring for somebody.’ How do you take that and go, ‘I want to be a doctor,’ versus, ‘I want to be a nurse,’ which is probably who you were interacting with more. Or, ‘I want to be a physical therapist,’ which is who you were interacting with a lot after you got out of the hospital.

Dr. Michelle Hure: Right, exactly. I think that’s a great question. I’ve actually lectured about this very topic on several occasions; why being a doctor? So I mean yes, it’s the exposure, I had tremendous exposure to many different fields- and nursing, physicians, physical therapy, everything. EMTs, paramedics. For me- and it took by the way several years to really sort of try different areas because I wanted to be sure that being a physician was what I really wanted to do. I think for me it came down to I felt that my personality was such that I probably wouldn’t be particularly happy doing anything other than being the head of the team. So I wanted to be the one making decisions, I wanted patient care to be sort of initiated with me, and having experienced many different aspects of medicine I appreciate all the different aspects of the medical field. But for me I knew that being a physician was really the only choice that I would be happy with. Having said that, I also knew that I don’t want to go into something and feel that I made a mistake, so I actually did a lot of different aspects of medicine, right? So like you said, you can be a PhD and do research and affect people’s lives. You can be a nurse and affect people’s lives. But I actually- I was an EMT, I worked on the ambulance for several years in college, I did research in the laboratory, I worked in the hospital. I did so many different things because I wanted to make sure this is exactly what I wanted to do because it’s a huge commitment. It’s a huge commitment for many different reasons; money, time, your youth, everything, and so I wanted to make the educated decision, and so I did. I did a lot of different things and that’s part- we can get into this later but that’s some of the reasons why I ended up going to the Caribbean, was because I did so many different things in college such that maybe I wasn’t getting the best grades that I could have gotten. So- but in the end I got great exposure, right? So not too many people can say like oh they were a medic on the ambulance, or they did this, they did that, they did novel research, and whatever. I wanted to make sure that this is what I wanted to do. And I think that for people who really want to go into medicine, you have to ask that question. My mother was a nurse practitioner so I knew mid-level was always an option. I could be a PA or a nurse practitioner, you know I have many nurses in my family. You know it’s just like what was going to be the best choice for me, and I feel that people should look into these different avenues to make sure, because you have to weigh the risks- not the risks but the costs and the benefits, right? So there’s a lot of costs to being a doctor. I don’t have to tell you that, you know, but to the people listening, maybe they don’t necessarily realize that. And you don’t know until really you get into it, and then at that point you might be like, ‘Well I’m stuck.’

Dr. Ryan Gray: Yeah and it’s not just financial cost. It’s the cost of family, and time, and everything else you were mentioning as well.

Dr. Michelle Hure: Absolutely, absolutely. And unfortunately when you realize that you’re sort of maybe in your third year of med school and you’re like, ‘Oh my gosh, what am I going to do? I’m kind of stuck.’ Right? I’ve heard that so many times and I’ve even felt that to a certain extent myself, and my husband has too. But at that point you’re kind of, ‘Well I’m’- especially going to the Caribbean where it’s maybe a little bit more expensive you’re kind of like, ‘Well this is the bed that I made, now I’m going to lie in it. This is it.’ You know?

Dr. Ryan Gray: Did you ever waver as you’re going through this process and be like, ‘Well maybe it’s not worth it. My mom has a great life, she’s happy, maybe I’ll just be an NP.’

Dr. Michelle Hure: I didn’t waver so much as different fields, right? So I didn’t ever think, ‘Okay I’m going to stop my track becoming a doctor, I’m going to do nurse practitioner.’ I knew that I wanted to be a doctor, I would probably feel that my whole life like, ‘What if? What if I had finished? What if I-‘ And I’m sure being a nurse practitioner would have been just fine, but I know myself, that I would have always thought, ‘Oh I wonder what it would have been like.’ So I knew that I was going to be a physician, what I did waver on was my specialty. We can always get into that if you want.

Dr. Ryan Gray: Yeah.

Dr. Michelle Hure: But like I had said, I felt that I had been saved when I was a kid in order to be the same type of physician that saved me. And I don’t know like how crazy that might sound, but to a seven year old it made sense and I sort of stuck with it, and I told myself, ‘Well I’m going to be a trauma surgeon, and I’m going to save people, and I’m going to commit my entire life to being a trauma surgeon, I’m not going to get married, and I’m not going to have kids because that’s going to get in the way of being the best surgeon that I can be.’ And at the time I really did feel that way, and not so much anymore, but I mean there is some truth to that unfortunately in this day in age, there still is. So my wavering really came into like what I’m going to go into, but I never really wavered in whether I was going to be a doctor.

Dr. Ryan Gray: So you’re seven years old going through this, and much older when you’re kind of done with it, rehab and everything else. Between that time and starting off your undergrad years being ‘premed’ what were you doing to continue to reaffirm to you that you wanted to be a physician, or you just had it in your mind and you just went on your merry way until you got to college?

Dr. Michelle Hure: Oh no I think when I started high school actually, every chance I’d get every summer I was interning- they call it interning, basically you do volunteer work in the hospital, so I was always in the emergency department. I was actually a candy striper back when they still had the cute little red and white candy stripe dresses, got my EMT license as soon as I could, and I was always on ridealongs- I was always doing something. And of course my mom had a lot of physician friends so I would go into their offices here and there every other week or something and just observe, shadow, help out whenever I could. I was constantly doing something. I was even learning how to suture, someone would like pull me aside in the ER and show me how. So I was very- I showed a lot of initiative, I really wanted to sort of get my hands dirty, and basically by the time I got to undergrad it was just even more of that. Right? So I just sort of immersed myself. I was in the hospital doing little internships that they would have, shadowing doctors, and I would come back every summer and do shadowing with the orthopedic trauma surgeon that actually saved my life and my leg when I was a kid. So we had an amazing relationship.

Getting Pushback as a Female in Medical School

Dr. Ryan Gray: Talk about for a second being interested in trauma surgery, whether you’re a general surgeon, trauma surgeon, or an orthopedic surgeon. You’re a female. Did you ever get questions or pushback that you were a female wanting to go into what is typically a male dominated field?

Dr. Michelle Hure: You know I never got pushback until medical school. In high school maybe they thought it was just like cute or something, I have no idea. But- and the fact that I was so close to the surgeon that I was shadowing with, that his umbrella sort of protected me against any of that sort of stuff because he was very encouraging of me. So I never got that impression. Usually people were like, ‘Oh wow that’s great.’ And of course some physicians said, ‘Just don’t be a physician.’ They never said, ‘Don’t be a surgeon.’ I think more oftentimes than not, any physicians that I knew would tell me, ‘Don’t be a doctor.’ And I think that’s the case I find a lot of times. I think statistics out there is like nine out of ten doctors won’t promote their field to someone that wants to go into it. So I never had that until medical school where I was actually doing rotations, which is unfortunate. And that made me sort of rethink- and it did make me rethink what I was going to go into.

Dr. Ryan Gray: What was that pushback like? What were the discussions or what was happening?

Dr. Michelle Hure: It wasn’t so much of like someone sitting me down and saying, ‘You can’t be a surgeon,’ or, ‘You shouldn’t be a surgeon.’ It was mostly the overall attitude that I had. Maybe I was just at a place that wasn’t as friendly, I’m not really sure. But it was pretty even abusive really, and it’s unfortunate because I’ve talked to a lot of people that loved their surgery rotations. Maybe I was just in a bad place to be, but it was just a general overall very sexist atmosphere. And even though I had pretty good talent in the OR suite, I’m pretty good with my hands, just being the only female actually on the team it was pretty tough and I just decided like, ‘You know what? I’m not going to put up with this. It’s not worth it to me and I can do other things and still be happy.’ And that’s when I sort of went through my crisis year of what am I going to do? Because this may not be the right thing for me.

Taking On Too Much

Dr. Ryan Gray: Let’s jump back a little bit in time and talk about your undergrad years. You kind of hinted at it already about doing maybe a little bit too much, which is a very, very common problem. Premeds just hit undergrad and don’t learn how to be a student, and they’re trying to volunteer, and shadow, and be part of leadership and doing all these things, and all of a sudden they end up with some poor grades. Is that your story?

Dr. Michelle Hure: Oh yeah, totally. And it’s sad. I mean in high school I think maybe I didn’t develop the best study skills, I didn’t really study very much, and that’s just the way it is. You know it’s possible to be AP or honors and not study that much and do pretty well, and then you get to college and you’re like, ‘Oh my God, I actually have to study and I don’t even know how to do that.’ So I think for me it was a little bit of that, and the fact that I loved getting involved in things. So I loved tennis, so I’m going to play on the tennis team. And then I’m going to- I used to be in the student council so I’m going to do that as well in undergrad. And then I’m going to go to the hospital and shadow, and intern, and this, and this, and this. And I’m going to do this club, and that club, and I’m going to do research, and-

Dr. Ryan Gray: Was that all with the thinking of, ‘This is going to make my application look good’?

Dr. Michelle Hure: Yes. Not all of it but a lot of it was just me having these interests, but then people pulled me aside and they were like, ‘Oh and this is going to look great for your application, and this, and this, and you need to have X, Y, and Z on your application.’ And then you get into this sort of spiral where you think you need to do all of these things for your application, but then it takes you away from studying and your classwork, and then you may not be getting the best grades you can. But it’s just unfortunate. I wish someone had pulled me aside and said, ‘Hey by the way, this is what you need to do if you want to go to medical school. And what you’re doing right now, all of it, is basically wrong.’

Dr. Ryan Gray: Start over.

Dr. Michelle Hure: Let’s start over. And of course going to UC Davis, University of California Davis, is pretty competitive. They don’t have a lot of grade inflation there. And then I picked a major, and then I double majored for some ridiculous reason, and then- yeah, and of course it was in a science, hard science, and I’m competing with people who study 24/7. So I wish someone could have sat me down and said, ‘Look, you need to do X, Y, and Z because what you’re doing is not right.’

Course Correction

Dr. Ryan Gray: We talk about course correction a lot on this podcast, or I do, about kind of assessing okay first year is done, it didn’t go so well. What went wrong? How can I do better because I can’t be where I’m at now.’ Did you ever do any sort of assessments like that? Or did you just kind of truck along and continue doing the wrong things?

Dr. Michelle Hure: Well to some extent I did. My first quarter there actually I think I went on academic probation, so that was at least early on an eye-opener, right? So I quit tennis, and I quit a lot of these clubs, and I quit this, and I quit that, and I think it’s good that that happened to me. Of course a lot of damage was done that first year. So I still didn’t quit some things that I probably should have, so I was still spending a lot of time in the hospital and doing internships and whatnot. And unfortunately being a science major- a biology major, you have a lot of tough classes, and if you’re not putting in a ton of time, and for me if I’m not super interested in something it’s hard for me to put a lot of time into it, then you’re not going to do that great. And I’ve always felt that the road to becoming a doctor is just basically a lot of hoops you jump through, and a lot of those hoops are the classes you take, right? So do you really need organic chemistry? No but it’s a weed out, right? And so it’s tough to do well and weed out classes unless you put all of your attention into them. So you know that’s what happened to me, I trucked along more of like a B average instead of an A which is really what you need, and by the time the time comes around to apply, and you don’t have those grades, you’re not going to get it. You’re just not. There’s- what am I- lectures I give there’s a great slide that gives the importance of all the different aspects of applying to medical school, and the most important thing of course is GPA and your MCAT score, and that’s it. Of course after that you have letters of rec, and you have personal statement, and then after that course load and where you went to school. But number one is GPA and MCAT, and I really wish someone would have showed me that slide when I first started, because in the end you need the numbers, otherwise it’s just not going to happen. It won’t happen for you.

Dr. Ryan Gray: Yeah. Well I don’t know about won’t, there’s- I have a lot of stories on this podcast of people that have done it, but it might take a little bit longer.

Dr. Michelle Hure: It’s very hard, I mean look at me, right? It happened. I didn’t have the GPA or- I mean my MCAT was very average and I’m still a doctor so it does happen but it’s not going to be easy. Let’s just say that.

Dr. Ryan Gray: So talk about your premed advising at UC Davis. You have a B average GPA, an average MCAT score. Were your advisors very positive about you applying to medical school?

Dr. Michelle Hure: Yeah I felt that they were a little bit out of touch with reality, to tell you the truth. So I don’t think they really understood maybe, I don’t know. But they were like, ‘Oh yeah, yeah, yeah just apply, do this, do that, you’ll be okay.’ And you know, that’s really not the case. And I ended up staying at UC Davis for grad school because I thought, ‘Okay maybe grad school will help me,’ after my first round of applications just didn’t go very well.’

Applying and Grad School

Dr. Ryan Gray: So you applied normal timeframe, and didn’t get in anywhere?

Dr. Michelle Hure: Exactly.

Dr. Ryan Gray: Did you get any interviews at that point?

Dr. Michelle Hure: I got I think one interview.

Dr. Ryan Gray: Okay.

Dr. Michelle Hure: And yeah, so it was a bust. And I re-took MCAT, and then I went into the graduate program.

Dr. Ryan Gray: Okay.

Dr. Michelle Hure: Thinking that that would help. And you know I actually did a lot of teaching while I was at UC Davis. I taught a lot of microbiology and anatomy classes while I was a grad student, and I thought, ‘Okay that’s going to help me too,’ since I was sort of in the school of medicine and getting great contacts there. And it didn’t really help, it just didn’t help. I think in retrospect- and we can talk about it, but instead of doing graduate school I probably should have done a post baccalaureate, but you know that was the decision that I made.

Dr. Ryan Gray: What was your grad school? Like what did you study?

Dr. Michelle Hure: Yeah I did- it was comparative pathology, but a lot of- that was like the general header of it, but a lot of what I did was immunology.

Dr. Ryan Gray: Okay so not ‘hard sciences.’

Dr. Michelle Hure: It was fairly hard. Yeah but- yeah so plus I wanted to stay and finish the research that I had been doing as an undergrad. For me I just wanted to do grad school, but in the end I probably should have done something else. At the time a post baccalaureate was much easier to get into medical school that route. Maybe now it’s a little bit harder.

Dr. Ryan Gray: How long was the Master’s program?

Dr. Michelle Hure: It was two years.

Dr. Ryan Gray: Okay so at the end of those two years you reapply to US schools?

Looking at Caribbean Schools

Dr. Michelle Hure: I reapplied in that timeframe and got an interview here and there and I really thought I was going end up staying at Davis, and it just didn’t end up happening, and at the very last moment- and then I was like, ‘Okay well I am not going to wait another application cycle. I’m just not going to do it.’ And I had a friend who was in the- she was actually a PhD student and she ended up going to Ross University, and I emailed her and I said, ‘Hey how is it over there?’ She was like, ‘It’s great.’ She was like, ‘You should come.’

Dr. Ryan Gray: Was that the extent of your research?

Dr. Michelle Hure: Well I mean I looked into a couple of schools. She had actually gone to St. George’s before and she transferred over to Ross, and she was like, ‘Yeah, no it’s much better here,’ and that was her opinion, and I called the school and I applied, and I was accepted the next week. And then I went- like it really happened literally in the course of like maybe two or three weeks. And then I was on a plane to Dominica.

Dr. Ryan Gray: To paradise.

Dr. Michelle Hure: Yeah basically, yeah.

Dr. Ryan Gray: At that point, what are you thinking? So you’re obviously in California hoping you get into UC Davis, you don’t, you’re like, ‘Is this dream ending?’ And two weeks later you’re in med school in the Caribbean. What are you thinking at that point? Are you mad that you’re in the Caribbean? Are you glad that you’re in the Caribbean? What was going through your head?

Dr. Michelle Hure: Well it was hard for me- it was hard for me because I thought that I was either settling, or I wasn’t good enough. You know I was a little bit depressed. I thought, ‘Gosh I’ve done all this work, I’ve made all these connections, I was told by X, Y, and Z, person on the admissions that I would get in, and this, and this, and this, and how did I get to this place? I’m supposed to go to medical school and this is just not working out.’ And so yeah, I was in a very dark place. And I thought, ‘Okay well this is it. Maybe I’ll go to the Caribbean, maybe I’ll transfer back into the states, who knows.’ Because then that can happen. I have known people that have done that and they’ve gone over in the Caribbean and they’ve transferred back after a year or a few semesters. But I got on the plane, I did it, it was crazy, but I flew over there and I have to say it was the most amazing feeling. I got off that plane- and you’re right, it is paradise. It looked like Jurassic Park or something, it was insane. We land the plane and I walk onto the tarmac, I walk down the stairs and I’m on the tarmac, and I don’t think I’ve ever had a greater sense of peace with my decision. I looked around and I thought, ‘Okay this is where I belong. This is the next chapter in my life, I need to move on, I’m going to be a doctor, this is it. I just need to buckle down, do really well, but here I am, this is the situation I’m in, I’m in medical school, let’s make it work.’ And I really felt good about the decision at that point, it was so crazy, it just immediately like washed over me like a flood.

Dr. Ryan Gray: Did you have any concerns about your future self- future doctor wanting to be a trauma surgeon still at that point I guess, or whatever you wanted to be? Did you think, ‘Well this may be limiting my career so I need to be careful’?

Stigmas of DO Schools and Caribbean Schools

Dr. Michelle Hure: You know that was always in the back of my mind, but I thought that, ‘Well if you do really well maybe you can overcome that prejudice that a lot of doctors from offshore schools have.’ And then I thought, ‘You never know, maybe I will transfer out, I’ll make it work.’ And I thought going forward is better than waiting around another cycle to apply. And at the time, I don’t know why, but I really didn’t think about a DO school very seriously. I felt that the stigma against DO at that time was probably more than offshore schools, because I had known a few doctors who were from offshore schools or they were from international schools. So I thought, ‘I’ll do this. I’d rather have an MD than a DO,’ and I really don’t think that that is the right choice now. I don’t. I don’t really see that as being a problem.

Dr. Ryan Gray: I would just to add as we’re in the middle of this discussion that a US DO would at this point be better than an offshore MD.

Dr. Michelle Hure: I have to agree with that. I have to agree and only because it’s so hard, and we can get into this, but it was really, really, really hard to come from an offshore school and succeed.

Dr. Ryan Gray: Well let’s talk about school. So you’re there- so it’s no secret that attrition rates at offshore schools are much, much higher than the state schools. How was it for you to go through school those first couple years, the non-clinical years, and be able to study while you’re sitting on the beach, or be able to study while your classmates are dropping out and going back home. What was that like for you?

Dr. Michelle Hure: Well one thing about Ross, and I’m not sure about the other schools, but Ross obviously- it’s a for profit school, and I knew that going into it. So obviously they let in almost everyone that applies. So I start off my first day and there’s 350 students in my class. Right? So a typical med school in the states is about 100. And so all these people were there, and the school is taking their money knowing full well they don’t belong there. And I knew that the first day, I mean there people that just should not be there. So going through that semester they drop like flies when they realize that it’s not right. The sad part are the ones that sort of stick around and re-do semesters that they have failed somehow and the school keeps taking their money, and that’s just unfortunate and such a waste. But for me, I mean luckily Dominica doesn’t have wonderful beautiful beaches, so I wasn’t actually really tempted to just sit on the beach and not do anything. I mean especially coming from where I did, knowing that I had made mistakes in undergrad, and that I should have really worked harder, I worked really hard. I was always studying, I was always just there in class, and I worked really hard. Yeah I did do other things there, right? I taught anatomy again as like the head TA there, I helped start a medical clinic for the native Caribbean Indians that still live there, there are other things that I did. That’s just me, but I knew that I still had to be number one, especially if I wanted to transfer. And the way things are there is that they don’t spoon feed you, and I feel like there are some US med schools where- you know I saw it at UC Davis, I saw the med students were just sort of like spoon fed, and they were helped at every turn. And at Ross, I don’t know about the other ones- offshore schools, but at Ross, man you really had to have a lot of initiative. Like it’s- you need to do it. You need to study, you need to do well, no one’s going to help you. And again that for me was second nature, that’s what I was used to growing up. Right? If I wanted to take those steps, if I wanted to learn how to walk, I need to do it, right? And so at Ross that’s exactly how it was. I taught myself a lot of the subjects. Luckily I had a really good background in anatomy, and physiology, and microbiology, and all these things. But for me it wasn’t that hard, but I knew that I had to do really, really, really well. And I did, and that’s just- you have to take that initiative. So if you want to go to an offshore school, don’t expect the school to really help you a lot. In fact it would be better if they don’t help you, right? Because if you don’t do well, then maybe you fail a semester, and you pay more money, you know what I mean? It’s better for them if you don’t do well honestly. You know what I mean?

Dr. Ryan Gray: Unfortunately.

Dr. Michelle Hure: Unfortunately, and that’s just the way it is.

Dr. Ryan Gray: So you did well.

Dr. Michelle Hure: Yeah.

Dr. Ryan Gray: You’ve talked about transferring back to the states.

Dr. Michelle Hure: Right.

Dr. Ryan Gray: How did you go about looking into that, and was that successful for you?

Dr. Michelle Hure: So it was something I did look into, and it was a definite possibility. The only problem- and it’s not really a problem, but I met my husband basically. He was one of my colleagues so he was a student in the same class as me. And so at the time we were dating and I didn’t want to transfer out without him, and it’s really hard to find a program that’s going to take two transfers at the same time.

Dr. Ryan Gray: Yeah.

Dr. Michelle Hure: So basically I was like, ‘Okay well I’ll just make this work, we’re going to stay here.’ So I ended up really not pursuing it as much as I thought I would.

Dr. Ryan Gray: Okay.

Dr. Michelle Hure: Yeah.

Clinical Years

Dr. Ryan Gray: Alright so you have your non-clinical years on the island there, and then clinical years. So one of the big negatives with a Caribbean school is clinical years. So a US school, especially MD schools, you’re associated with a big academic medical center. As a Caribbean student you’re usually travelling around a lot your clinical years. What was that like for you?

Dr. Michelle Hure: I have to say, again it’s not usual what we did. So if Ross had put together our clinical rotations, we would have been in New York in some hospital that probably doesn’t have that great of teaching, or we’d end up all over the place piece meal, and who knows if it would have been any good. And I knew that if I wanted to have any sort of competitive specialty, that I have to have good rotations and in places where I can make connections. So honestly what I did not a lot of people will do, I actually cold-called a lot of different places and just said, ‘This is who I am, I’m a third year med student- or soon to be third year med student, and I want to set up rotations.’ And at that time actually a lot of places were still open to offshore students. Since then they’ve sort of closed off to Ross students especially. But I actually called and set up probably 80% of my rotations and my husband’s rotations, so they took both of us. So we ended up having- you know we have connections. His parents are also physicians and they did training at Yale, and they still had connections back there so I called and we got probably maybe like seven months’ worth of rotation- six, seven months. We did most of our cores there- core rotations, and then I still had connections at UC Davis, we did pediatrics there. So we went actually to a lot of really, really good institutions, and just calling them and saying, ‘This is who we are, can we do rotations with you?’ And it worked out really well. That is not the norm. That is kind of crazy actually. So I think nowadays that’s the number one thing that I would say is the negative against offshore school. Especially Ross but their clinical rotations are not the best, and they have so many students it’s hard to place everyone. I had to find my own OB-GYN rotation because I think they said the next opening was in like a year and a half. I was like, ‘I’m going to be like a resident at that point, so what would you like me to do?’ So you just find your own. Unfortunately that’s not the case now. So hopefully they have more openings, but that is the number one negative, is finding good rotations where they don’t kind of use you and abuse you, and you don’t learn a lot so that’s the problem.

Matching Out of a Foreign Medical School

Dr. Ryan Gray: At some point along the way you determined that you wanted to go into dermatology, which if you’re listening to this and you don’t know, it’s one of the hardest specialties to match into. What were you thinking when you were like, ‘I want to match in dermatology and I’m a Caribbean student.’ What were you thinking you needed to do at that point?

Dr. Michelle Hure: To tell you the truth I didn’t even know it was that crazy, crazy hard. I thought, ‘Well whatever, we’ll figure it out.’ And for me- I know it’s crazy, right? I’m like, ‘Well if this is what I want, it’s going to happen. You know I’ll make- it’ll just happen. I’m going to make it happen.’ This has since changed, I guess they’ve changed this rule, but back then as a foreign med grad you can pre-match. And so my husband matched for radiology, which is actually another fairly competitive specialty out of the Caribbean to get, right? And so he matched into that, and then we were able to pre-match because we had done our clinical rotations at one of the Yale hospitals and we knew them really well, and we were foreign med grads so we could match into their internal medicine prelim year. So I pre-matched there and knew that I had to find something in Massachusetts for residency, and basically it just came down to don’t necessarily have to go through the match at that point because you’re doing a year already- you’re internal medicine, so if somewhere has like an opening you can just pre-match into it, you don’t have to go through the match, especially as a foreign med grad. And correct me if I’m wrong but I think they’ve actually changed that now.

Dr. Ryan Gray: I think so.

Dr. Michelle Hure: Yeah so back then it was just different, you know?

Dr. Ryan Gray: Yeah.

Dr. Michelle Hure: So it just happened that I called UMass and applied, and at the interview I said, ‘I want to go here, I want you to match me.’

Dr. Ryan Gray: ‘Take me, please.’

Dr. Michelle Hure: ‘Take me, please.’ My husband ended up going to Tufts Baystate Hospital, and then I got University of Massachusetts and ended up going there. It’s pretty crazy but you just make it happen. I don’t know, it just sort of fell into it that way. But I mean it’s a lot of hard work, right? There’s a lot of long nights in med school, and clinical rotations, and getting great letters, and putting in the time and effort in your rotations in order to get to the position where they would actually look at your application, right?

Taking the Boards

Dr. Ryan Gray: Were you super stressed about board scores?

Dr. Michelle Hure: I was. I put in so much time and energy into my step one. I figured step two was- you know some places wouldn’t even see your step two boards, and it’s an easier test. So I said, ‘Okay I’m going to put in all of my effort to step one score.’ And I had like this huge calendar and every day I would do X many hours of this subject, and I mean it was insane. My husband never saw me basically, I was studying literally like eighteen hours a day. And yeah, no I did really well but I felt like I had this urgency. It was like, ‘Okay I need to overcome the fact that I went to Ross,’ which is sad because it’s still medical school and I do feel that the instructors there were really good, and I had great learning experience, but there’s a stigma, and there still is, and there probably always will be, so you have to overcome that in some way unless you don’t want an ultra-competitive specialty, and that’s to do well in your board scores, and there’s just no other way around it. That’s how my husband matched into radiology, he did really well for his step one. That’s just what you have to do. If you want a competitive residency, that’s what you have to do, that’s it.

Effects of Graduating from a Caribbean Medical School

Dr. Ryan Gray: Has the fact that both of you are Caribbean grads- has that hindered either of your careers as far as finding jobs and answering those questions?

Dr. Michelle Hure: You know I feel like we’ve both gotten whatever positions we wanted to get, the problem is you always have to field this question, ‘So why did you go to the Caribbean?’ And then you have to go through this rigmarole like, ‘Well you know I blah, blah, blah, I didn’t apply to very many schools, I thought I’d get in here but I didn’t,’ and it was the same for my husband. You know he was the same sort of thing, like he just didn’t do as well because he was doing all these other things, and then he had also only applied to California schools. And so you know, we were just stupid I guess, I don’t know. We had no idea what we were doing. There really wasn’t great premed advising, but you know we were both in the same situation. And we have to even to this day answer these same sort of questions, and it’s ridiculous. I mean it really is ridiculous. What does it matter? What does it matter honestly where I went to medical school? You know you might as well ask me where I went to high school. What does it matter? I still am an MD, I did well, I did well on my boards, I’m a good physician and it really shouldn’t matter whether I went to Harvard or whether I went to Ross because I’d do the same job. And so it’s really, really frustrating when people sort of throw this attitude at you as if they’re better, and that’s something you have to deal with. And I’m sure some DOs feel that way too, which is also ridiculous.

Dr. Ryan Gray: Do you think that our residency training, the way that’s set up, that it should be factored in that US students are given higher priority than Caribbean school students, or other foreign grads?

Dr. Michelle Hure: I mean I think the best persons for the job should be taken, right? So if I have an applicant who’s really good, but they’re from the Caribbean, what does it matter? They’re really good. I don’t know I guess maybe I’m biased on this, but I don’t think that the US students should get priority just because they’re US students. And it’s- you know maybe people who aren’t citizens, that’s one thing, so if you have to get a visa and all that stuff, but you know I’m born and raised in California. Yeah I went to Ross, big deal, you know what I mean? I still did well and what does it matter? You know what I mean? I just feel like that’s kind of like a poor me-

What Dr. Hure Would Have Done Differently

Dr. Ryan Gray: There are a lot of things above our pay grade as far as government funding, and public institutions, and making sure that their students are taken care of. So there’s a lot of that that probably gets factored into it as well, which is probably a discussion for another podcast. But you’ve ‘overcome’ the Caribbean stigma, you’re a practicing dermatopathologist, your husband’s a radiologist, both Caribbean grads. If you were to do it all over again, knowing what you know now, where would you have done something different? What would you have done differently to I guess ensure that you went to a US school?

Dr. Michelle Hure: Yeah well I think first off starting back in undergrad I would have picked a much easier major, much easier. So- and I think even med schools look highly on that, like you’re more diverse, right if you’re a literature, or English, or psychology or something major. I’m not saying these are like super easy majors, but they’re much easier than a hard science. That’s just the way it is. I would have picked a major that was much, much more doable and I knew that I would be able to get better grades. And I probably would have not done as many extracurricular activities, and maybe only picked a few. I feel like med school likes a good story, right? So you need a good story. I had a good story with my accident, I think that they appreciated that, but unless you have the numbers they’re not really going to see it. So you have to put your energy into making yourself look good on paper. So just put all your energy into good GPA, put all your energy into a good MCAT, and if you have a couple of things here and there that really give you that extracurricular activity, then that’s great. And then so I would have definitely done that differently. Still- if I still was not up to par with getting into a US MD school, I definitely in retrospect would have- or should have applied to a DO school in order to stay in the states and not had that foreign med grad stigma. It’s not to say that DOs don’t have that stigma, I know quite a few DOs that have also had to shoulder that question of like, ‘Well why did you go to a DO school?’ And so they also get that stigma but not as much, and it’s so much easier to be in the states, that’s just the way it is. So I would have done that differently, or I would have done a post baccalaureate. I think now it’s not as easy. Usually- I mean back then it was like you did a postbac and then you’d get into that med school where the postbac is. I don’t think that’s the same case anymore. But I would have done these things differently. I really wish someone would have just sat me down and said, ‘Look this is the secret nobody knows. Like you need to do X, Y, and Z if you want to get in.’ Because I just feel like I did basically almost everything wrong. But I mean it was good, right? I met my husband, I had a good experience, I’m much stronger than I used to be, and I feel like when I was at the Yale program they actually took quite a few Ross students because they loved the fact that they were so independent and they didn’t need to be spoon fed, and they had a lot of initiative, and they’re very hard workers. But you know it’s hard, it’s really hard to be that on your game all the time, like that much- it’s just tough. And then after all of that hard work to be met with this resistance every time you apply for a position. They’re like, ‘Why’d you go there? Why’d you go there? Like what’s wrong with you? Why’d you have to go offshore?’ It’s not good but it is what it is, right? So that’s what I would do if I had it all over again; be a better student in undergrad, pick a major that’s easier, don’t overextend yourself, and then look into other programs, DO if you don’t get into a US med school- an MD school.

Words of Wisdom to Students Leaning Towards a Caribbean School

Dr. Ryan Gray: Any last words of encouragement or advice for the student that has applied several times to US schools, MD and DO, and now is on their way to a Caribbean school?

Dr. Michelle Hure: Well if you’ve already made that decision, and you’re on your way and you’re going to go to one of the schools, make sure that you’ve picked wisely. I really feel that there’s only two med schools in the Caribbean that are worthy of the sort of commitment. And just know that it’s all on you. So your success or failure is going to depend on you, so you have to really put in that time and energy, and you have to be serious about it, and hopefully you’ve made the right decision to be a doctor, and that can be another podcast in itself, right? There are so many reasons to be a physician, and is that going to be enough for you- to sustain you through the sleepless nights, and the work, and the giving up so many things, and hopefully it is. And if it’s really what you want, and you are prepared to go through how hard it is to be in the Caribbean for med school, just know that if you’re there, that’s what you’re committing to, don’t give up. It may seem really, really tough but you can get through it as long as you really put in that energy, you really put in that time. But also it’s important to keep in mind if you don’t feel that it is for you, if it’s not right, if it doesn’t feel right, if it’s too hard, don’t wait too long to get out because Caribbean schools are expensive and so you don’t want to make a big very, very expensive mistake and just stick with it if it’s not the right choice for you. I’ve seen that a lot, and then you’re even worse off. So it’s kind of like a fine line, right? So either stick in it, but if you know that this is not the right thing for you, don’t just wait around, just get out as soon as you can. You have to because it’s a lot of money and it’s a lot of commitment to stay out there. But if it’s worth it for you, and that’s what you want to do, then don’t give up.

Final Thoughts

Dr. Ryan Gray: Alright that again was Dr. Michelle Hure. She was again on the Specialty Stories podcast, episode number one, talking about being a dermatopathologist. We also did an episode about Caribbean medical schools and had a Caribbean medical student on back in episode 51. You can find that at www.MedicalSchoolHQ.net/51.

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I hope you have a great week, I hope you continue to push forward on this journey, and I hope you join us next week here at the Medical School Headquarters, and The Premed Years Podcast.