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.