Tuesday, July 31, 2012

Money, Money, Money, Money . . . MONEEYYY!

note: the title of this post was to belted out a la the apprentice theme song (if you need a little refresher click here)

There is no sense in denying the fact that one factor that often pulls people towards a career in medicine is the financial compensation.  For some reason it feels like a taboo topic, to admit out loud that the of course you have  passion for helping people and a strong desire to serve and it doesn't hurt that you're going to be making a fairly comfortable living.  Nobody gets upset at lawyers for being money grubbers (but then again, aren't we all just looking for an excuse to hate them) or accountants (although being such a personality less number-cruncher should have some kind of upside) for pursuing opportunities that pay the highest.  Its a very strange phenomenon that I think we somehow hold ourselves to a higher standard as well, when I consider my future I feel bad weighing the options because of how much pull salaries can have.

All that being said the more important point I wanted to bring up was that if you intention is to become very rich, very fast I implore you to explore other career options.  Although the compensation is likely in the 6 figure range even for those pursuing primary care positions the fact remains that compared to other career paths this one pays out far too slowly to be a viable option for those looking for quick monetary gains.  Let me explain a little bit of why I find this to be the case with a look at some numbers as well as some anecdotal experience.  Once again I have to emphasize this is how I have come to see the world, at the end of the day its my opinion and please take it as just that.

So lets look at a timeline of education and earning.  According to the AAMC the average age of matriculation to medical school for women is 24 and for men is 25 so lets put that at 24.5 years old (source).  Medical school across the board is always going to be four years and theses years have to be billed as negative income especially because as of this year all loan money is UNsubsidized which means every cent that you borrow will collect interest from the day you start to borrow it, this is a serious bummer for graduate students (source).  In any case if you bill each year at about 40,000 a year (this figure is debatable but just for argument's sake I picked a round number that comes close for many people) x four years according to the AMA the average medical student graduates with $157,944 because lets not forget the interest that will be accruing at about 7% which will be compounded at the end and you will be charged interest on the interest once you graduate (source).  So you finish medical school at 28.5 and finally start making money and residency is anywhere between 3 - 5 years during which according to the AAMC you will make an average of $48,4600 (increasing incrementally each year) (source)  So at this point you're between 31 - 33 and are about to plunge back in for some more training i.e. fellowship or you're out into the real work making some real monies.

If for example you decided to become an accountant at about 23 and start making $50,000 a year and lets say a very modest 3% raise per year, in the ten years your buddy was in medical school you've made about $570,000 assuming no bonuses or proper pay increases.

My point here was not to frighten you away from you dream of being a physician but rather to deter those who pursue this career path for reasons based in financial success.  Yes you are rewarded handsomely  eventually, but the road there is a long, long one.  If you don't do this because you absolutely love it you will without question be miserable.  Once you become a doctor paying back these loans is a matter of budgeting and financial savvy, nbd.  But the path there can be absolutely miserable.  I try to bring this back whenever I can but the best way to make it through medical school is to understand as a student (which you arguably will be for at least 7 years and longer when fellowship is considered, and don't even get me started on those MD/PhDs but most of them don't pay very much so thats a different story) your life doesn't end.

Medical education and training is a journey meant to run parallel to your life story, not completely take it over.  With that attitude you will be able to enjoy all of what your life experiences bring you instead of constantly looking to the end and making promises of what your life will be when you are finally a doctor.  I think what i'm trying to say is carpe diem (I refuse to say YOLO although it seems pretty appropriate here).

Oh yeah, with the average internist being offered $205,000 without bonuses and incentives x however may years you work for the rest of your life, I think at some point you will be able to recoup any and all  losses you have incurred.  Maybe you can even take your accountant friend out for lunch.

Thursday, July 26, 2012

Teachable Moments I

**please note: names have been changed for reasons of privacy**

Finally, no more shadowing and awkwardly stumbling around while my overly dressed up self scrambled to follow a doctor from room to room, nope because I’m a medical student.  It was time for me to get assigned to my preceptor for the year!  If you’re as confused as I was about what that is let me explain: physician shadowing, except this time you get to wear a white coat and a stethoscope.
 As first year students we come equipped with a severe lack of any clinical knowledge juxtaposed with a strong desire to act cool in clinic.
 A memory I know that I will reference for a long time in the future, as a yardstick for measuring how I have connected with a patient and family is from a day that I spent in the hospital with my preceptor rounding on patients on the Family Medicine service.  The day was essentially over and he decided to go check up on a few patients before heading out for the day.  One of the last patients we saw was an older African American man who was recovering from a brain surgery after a severe stroke.  The following is my recollection of that encounter:
“Hi, I’m Michael Parker, I’m one of the physicians taking care of your loved one today”.  Can we stop right there? Have you ever heard a doctor introduce themselves as not doctor? I feel like by the time we complete all of our training we wear our title of doctor not as a badge of honor but rather a triumph.  Maybe it was unintentional, maybe not, but in knocking on the door and simply stating his own name he put himself at the level of the patient and his family.  It made him immediately accessible.  There were two women and one man visiting the patient and he was wavering in and out of consciousness.  He was not able to interact at all, at that point the doctor would probably not have much to do, right?
Dr. Parker took the time to introduce who I was to the family and ask if it would be okay if I stepped into the room, they were more than happy to allow that.  He then inquired about how the patient was recovering from surgery and the family related that they were unsure how he was doing because of the unstability of his consciousness.  
Here it comes, teaching moment for life.  Dr. Parke proceeded to relate to me how difficult it can be for a family when they are going through a recovery process from such a major surgery especially when the course of recovery can be so varied.  He addressed me but also engaged the family in the conversation and they could be heard expressing hushed agreements—“mmhmmm” and “that’s right”—and nodding along as Dr. Parker conversed with me.  He then turned back to the family who had been listening to him with rapt attention and asked them again if they had any other questions.  The woman sitting at the patient’s bedside echoed some of the sentiments that Dr. Parker had shared with me while the other family members nodded in agreement.
It was amazing for me to see how in such a creative way he was able to express the uncertainty of the situation for their loved one without robbing them of hope or giving a promise of too much.  By the time we were ready to leave the room the patient’s visitors were wishing me the best of luck in my career and relating that they had a niece who had similar aspirations.  Before we left Dr. Parker thanked the family for allowing us to speak with them and noted that someone would check in with them again shortly. 
The lesson I’ve learned from Dr. Parker is that we will have an urgent responsibility as physicians not only to treat patients but also to effectively interact with the environment around them. In that conversation there was nothing Dr. Parker did directly for the patient, but he reinforced the support system that will be vital to this patient’s recovery, something that is integral albeit indirectly to the patients health.  In that moment he transcended race, gender, age, ethnicity and socioeconomic status.
It is of great surprise to me to know that no matter how much we prepare and study it will only be with time and an active desire to improve that we will come close to delivering optimal care to our patients, I think I now have a greater understanding of why we practice medicine. 

Monday, July 23, 2012

Doctors: Humanitarians First, People Later

Warning: I may get a little preachy here, the line between opinion and fact will be blurred, but please try to look past that and understand what I'm trying to get at

Whether you are currently a medical student or even a doctor or just beginning to contemplate the idea of pursuing a career in medicine you have at some point pondered what has pulled you that way. Stock answer "i want to help people".  We're so programmed to think that and to say that but I feel as though the true force behind that statement has been diluted.

What prompted me to write this post was the onslaught of status updates via different social media regarding the absolutely horrific events that unfolded at the Batman movie premiere.  There were a variety of different reactions as well as differing levels of sensitivity (or insensitivity) that got me to thinking.  I realized then that insensitivity (be it online or otherwise) strikes a chord with me the most when the individual is a medical student (and as the slow progression up the totem pole of medical education occurs for me eventually it will be residents, fellow doctors, etc).  No matter how human we may be by taking on the role of physician we are answering a higher calling.  People expect more.  There is an expectation that you are more caring, more understanding, more sensitive and more skilled in empathy than the average person.  Additionally, we are all in this thing together, if one med student is a jerk I feel like it reflects on use poorly as a community.

Maybe there isn't an expectation and I came into this with my head in the clouds but I do feel that way. We owe it to ourselves as well as our future patients to shift our world views in a way that allows us to empathize first, judge and mock later

One of the hardest lessons the past year has taught me is that although I chose medicine because I absolutely am enthralled by the inner working of the human body and because talking to people, learning their stories and understanding how I can bridge the gap between science and medicine and society and culture, not everyone does.  Sometimes people want to go to medical school because they have a passion to serve the underserved while others crave the honor and prestige of being a world renown surgeon while others still simply want to secure themselves a certain type of lifestyle.  The toughest pill for me to swallow is that its okay.

Medical school gives you ample opportunity to self reflect from a pit of angst and rage, it is easy to forget the optimism and lofty ideals that may have brought you where you are, but I implore each and every one of you to look deep down inside you and hang on to that thinnest thread of wanting to care for people.

I am a firm believer that little things like that can truly change the face of medicine.

Sunday, July 15, 2012

Life Lessons on Public Transit

As future or current medical students something that we all likely envision is ourselves in our white coats.  Although I touched on this earlier there is a definite sense of accomplishment and pride that is associated with this simple garment.

I remember getting my white coat and gently running my fingers along the slightly raised letters that spelled out my name.  Its seriously awesome.  But a giant lesson I learned is that wearing a white coat is an exclusive privilege of a clinical setting.  No matter how cool you think you look wearing your white coat down the street and/or the bus or train, you aren't.

Nothing crystalizes some facts of life like seeing some reflection of yourself in another person and what follows are two stories that have helped shaped my understanding of white coating.

*     *     *
The rickety back and forth motion of the train made it hard not to look up occasionally and make sure the train was still on a track and nobody else was panicking.  The doors slid shut and out of the corner of my eye I caught a flash of white and looked up to see a full on white coat.  Additionally the student doctor was also from my own institution as evidenced by the patch on her coat.  In my head I rolled my eyes, really nobody wants to see that.  Nobody is sitting there thinking 'oh wow, she's a doctor' they're all wondering why the F you wore your work clothes onto the train.  It would be like if a chef walked onto the bus with his giant chef had still on, makes zero sense.  I went back to reading my book and at the next stop approached glanced up again and there wasn't a white coat to be found.  Initially there was confusion, but standing in the exact spot was just another urbanite getting from point A to point B.  As soon as she had hopped on the train she had removed the coat and stashed it away probably because she had to rush to catch the train and didn't have a chance to remove it before.  For some reason I just really appreciated that she had done that, maybe its just me but that really resonated with me.
*     *     *
Its rush hour, the bus is packed and at least twelve more people just got on.  I'm putting that out there because I was already on the edge of my seat (both literally and figuratively) so my toleration for irritation was far lower than usual.  In the hustle and bustle of all of this one guy sticks out, like a sore thumb.  Who would that be? The obnoxious medical student that is dressed in plain clothes and his white coat.  The best part is that the only people who ever do this are medical students and weirdo lab techs (I also have no idea why they do that either).  I'm still not sure if this is also slightly a part of my imagination or not but I felt like white coat guy was looking around with a stupid sneer on his face to see if people were looking at him and his white coat.  Whether or not he was I contend that wearing a white coat in public, in non-clinical or non-clinic related settings is attention seeking behavior.  You're essentially trying to make a spectacle of yourself.
*    *    *

Don't get me wrong here, if you want to be that guy, then go ahead.  By all means, wear your white coat down the street and all the way home in your heading thinking you look like BAMF when in reality everyone is whispering about how you look like a total a**hole OR not even noticing you.

Maybe some of you disagree but the verdict is: no white coats in public

Tuesday, July 3, 2012

A BRS is Worth A Thousand Textbooks

I’m going to share with you all what I think is one of the most, if not the single most useful piece of information that I didn’t figure out until about half way through my first year.  Something you may have started to notice is that I like creative titles, it keeps things interesting for the reader but also pushes me to keep the content something challenging to write—something I would want to read.  Anyway so as the saying goes, a picture is worth a thousand words and let me tell you there are some BRS books that are literally worth their weight in gold (I’m using literally correctly here, they are MONEY).  Let me explain a little more.

As I mentioned in the last post study guides are the way I like to study.  Typing up all the information into handy little bulleted nuggets that I can sit and gnaw on.  Although there is much to be said for reviewing individual powerpoints to make sure you understand what the professor is really honing in on, a true understanding of basic underlying concepts will get your incredibly far, especially in physiology (but I’ll leave that for a post on study habits or lack thereof). 

So lets cut to a few weeks into school when there was a book sale where all the M2s and beyond put for sale a bunch of books that they didn’t need anymore.  As I wandered past the stacks of netter flash cards, clinical case files books and a smattering of assigned textbooks I kept catching glimpses of these compact little books with titles like BRS PhysiologyRapid Review HistologyBRS Anatomy so naturally not knowing what they were I figured I’d just buy the one that had the largest stack and figure it out later.  I then went home and proceeded to buy every single required text book from Amazon BIGGEST MISTAKE EVER.  I was kicking myself in the face 3 months later when I realized that one of these little guys I’d picked up from the book sale was sitting on my book shelf staring me in the face as I trudged my way through histology.  

The only "textbook" that was
ever worth what I paid for it
Alright, I know what some of you are thinking, WTF IS A BRS.  BRS stands for Board Review Series.  Essentially these books are created to put together all of the most high yield information for a certain subject and created a bulleted/outline type format of a book for review.  Although these are more useful come time for Step Prep (I’m not there yet so I can’t comment with much confidence) these are hands down the single best study aid you can use for medical school.  Notice I said aid, I don’t encourage skipping all your classes and exclusively using a BRS but as a supplement these are phenomenol.  Different people have different preferences among the different companies for particular subjects and there are a lot of them out there so do your research and get yourself some of those.  If I were to recommend one BRS that is an absolute must have is BRS Physiology by Costanzo.  Just trust me, by the end of M1 you will come to understand how absolutely mind blowingly amazing this book is and that Costanzo is baller status.

This is not to say that there aren’t some textbooks that you’ll have to fork over the cash for because you absolutely need to have a Gray’s Anatomy for Students because there can’t be a review book that is quite as thorough for the little nit-picky things you need to know for anatomy.  You absolutely have to have something like Ross and Pawlina for Histology because the plates at the end of each chapter, in full color, are incredible and there is no resource that can fill in for those.

All I’m saying is you have to feel it out and see what you need and explore what is out there and find a combination of sources that work for you.  Some people swear by class notes and textbooks and if you are that person then by all means do that.  But for the rest of us that need other supplements, that are constantly hoarding sources I would highly encourage and recommend looking into subject specific board review books because they are concise and great for review and they come with review questions (ß another money in the bank situation, in medical school you will become a review question whore, you will do anything for more practice questions). 

You’ll be surprised at how exactly your coursework will follow with the material presented in these books mostly because to a certain extent there is a standardization of what medical students need to learn so the basic, giant, overarching concepts get nailed down pretty hard no matter where you are and so these books are a great little supplement.

That is of course just what I found to be true, as with any advice I give here, it is such an individual process this is just my take on it.  You will start medical school and you will have trial and error and eventually it will click and you’ll find your groove, until then it kind of feels like you’re walking up on a down escalator.

If you have any personal recommendations or general comments or questions about study skills or aids please leave a comment

Moral of the story: when and if the upperclassmen have a book sale be the super informed M1s that charge in their and snap up all the BRS books for $6 a pop.