Pediatrics Rotations

I am finished with my pediatrics rotation, and it was much more fun than I ever expected. I've always liked kids, but I honestly thought peds was going to be constant crying/screaming. It wasn't. For the most part, all of the kids were pleasant, and I can't believe that I ever was willing to do so much for a sticker.

Coming into medical school, I thought that peds would be one of my least favorite rotations, but it has actually been my favorite. I came into med school thinking Emergency Medicine was my future, and I thoroughly believed that I would be that 1 person to not change my mind. While I may still do EM (nothing is set in stone yet), I definitely see myself specializing in something with kids. My flavors of the week: Child Psych, Pedi Endocrinology, Pedi EM - in that order.

I still have 3.5 rotations left so things may change considerably. Let's just hope I am 100% sure of something by the time I have to submit applications!

Obama and Healthcare

Obama claims that "trickle-down economics" does not work, but he is wrong. It can work, and benefit physicians. It just currently is not. Hear me out.

Providing tax-breaks to big businesses does not currently benefit the lay-person. However eliminating these tax breaks all together will force businesses to lay-off employees and/or raise prices. How does this help anyone?

Obama should maintain tax-breaks to companies as an incentive. My idea: Companies can keep their tax breaks as long as they provide full health insurance coverage to employees.

This is a win-win situation. Companies keep their tax breaks, jobs are kept, and more Americans have insurance plans. Is this not genius?

Mr. Obama - I am waiting for your call to be your economic/healthcare stimulus plan advisor.

Medical Student Burnout

I recently read this article (http://www.nytimes.com/2008/10/31/health/chen10-30.html?_r=1&oref=slogin), and I can definitely understand where the author is coming from. Medical school is not easy and often not fun. Sometimes I wonder why certain faculty are allowed to teach or why students interested in family medicine (or many other things) spend hours on their surgery rotation retracting when they could be learning.

A lot of medical school is simply putting-up with tedious hospital/clinic duties that have no educational relevance. My recommendation: bring a good book with you wherever you go.

Are there good/happy aspects to medical school - of course. When I get to see patients on my own, I learn whether or not I get the diagnosis correct. I wish all faculty would let students first see every patient on their own. It facilitates learning. I also love getting to see patients respond to treatment, and nothing is better than "high fives" from 5 year olds in pediatrics.

There is also ample time for fun if you aren't too Type A to relax every once in awhile. I recently went to Las Vegas over the weekend to watch TCU demolish UNLV. Go Frogs! I also lost about $100 in the process. Gambling is not for me apparently. I plan on watching the Frogs destroy Utah tomorrow on CBSSports. Can TCU go BCS this year? I hope so!

Still considering Ivy league over state school?

For those still considering the idea of attending an Ivy league/expensive private school over a cheap state school, read http://money.cnn.com/2007/11/16/pf/young_doctors.moneymag/index.htm .

The numbers are shocking! I am so glad I went to state school right now. I'll be able to pay off all of my debt by the end of residency (hopefully!).

For those that want the Ivy league name, attend a state school for medical school and do your residency wherever you want. It is very possible.

Medical Specialty Poll Results

My poll recently ended, and the question was ---- "What is the most important factor in choosing a medical specialty?" Personal interest was the leading factor pulling two-thirds of the votes. The remaining one-third of the votes chose lifestyle as the leading factor. There was 1 outlier that chose money - thank you for your honesty.

I found these results interesting because I have only heard 2 things from current practicing physicians - choose what you enjoy or choose the most lucrative field you can. I haven't ever been told to choose the field with the best lifestyle.

While many fields can be tailored to meet any lifestyle, I can definitely understand why this is such an important factor. I think medicine is the only field where someone can work 60 hours in residency and say that it wasn't a bad week. I often talk to my high school friends, and they all seem to be "living" more than I am. For the record, I still wouldn't choose any other profession.

I will probably try to find some sort of happy medium between personal interest and lifestyle. I think it will be easier for me because I seem to enjoy more fields than I dislike.

For those that aren't in their clinical years of medical school yet, keep your mind open to everything. When you actually get to experience the every-day feel of a specialty, it is often times much different than you thought.

Rubella

This past week I saw a case of congenital Rubella! I thought that here in the U.S. my medical school training would not involve something that has had such a successful vaccine for so long. While I do not know how many other medical students have seen this Congenital Rubella Syndrome, I am really glad that I am doing my training where I am because of the rare diseases I have seen.

While I consider myself lucky to have learned from this, this "unlucky" child was deaf, had cataracts, maintained a patent ductus arteriosus, had microcephaly, and was mentally disabled. After some research I learned what an "unlucky" kid this patient actually was. First his mother had to contract Rubella. If the mother contracted this rare disease 1 month prior to becoming pregnant to 3 months after conceiving, there was about a 50% of Congenital Rubella Syndrome. If the mother got Rubella in the second trimester, the percentage drops to 25%. In the third trimester, the disease is practically unheard of.

So this kid was developing for 9 months and was exposed 1 month prior to conception = 10 months of exposure in the womb. 3 of those months are immune. The mother had a 7 month window of her life (first pregnancy) where getting Rubella could affect her unborn child!

I know many pre-meds, medical students, and residents often get frustrated with the system of medicine. Medicine can be frustrating at times, and the treatment for Congenital Rubella Syndrome is especially frustrating because there really isn't much. However, experiencing cases like these and realizing how far medicine has come is really amazing.

Who knows.....maybe when I finish my training I can help bring vaccines to foreign countries (I really felt like a pre-med on interviews just then)!

Mid-Levels

I am starting to be concerned about mid-level providers in healthcare. It's not that I am worried about my job security or any of that non-sense. Instead I am worried about the quality of healthcare that future Americans will be receiving.

I was recently sent an e-mail by a friend of mine that breaks down some of the "required clinical hours" in different healthcare fields. They were as follows:
DNP (doctorate degree in nursing): <800 hours
PA (physician assistant: approx. 2500 hours
M.D./D.O. (physician): >15,000 hours

At first, I did not believe that you could get a doctorate in nursing so easily. Maybe somebody more experienced in this degree can comment, but I googled this degree recently. What I found was startling. There are "on-line" doctorate degrees for nurses! There must be more too this than I am finding. My brother has taken some on-line courses, and they are the easiest courses I have ever seen. Some of these doctorate programs for nursing required you to attend "4x/year"! Where is the quality assurance aspect? Please somebody comment on this because from what I can find on google, this degree doesn't seem like it adds anything.

I found a more "rigorous" program at my alma mater. They only require 30 credit hours for completion (feel free the check the website). I really do not mean to be condescending. I respect nurses, and I know some great nurse practitioners. This DNP program just doesn't impress me. I do not have a problem addressing a nurse with a DNP degree as "doctor" if he/she earns it. I do have a problem if it affects patient care.

From what I have found, the P.A. degree seems to be organized and has great quality assurance. They have (on average) 3x the clinical experience of a DNP in a supervised program. P.A. students attend full-time (not on-line), many programs have mandatory attendance to all classes, and it lasts an extra year compared to the DNP degree.

Once again, I think nurses are great. I have no problem working with mid-level providers, and I plan to do so in the future. The question is......which should I hire? If I needed to hire a mid-level provider, all things being equal, right now I would definitely hire the P.A.

If I were a nurse, I would be upset (to say the least) that some of these DNP programs were so relaxed. Someone needs to jump in and push to make this new DNP program a quality degree with tougher requirements.

Physician Salary Averages

I commonly get asked the question, "How much does a physician in specialty X make?" The question is just as easy to answer as "What is the cure for AIDS?". You can't easily compare salaries in medicine because some docs work 30 hr weeks and some work 80hr weeks. Some physicians take call, some are in private practice, some work for a hospital, some take insurance, some are cash-only, some see general patients, and some do procedures only.

Just to give some examples of the complexity of physician salaries: I know a psychiatrist making $600,000+/year. I know another psychiatrist making $110,000/year. I know a pediatrician making $100,000/year and another making $350,000/year. I've seen a dermatologist making $180,000/year and another $1.1 million. I know a family practitioner making $90,000/year and another making $750,000+/year. I know a general surgeon making $180,000/year and another making $900,000. I've seen a psychiatrist moonlight in residency and make more money than practicing physicians with 10 years experience. Salaries literally vary $200,000+ in every field, and these are NOT outliers. Many people are on both sides of the spectrum.

With all this variety, medical students still take average salaries into account when choosing a medical specialty. I guess this makes sense if you want to work for a group practice where you have little say in management, take minimal call if any, and work the "average" hours/week in that field. If you actually have any business sense, don't mind working more than average, or can stand call every once in awhile, "averages" aren't very useful.

I guess my advise is this: If you want to practice "average" medicine and come straight home to your family, pay attention to average salaries because you will end up with one. Maybe it is worth doing anesthesia over family practice if money is that important. It just depends on your priorities. However if you really enjoy a specialty and want to make a good amount of money at the same time, you can do it in ANY field. Sometimes it takes more work and definitely more risk, but every field can be extremely profitable if you work at it.

D.O. degree more holistic?

The D.O. degree was originally started by an M.D. who was dissatisfied with the current practice of medicine. He made a number of changes and constructed the D.O. degree. Originally the degree had a different value. It was described as more holistic and was taught a little differently.

However over the year, the M.D. and D.O. curriculum's have basically merged. M.D. curriculums picked up where they were lacking, and now D.O. schools usually only have 1 extra class called OMM for Osteopathic Manipulative Medicine. This 1 class is the only difference between an M.D. and a D.O.

Do not tell me that I am more qualified for being an M.D. or that I am less holistic for not being a D.O. The arguement is useless because we are all trained the same. I have talked to MANY D.O.'s, and I have not had a single one disagree with me.

I have also heard that D.O.'s are more holistic because D.O. schools look at more than numbers when picking students. This is also false. D.O. students go through interviews just like M.D. students. We both have relatively high grade point averages and test scores. We both have older students in our classes. We both submit CV's.

People need to quit bickering and realize that M.D.'s are no better practicing medicine than D.O.'s and D.O.'s are no better at making me feel more comfortable than M.D.'s. Sure everyone has a personal study of n=1, but I don't want to hear it (sorry if that sentence doesn't make sense to everyone).

Now go hug!

D.O. degree

Many people bash, down-play, and even insult the D.O. medical degree. Maybe someone can explain their reasoning to me, because I just don't understand it. For those that don't know, the M.D. = D.O. with legal abilities inside the United States.

Sure there are some minor set-backs that D.O. degree holders will have to battle, but I consider them minor. Let's consider these set-backs first.

1. Outside the United States, some countries do not recognize the D.O. degree. This means you can not practice medicine in some countries. If you plan on practicing medicine inside the U.S. your entire life, this does not affect you. If you want to do mission work, you need to research which countries accept D.O. degree holders.

2. Specialty selection. There is still some stigma against D.O. students. This means that D.O. students need to work especially hard to get competitive specialties. However, if your future plans involve primary care (ob/gyn, family, internal med, psych, peds), you will not have a problem. Other well-reachable fields include general surgery, anesthesia, pathology, emergency medicine, neurology, radiology, ortho surgery, and PM&R. These fields require some pretty good scores and possibly research, but I know many D.O.'s in these fields. The real problem that D.O. students have is attaining fields like dermatology, ophthalmology, radiation oncology, ENT, plastic surgery, neurosurgery, and urology. I'm not saying that these fields are impossible for D.O. students because nothing is impossible. I'm just saying that I don't personally know of any D.O. to have ever entered these fields. Regardless of D.O. or M.D. if you want to enter the most competitive fields, you better work like never before and be prepared to sell a couple fingers/kidneys to the black market. Ok, maybe not that far.

3. I have also heard of some people refusing to see D.O. physicians for medical care. While some people are closed-minded, this is not the majority. I know this because specialty for specialty average salaries are relatively equivalent for D.O.'s and M.D.'s alike.

The only qualm I have about the D.O. degree is that some new D.O. schools do not plan their new schools very well. I would be wary about attending a brand-new D.O. school because I have seen some fail where I have never seen a new M.D. school fail before. Still, many new D.O. schools flourish too. I have heard very good things about DeBusk College of Osteopathic Medicine, only in their 2nd year. Most new M.D. schools are based out of excellent undergraduate schools, and they have all the funds and name-recognition to help them excel. Thus I believe new M.D. schools have the clear advantage here. While all students complain, new M.D. schools seem to excel from year 1 universally.

In Texas, we have TCOM, and from what I have heard and seen, it is an excellent school. I have seen their top-notch labs, their quality curriculum, and alumni excel in all aspects of medicine. Would I trust a TCOM grad with my medical care - of course.

Would I recommend my children attend an M.D. school before a D.O. school? Yes, I would, but only because most D.O. schools are very costly (a couple exceptions) compared to allopathic state schools. Still I recommend everyone applying to med school to apply both M.D. and D.O. Putting off med school by applying M.D. in year 1 -failing, and applying to both program the next year because you didn't want to deal with the stigmas, just lost you $200,000+ in future earnings by being stubborn in that 1 year.

Ivy vs. State med school

I've been asked, "If you had the choice to attend a Top Ivy league med school or a state school, which would you choose."

My question in response - "Do I have a full scholarship to the Ivy league school?"

All things equal, I can't see a down-side to attending a top rated med school. However things aren't always equal. Most top schools do not need to lure students with amazing scholarships to get people to attend. With that in mind, I would not pay to attend a top med school if I could pay a fraction of the cost to attend a state school.

For residency programs, USMLE scores are the great equalizer. If you have a great Step score, you write your own ticket. Do lesser known med schools produce students with good numbers - yes. Do lesser known med schools have as many students producing big numbers compared to Ivy schools - no. However, this is expected because the "smartest" (best test-takers) students are more concentrated in big name schools. If you take the same intelligent student, he/she has the ability to thrive at any medical school.

Case #1. JD attended Texas Tech HSC School of Medicine. A good school - yes. Ivy - not even close. JD studied hard and scored 240+ on his step 1. JD expressed interest in research to the anesthesia department from day 1 at TTUHSC and subsequently published over 40 papers in 4 years of medical school. Incredible - yes. True - yes. JD decided anesthesia wasn't for him and switched during 4th year to apply neurosurgery. JD was offered an interview at every program he applied to and matched at Mayo neurosurgery.

Is JD an exception to the norm - of course. Still, this is only 1 of numerous success stories that has happened in just the past 3 years at one of the smaller Texas state medical schools. Could JD have done the same at an Ivy league school - of course. Would it have been worth paying the extra $30,000+/year to attend a Top Tier med school? I won't answer that question for you.

The answer to the original question posed to me is that I believe that anyone can have just as much success no matter the school you attend. If it makes you happier to attend Harvard and you don't mind the bill, by all means attend Harvard. When I applied to medical schools, I had offers from a few out-of-state schools (Georgetown, GW, Miami). They aren't Ivy schools by any means, but even these schools cost a fortune compared to most state schools.

I pay approximately $8000/year tuition for my state school, and between grants, investments, and a loving family, I just may graduate completely debt free. In my opinion, debt-free is priceless!

Surgery Clerkship

I just finished my surgery clerkship, and wow! I loved being able to finally do some procedures (inserted chest tubes, started central lines, etc.). It actually feels like you are a doctor during your surgery clerkship.

To my surprise, the surgical residents are, for the most part, incredibly nice. From horror stories, I was half expecting all surgical residents to be royal jerks. They weren't. The people were overall very nice to talk to and seemed genuinely kind.

One downside I found in surgery, was the lack of teaching. When the residents did take time to teach, they were very good at it. However, it appeared like the residents were worked so hard that finding time to teach was rather difficult. Teaching is partly student-run however. As medical students, if you want to learn about something, you need to ask about it. Therefore, I think some of my teammates learned a lot more than others.

To be honest, the reason I disliked surgery the most was gowning up in the OR. I'm an athletic male that has the potential to sweat profusely, and putting on a gown, gloves, facemask, etc. is not my idea of a fun time. Having a change of scrubs is essential, and I would bring shower materials on call days. That said, I loved every other aspect of the OR. Ok....maybe I could do without a few of the smells, but it was worth it.

For the NBME exam, I definitely recommend NMS Casebook. I read Kaplan, NMS casebook, some CaseFiles, FA Surgery, and A&L Q&A. Yeah, I went a little overboard. NMS Casebook was definitely most helpful for the NBME exam. I haven't gotten my grades back, but I think I did pretty well.

Will I do surgery for a residency? Possibly. I liked the residents, material, and procedures. What is holding me back? I consider myself more of a family-oriented person, and I fear that surgery is one of the most time-consuming residencies/lives of all physicians. So we'll just have to see how the other clerkships pan out first.

Choosing a Medical School

So you have the interviews already, but you have no idea which school fits you the best..........
A bunch of my undergrad buddies and I got together recently. All of us are in different medical schools now. What I found quite interesting in our conversation was that we all agreed that curriculum mattered the least when choosing a medical school.

The fact is that almost every medical school has a slightly different curriculum. Some are systems based, others organ based, and some based in pure randomness. Yet, every medical school churns out excellent medical doctors that go on to practice in every field of medicine. What does this tell me? Curriculum does not matter. The knowledge needed to pass medical school and do well is there no matter what order you teach it.

A friend of mine attends UTHSCSA and hates/loves the curriculum. The school has class hours on the higher end of medical schools, but my buddy hates class. The result - he never attends class. By staying at home and learning the material on his own, my buddy has kept himself in the top 10 people in class rank thus far.

Even for those that attend class, curriculum does not seem to matter. The same material is taught at every medical school, and for the most part, students use the same review books at every school. The order you receive the material just does not matter.

Now my friends decided what mattered most: Cost, Location, and Amenities. When you look at loans and how they will affect the rest of your life, it is stupid to not consider COST of medical school when deciding between schools. I chose the school with tuition near the bottom ($7000/year) in a location that has minimal cost of living (Lubbock and El Paso, TX), and I could not be happier. I pay for a 2 bedroom townhouse what people in Houston pay for a small 1 bedroom and people in California pay for a closet. I know you are also thinking that I am crazy for thinking medical schools have amenities.........but they do. Some schools have extra rec centers for students; some schools give students free access to their associated institution's sporting events; some schools have amazing cafeterias. All of these things matter when it comes to quality of life, and when you are in medical school and have limited time for fun, everything you can add to quality of life - MATTERS!!!!!!

To sum up, go to the cheapest medical school you can find where you can maximize your own quality of life, and you won't regret it.

Introduction

I am currently a third year medical student at TTUHSC School of Medicine. While I am not exactly sure what field of medicine I will enter at this time, I know that I want to go into a specialty that allows me time for hobbies, friends, and family. In just a few short years of medicine, I have seen how the medical profession can quickly take over your life (I'll try to go into this later), and while I love taking care of patients, it is important to have "me time."

I enjoy NCAA football (especially Texas Christian University), staying in shape, and learning about new things. I also enjoy flying a Cessna 172 when I get the chance; I received my pilot's license back in undergrad at TCU.

I will try to keep most of my posts medical, but some will probably be about TCU football and life in general. Please feel free to ask any questions. I love helping students through the medical school application process and medical school in general.

I hope you all enjoy my blog!