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4th year schedule

When determining your 4th year schedule, there are a few things to consider. The first is how many away rotations you will do. If you go into a competitive field, you will need a few away rotations. That is fine.

The big mistake many medical students make is choosing elective rotations in their field of interest. That is what residency is for. Use the rest of your 4th year to explore fields that you will never get to see again. You will be a better, more well-rounded doctor for it.

Next, don't make 4th year too stressful. Choose fun, relaxed rotations where you will learn something new. For example: I've decided to persue child & adolescent psychiatry. A few of my electives were radiology, sports medicine, emergency medicine, etc.

Last of all: enjoy life. Intern year will stress you out enough.

Away Electives

Deciding to do "away rotations" at another institution is always a big headache for 3rd year med students. Should you do them? Where should you go? Will it be helpful? What should you do there? etc. etc.

Should you do them? - If you are applying to a competitive field, I would strongly recommend you do at least 1 away elective. For something super competitive like Derm, I would recommend at least 2. For less competitive fields, away rotations are optional.

Where should you go? - Only do away rotations at institutions that you could easily see yourself at for residency. Away rotations are "auditions", but at the same time, it is for you to decide if you want to do residency there. I would also choose to do an away rotation at an institution in which I would be considered underqualified (by step scores, etc.). This can get your foot in the door at places your foot couldn't have gone before. Also if I am already fully qualified to get an interview at a program, I don't gain much by doing an away rotation. In fact, an away rotation could hurt if I don't get along with residents, don't put enough work in, slack off, etc. etc. Analyze whether you have more to gain or more to lose before choosing an away rotation.

Will it be helpful? - There is an unwritten rule that most students that do an away rotation will get an interview. At some places, not rotating there means no interview (very selective places). If you have less than stellar scores and want to do residency at Harvard, DO an away rotation there. Away rotations can also be helpful if you are really considering a location and just want to see how the program works. Still, you need to work hard.

What should you do there? - While there, I would strongly recommend setting up a meeting with the residency program director. Let them know you are interested. Come early to the rotation and stay late. Offer to help with anyone's research project. Be a team player. In other words, plan to work harder than you have ever worked. Your hard work could get you into a residency that you otherwise would never be able to obtain.

Don't feel pressured into doing away rotations, because everyone else is doing it. Many people don't do away rotations at all, and they do just fine.

Ob/Gyn Rotation

Before I even begin talking about my Ob/Gyn rotation, I would like to offer one piece of advice: As soon as you get to the Obstetrics floor, put on the BIGGEST booties (for your shoes) you can find. Shoes get ruined in this rotation!

Overall I really enjoyed my Ob/Gyn rotation, but I quickly learned it was not for me. My school's 2 month rotation was set-up very well. Every week, students rotate through a different specialty clinic/surgery center. It was very well planned by the clerkship director.

I prefer Gyn over Ob. You have more of a bond between you and your patients in Gyn. The stories are also much more entertaining. For example: I was asked if shaking up a coke bottle and opening it inside the vagina was effective to expel sperm. You can't make these things up.

Ob is much more intense. Lots of emotions flying around the room. Not very sanitary. Not my thing.

Another hint: When performing your end of rotation practical (OSCE), do not use slang terminology. Someone I know (not me I promise) used "vault" during the practical. It doesn't help your grade.

The rotation can be lots of fun and informative if you let it. I definitely have a greater respect for Ob/Gyn after my rotation; however, I will not be entering this field. If you love moments of chaos, spontaneity, and procedures, consider this field.

Away

Sorry that I have been away for awhile. I plan on catching up with posts here in the near future now that everything has calmed down a bit.

Internal Medicine

IM was quite a ride. My school had me at 2 different hospitals with 2 completly different systems. I thoroughly enjoyed the program through our main teaching hospital, but the second month through the military hospital was very hectic. The military hospital was not very supportive in my opinion. I got the distinct feeling that some physicians were only working there to "pay-back" the government. The best teaching physicians seemed to be non-military. While my team was better than most, a fellow med student was put on a team that would never inform her of when rounding would begin or even where it would begin. Very hectic.

I thought our main teaching hospital did a GREAT job in IM though. One of my faculty members I would consider a complete genius, and I would gladly work with him again.

IM residents work very hard here. I definitely give them 2 thumbs up for enduring such a rigorous program. After these two months, I have definitely learned to appreciate the field, but I can't see myself in Internal Medicine.

Psychiatry

I have finished my psychiatry rotation, and it has by far been the most fun and exciting rotation yet. Coming into medical school, I was dead set on emergency medicine because you have new and exciting challenges with every patient. Psychiatry seems to be very similar in that almost every patient has a different story, yet psychiatry still has continuity of care. Originally I didn't really know whether continuity of care made a difference to me, but I am quickly learning how much I enjoy seeing my patients get better and lead more fulfilling lives.

We also had some exposure to child psychiatry during my rotation, and I thought it was a lot of fun. I've heard from numerous sources that the field has a high burn-out rate, it is just too hard to deal with, etc., but I don't see why. The chance to make an improvement in a child's emotional well-being seems greatly rewarding. Maybe this burn-out rate is partially due to dealing with parents, but if you are going to be dealing with kids in any aspect, you need to be able to handle parents.

I think right now my top two choices in residency are:
1.) Psychiatry with a fellowship in child & adolescents
2.) Pediatrics

Looks like I am stuck dealing with parents in either case. :)

Sure the pay isn't as great as other fields and psychiatry isn't the most prestigious specialty around, but I think if I could benefit just 1 child in every 100, I'd be happier in child psychiatry than a lot of other fields.

I would definitely recommend others looking into this exciting field, and feel free to ask any questions. I'll do my best to answer them.

Mission Trip

This past week I participated in a small medical mission trip within the small town of Canutillo(sidenote: If you haven't ever been on a medical mission trip, you are missing out). There was a bunch of MSI's, a couple MSII's, and a few MSIII's watching over everything. While we didn't have all the medications that I would have liked, I think we did a lot of good. On top of all the good we did, I learned a few things myself.

For one, I love teaching. 90% sure I will go into academics at least part-time.

Second, be careful with needles. We had an MSI stick herself with a used needle, and I had to get her to the hospital for bloodwork. Everything turned out well though.

So whether you are a pre-med, med student, or doctor try to make time for medical mission work. It can be lots of fun.

Children Poll

I recently posted a poll asking "How many children could you raise in medical school?" I won't even provide all the stats because there was an overwhelming majority saying they could raise a grand total of ............0.

I asked this question because there is a number of students in my class that are currently raising children. While I am in the majority that doubts I could ever raise children in medical school, the group in our class that have kids are doing amazing. Two classmates have 3 kids under the age of 10!!!! Wow! And all of them are wonderful kids.

So for those thinking about raising a family in medical school - it is definitely possible. Just make sure you have a VERY supportive spouse.

Family Medicine

Its been awhile since I posted, but I am now also done with family medicine. It was a lot more fun than I expected. I love trying (and hopefully succeeding most of the time) to diagnose anything and everything. Still, I am not a big fan of DRE's, and I am sure it will only get worse once Internal comes around.

Overall my school gives students a lot of autonomy in family, and it really facilitated learning. I think family provided me with a solid background for whatever I decide to specialize in. I know that many students bash family for the lack of pay, prestige, etc., but I think everyone should give it a chance. You will learn a lot and have a lot of fun doing it.

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.